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HomeMy WebLinkAboutBuilding Permit # 8/22/2016 BUILDING PERMITNora, Qx..[LEU TOWN OF NORTH ANDOVER _ APPLICATION FOR PLAN EXAMINATION T 4xi Rive M1 Permit No#: Date Received �yssgcus��.�y Date Issued: / ORTANT: Applicant must complete all items on this page LOCATION 1- �--4 Print PROPERTY OWNER Print 100 Year Structure yesCno MAP PARCEL: ZONING DISTRICT: Historic District yesMachine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ane family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No, of units: ❑ Commercial ,Repair, replacement- ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Se tic ❑Wel! ❑ Floodplain ❑Wetiands y` ` h�s. Wa#ershed Distract DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name:_ 2/-) LL, )Q L'i Phone: Address: , ,�- cdl Contractor Name:• 0Ct3 �?c L)�, 0 f ,/, Phone: ''1 ) )L-O Email C i f) ' f6 uh4 . CCS^-1 Address- ,,,.,2 �r l ha �. P� CJ! �„- Supervisor's Construction License: Exp. Date: / J G J Home Improvement License: Exp. Date: ..7 A/ ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S-F. 1 �� Total Project Cost: $ .,�7 `FEE: $ f Check No.: Receipt No.: NOTE: Persons contras ng with unregistered contractors do not have access to the guaranty fund t&QRTH '� own of ndover ® ca No, r--. h ver, Mass, t a 0 q� COCr�tt K[w�Cu yry. 7,95 RATED r4a�,c5 U BOARD OF HEALTH Food/Kitchen Septic System j4 THIS CERTIFIES THAT .....PERMI �o bA sit; BUILDING INSPECTOR ..... .............a..,...........................,...... ........has permission to erect .......................... huildl .. ,. ,. v�..�... . .......... Foundation buildings an .. .. ........ ... ..... Rough to be occupied a5 ......... ::! �,.... .. .. .. chimney provided that the person acceptingthis permit shall in eve respect conform to the terms o r t�applicatJawion p � p 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 IN 6 MONTHS ELECTRICAL INSPECTOR LESS C T TION Rough Service .. ...... .. . ........ ....... Final BUILDING I ECT GAS INSPECTOR Occupancy .Permit Required to Occupy Ruiidin 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, PRIES. CASTRICONE ROOFING & SIDING INC. ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS NOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 231R SUTTON STREET UNIT 3A, NO.ANDOVER,MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314 1/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 premises be described: 4IL.tJ..�(f..5......1.............,..�.../rT .�.... T(\�Je pho.ne fl... Owner Name. Job Address.. az� .. ...:�! e..... Cit3••{• Qr:.9...�.1.j.•.+....1... State.....' Specifrcaiions: e'x' ......................................... ......ne...... d..t.9..p... . e..d..g.e...t.o...all.... ....s.....................................................................................1111...................... trip eisting sltingles,�ly� rl�ip..lyw ed....ge �j j�fy�,/6.)r,. S /r 1,4pply _feet 9� membrane to bottom ed es of ltouse,3 feet in valleys and bottom edges of any unheated areas of house. ..........................................�. �... ....................................... .......,.................I'll...... rfApply feibpa Paper undellayment. ^Install ri ge vent to . . .............. .. ........................ .......... :. ........ .......1111. ....................................................................................... ✓lteroof sin Etingles year warranty. .............................................................................................................................................................................................................. VICounterflash chimney.vNew vent pipe flashing, fegal disposal of all debris. ,1 ...........................................................-. .................. ..... ......................................................................... .................................... Areas to be worked on-. n .......... f ,,.C�.,�:.. ....1.1,S.�.rC.E:F .....�.�l.rt.. '....Q.e�L...,... 1111.. r 1111. ...........� m►�...: ....J.,��........1. .. ... .............................................................................................. " .. .... ... . . .. io.....x. ...................... Roof•boa►;c]replaceme�it if necessarY..(a i,�j.(sheet or• °�lfoot.................................................... .............................. .......... . .Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as sp'ci y�it ur The ctor agr to perform the wofkat d�fu is the materials specified above for the SU f$1111 ......, ............. �f Payable .Q.Q..L?......,an. �./.'. ............... Payable.........'r..............on.1...11.1..,`".................. A alauce payable on completion of job Owner or Owners are not responsible for Property Damage or Liability whr is in operation. Contractor is not responsible for any damage to the interior of property,including preexisting conditions(i&water stains,crumbling piaster,exposed nails)or conditions resulting from application of materials specified above(i.e.objects coming loose from walls,crumbling piaster,exposed nails,dust in unit 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 work,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 lion 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((hey are)the owners(s)orthe above mentioned premises and that legal title thereto stands of record in his(their) re names(s).There ano representations,guaranties or warranties,except such as may be herein incorporated,if any,nor any agreements collateral hereto,not 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)473.8700. 