Loading...
HomeMy WebLinkAboutBuilding Permit # 2/3/2016 1 %AORTH q BUILDING PERMIT O t�eo 6 4, TOWN OF NORTH ANDOVER ® APPLICATION FOR PLAN EXAMINATION Permit No#: - .,2 Date Received 0 ArE.w.Pa��y � greo P SSacHusEc Date Issued: IMPORTANT: Applicant/must complete all items on this page pl LOCATION '� / � 0`�/�l C�� f`I ejxl Print / PROPERTY OWNER Alz) I l VA//-/cc Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial >44Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District DESCRIPTION OF WORK TO BE PERFORMED: Avg ILI U/l 1 u/ �S l�>� Gt �� 4 l reki Identification- Please Type or Print Clearly OWNER: Name: Phone: �)S 6 7/ 9T Address: k1 C��� ��7 �Dw�� �� �/1�0 Contractor Namei�,/ LL��� ,l Email: Address: ,) / �f� s� f �<f Supervisor's Construction License: Exp. Date: /c,� --/6 /°7 Home Improvement License: / �Jf& % Exp. Date: �- 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: $ ~p a,) FEE: $ d Check No.: Receipt No.: `2171 c,? NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund tt®RTH irown Of Alidu V VF ® - s /O LA.IF ♦ e ' �.SS' �' Coc"ic"t AO a`y RAreo S U Ar IR LPEDBOARD OF HEALTH �� IT �1Food/Kitchen Septic System THIS CERTIFIES THAT ...............�:�I ?!:i..�....v�rr e� .L'..:.............. BUILDING INSPECTOR .... .... .... �'G r Foundation has permission to erect.......................... buildings on .. .��.. r�........ .. ::t: :: :... vE........................... Rough to be occupied as �:�. '. ...................... ........................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the'application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR CONSTRUCTION - UNLESS STARTS Rough J� Service ........ ...... ................................................................ Final BUILDING INSPECTOR 1 7 GAS INSPECTOR Occupancy Permit Required to Occupy Buil inz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. C _: CRICC)sNE ROOFING & SIDING INC. :,.00FING,Si At(G& REMODELING RE,PPLACP,Mtl+NT WINDOWS HOME IIv! .<OVF.'MENT CONTRACTOR REGISTRATION NUMBER 104569 I` 2% '!JTTON STREET, —426,NO.ANDOVER,MA 01845 fn Nr r0 Indover 978-683-3420 In Boxford 978-887-6747 Ga Haverhill 978-374-7374 1/we the owner(s)of the premises mer i:oned below,hereby contract with and authorize you as contractor,to furnish all necessary materials,labor and workmanship,to ii;stall,construct and place the improvements according to the following specifications,terms and conditions,on premises below deserts.d: (,ck' 6t , ,l -� r�� Owner's Name......:f �(.? .. � . ...... . 1 .. ) f.Telephone N ............................ ,...... ..... � V�� I�s�..t..t.....:.�...t.l...t.�..-.l...t.-..t..{. .............State.AA..........Job Address......... } . 5 LI .. : .. .., City.......... Specificalions: ' ..... � .......... ........... ............ Areas to be cover:.t1: � +, , v' r, �� / ............................................ �.............................................. Apply ........................................................... : c: 4 .......................... vinylsidin; and corners. Ty;; veover fascia bout t1b and lake boars:,. Install vinyl soffit - solid /(E.-!oraled ` .................................................................................... ................................................................................................................... i''Cover wood casins around windo,� 1.41 Replace any gable vents and dryer vents with vinyl ..:.............................................. fill ly undulttynt nt Type. Existing . F..;...W/on-ov, 1 -_.._...._.. bgal drs os: of all debris. ............... r 'Rotted wood re)li,ced�d, l ................................................................................. i. —<i or � .5 /foot. , I ..,,F la 4(�..1;.:� ! .('.�. .�. I C 1�1 . .d.�si.... . ............................... ................................ L!.1.:<<� :,4.. ' 1 ............................. +........ ... ( I } .. ....... ....................... .......................... iJ{: ..'�.�.!:. ........ti..t �.......'� :4:�:%............................ �7�G\..... X .{�, ....�,i_.�..�.y.�fff Vii.. .............. ............................................I..........: 1L14,t../.. /. �..... ..(..l 4 S,L.... Y.f.S,t—.I4 ..... One Year Workmanship Warranty s,04ot Transferubie) Manufactln•er's Warranty as sl)ecified b _rna-WI WW",", The conn ctor agrees to rfonu die ,�nrk and furnish the materials specified above for the SUM of$..�`..�:I,j.11..,,,•,,,•,•• Payable.............................of.......:-...................... -lance payable on completion ofjob Owner or Owners we n,t responsible for Lhop j Diamntge or Liability while job is in operation. Contractor is not respwiblc for any danage t:.`:Le interior of property,including pre-existing conditions(i.e.water stains,crumbling plaster,exposed nails)or conditions resulting t'roi n application of mateti,_.specified above (i.e.objects coming loose from walls,crumbling plotter,exposed orals,drat in attic or other living spaces).Upon armphni:n of above work,all u...;crstgned agree to execute and deliver to contractor,their joint note in accordance with his(their)above obligation as reyues(ed by contractor Upon refitsal to do so„.ontraclor may tit its option declare the entire contract price or so much as then remains unpaid,immediately due and payable. It is agreed that,if permitted by law, .otraclor shall be paid by the owner(s)all reasonable costs,attorney fees aW expenses,in addition to the amount due and unpaid,that shad Lc incurred in enforcing r-i,c lens and conditions of the contract and/or arty lien in connection herewith.It is further agreed that this contract may be assigned by cotaraclor,mid also that ih.i-obligations hereof shall bind and apply to their heirs,successors or estates of the parties.The undersigned warrants) that he is(they ore)i,,,.,wutrs(s)of floe above.,.entioncd premises and unit legal title thereto stands of