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Home My WebLink AboutBuilding Permit # 9/27/2016 FORTH BUILDING PERMIT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION lJ0 °paATE Date Received Permit No#: 3,�-e) -,,)ol'7 �O & AC 0 Date Issued: 9�'? -- �) c 17 IMPOWf ANT:Applicant must complete all items on this paw____ LOCATION P(_6 k Print PROPERTY OWNER 70 i I- (7,4L Print 100 Year Structure yes no MAP PARCEL: O C7 ZONING DISTRICT:,,---Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE ............... Residential Non- Residential [I New Building 144�One family 11 Addition [I Two or more family [-J Industrial E Alteration No. of units: Ei Commercial__ ,Repair, replacement n Assessory Bldg L Others: Cl Demolition o Other 7 Watershed ric Wetlands/',,/, gq -'s DESCRIPTION OF WORK TO BE PERFORMED: k A t Identificatiori- Please Type or Print Clearly Phone: _5 OWNER: Name: i-�K t e Z rZ 0-5 7 9 2C S I Address: Contractor Name: Phone: Email: —A (LQ LLC4, zv Address: 7 3 /A 10 0V L4n I /-k 6 Supervisor's Construction License: Exr). Date: 1,_J. I LomeImprol� Exp. Date: 1 Home 4. 1 'J — ARCH ITECT/ENGINEER Phone: Address: —I 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: ) � FEE: $ Check No.: 3 5_3 (,7 Receipt No.: t rantyfund NOTE: Person contracting with unregistered contractors do not have access ro the b ua Si -9 r-11111111117-4111 AM Vt R Til mi-Idover Town ot 0 No. 11L ver Mass, — a 0 BOARD OF HEALTH Food/Kitchen r- ERM IT LD Septic System THIS CERTIFIES THAT "..... Aem.40law...........zoo 1 !. BUILDING INSPECTOR ................. ........................ has permission to erect .......................... buildings on ... ......" .{ + .....,. .. . ... Foundation > Ir Ro � r Rough tobe occupied as ................... . .......... ........................ ......... ............................................... chimney provided that the person accepting this 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR., UNLESS CONSTRUCTION STARTS Rough Service &P;.............. ... ..................... ..................................... BUILDING INSPECTOR Final GAS INSPECTOR Qccupancv Permit REquired to Occupy B Rough Display a Conspicuous Place on the Premises — Do Not Remove Final No Lathing ®r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and ApprovedBuilding s eet ra Burner Street No. Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents a I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia NVorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. ApWicant Information Please Print Le ibl Name (Business/Organization/Individual): _t`.AV JS) C—All IQ CIS HE kou f I N G. i t6L Address: -A 61 (Z �-,y Tm ty u T �J(m t 6A City/State/Zip: go• A N bo d tE� ILIA o 1 �4 s Phone#J79 -693.3 Yd-O AZa, an employer?Check the appropriate box: Type of project(required): m a employerwith employees(full and/or part-time).* 7. ❑New construction m a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself,[No workers'comp.insurance required.]t IO 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.M 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 l 3. oof repairs 6.❑we are a corporation and its officers have exercised their right of exemption per MGL C. 14.❑Other €52,§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'cotnpensalion 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. IContractors 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 RA N I T-C JT^-T ty I ISE Sy gyAN C G Policy#or Self-ins.Lie. #: Expiration Date: Job Site Address: 7 AVS A I-T City/State/Zip: 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 andpe�. n__aJJlties of perjury that the information provided above is true and correct. Signature: .�J CO "`"" Date: Phone#: 9 2 L S 3 -3 q 0,0 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#: DAVID CASTRICONE, FRES. CASTRICONE ROOFING & SIDING INC. ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 231R SUTTON STREET UNI 3-3A, NO.ANDOVER, MA 01845 In North Andover 978-683-3420 In Boxforaf 978-887-6147 1n Haverhill978-374-7314 ]/we the owner(s)of the premises mentioned below,hereby contract Willi and authorize you ac contractor,to fai-nish all necessary waterials,labor and workmanship,to install,vonso-W and place the improvements according to the following specifications,terms and conditions,on prepiisu below described: .:................................ N. ::�l.f•-1..... � 1.�L.,.. Job Aildress.. ..to'...1.... .............City... ..1.1. 'X.E:..!•t�.i��`:..............State.