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...............................111.1..................... 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. u 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 8c Siding Inc,231 Sutton St.,No.AE er, A 01845. IN WITNESS WHEREOF,the parties have hereunto signed their names this.,k&L,day of Accepted: ..1111. Owner Signed............................................................................. Owner .cam—�J..N .... ,. .. .. _ David Castricone,President 3I: / I li The Commonwealth of Massachusetts Department of.Industrial Accidents M 1 Congress Street, Suite 100 Boston,MA 02114-2017 y www mass.gov/dia N'Vorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Avolitant Information Please Print Le ibl Name (Business/Organizationllndividual); !' [` 11K l C.6 N C ka CLLI1 ' i M�- Address: -A b) iK Su -v-m,,t,3 cx t t� -7 T \.)1~%v 5A City/State/Zip: go. A N Dc;d l✓/C NA 61 ��!�` Phone#: q 7g • 6 B.3 Yd-O Are you an employer?Check the appropriate box: Type of project(required): am a employer with em&yces(full and/or part-time).* 7. ❑ New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in S. []Remodeling any capacity.[No workers'comp,insurance required.] 9. El Demolition 3711 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑ Building addition 4.❑l 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 I L❑Electrical repairs or additions proprietors with no employees, 12�lumbing repairs or additions 5.❑I 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 152,§1(4),and we have no employees,[No workers'comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing alt 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site information. � C1 Insurance Company Name: l2H N i "f-G JT^-T Policy#or Self-ins. Lic. #: j C-0 0 3 2 el 7A :)S Expiration Date: Job Site Address: > ( _ �li(�lCx SSS) CitylS � tate/Zip:h z"Ou �V 61 J Jr 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 underthee�pains and penalties of perjury that the information provided above is true and correct. Signature: {...J�/ . Date: Phone#: 3 __3 q du 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#: A CERTIFICATE OF LIABILITY INSURANCE 9ZBi2 D 5 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 endorsement(s). PRODUCER CONTACT Select Dept. Eastern Insurance Group LLC PHONE (800}333-7234 7[66807 F� o:S78])585-8244 233 West Central St -MAIL ADDRESS,se 1 ectwo rk@ eastern insurance.com INSURER(Si AFFOROFNG COVERAGE NAIL ft Natick MA 01750 INSURER AWestern World Insurance Co INSURED INSURERa;Commerce Insurance Company 4754 David Gastricone Roofing & Siding Inc. 1NSURERc:Granite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER D: INSURER E: North Andover MA 01845 1 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. NOTWfTHSTANO#NG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WH#CH 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 CLMMS. iNSR TypE OF INSURANCE L U R POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIYYYY11 (MMJ0D1YYYyI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 50,000 PREMISES Ea occurrenceS A CLAIMS-MADE ❑X OCCUR NPP1404373 9/6/2015 9/6/2016 MED EXP(Any one person) S 1,000 PERSONAL&ADV INJURY S 11000,000 GENERAL AGGREGATE i $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X POLICY JECI PRO LOC fi AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (F a accident 5 1,000_000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED rx SCHEDULED CNGCV /1/2015 /]./2016 BODILY INJURY(Per accident) S AUTOS AUTOS 'Y HIRED AUTOS NONI-OWNED PROPERTY DAMAGE S AUTOS Par accident 5 UMBRELLA LIAR OCCUR EACH OCCURRENCE 5 EXCESS LIAR HCLAIMS-MADE AGGREGATE 5 PED RETENTIONS 5 C `WORKERS COMPENSATIONWC STATU- DTH- !AND EMPLOYERS'LIABILITY Y i N XMTqJ ANY PROPRIETORIPARTNEPJLXrGUTIVE IN NIA E.L.EACH ACCIDENT 5 100 000 OFFlCERIMEMBER EXCLUDED? (Mandatory in NH) ET DISEASE-EA EMPLOYE S 100,000 If yes,describe under 0003989723 9/23/2035 9/23/2016 DESCRIPTION OF OPERATIONS belay E.L.DISEASE-POLICY LEMIT I S 500,000 DESCRIPTION OF OPERATIONS i LOCATIONS f VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if 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 'SOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING INSPEC'T'OR 1600 OSGOOD STREET AUTHORIZED REPRESENTATIVE NORTH ANDOVER, MA 01845 John Koegel/KH3 ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS026mmnnsln+ Thn j&rew 1 normo nnri Innn aro rwnieiorori mar4q of firman c� ez1�u.urr�recfe«lt/c�C l��r:reac/%crerlts License or registration valid for iudividut use only beforetl�e expiration date. If found return to: _ Office of Consumer Affairs&Business Regulation IlN{PROVEMENT CONTRACTOR Type Office of Consumer Affairs and Business Regulation ROMEregistration: 104569 10 Park Plaza-Suite 5170 xpiration. 211412016.:. Private Corporatic') Boston,MA 02116 DAVID CASTRICONE ROOFING S(bING& David Castricone = _a 231 R SUTTON 5T SUITE 3n g Not valid x�vitliout signature NORTH ANDOVER.MA 01845 Undersecretary 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 CA, Expiration: Commissioner12/1612017 i u u ga 9 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 (�-jZ7, CA— Expiration: Commissioner 12116/2017 _ Office of Consumer.affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration: 104569 Type: Expiration: 7/1412018 Private Corporation DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A _ NORTH ANDOVER, MA 01845 Undersecretary