record in his(their)nantes(s).There are no representations, guaranies or warranties except such as may bx Lenin incorporated,if arty,nor arty agr"mcnts collateral hereto,our is the contract dependent upon or subject[o any Coll nm herein stared.Any subseyucnt ai;;eement in reference hereto shall be binding only iris writing and signed by all panics. All Home Improve-ent Contractors shall he registered and any inquiries about a contractor or subcontractor relating to a registration should be direct�d to:,Dirgctor,Home improven)ent Conuaclor Registration, One Ashburton Place, Room 1301,Boston,MA 02108 Tel:617-'127-8598 Any and all necessary construction-rel fled permits shall be obtained by the Contractor. Any Owner who secures his own construction- related permit or deals with mtregister,:j conu�actors is excluded fi-om the Guaranty Fund provisions of MGL c. 142A. Approximate startirig date of work................................................ Completion date................... Receipt of a copy of'this contact is hereby acknowledged,and it is further acknowledged by the undersigned that the foregoing provisions Have been read and the contents thereof understood and that no representation or agreement not herein contained shall be binding upon tate parties and that all of the agreements and understandings of said parties are contained herein. DO NOT SIGN THIS CONI RACF IF THERE ARE ANY BLANK SPACES Owner has three business days to cancrl this contract and incur no penalty (see notice of cancellation). �tlyr y .1 IN WITNESS WHkiREOP,the partie:�.have hereunto signed their names this.................da of....�. �;:�::: � ......... ,20..7.,...... Accepted: f_ r Signed .. .. C- - > .............. Owner i } Signed................................................................. ........ Owner David Cas(ricoae,President The Commonwealth of Massachusetts Department of Industrial Accidents d I Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): J)&) n ('M /C 0/(JE: J-141106 1106 /hj` Address: ca3//? dO770 1 5/—)ZE City/State/Zip:/Z)D /7/>,)6 t/�/? IV A Phone#: Are you an employer?Check the appropriate box: Type of project(required): I am a employer with 1� employees(full and/or part-time).* 7. New construction 2.[:]I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs Or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ROof repairs These sub-contractors have employees and have workers'comp,insurance., 6.❑We are a corporation and its officers have exercised their right of exemption per MGL C. 14Other Sj b 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. #Contractors 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-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information. Insurance Company Name: G219 4J/ 71 S7`9 Policy#or Self-ins.Lie. !)U&� �l Expiration Date: 02 3`01 L>/ & Job Site Address: lam? C'//-)%Ci)S0A) City/State/Zip: 1W ///1 y d il1'o(- /,q/1 6/,� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration 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 the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u�`nnd'err the pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: Phone#• % ) y Official 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#: TE A�® CERTIFICATE ®F LIABILITY INSURANCE 9/16/201rc5) 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 CONTACT Select Dept. Eastern Insurance Group LLC PHONE (800)333-7234 x66807 F� No:(761)586-8244 233 West Central St E-MAIL ADD ESS:selectwork@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC p Natick MA 01760 INSURER A.-Wes tern World Insurance Co INSURED - INSURERS Commerce Insurance Company 34754 David Castricone Roofing & Siding Inc. INSURER C:Granite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURERD: INSURER E North Andover MA 011345 INSURERF: COVERAGES CERTIFICATE NUMBER:CL159964794 REVISION NUMBER: THS 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 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. ILTR TYPE OF INSURANCE I DL U POUCY NUMBER MWDDY/YEYYY POLICY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RoccENTED X COMMERCIAL GENERAL LIABILITY 50,000 PREMISES Ea urrence S A CLAIMS-MADE [A]OCCUR NPP1404373 9/6/2015 9/6/2016 MED EXP(Any one person) S 1,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG S 2,000,000 '.. X (POLICY PROJE,- LOC S AUTOMOBILE LIABILITYOa accident)Dt SINGLE LIMIT ES 1,000,000 BANY AUTO BODILY INJURY(Per person) S ALL OWNED X SCHEDULED CNGCV /1/2015 /1/2016 AUTOS AUTOS BODILY INJURY(Per accident) S X HIRED AUTOS X NON-OWNED PROPERTYDAMAGE '.. AUTOS Per accident S S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS S C WORKERS COMPENSATIONWC STATU• 0TH- AND EMPLOYERS'LIABILITY YIN X ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 100 ODD OEF ICE.IMEA1EER EXCLUDED? O NIA (Mandatory in NH) C0039a9723 /23/2014 /23/2015 E.L.DISEASE-EA EMPLOYEE S 100,000 I1 yes,desc2e'rider DESCRIPTION OF OPERATIONS below HCO03989723 9/23/2015 9/23/2016 E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,d more space is required) Roofing & siding contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Castricone Roofing & Siding THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Unit 3A ACCORDANCE WITH THE POLICY PROVISIONS. 231 R Sutton Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 John Koegel/KH3 ACORD 25(2010/05) ©1988.2010 ACORD CORPORATION. All rights reserved. INS025(.nim;)ni The Ar:r1Rr1 nzme enrl Innn are ronicfereri mart, of Ar.r pn Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099358 Construction Supervisor Specialty DAVID T CASTRICONE 31 COURT STREET NORTH ANDOVER MA 01845 Expiration: Commissioner 12/16/2017 =, Office of Consumer Affairs& Business Regulation ROME IMPROVEMENT CONTRACTOR -_ ppegistration: 104569 t, "1 Type: >, xpiration: 7/14/2016 Private Corporatic DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3AB NORTH ANDOVER, MA 01845 Undersecretary