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HomeMy WebLinkAboutBuilding Permit # 6/9/2016 BUILDING ® PERMIT �oRTti `�tl@D 16�-yO TOWN OF NORTHA DOVE � ® APPLICATION FOR PLAN EXAMINATION p Permit No#: Date Received Q�Rareo rPaygS �SSus�R Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION J 0 C)a�<e,S Print. PROPERTY OWNER �QL� �� s+rb ry) Print 100 Year Structure yes no MAP PARCEL: �!' ZONING DISTRICT: Historic District yes no Machine Shop Village ye n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building XOne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial `Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other C(Septic ❑Well ❑ Flaodplam ❑Wetlands ❑,Watershed Distr[ct DESCRIPTION OF WORK TO BE PERFORMED: OA Identification- Please Type or Print Clearly OWNER: Name: � � Phone: Address: �'3C) Contractor Name:. ua Phone: q�� �� y Email: d L-i_Q 1O L� e a Stdanr, such oz, ccm' Address: 2,3 1�& Si Supervisor's Construction License: q3,�- Exp. Date: lT 1 -7 Home Improvement License: Exp. Date: 07 - 1 L4- ARCH ITECT/ENGI NEER ,ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT. $92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ q 0 M. FEE: $ � Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have/access t ie aranty fund ,IRT111 f Andover Town o L ;t� 15 761(p ver, Mass, ®� COC IC QWICK ,®QD'�?ATED AP���� S U BOARD OF HEALTH Food/Kitchen Septic System P LM IT & T BUILDING INSPECTOR THISCERTIFIES THAT ....... .. ...... .. ...... .. .. ... .. ...................................................... Foundation has permission to erect .. buildings on ... ..... ... ... .• ...... .. ....... .. ... ... ........................ Rough .. ... ....................................................... Chimney to be occupied as .... A. ............. - ev provided that the person accepting thi 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS ION Rough Service ....... ... .. .... ..... ... Final BUILDING INS CT R GAS INSPECTOR Occupancy Permit Required t® Occupy Buildi Rough Display a Conspicuous Place on the Premises — Do Not Remove Final No Lathingr all e ® e FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. The Commonwealth of Massachusetts z Department of Industrial Accidents d I Congress Street, Suite 100 Boston,MA 02114-2017 y www mass.gov/dia X01 V v Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lel4ibly Name (Business/Organization/Individual): IAV 1 D C- ST(i l C&d uT I N G + S ►D 11J L i L'i� Address: 6A City/State/Zip: �Ap. P03 DCS d C_1�- H/-I 01 �`f 5 Phone#: q 7g 6 B..3 Are you an employer?Check the appropriate box: Type of project(required): 1.reZ[1 am a employer with S employees(full and/or part-time).* 7. ❑New construction 2.0 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. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp,insurance required.]t 10 ❑Building addition 4.[:]]am a homeowner and will be hiring contractors to conduct all work on my property. [will ensure that all contractors either have workers'compensation insurance or are sole 11.❑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. These sub-contractors have employees and have workers'comp.insurance.t 13oof repairs 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#I 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. //__ Insurance Company Name: V (2_A I4 11-6 JT Policy#or Self-ins.Lic.#: 'V CU® 5 9 �9 TA Expiration Date: ` 3 0 (c ) 6 Job Site Address: 3c) GaLf?J 'Do �tc City/State/Zip: N6 A i`t Velma t_ , 0/� r 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: r J_�/ C Date: r Phone#: -7 - (c S 3 ~:3 q dy 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#: ® DATE(MMIDD/YY) ACCW? CERTIFICATE ® LIABILITY INSURANCE W9/16/2015 Ill 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). CONT ACT Select Dept. PRODUCER � NAM.EE: Eastern Insurance Group LLC PHONE (800)333-7234 x66807 FAX (781)586-8244 AC No: 233 West Central St EADDREMAILS ..selectwork@easterninsurance.com INSIJRrRtSI AFFORDING COVERAGE NAIC d Natick MA 01760 INSURER A'Western World Insurance Co INSURED INSURER8:Commerce Insurance Company 34754 David Castricone Roofing & Siding Inc. INSURERCGranite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER D: INSURER E North Andover MA 01845 1 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 INSR A DL POUCY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MWDD7YYYY MMID01YYYY GENERAL UABIUTY EACH OCCURRENCE S 1,000,000 � DAMAGE TO RENTED SO,OOO X1 l COMMERCIAL GENERAL LIABILITY PREMISES Ea ocwrrence S _ A ( CLAIMS-MADE Fx—I OCCUR NPP1404373 9/6/2015 9/6/2016 MED EXP(Any one person) S 1,000 l PERSONALB ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GLNl AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG S 2,000,0001 X pOUCY 17 PRO- LOG S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 5 1,000,000 ANY AUTO BODILY INJURY(Per person) S B — ALL OwNED SCHEDULED CNGCV /1/2015 /1/2016 AU T O� X AUTOS BODILY INJURY(Per arsJdent) S NON-OWNED PROPERTY DAMAGE ^ I HBRED AUTOS X AUTOS Per accident S I I I S UMBRELLA LIAB OCCUR EACH OCCURRENCE S j EXCESS UAB CLAIMS-MAGE AGGREGATE S DED RETENTIONS S C WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITYYIN ` IIANY ROPRI:rOR/PARTNER/EX ECUTIVE� NIA EL EACH ACCIOE NT S 100 000 o..IcERm+Ensa,.)ExcwDEl7 C003989723 /23/2014 /23/2015(Mxndarory in NHEL DISEASE-EA EMPLOYED 5 100, 000 dyes Gesc'lbeUnder 0003989723 9/23/2015 9/23/2016 Oc�CRIPTICN OF OPERATIONS below E DISEASE-POLICY LIMIT S 500,000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORO 101,Additional Remarks Schedule,it 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. INS025r%mnn9m Thu Ar.r)Rtl Hama anrf Innn aro ronicfururf mar4e of ardor/ Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099358 Construction Supervisor Specialty DAVID T CASTRICONE 31 COURT STREET 10- NORTH ANDOVER MA 01845 ( —j Z7- (,A— Expiration: Commissioner 12/16/2017 Office of Consumer Affairs& Business Regulation ;iROME IMPROVEMENT CONTRACTOR am I registration: 104569 Type: xpiration: 7/14/2016 Private Corporatic DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A �� � NORTH ANDOVER, MA 01845 Undersecretary DAVID CASTRICONE, PRIES. J-,/9 I& +� 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 prepf2s be. desc 'b �z"-4 ? /..Owner's Name..... . ..................... QT ep.h(/one#...� �.- /� D.") PD ... Ci ...............State-...�...... ...... Job Address... !... .. .... .......... Specifications: ................ .................................................................................................................................................. Stripexisting shingles II $�,, g g �i�Apply new drip edge to all edges.wkr.., ..................................I......................;....................................................................................................................................................... t,/Apply feet t membrane to bottom edges of house.3 feet in valleys and bottom edges of any unheated areas of house. ... ..................................m—'e'........u-st-a.......................................,............................................J........................................-................... Apply felt paper underlayment. ' stall ridge vent to ✓Reroof using i shingles with a ,3f� year warranty. tib br -- ......................................... N ............. ,............. .... viunterflash chimney. ew ventpipe flashing -Legal disposal of all debris. xl !Nk ' .. . .. .................................................. . .. . ..... ........ ... ........... ...... Area(s)to be worked on: ) .....D. .. bra.t :..� .z5. /1�.t,tS.Q.... ? i�:s:... <?'y...lall.la .irv..1L?.v... .....r!�.....Lf 4n :f�S... ...PQ.ci. �.Il ;l �................ ... ...................... 1 :t.....:7,A� ... ....................... ........................................................./......./........................................................................................................................................ Roof board replacement if necessary„aC� IAV..../sheeto 5 /foot;,,,,,,,,,,,,,,,,,•,,,,,,,,,,,,.,,,.,,,,..,,,,,,,,,,:,,,,,,,•,,,,,,,,,,,.-.,,,-.,,.......,,......... P..............ty( ) Y P Y Five Year Workmanship Warranty Not Transferable Manufacturers Warrant as eci ma The ctor agrf s t perform the work �{ish he materials specified above for the SU of$..... �jb....... ••.... �ayable�` L1.�Q0.......on. .a ...t......... Payable........=.4..............on...........'.................... glance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability whilelob 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 warrants)that he is(they are)the owners(s)of the above mentioned promises 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................................................ 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 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.Andover,MA 0/1845. IN WITNESS WHEREOF,the parties have hereunto signed their names 's... q day of.,Ma76................20.)/a.• Accepted: %J) Zv� L Ct�L_�----- Signed..........(,L............................................................... Owner Signed............................................................................. Owner Li`!u.. J... David Castricone,President