The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 8/8/2016 NORr� BUILDING PERMIT oF��, TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION � o ° qq[o[nl[niwc `v Permit No#: Date Received �Ssac�+us�t�y Date Issued: 1 I PORTANT: Applicant must coimplete all items on this page LOCATION c )< ® Print PROPERTY OWNER C-1 ! Print 100 Year Structure yes no MAP PARCEL- ZONING DISTRICT: Historic District yes no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building X6ne family ❑Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ,Akepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �Se ttc ❑l�lUell z Nil 1,11-0-911 `zf �:�a :' s' sr h�f'.r'`�,� '..✓"�a 'z.,y�- �f``.� � '"� .��. c�,�..�v'v��r:,�i � Vatrlewe .. :°k, DESCRIPTION OF WORK TO BE PERFORMED: A Identificatio Please Type or Print Clearly OWNER: Name: 1 4hIc: � �5 ' Phone: v '016 Address: ,�_ Ou I 67)U � i � w. ff LA Contractor Name:_b,(2J-_u iii u3ne- Lntdi� Phone: q7Z LCL 3 JgJb Email da01 0 n,.(, c Address: ,z,- � t Supervisor's Construction License: Exp. Date: - 6 I"7 Home Improvement License: Q` �� Exp. Date: ARCH ITECTIENG[NEER 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. Total Project Cost: $ , liaw,, CSL:. FEE: $ T Check No.: Receipt No.: �� NOTE Persons contracting With unregistered contractors do not have access to the uarantyfund IA®RT� Town of �_ ndover 0 491 b �A�, h ver, Nlass, 461 Auyul 9- 261 LO[.aCNt w�cK 1' �iOO Pay s � BOARD OF HEALTH Food/Kitchen PER IT T LD Septic System THIS CERTIFIES THAT1.14-4- 1A .. .�.... Pte. .... Foundation BUILDING INSPECTOR . . . has permission to erect.......................... buildings on .... a,......... .. . ......... . . . Rough tobe Occupied as ....,. ....A�.. �. .......................................................................... chimney provided that the person acceptin�'tllis permit shall in ry respect conform to the terms of thea application pp 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®NSTRU TION T S Rough Service .... . ..... .. ......... ...... ........ Final BUILDINSFE TOR GAS INSPECTOR Occupancy 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 CASTRICONE ROOFING & SIDING INC. ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 26-SUTTON STREET,SUITE-4267NO,ANDOVER,MA 01845 In North Andover 978-683-3424 In Boxford 978-887-6147 In 11averhill 9 78-3 74-7314 I/wo the owner(s)of the premises mentioned below,hereby contract with acid 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 ilescribe& Owner's Name...� ......................................T t phone li...��.......�'L.:.Q.� Job Address.....1. ..... . f.7.-F.. :../`CJ.C.7/...1.,.... e�.,.......City..r!.1�.0.t..�.t."�-L�a'. �...............State.......... Specrylcaflons: .................................. YIAreas to be covered: fi ................................ .. f.� ..c l.d..r,<... .......... ...f...... �`ea..:.7....,.....E..�a"............,......'�+`...................-...................................... .. 6Apply vinyl siding and corners. 'Type: 7�9 .................................................... !1. ?.l�.0 ? lr�S'...�rpf"over fascia bnnrds and rake boards. ✓ilnstant vinyl soffit - solid / 7 ......................................w.in......s,............................ ..........,Yg..................a"n ....�......c"n't'...............y.....................,.................... . �Gover wood casings around windows. i.Re lace an able vents and d er vents with vin 1. :............................ .........�.................................. ......................................... ................................ . ✓4pply anderiayment. Type• .... ............................. .......... ..,......I..)!.V..:E,�.,1.....�..�.ir.1�`a.:......j1C.d:GI:/1....,�V��.S.c.6=i.��.� ................................. FEsisting siding stripped go-o er Vegal disposal of 11 debris. .............. ...... � ..... W ✓:J hotted woad replaced ta)� /sheet ours' r .2:7.71f`... r ...... {R y7 �`�. ...�L7e7,j`... ,Lk.hS.1'.'_..)�4 ? 1. l ........................... . ..Co.l .... 1Y.r. 1 One Year Workmanship Warranty('Not TratF�ierable) 1f�anufacturer�WarI my as spec' tl�iiufactttrer_ The tractor ag,9 s to perforin the work,�}�d�f�i,�'s�h,the materials specified above for the SU of S..,,/S.Y.F',Z?..�:..':., Paynbla `, on..:S.I.o..f:..l........ .... ry ..................on.......::. ':........,......... r� stance payable on completion ofJ !� Owner or Owners are not responsible for N operty Damage or Liability writ e- is in operation. Contractor is not responsible for any damage to the interior orproperty,including pr"xisling conditions(i.e.water stains,Crum g p as'Ier,exposed nails)or conditions resulting from application of materials specified above(i.e.ohjects Coming loose from walls,crumbling plaster,exposed nails,dust in attic or other living spaces).Upon completion of above wort:,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. II 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 duo and unpaid,that shall be incurred in enforcing the ferns and conditions of the contract andlof any lien in connection herewith.It is further agreed that this contract may be assigned by contractor,and also that dee obligations hereof shall bind and apply to their heirs,successors or ostatcs of the parties.The undersigned womint(s) that he is(they are)the owners(s)of the above mentioned premises and that tegaf title thereto stands of record in his(their)names(s).there arc no representations, guaranties or warranties,except such as may be herein incorporated,if any,nor tory agreements collateral hereto,nor Is the contract dependent upon or subject to any conditions not herein stated.Any subsequent agrecmeal in reference hereto shall be binding only if in writing and signed by all parties, , All Home Improvement Contraetors g�all be registered and any inquiries about a contractor or subcontractor relating to a registration should be dirpeted,to:Director,Home Improvement Comrac:or Registration, One Ashburton Place, Room 1301,Boston,MA 02108 Tel:617-727-8598 Any and all necessaryconstruction-related permits shall be obtained by the Contractor, Any Owner who secures his own construction- related permit or deals with unregistered co tr�eta is excluded from the Guaranty Fund�ovisilggs of MGL c. 142A. Approximate starting date of work./ !1N ?rt ��r Completion date lFfdXt l{z?