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HomeMy WebLinkAboutBuilding Permit #489-16 - Fernview Avenue 10/16/2015Cpwne D /0//:�W/S Permit No#: "/ BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received Date Issued: 1 — 3 � e `(2 � V 1 e-� ! — I PORTANT: ADDlicant must complete all items on this page LOCATION 4 F� �i,_V � _f'� A^4 U►'CJ AAA - oZtI PROPERTY OWNER 0 MAP PARCEL: PARCEL: r . `rk'w� Print 00 Year Structure NING DIST CT: Historic District Machine Shop Vil F NORTH o � h Yes n� yes no e yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer sk, OWNER: Name Address: DESCRIPTION OI- VVOKK i u tit rtKrUKivitu: WIN 0 Clearly Al Email: Address: Supervisor's Construction License: CS V l YJ �/ Exp. Date: L.31)"? Home Improvement License: Date: 1. ;)-)• / 7 ARCHITECT/ENGINEER Phone: - Address: Reg. No. FEE SCHEDULE. BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.:y�� Receipt No.: 2 NOTP. Persons contractin =retractors do not have acces t the guarantyfund Signature o Agent/owner n ture of contra ' Location Al No. f — /(-- Date Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS _ CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Col iservation Decision: Com Comm Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Usgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no_ Located.at 124 MainStreet Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NU 1 is ana UA I A — (f or cie ❑ Notified for pickup Cal Date Time Doc.Building Pennit Revised 2014 ent use mail Contact Na No Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses a Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2014 V V, WD Q = LL 0 Q m O O LL E N N O_ N N 0 W H Z Z m C C 7 O LL to_ 7 O K T U c0 LL 0 V W N Z Z J d L j O w to LL 0 u W N Z J v V W t = O K UL i v N c6 O LL oC 0 V W N Z Q 7 O of to LL Z W oC Q W W LL i m O Z N i v Y O E y I °010 Lu o az N J O as _ �:- r 2 O 2. .� 4) .=_ 0 0 — � nm l = V Q a� Q ` �E 0 t w W rCD CD L CL(D V i I °010 Lu o az Fa 2 z G co z W w CL W W CL 0 w :a Z z m Q U) 0 V z v CO J n ILS, ON E O O z N O = CD CD wwI V/ •E • . • • . . CL 4 O �+ CD OL- m CL a CL co Q o r _v J •CL O W U)z � 0 U vii CL 0 N J as _ o N c .=_ 0 0 — � l = V Q ` �E 0 NO O L CL(D cc 0 'M �--- C3 .� F- O CL v =5N m y W _ O M O O LL 2 .Q N O LU E V v 0 �.- � co U Q O m H U) -0 O U 4. CL 0 Fa 2 z G co z W w CL W W CL 0 w :a Z z m Q U) 0 V z v CO J n ILS, ON E O O z N O = CD CD wwI V/ •E • . • • . . CL 4 O �+ CD OL- m CL a CL co Q o r _v J •CL O W U)z � 0 U vii CL 0 Oct 09 2015 02 54PM HP Fax page 1 L. E. MORGAN CONSTRUCTION I14C. 86 BILLERICA AVE., N. BILLERICA, Mj 01862 PH: 978-670-4747 / Fax: 978-6V-6477 PROPOSAL Submitted To: Affinity Realty Management Address: 39 Rear Farrwood Rd., ( Clubhouse ) N. Andover, MA 01845 Cell / Fax: 978-376-9687 / 978-685-0521 Job Site: Heritage Green Condominiums 1/3 Fernview Rd., N. Andover, MA, Approx. WE HEREBY submit our proposal for the following scope of work; 1. Remove the existing shingles down to the wood deck and dispc 2. Install 6' of ice & water shield at the leading edges and 3' in all 3. Install RHINO SHIELD synthetic underlayment to the remainder 4. Install 8" white aluminum drip edge to the entire perimeter & i 5. Install Certainteed Swiftstart shingles as a beginning course. 6. Install Certainteed landmark Silver Birch architectural shingles 7. Install 4 new pipe flanges, 2 slant back attic vents, new lead on 8. Install new ridge vent and matching cap shingles. 