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HomeMy WebLinkAboutBuilding Permit # 4/25/2016 0ORTy BUILDING PERMIT ,LED TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received oAra �SSgcHus���y Date Issued: 7,&) IMPORTANT: Applicant must complete all items on this page LOCATION 6 Print PROPERTY OWNER v6w(( '" Print 100 Year Structure yes LnoMAP PARCEL: ZONING DISTRICT: Historic District yesMachine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building )0 One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg_ ❑ Others: ❑ Demolition ❑ Other r 3 qqp '/c ❑Well j ❑ Floodplain U Wetlands ❑ Watershed Distract: DESCRIPTION OF WORK TO BE PERFORMED: �� ,I�dentificati - Please Type or Print Clearly OWNER: Name: '' (� { y� Ma c Phone: Address: q �bb ,1 Contractor Name: ). C&S 4-' Lune_ �o h n Phone: �= Email: d t )U I-) Address: 3 A. Supervisor's Construction License: 9 CO S Exp. Date: I X Home Improvement License: -104 Sl e% Exp. Date: V7 /l /f ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ ( � �' �� ( FEE: $ It Check No.: s ( Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access two the guaranty fund -- -- -� - AM t%O R TFi E. �� ®ver ® 1n -n Z60h , ver, Mass,,` O 4LAKE 1+ COCMICHE WICK ®S64ATED 100? V BOARD OF HEALTH E R -gT T . Food/Kitchen Septic System L THIS CERTIFIES THAT BUILDING INSPECTOR ............ . .... ....... .. .............. .... ...... . ....... . . ................ ............. .. .... has permission to erect .......... buildings on Foundation .... ... .. . . . Rough to be occupied as .........?acceppii*ng?is, . . .. ....4. .... ... . .................................................................... chimney provided that the person 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final IT EXPIRESIN 6 ®NS ELECTRICAL INSPECTOR CONSTRUCTIONUNLESS STARTS Rough Service ........................1... .... .. . Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired t® Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final o Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. DAVID CASTRICONE, PRES. e CASTRICONE ROOFING & SIDING INC. ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 231 R SUTTON STREET UNIT 3A, NO.ANDOVER, MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314 Uwe the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to furnish all necessary materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on premises below described: 7 Owner's Name.�.J.... e- ...t�...d,4Q_X...........................................A)._ Tlephone#..`4�. $✓•.a.......... Y c Job Address...... .. ....1 .f�...VJ... ..(f........ ........................City.... .veJ..........................State... /....1�...... Specifications: .................................................................. .......................................................................I......................... ✓Strip existing shinglesW +`Applx new drip edge to all edges. �t/�j X, g f r ......................I..............I...... ............................................................................................................................. /Apply I feet : I ' membrane to bottom edges of house.3 feet n in valleys and bottom edges of any unheated areas of house. Apply felt p rpt erlayment. nstall ridge vent to yReroof using Le c�. J ae1 C�r JeG�j shingles with a .21}_year warranty. v t��`. -- ............................................................................................... i ✓Counterflash chimney. ✓l ew vent pipe flashing."Legal disposal of all debris. ..............................................r. _........ .......................... ............ ...... (. Area(s)to be worked on: 9............ ................................I..................... 1 .l lyl-�... . . .�Y....... L�.1-......1..Q/2.4 h:41; .,..:........................................................................................ .................................................................................................................................................................................................. Roof board replacement if necessary.,@_ ./sheet o��'_/foot. .... ..................................................y . ...— Five year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specif by m nufacturer The c�actor a s to perform the work an fu�4 i��h the materials specified above for the SiJM of$.... .�. �........ ....... i ayable L..A.0..........on..... llw_c............. Payable.........:.................on..........-....................Balance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability while job is in operation. Contractor is not responsible for any damage to the interior of property,including pre-existing conditions(i.e.water stains,crumbling plaster,exposed nails)or conditions resulting from application of materials specified above(i.e.objects coming loose from walls,crumbling plaster,exposed nails,dust in attic or other living spaces). Items in attic may need to be covered by homeowner.All materials are property of contractor.Any dumpster placed by contractor is for his use only.Upon completion ofabove woik,all undersigned agree to execute and deliver to contractor,their joint note in accordance with his(their)above obligation as requested by contractor. Upon refusal to do so,contractor may at 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,contractor shall be paid by the owner(s)all reasonable costs,attorney fees and expenses,in addition to the amount due and unpaid,that shall be incurred in enforcing the terms and conditions of the contract and/or any lien in connection herewith.Property may be subject to mechanic's lien if unpaid.It is further agreed that this contract may be assigned by contractor,and also that the obligations hereof shall bind and apply to their heirs,successors or estates of the parties.The undersigned warrant(s)that he is(they are)the owners(s)of the above mentioned premises and that legal title thereto stands of record in his(their) names(s).There are no representations,guaranties or warranties,except such as may be herein incorporated,if any,nor any agreements collateral hereto,nor is the contract dependent upon or subject to any conditions not herein stated.Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all parties. All Home Improvement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to the Office of Consumer Affairs and Business Regulations,Tel.(617)973-8700. Any and all,necessary construction-related permits shall be obtained by the Contractor. Any Owner who secures his own construction- related permit or deals with unregistered contractors is excluded from the Guaranty Fund provisions of MGL c.142A. Approximate starting date of work......—/.....fV....'[I.:).. 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 the understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and understandings of said parties are contained herein. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES This contract may be cancelled,without penalty or obligation,within three business days of the below-referenced date.Mail or deliver a signed and dated notice or send a telegram to Castricone Roofing&Siding Inc,231 Sutton St.,No.Ando MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their names this... day of... 20...` Accepted: Owner r Signed............................................................................. Owner . ODavi .... .. ...... tricone,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): _1'AV I) e—ASrt 9I C6 NC QhC',,F I N V S 1 D 11, G i ML Address: -A b 1 C S,y T--n t__� T 5A City/State/Zip: I Ao. P\M N1,V EA NA 01 �4�_ Phone#: q 79 .4A3.3 1 d-`' Are you an employer?Check the appropriate box: Type of project(required): 1 am a employer with employees(full and/or part-time).* 7. New construction ®I am a sole proprietor or partnership and have no employees workin for me in p P P Pg 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.®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 11.0 Electrical repairs or additions proprietors with no employees. 12.❑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. 14.❑Other 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 and job site information. <_ Insurance Company Name: V JZA K I 1—t5 JT/-,-,-T S4AN C Policy#or Self-ins.Lic.#: ZR I Expiration Date: G -;A 3 `12C; i (� Job Site Address: `f 'f i� 1J�J(} 1 S�(CUt City/State/Zip:ky A(\A6 Vfe J 1 /, 6 t d q J 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 under the pains and penalties of perjury that the information provided above is true and correct. Signature: .�_/ ✓ C Date; Phone#: !9-7 .3 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#: ACORL? YYYJ 1* ® CERTIFICATE OF LIABILITY IN U NC DATE IMMIDD/Y./ 9/16/20155 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 COOMNTACT Select Dept, NA Eastern Insurance Group LLCPHONE (800)333-7234 x66807 "C No:(781)586-8244 233 West Central St AE-MADDREILS ..selectwork@easterninsurance.com INSURERS AFFORDING COVERAGE NAIL tl Natick MA 01760 INSURERA-Western World Insurance Co INSURED INSURER e Commerce Insurance Company 34754 David Castricone Roofing & Siding Inc. INSURER C.Grani te State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER D: INSURER E North Andover MA 01845 INSURERF: COVERAGES CERTIFICATE NUMBER:CL159964794 REVISION NUMBER: TH;S 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. INSRTYPE OF INSURANCE A L U POLICY EFF POLICY EXP LTR POLICY NUMBER MWDOr/YYY MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence S 50,000 ?� ( DAMAGE TO RENTED CLAIMS-MADE �OCCUR PP1404373 9/6/2015 9/6/2016 MED EXP(Any one person) S 1,000 PERSONAL 8 ADV INJURY S 1,000,000 1� GENERAL AGGREGATE S 2,000,000 LNl AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG S 2,000,000'. X I POLICY I I PRO- LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 1,000,000 B A.NY AUTO BODILY INJURY(Per person) S =LL OwnEO X SCHEOULEO CNGCV /1/2015 /1/2016 AUTGS AUTOS BODILY INJURY(Per awdenl) S NON-OWNED PROPERTY X r:IREO AUTOS X DAMAGE AUTOS Per accitlent S I � s UMBRELLA LAB OCCUR EACH OCCURRENCE S j EXCESS LAB CLAIMS-MADE AGGREGATE S DcD RETENTIONS g C WORKERS COMPENSATION WC STATU 0TH- AND EMPLOYERS'LIABILITY YIN X L Oguy R,M-Ml EGUTIVE O N r A E.L.EACH ACCIOE NT r S oFrIC ER/M1,c SER EXCLUDED' 100 000 (Mar,utory In NM) C003989723 9/23/2014 9/23/2015 ;I yes c'escnoe under E .DISEASE EA EMPLOYE S 100,000 DESCRIPTION Or OPERATIONS below HC003989723 9/23/2015 9/23/2016 EL DISEASE-POLICY LlhllT 5 Soo,000 I � DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,N more SPa Ce 17 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. INS02s—,nn;,n, TH.&r`r)pn nam.2nH Inns oro rnnicf.r.rl_,_of ARr)pn Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099358 Construction Supervisor Specialty DAVID T CASTRICONE 31 COURT STREET 13- NORTH ANDOVER MA 01845 (-�Z7 ("�— Expiration: Commissioner 12/16/2017 Office of Consumer Affairs& Business Re;ulation ROME IMPROVEMENT CONTRACTOR 06egistration: 104569 Type: z ,;.Expiration: 7/14/2016 Private Corporatic DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3AB _ NORTH ANDOVER, MA 01845 UntJcrsecrctary