The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 8/8/2016 NORTH BUILDING PERMIT -T V0 bA�o TOWN OF NORTH ANDOVER 32 APPLICATION FOR PLAN EXAMINATION 7° 16- Permit IVO#: Date Received �� q'TED SSRcliU Date Issued: 4Si1Mf—RTANT-: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER G.N Lo ( 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 -�=0ne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other lam` , ❑`IVetlarids C 1latershed bstrict� t�d,;-m /s,"� r��, s.,� r�✓,��-! v �' ,.^ i,��'� ✓„ ; �'^�l.';,�c �/mow, / '� '.,,,.,1 r� "r}�./,�'�, �^,� *r..,o .M�' .c ��,� '.',. ,�„�r."r°. DESCRIPTION OF WORK TO BE PERFORMED: L) Identification- Please Type or Print Clearly OWNER: Name: C� o Phone: Address: �� D / LA � L � Contractor Name CIS ]LL 1 blit _ r iA Phone. q-7 (,o 3-3 qC Email: ) ..-) U M Address: i R Y 7b C�,J�:/Ls� Supervisor's Construction License: q q j3 -b Exp. Date: I Home Improvement License: d y J (1:1"� Exp. Date: ARCHITECTIENGINEER 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: $ 20 ° FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund � ----------- ........................................... ................. T 14ORT11 own o n over 0 . 0% No. C, ver, Mass, Alwwa8 U BOARD OF HEALTH Food/Kitchen PERR Septic System Lj T LD 1 Wq 1 401, a* BUILDING INSPECTOR THIS CERTIFIES THAT ............. . .. .... ..................... has permission to erect *', 'S J Foundation .................. ....... buildings on .. A4.-k ... "Maw.......... ..... ... .......... Rough tobe occupied as .... ��................................................................... Chimney provided that the person acce linj is 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 UNLESS CONSP;W4�TION Rough Service ... ...... . . ..... BUILD V1 N"S"P"ER W Final GAS INSPECTOR Occupancy Permit Required t® Occupy By 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. 14-1 A71/4- CASTRICONE ROOFING & SIDING INC. ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104559 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 accordin the ollowing specifications,terms and conditions,on premises below describe Owner's Nante.. ,tr .. .... 1� .....4� 5ye ........Tefc,�� eC " t . -Job Address.....4. .. �1 ......City... V147 t..�.�V1 .. .I`..........State.... .... Specifications: A")S y e—, MSA-1- 0AJ'�� t ....................................................................... Strip existing shinglesCW� Apply new drip edge to all edges. i f e-411 .......................�....._.......... ,...................................,.,.....,...,.....................1. .................... .................,�-�......,.............,,......,.. VApply___6_feet membrane to bottom edges of)rouse.3 feet , f in valleys anuh d bottom edges of any oil eat areas of house. ,r��r �t �� A,y�fy-441 Irl .................................................................................................z,.........,..,...............,........,..,..-..,...... ......................,......... . fir ti�pply��pap�t-underlayment. Inst l ridge vent#o ^� I.e.,t r.. ............................................t...... ...................,.. t/�terotff'usin shingles with a�_yenr warrnnty. punter dash chimney. VNew vent pipe flashing, eget disposal of all debris. ( e-/L5 Areas)to be worked on 3.;....�1......... .............................................. .. . ........ .. .. 49 l....1. ....1..y.Ir..,S > . . .' : .. ...........Q ....�t .....�r . t ��. . . .r........ ..Jaw Roof board replacement if ltecessary,n............../sheet ot.., i 4.o.4:...............,....................................... .:.......,..... ... Five year Workmanship Warranty(Not Transferab)e) Manufacturer's Warranty as speci y manufa rer The ctor afiregs to perform the work n is ffie trtaerials specified above for the SU of .„4:' ayable...� (, .Q.Q...on... yt„�tykl�� /oyr✓�nce payable on completion of job Ow r Owners arc not responsible farFroperty Damage or L ability while job is in operation. Contractor is not responsible for any damage to[hc interiorof property,including preexisting conditions(i.e.water stains,crumbling plaster,expos ma coadiiians resulting Som application ofmateriats specified above (i,b.objects coming loose from walls,crumbling plaster,exposed nails,dust in attic or other living spans), Items in to may need to be covered by homeowner.Alt materials are property ofcontraclar. Any dumpster placed by contractor is for his use only.Upon completion afAmve 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 shalt 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,su"murs or estates ofthe parties.The undersigned warrant(s)that he is(they are)the owners(s)of the above mentioned promises and that tegat 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 ofMdL t:,142A. Approximate starting date of work.............. ................