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HomeMy WebLinkAboutBuilding Permit # 4/25/2016 BUILDING PERMITOORTy ,,ED ,6�"Y0 16 TOWN OF NORTH ANDOVER - APPLICATION FOR PLAN EXAMINATION p / o� o mow, Permit IVo#: Date Received A�RArEU Pea ty �SSACHu`��� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION /C) r �L LLQ ?0—f `� Print PROPERTY OWNER I E �7 1 e i � Print 100 Year Structure yes no MAP � Y PARCEL: SPC ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building %POne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial >'Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well [ Flooc�plam ❑Wetlands ❑ Watershed District ❑,,,Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: CL 1 Identification- Please Type or Print Clearly OWNER: Name: Def) I SC Lnfallei Phone: Address: Contractor Name: 0&,1//?,(o"'Ie R0D fil/ q Phone: fr Email: Cl((L)lc) & 6 cka 1'19Lc1?c o(,)/1; C�� Address: ,� - a,� e �T)ve, c)/ Supervisor's Construction License: Exp. Date: Home Improvement License: f� � % Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. � a Total Project Cost: $ / ®' FEE: $ /�®• Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund NORTH Town of �' ®ver O 0% ver, Mass,Lx COCKICMEWICK ORATED r'P�,`'�� S ►JBOARD OF HEALTH Food/Kitchen PaRM T T L �U Septic System ,ea� s� BUILDING INSPECTOR THISCERTIFIES THAT ........... (:................................................................................................. Foundation has permission to erect .......................... buildings on ....5. .... ......f.. .. .. ..... �........................��.. Rough �. :.... � " ®® - Chimney to be occupied as ...... ..... .................................................................. 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 PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMITIRE IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S ARTS Rough Service .................... . . ................................ BUILDING INSPECTOR Final GAS INSPECTOR ccupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No 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. 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 I/we 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 prem' below described: 6. c7 r Owner's Name......... .......G..J.�,46'.. ......................... ..........T hone#...�+.. 0.:�tr.2t�."`.Q..CJ../.�. 9� . Job Address....�1 lf ....�./`P.u.....f'r..... City.......L�.t. !1 G. �}r ...........State....................... Specifications: ��1ti J S e e t./....................t.�w� ,,e IyL/ ............................................................................................................... I......I....................... trip existing shingles.(1-' Apply new drip edge to all edges. � 4l—e g, "r ...................................................................................................................................................................................................................... -✓Apply_feet ice and water shield membrane to bottom edges of house.3 feet ice and water shield membrane in valleys and bottom edges of any unheated areas of house, —> Pic// &. ....... .... . Apply F®llcpa�etlnderlayment. nstall ridge vent to S �... .�.�. ,....... .............. ............. ............. .. / ............... . .................................................. id�eroof since , shingles with a t5 C year warranty. i f.......................................... ......f......., ........................ ............................................... . +'�ounterdash chimney. New vent pipe dashing. egal disposal of all debris. m Area(s)to be worked on: ..... ..... 1.. .. ... ........ ...... ............. Q. .... ..a ................................ s !:.:...../.' ...... � ............... . .: .1..1...., ..... .... ......... ........ . . .... Roof board replacement rf necessary @ /sheet o��/foot. pp . _9 r zi e s U .................... ... .............................................................................................. ............................... .... ....................... ......p Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specif d by nufacturer The contractor agrees t e....rform the work d 'sh a materials specified above for the SUM f S.. .......q ........... Payable...:.r�. on.JC.. ... ................ ....... Payable.............................on.................................. Balance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability while jab 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 date......................................................... Receipt of a copy of this contact is hereby acknowledgaH,an 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 on 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,231R Sutton St. over,MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their names this.. ./6L..day of.0 ei.,20..�� Acceptedto)vr V��La--(G'4"S 4'.De Signed— ............................................................. Owner r Signed............................................................................. Owner David Castricone,President The Conunomveahoh of Tt aSsachu.