9. Remove the metal siding on dormers, & install 100% ice & wat 10. Install new white vinyl siding on all 3 dormers with white vinyl 11. Install white aluminum coil over all rake and fascia, and 100 % WE propose hereby to furnish materials & labor, complete in accc specifications, for the sum of, -.Eighteen Thousand Six Hundred Tw AUTHORIZED Lawrence E. ACCEPTANCE of PROPOSAL: The above prices, specifications & are hereby accepted. You are authorized to do the work as spi AUTHORIZED BUYER SiGNATUPZ " THANK YOU FOR CHOOSING MOR N G� Date: 6-15-15 SQ FT of off- site. the wood deck. -hanicaliv fasten. hurricane nail. e chimney. shield on the walls. vinyl on soffits. ce with the above Dollars: $18,620.00 are satisfactory and UCTION WJ— The Commonwealth of Massachusetts Department of IndustrialAccidents - ---- d 1 Congress Street, Suite 100 t Boston, MA 02114-2017 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAUTTING AUTHORITY. Name Address:,_ S 4J A 1\ Q ICA a City/State/Zips. 11 #: l I 1 Are yon ployer? Chec the appropriate box: Type Of project (required): 1. am a employer with employees (full and/or part-time).* 7. El New construction 2. ❑ I am a sole proprietor or partnership and have no employees working for me in 8. E] Remodeling any capacity. [No workers' comp. insurance required.] 9. El Demolition 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 FI Building addition ensure that all contractors either have workers' compensation insurance or are sole 11. ❑ Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. 13. ' f s These sub -contractors have employees and have workers' comp. insurance.: 6.FJ We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Oth 152, §1(4), and we have no. employees. [No workers' comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -cont Tactors have employees, they must provide their workers' comp. policy number. I am an employer that is p; information. Insurance Company Name: workers' compensation imurance for my employees.' Below is the policy and job site Policy # or Self -ins. L'c. #: ��6 ,Z� �� Expiration Date: Job Site Address: I Pie %n vi fly City/State/Zip: WI 1dk ( ft) g t) INS S Attach a copy of the orkers' compensation policy declaration page (showing the policy number and expira ion date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against thAviolator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance I do here tafy under the painspepuzwn sofpefjury that th nformation providiied ab a is rue and correct. Rinnafnr _ IA IA,1.%1,�� , Date: I use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone 5 CERTIFICATE OF LIABILITY INSURANCE DATE (MM /2015 ) W$.C.ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. fC HIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE R PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER CONTACT NAME: PHONE FAX BALDR'INMBLSH PARKER INS 131 COOLIDGE ST. SUITE #100 (A/C, No, Ext): (AIC, No): E-MAIL ADDRESS: HUDSON, MA 01749 271CLD INSURER(S) AFFORDING COVERAGE NAIL # INSURED I INSURER A: AMERICAN ZURICH INSURANCE COMPANY L E MORGAN CONSTRUCTION INC INSURER B: I INSURER C: PO BOX 75 INSURER D: INSURER E: NORTH BILLERICA, MA 01862 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADD L SUB R POLICY NUMBER POLICY EFF DATE (MMIDMYYYY) POLICY EXP DATE (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE Is COMMERCIAL GENERAL LIABILITY CLAIMS MADE [7 OCCUR. DAMAGE TO RENTED PREMISES (Ea occurrence) I $ MED EXP (Any one person) S PERSONAL & ADV INJURY IS GEN'L AGGREGATE LIMIT APPLIES PER: POLICY [] PROJECT ❑ LOC GENERAL AGGREGATE Is PRODUCTS - COMP/OP AGG S AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) S ALL OWNED AUTOS BODILY INJURY SCHEDULE AUTOS (Per person) IS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE S ,H (Per accident) UMBRELLA LIAB []OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE g DEDUCTIBLE $ RETENTION S (8 A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY Y/N UB -5B738312-14 12/14/2014 12/14/2015 X WC STATUTORY LIMITS OTHER ANY PROPERITORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? FN7 NIA E. L. EACH ACCIDENT __T$ 1,000,000 E.L. DISEASE - EA EMPLOYEE S 1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I S 1,000,000 .DESCRIPTION OF OPERA-(ONSILOCATIONSIVEHICLESIRESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD ST. BLDG 20. STE 2035 BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER, MA 01845 AUTHORIZED REPR TAvE ACURU 25 (2U1 U105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. LEMORGA-01 BBOYER ACO/2® CERTIFICATE OF LIABILITY INSURANCE �--� DAT71712 D1YYY1) 717/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Welsh & Parker Insurance Agency, Inc. / Hudson Office 131 Coolidge Street, Suite 100(AIC,No Hudson, MA 01749 CONTACT NAME: PHONE 978 562-5652 alXXC No : 978 562-7120 Ext: ) ( ) E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 0411312015 INSURER A:WeStern World Insurance Company EACH OCCURRENCE S 1,000,000 INSURED ENSURER B: Safety INSURER C -.Scottsdale Insurance LE Morgan Construction Inc INSURER D: PO BOX 75 Billerica, MA 01821 INSURER E: INSURER F: B COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ !LTR TYPE OF INSURANCE /NSD NlVD POLICY NUMBER POLICY EFF MM1DD POLICY EXP MM1DD UMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR X Contractual Liabilit NPP8237995 0411312015 04/13/2016 EACH OCCURRENCE S 1,000,000 PREMISES Ea occurrenceS 100,000 MED EXP (Any one person) S 5,000 PERSONAL &ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY [_-]PRO- ❑ JECT LOC OTHER: GENERAL AGGREGATE S 2,044,440 PRODUCTS-COMP/OPAGG S 2,000,000 S B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED XSCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS COM6230688 10/13/2014 1011312015 COMBINED SINGLE LIMIT $ 1,000000 Ea accident, BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERTY DAMAGE S Per accident S C X1 UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE XLS0096729 04/13/2015 0411312016 EACH OCCURRENCE S 5,000,000 AGGREGATE S 5,000,000 DED I I RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ElNIA (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS belay I PER OTH- STATUTE ER E.L. EACH ACCIDENT S E.L. DISEASE -EA EMPLOYE S E.L DISEASE -POLICY LIMIT I S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Proof of Workers Compensation coverage will be sent directly by the carrier. UtK I It-K:A It MULUtK UANULLLA i IVN Town of North Andover 1600 Osgood Street, Bldg 20, Suite 2035 North Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD Massachusetts - Department of Public Safety B2 o acv Of zr Liiiviny ,v..y u at. en$ an vi$t"aaraas License: CS -079476 LAWRENCE E M$RG.. ';.WL 86 BILLERICA ANVE L.. . N MLERICA NfA 0186 `� j J.G,.., tJ�. "14►'� Expiration Commissioner 06/0312017 ��Fi�3 L5: 5aretY�id7Saattfi 1 3L1 31 aM.Litc�aBen This card a&nowledgesthat the recipient has successfully completed a 30 -hour Ocbupatibnai Safety and Healthfra ning Course in Construction Saf* and Health f � C r j (Trai1.ner name — print or type) (Course end date) ��•-\ ottCe viion npp�?LJJ' ltr2s IQ.. D�PS. S"y.KJ9gII atIOO T =yam HOME IMPROVEMENT CONTRACTOR '.', Registration: 137913 Expiration: 1/2712017 Type: G'' P Individual I AMkENCE E. MORGAN JR_ LAWRENCE MORGAN JR. 86 BILLERICA AVE UNIT 1 N.BILLERICA, MA 01862 Undersecretary fR.- HA cep2rtr.:eni Of =et:;.- Occupationaf Safety ar,0 Health Acm r!stral,e'i L LARRY MOR&AtQ as successfully completed i ?i?-` sur Or cupwional Safety anal Health Training Coume in Construction Safety 8 Health Low S RCwjDS&'J S OSAU &69 1 ra ter) ;Cate! - 1 ROOF MP RECYCLING Recyclers of Asphalt Shingles SEAN ANESTIS PRBIDEI%rr & CEO 369 CODMAN HILI. ROAD TEL 978-263-1899 BoxBoRoUGH, MA FAM 978-263-1879 EMAIL: ROOFroPl@VERIZON.NET CELL: 508-726-5341