HomeMy WebLinkAboutBuilding Permit # 8/8/2016 (2) NO F2TIy
BUILDING PERMIT 0F�t4n
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Permit No#: ' +� Date Received �ysQA^TEo �f¢��y
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Date Issued:
T ORTANT: Applicant must complete all items on this page
LOCATION 1 4L) L-Ro—a=L( —
PROPERTY OWNER_ ��,i .�CAS I --wr -
Print 100 Year Structure yes Dbo
MAP �PARCEL: ZONING DISTRICT: Historic District yes
Machine Shap Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building One family
[I Addition L1 Two or more family 11 Industrial
❑Alteration No. of units: ❑ Commercial
Repair, replacement ❑Assessory Bldg_ [I Others:
❑ Demolition ❑ Other
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DESCRIPTION OF WORK TO BE PERFORMED:
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Identificatio Please Type or Print Clearly
OWNER: Name:
(e- Phone: �10 6 8 6,�)
Address. � � k)LA_cAnu&,
W.
Contractor Name:JJ ` r Phone: O(�
Email J kr3,
Address: L Vs-
4 ��� A1
8.
Supervisor's Construction License: L Exp. Date: l -1 _
Home Improvement License:
-7
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BUILDING PERMM$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ � _FEE: $
Check No.: t Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
t&®R'TFI
Town of a ¢ �� bAndover
® .yr, wry 90
)LI'lobilNo.
:gree h ver, Mass,
Al COCN1Crie Wee.R I-
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ATED 0
S �
BOARD OF HEALTH
Food/Kitchen
"PE IT LD Septic System
THIS CERTIFIES TN Ti BUILDING INSPECTOR
.. . .. � Foundation
has permission to erect ....... ................. buildings on !llll;... ....................�.vwwsr. ... .. . n1 r� Rough
to be occu ied as ........... . Chimney
provided that the person accepting his permit shall in every respect conform t term f 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 16 MONTHS ELECTRICAL INSPECTOR
UNLESS C®NST TI® 4 Rough
Service
.. ....... ..... .................. .. ........
Final
BUILDING INS TOR
GAS INSPECTOR
®empaney Permit Required to Occupy By din 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, FRES.
CASTRICONE ROOFING & SIDING INC.
ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS
HOME Iiv1PROVEMENT CONTRACTOR REGISTRATION NUMBER 104569
231 R SUTTON STREET UNIT 3A, NO.ANDOVER, MA 01845
In North Andover 978-683-3420 hi BoxfortJ 978-887-6747 M HaverhW 978-374-7314
Ihve 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,oil premises below described:
Owner's Name,..... .........1.......
Job Atidt i:ss.....Jyr ...J.. t. F '1.`L?�y.L ..... � ........ ..........state.../`Il�....
specrficalions:
Strip existing shingles `- )v'allply 1 ...............................................�.`�........,. ..
.......................................................... ..............................................................................
r
r .
r . ... r .. lett'drip cd„c to all cligcs, � � ! 'C..J
... _...# cl l:.......................................................................................................................................................
y-Apply��1CC1 „ -4, E invalln-all to Ioltoln edges of house.3 I'eet \
to valleys and hotloill edges of any unheated tlr'eas of house.(c{� or f� d,4I-er”-`(-MV-)
.............................................:......................................................... c / ..............................................
L ,
} { ........
yi pllly yult paper k r de'I;tyntcnl, Install ridge vent to
i�>tcroof usnkg � � =7 Yf�r�� F � illi It_ _year warranty.
..................................................................................................................
i�Countertlnsh cltinlney. ✓i�err vent pi)1C flnsliing. gal disposal of all debris.
....................................................................f...... .......................-.--...................................... ..
Area(s)In be worked mr.
' 1
� yLAO
......................................................... .... a. . .t...................... ,.............................................................................
Ruol'I?4itJ;d.retlEilcctEtctti if access....Y!,C.rr�....k�-ltiltf&i arL�.::. {�(1.4.4•....................................................... .
Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as sll e,6 y manufacturer
The tractor agrees to perform the work and is the materials specified above for the SEI of$......y4,`d O........ ......
Ei payablx.1SJ5r)..,)........on.s"x. .o.!`................
Payable.............................on._.........................:7alance payable on completion of job
Owner or Owners are not responsible rot property Damage or Liability w -.j is in operallmi.