�-`.......�..... Completion 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 R Sutton St.,rNo.Andover,MA 011845, I1+I WITNESS WHEREOF,the parties have hereunto signed their names this.. I.S�y Accepted: ffiigned.............. :........... ................. Owner kSigued....... ..... .. Owner � �.{. .. .. David Castricone,President r The Commonwealth of Massachusetts = Department of Industrial Accidents a s I Congress Street, Suite 100 d Boston, MA 02114-2017 r www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibi Name (Business/Organization/Individual): 'L L K I(O F ;� I D i '(_ Address:_ -A 2)) S u r-rz N Srt e T Q ry &A City/State/Zip: �J0• A ti Do\(6-i NA &i�4 s' Phone#:_9 7$ •6 93,3�d-O Are you an employer?Check the appropriate box: Type of project(required): 1. I am a sole proprietor or partnership and have no employees working,am a employer with _employees(full and/or part-time).* 7. [:]New construction ❑ g for me in $. E] Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3T1 am a homeowner doing all work myself.[No workers'comp.insurance required,]t ❑ [�4.❑I am homeowner and will be hiring contractors to conduct all work on my property. [will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.0 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-can€Tactors have employees and have workers'comp,insurance.t 1 15.Roof 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 9 1 must also 611 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 ant an employer that is providing workers'compensation insurance for my employees. Below is thepolicy andjob site information. _y ll�s Insurance Company Name: V [`ZH N k Te �T/� t� s/AN<_ Policy#or Self-ins. Lie.#: Expiration Date: Job Site Address: 93 S City/State/Zip: 90. lm.ho_11_u, of K, 7i' 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 andpenalties ofperjury that the information provided above is true and correct. Signature: ti �J �' ev Date: Phone#: �. `i<01u 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#: AC"R" CERTIFICATE OF LIABILITY INSURANCE DATEIMM1DDfY5 �--� 9/28/201 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 INSURERIS), 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 AME CT Select Dept, Eastern Insurance Group LLC PHONEIAJCNo {1300)333-7234 x56807 FAC NW ("1)566-8244 233 West Central St E-MAIL DDREDDRE SS:selectwork@easterni.nsurance.com A INSURER(S)AFFORDING COVERAGE NAIC 0 Natick MA 01760 INSURER Western World Insurance Co INSURED INSURERB:COMMerOe Insurance Company 4754 David Castricone Roofing & Siding Inc. INSURERC:Granite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER D; INSURER E North Andover MA 01843 INSURER F: COVERAGES CERTIFICATE NUMBER:CL159954794 REVISION NUMBER: THIS IS TO CERTIFY THAT THE E'OI ICIES 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 PERTA€N, 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBERMMIDDfYYYY MMIODNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE [i]OCCUR P1404373 9/6/2015 9/6/2016 MED EXP(Any one person) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE 1 $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X POLICY PRO- LOC I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 11000,000 BANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BCNGCV /1/2015 /1/2016 AUTOS AUTOS BODILY INJURY(Per accident) $ Ix HIRED AUTOS X NON-OWNED PROPERTY DAMAGE '.. AUTOS Per accident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ ' EXCESS LEAK CLAIMS-MADE AGGREGATE $ UED RETENTION$ $ C WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS`LIABILITY YIN X ANY PRORIPARTNERfEXCCUTNE CFFICERIMEMBEi41EMBER EJCCLUpED? NIA E.L.EACH ACCIDENT $ 100,000 (Mandatory In E.L.DISEASE-EA EMPLOYE $ 100 000 byes,dsscri under 0003989723 9/23/2015 9/23/2016 DESCRIPTIONNand OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,AdditionaF Remarks Schedule,it more space Is required) ROOFING & 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 -- ACORD 25(2010/05) O 1988-2014 ACORD CORPORATION. All rights reserved. INS025 C7nlnn51 n1 Tha ARflprl mama anri Innn nra rnnl0arorf marlre of ACr1Rr1 3 r i 0 Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099358 Construction Supervisor Specialty DAVID T CASTRIC ONE 31 COURT STREET NORTH ANDOVER MA 0S" Expiration; Commissioner 12,/16/2017 Office of Consumer affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR � Registration: 104569 Type: .% Expiration: 7114/2018 Private Corporation DAVID CASTRICONE ROOFING,SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undersecretary