[x,Slr,�„ Receipt of a copy of this contact is here ackVwledged,and it is further acknowledged by die undersigned that the foregobig/ 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 al l of the agreements and understandings of said parties are contained herein. DO NOT SIGN THUS CONTRACT IF THERE ARE ANY BLANK SPACES Owner has three business days to cancel this contract and incur no penalty (see notice f cancellation). IN WITNESS WHEREOF,the parties have hereunto signed their names this_. ... 1r day of....jlk-A-yl.........20..,i& Accepted: Signed.,..... .,......,..., Owner �} Signed............................................................................. Owner David Castricone,President�y�� The Commonwealth of Massachusetts Department of Industrial Accidents d I Congress Street, Suite 100 Y Boston,MA 02114-2017 �y www.mass.gov/dia NVorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMIT'T'ING AUTHORITY. Applicant Information Please Print Lealb Name (Business/Organization/Individual):� I17 _ C-I\ ( 1�'i(Z ME JZo Cy�i N C� � S 1 b t t.�L_ i Address: .A b) J� 5 v �L;r T Q(\�T 6A City/State/Zip: b• NN W d 64Q "A 61 5 Phone #: q 78 • G,93-3 Yd-L Are you an employer?Check the appropriate box: Type of project(required): I I am a employer with___�_employees(full and/or part-time).* 7. E]New construction 2,[:]1 am a sole proprietor or partnership and have no employees working for me in $. E] Remodeling any capacity.[No workers'camp,insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 E] 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. Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 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.t 6.[:]We are a corporation and its officers have exercised their right of exemption per MGL c. 14 Other ],�j �,�[ 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 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. tContractors 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 the policy and job site information. Insurance Company Name: IZH N i Policy#or Self-ins.Lic.#: \N1 CL}(5 .19 19 TR Expiration Date:.... Job Site Address: } [� k V hb� ��RA City/State/Zip: f` p, NA 61 s/ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGI.,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. Si nature: Dater_'_!1. Phone#: 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: ® DATE(MMIDDNYYY) AC"R" CERTIFICATE 4F LIABILITY INSURANCE 9/28/2015 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 poilcy(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 cOOMTACT Select Dept. Eastern Insurance Group LLC PHONE (800)333-7234 x66807 FpA/xC NW:(781)586-8244 233 West Central St EbmAIE :selectwork@easterninsurance.cam INSURER(S)AFFORDING COVERAGE NAIC q Natick MA 01760 INSURER A:Was tern World Insurance Co INSURED - INSURERBCommerce 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 01845 iNSURERF: COVERAGES CERTIFICATE NUMBER:CL159964794 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANOfNG 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. ILTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY YIYYYY MWDDtYYYY LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE X COMMERCIAL GENERAL LIABILITY PREMISES.acct"�nce S 50,000 A CLAIMS-MADE [K]OCCUR NPPI404373 9/6/2015 9/6/2016 MED EXP(Any one person) S 1,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE UWT APPLIES PER. PRODUCTS-CCMPIOP AGG S 2,000,000 X POLICY PRG- JECT El LOC 5 AUTOMOBILE LIABILITY EO BINEDE SINGLE LIMIT S 1 ODo Oop ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDrx SCHEDULED CNGCV /1/2015 /1/2016 BODILY INJURY(Per awdent) S AUTOS AUTOS X HIRED AUTOS NON-OWNED PROPERTY DAMAGE S AUTOS per accident $ UMBRELLA LiAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DEO RETENTIONS 5 C -WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PRCPRIETORIPARTNEWeXECUT:V6E-L-EACH ACCIDENT S 10(),000 OFFICER/MEkIBER EXCLUDED? � N I A (Mandatory in NH) E.L.DISEASE-FA EMPLOYE s 100,000 It yes,describe Under 0003989723 9/23/2015 9/23/2016 DESCRIPTICN OF OPERATIONS belvx E.L.DISEASE-POUCY LIMIT I S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,N 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, DSA 01845 John Koegel/KH3 �s -- ACORD 25(2010105) OO 1988.2010 ACORD CORPORATION. All rights reserved. INS025 oninnsi ni Tha hr-non nam-anti Innn aro raniafarari mance of hflr117f1 I Massachusetts Department of Public Safety ® Board of Building Regulations and Standards License: CSSL-099358 Construction Supervisor Specialty DAVID T CASTRICONE 31 COUNT STREET 13- NORTH ANDOVER MA DiW ° l""'7 l ,-- Expiration: Commissioner 1211612017 0:= Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR tom, 'i Registration: 108569 Type: Expiration: 7/94/2018 Private Corporation DAVID CASTRJCONE ROOFING, SIDING 8 David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01,946 undersecretary