Contractor is not responsible for any damage,to lite interior of property,including pre-existing conditions(i.e.water stains,crumbling plaster,exposed nails)or
conditions resulting horn 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 he covered by homeowner.All materials are property of contractor. Any dwnpstcr placed by contractor is for his use only.Upon
completion of.ahave woik,all undersigned agree to execute and deliver to watractor,their joint note in accordanoc with his(their)above obligation as requested by
contractor. Upon refusal to do so,conlractor 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 rtes and expenses,in addition to the amount due and unpaid,that
shalt be incurred in enforcing the temis and conditions of the contract and/or any lien in connection herewith.Property may be subject to mechanic's lien ifunpaid.It
is further agreed that this contract may be assigned by wntruetor,and'atso that the obligations hereof shall bind and apply to their heirs,sucCcssors or estates of the
parties.The undels'kgntd wartani(s)that he is(they are)the owners(s)of the above menlinaed premises and that legal title thereto Maids of record in his(their)
names(s).There are no tcpttsentalions,guar€e4ics or wartanlits,except such as may be herein incorporated,if any,nor any agreements collateral hereto,nor is the
contract dependeal upon or subject to any conditions not herein stated.Any subsequent agreement in reference hereto shalt he binding only if in writing and signed by
all patties.
All Home l>inprovement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration
should b6 diracted'to the OfFice of Consumer Affairs and Business Regulations,Tel.(517)973-8700.
Any and ali.nt:eessary constnicfion-related permits shalt be obtained by Clic Contractor. Any Owner who secures his own construction-
related permit or deals with unregistered contr tors.is excluded from the Guaranty bund provisions of MGL c.142A.
' � �
Approximate starting date ofwork I .t^ .. � ••••• Completion date.t �i.7 L i.E .LIt7.t?4cS-4 V•�• .�' i?t J'" 4
Receipt of a copy of this contact is her ;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 arc contained herein.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
This contract tray be cancelled,without penalty or obligation,within three business days of the below-referenced dale.Mail or deliver
a signed and dated notice or send a telegram to Castricone Roofing&Siding Inc,23 R Stitton St.,No.Andover,MA 01845,
IN WITNESS WHEREOF,the parties have hereunto signed their names this... .J.'....day of1.y/.L.L.).'. 20'•F• •
Accepted:
Signed........m. .Sr.lk.. .......... Owticf
SigrkOd............................................................................ Owner
David Castricone,President t
g9 61�_"
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I
Tl e Common wealfh of T lassach a el►'zs
��u = epor11"errr of Industrirl.Aceiden(s
Office o. ,fnvestigatdojls
GaagVashin ionstreef
A ,
'S '1 Boston, AL4 02111
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Wat-kers' Compensstfori Insurance Affidavit: Builders/Conti•actor-s[Electi-icialas[Plumbeit•s
k Dficaut Information Please Print I ibl
Jame (Business/Organizatiordindividual):
Wdress: 023 SU -FTZ o S �-� T V 1� k {` 3A
:ity/StatelZip: N0. AMbDJ t1(, t1A a l L4fY Phone #: q7 (0� 3 3� Zy
re you an employer? Check the appropriate box: Type of project (required):
Q. ❑ 1 am a general contractor and !
I am a employer with � 6_ New canstnictian
employees(full and/orpart-time).* have hired the sub-contractors
listed on the attached sheet. 7. ❑ Remodeling
1 a'r't a sole proprietor or partner- These sub-contractors have
ship at7d have no employees 8. [] Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
a workers' comp- insurance
comp. insurance.
� 5. ❑ We are a corporation and its 1Q.❑ Elecvical repairs or additions
required.]
I am a homeowner doing all work officers have exercised their 1].EJ Plumbing repairs or additions
myself. [Na workers' camp. right orexetnption per MGL 1� Roof repairs
c 7I 52. 1('t); and Svc,have no
insurance required.] t 13.0 Other,
employees. [1'Ja worleers'
comp, insurance required.]
I npplicani that checks box tt1 must also rill out the section below showing their workers' compensation policy irrronnation.
meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tractors that check this box must attached an additional Sheet shokvinn the name of the sub-Con rcoctors'and state whether or not 11105e entities have
oyees. if the sub-contractors have emplayces,they must Provide'Ile if +corkerscamp,policy number.
rl air employer tlrat is providing worherS'coillpe rsaliolt iltSl:3'l71tCe fUi'rrtV employees. Below/s thepolrc;+and full Site
' �ri.ratiPn.