-efts -�-R' Depar•tinefti of hedusir ial.Accideitfs Of Ice of Invesd adons 600 PPashin torr Street Boston, AL4 02111 5_ 'fir 1001).Mass.fgovld£tl Woi!-kers' Compensation insurance Affidavit: Builders/Cont>i-actor•s/Electi-icians/Plumbet-s applicant Information Please Print Le>sibly d /1ame (Business/Organization/Individual): DAV l h l AST2 L u NkE p 1'/M1h { S11> 1106 , /)Ut- \.ddress: 023 ( 1Z SUTT-60 5T&-tA-1 , UtJ IT 3A :ity/Stale/Zip: . No. ANcog e✓1< MA 6 / �Lfy Phone #: �(^?$ (0� 3 3� 2A re you an employer? Check the appropriate box: Type of project (required): X I am a employer with 4. ❑ 1 am a general contractor and I employees(full and/or pari-lime)." have hired the sub-contractors 6. E] New construction 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• EJ Demolition employees and I}ave workers' 9 ❑ Building working Forme in any capacity. g addition [No workers' comp_ insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions I am a homeowner doing all work officers have exercised their I1.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12�Roof repairs insurance required.) t c. 1522. 1(4); and %ve have no employees. [No workers' 13.❑ Other COMP. insurance required.] t applicant that Alecks box ill must also rill out the section below showing their workers' compensation policy utformation. meo\vners who submit this affidavit indicating they are doing all%vork and than hire outside contractors must submit a new affidavit indicating such. tractors that check this box must attached an additional sheet shor.•ino the name of die sub-contractors'and state whether or not those entities have oyees. 1f the sub-contractors have employees,they must provide their �:orkers'comp. policy number. u an employer that is providing workers'Compensation insurance for mY emploUees. Below is the polio, and job site wination. rranceCompany Name: RA6) S-r�� �0Sv"A-J" cy # or Self-ins. Lic. b: -7 XJ Expiration Date: Site Address: 13 r' /C 176-111 City/State/Zip:/Vol// fl/)WclX1 ach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Lire to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 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 !p to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of :�stigations of the DLA for insurance coverage verification. > hereby certify under the ains and penalties of perjury that the in%ormation provided above is trite/acrd correct. nature: Cfd "� Date- the 11: .371Q Official nge only. Do not write in this area, io be completed by citi:oi-to}+�n offs-iaL City or Town:_ f cr�rtitlLiccats, it issuing Authority (circle one): 1. Roarcl of Health 2. Building Department 3. City/Tov•n Cierlt 4. Electrical inspector 5. Plurrtbio- Inspector Aco CERTIFICATE OF LIABILITY INSURANCEDATE(MMI0 YYYY) 9/16/2015 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 NONEACT Select Dept. Eastern Insurance Group LLC PHONE (800)333-7234 x66807 F C( No:(781)586-8244 233 West Central St EMAI DRLESS:selectwork@easterninsurance.com AD INSURER(S)AFFORDING COVERAGE NAIC p Natick MA 01760 INSURER A:Wes tern World Insurance Cc INSURED INSURERB:Commerce Insurance Company 34754 David Castricone Roofing & Siding Inc. INSURERCGranite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURERD: INSURER E North Andover MA 01845 INSURERF: COVERAGES CERTIFICATE NUMBER:CL159964794 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 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. TN—SR A L U LTR TYPE OF INSURANCE POLICY NUMBER MWDDO� MMIDDtYEYYY LIMITS GENERAL DABIDTY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence S 50,000 A 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 GENERAL AGGREGATE S 2,000,000 GEN L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG S 2,000,000 X I POLICY PRO- LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 1,000,000 ANY AUTO $ BODILY INJURY(Per person) S ALLOWNED X SCHEDULED CNGG^! /1/2015 /1/2016 AUTOS AUTOS BODILY INJURY(Peracddenry S X HIRED AUTOS X WN NON-OED PROPERT-DAMAGE AUTOS Per acdcleno S I S UMBRELLA LIAB OCCUR F1 EXCESS uae EACH OCCURRENCE S CLAIMS-MADE AGGREGATE S DED7 I RETENTION S S C WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N X l ANY PROP IETOR/PARTNER/EXECUTIVE 0 PI EXCLUDED' O JJ7 E.L.EACH ACCIDENT S 100 000 (Mandatory in NH) 9723 /23/2014 /23/2015 E.L.DISEASE-EA EMPLOYE S 100 000 Ii If yes.desCnoe under I DESCRIPTION OP OPERATIONS oefow 9723 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,A 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(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 frnlnri.q ni Th.Ar:r1RI1 name and Innn aro rnniefnrori martre of Ar.r1Rr1 7. 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 �-J- 7 CA— Expiration: Commissioner 12/16/2017 Office of Consumer Affairs& Business Regulation :i �G,OME IMPROVEMENT CONTRACTOR egistration: 104569 Type: >, ,:Expiration: 7/14/2016 Private Corporatic DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undersecretary