2 flly TF S-A--r->r 4Js�t2 NC-rL
trance Company Name:_ .I S
cy If or Self-ins. Lic. i/:� ��6 3 7�3 Expiration Dater
t u
Site Address:_
j 1� � {� City/State/Zip: P, G� ` J
acb a copy of tine workers' compensation policy declaration page (sEtoV—L4
the policy number and expiration dafe).
ure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
up to x;1,500.00 and/or one-yeas imprisonment, as well as civil penalties in the form of STOP WORK ORDER and a line
tp to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to idle Office of
�stigations of the DIA for insurance coverage verification.
hereby ceridfv r'i'der ilre pair's and perrnlfles of perjury that tha information tion providers above is trite Wird cu'd'gel_
2)2 nature:
�1 �C.ZL Date: '
me 11: 7 3
Offz4ial rise only. fro idol write in flits j21-en, io be completed&Y cit, 01'to)",' official
City or Town: � F crrrtitfi,icctisc ii
Issuing A;uthRority (circle oue):
L Board cdfI ealth 2. Buildsng department 3. City/Towfi Cict 1, 4. Electrical Inspector . 1'S�tmbinB Inspector
A CERTIFICATE OF LIABILITY INSURANCE 9/2a/2a15 DATE€MMJ01M5"'
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(les)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 andorsement(s).
PRODUCER NAMEACT
i Select Dept.
Eastern Insurance Group LLC PHONE (800)333-7234 x66807 FAX
Nol:(781)586-8244
233 West Central St E'MAIzES5:seleetwork@easterninsuranae.com
ODR
INSURER(S)AFFORDING COVERAGE NAIC N
Natick MA 01760 INSURER A Western World Insurance Cc
INSURED INSURER B Commerce Insurance Company 4754
David Castricone Roofing S Siding Inc. INSURERc:Granite State Insurance Co.
231 Rear Sutton Street, Unit 3A INSURER D:
INSURER E:
North Andover MA 01845 INSURER F:
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
-
fNSR ADDL SUER POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY) (MWDDfYYYY1 LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
�17
MERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES Ea occurrence $ 50,000
A CLAIMS-MADE ❑X OCCUR RPP1404373 9/6/2015 9/6/2016 MEDEXP(Any one Person) 5 1,000
PERSONAL&ADV INJURY S 1,000,000
GENERAL AGGREGATE S 2,000,000
GEN'#.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000
X JECT POLICY PRO- LOC 5
AUTOMOBILE LIABILITY _EMBINED GLE LIMIT
accident SIN5 1 000 000
ANY AUTO BODILY INJURY(Per person) $
ALL OWNEDSCHEDULED CNGCV /1/2015 /1/2016
AUTOS X AUTOS BODILY INJURY(Pet accident) S
.X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE S
IAUTOS Per accident
$
UMBRELLA LIAROCCUR EACH OCCURRENCE S
EXCESS UAB HCI-AIMS-MADE AGGREGATE S
DED RETENTIONS 5
C I WORKERS COMPENSATION WC STATU OTH-
AND EMPLOYERS'LIABILITY YIN X Mi ER
ANY PROPRIETORIPARTNrPJ XI=GUTIVEE.L.EACH ACCIDENT S 3.00 000
OFFICERWEMBER EXCLUDED? N N 1 A
(Mandatory in NH) E.L.DISEASE-EA FMPLOYEE S 100,000
tl yes,describe under 0003989723 9/23/2015 9/23/2016
DESCRIPTICN OF OPERATIONS bely E.L.DISEASE-POLICY LIMIT S 500 000
DESCRIPTION OF OPERATIONS I t,OCATIONS i VEHICLES (Attach ACORD t01,Additional Remarks Schedule,if more space is required)
ROOFING S SIDING INSTALLATION
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS.
BUILDING INSPECTOR
1600 OSGOOD STREET AUTHORIZED REPRESENTATIVE
NORTH ANDOVER, MA 01845
john Koegel/KH3 _ �y
ACORD 25(2010105) O 9988-2010 ACORD CORPORATION. All rights reserved.
INS025 mmnn.55n1 Tho Ar00n nam-anti Innn am rnnletarnrl mar€re of Amon
s
€
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CSSL-099358
Construction Supervisor Specialty
DAVID T CASTRIC ONE
31 COURT STREET 13-
NORTH
ANDOVER MA 01845
�= CA— Expiration:
Commissioner 1 211 612 0 4 7
���' �rrrr arrrrrr•rrr�/�r./r`��rr.Lur�rcir//;
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
Re istration:
104569 Type:
Expiration: 7114/2018 Private Corporation
DAVID CASTRICONE ROOFING,SIDING&
David Castricone
231 R SUTTON ST SUITE 3A _
NORTH ANDOVER, MA 01845 Undersecretary