-MA...... Specifications: ...................................................................................................................................... ' r f Strip existing shinglcsi4 `'(Imply new drip edge(0 ill edges. ys/jL f(; i z/A t tl1'_ feet7I'll ntbr;omc to boftont cdges of huusc. t feet in vulleys and bottoni edges of ait} anhcatetl:wens ofliouse. ............................................................ ..kpply li palt4`r uuderlttylnenl ''10A:L11 ridge Neat to ` \t shin�lcs ssith a ) to u•n•arruttt -Rernut trtiing � ��:tr�v 1, •. .fir __.� � y l ..................................................................................�.........;............. ............,j 1I.. ¢:otottcrtlash cltinttti 3Ve»'vent pipe flushing. '-Cegal disposal of ali debris. �:6 f pr.....��Q.Y.� ........................................................x ..E............. r,]1'C:I{5)(ll t1l'1YOE'ISC[I pn; i- y�. ��...... ..s.11l.l.lx .). . . .....��........ z.�t. tr .•............................................................... _.....`. . .l-l'.n�..l........ .x.....1.5....f 11.c ..t ,. ... ..........�.. ...................................... .............:�...`.>..�tf.f::,t��..�..,...:!.l. aa�!C1C.>.i.....1..�....1,k•��'.r...zt,.,r1.,..1.'lari....CJ.S��x...:.,{:.s:i:�.Ur................., ....,.,...,..... } .�.YY.Gi.)l.0 ..,::...�> .�t...c ,111'Z r 4�. p....._ .a:1.S.1. �. t`.r I.G f It......t'c i �.��...Li. ii{tul;l)trll.r(.i.c Ela�c.((icut tl'ucccs.al;r„t{!l ! Ishecl nr .................... Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty ass ted by.manufacture The c nl<actor agrges to perform the work and firm• It the materials specified above for tltc M of$.W.TY0...•.•••..• h11, ayable...:1,.��, .............. Payable.............................on................................. Q Balance payable on compteuon of�o€t Owner or Owners are not responsible for Property Dam �age or Liability w Icis in operation. Contractor is not responsible for airy damage to the interior of propurty,including pre-existing conditions(i.e.water stains,crumbling plaster,exposed nails)or conditions resulting Frons applicalion of materials specified above (i.e.objects coming Inose from Wal Is,crumbling ptaster•exposed nails,dust in attic or other living spaces). Items iii auie may need to be cmcied by homeowner.All materials are property of contraclor• Any dumpsicr plueed by contractor is for his use only.Upon contplenrro of.ahove wort:,ail undersigned agree to execute mid deliver to contractor,their joint note in accordance with his(their)above obligation as tequested by contractor. upon recusal to do so,contraclor may at its oplion declare the entire contract pace or so much its then remains unpaid,immediately due and payable. It is agreed thal,if petmittcd by law,conuactur shall be paid by the owner(s)all reasonable costs,attorney fees and expenses,in addition 10 the amount due and unpaid,that shall be incurred in cnforcing the Ienns and conditiuns of the contract and/or uny lien in connection herewilh.Ptolway may be subject to mechanic's lien iruupaid.It is further agreed that this contract may he assigned by contractor,and also that the ubligalioei hereof shall hind and apply to their heirs,successors or estates of the parties.I'he undersigned warrant(s).[hot tic is(they are)the owners(s)of the above nrentinned premises and that legal title thereto stands ofrecord in his(their) narnes(s),Them are,neo rcpresenlations,guarunties 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 slated.Any subsequent agreement in reference hereto shalt he binding only il'in writing and signed by all patties. All Home Intprovetn(;nt Contractors shall be regislered and any inquiries about a contractor or subcontractor relating to a registration should be diret;ted to thB-Offce of Consumer Affairs and Business Regulations,Tel.(6 17)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 Mot unregistered contractors is excluded from the Guaranty Fund provisions of MGL c. I42A. Approx imatc staging date of work..............................-..........,.,... Completion date......................................................... Receipt of a copy of this contact is hereby acknowledged,and it is further acknowledged by the undersigned that(fie foregoing provisions have been read and the contents thereof understood and that no repress.nation or agrceincilt not herein contained shall be binding upon die patties and that all of the agreements and understandings of said parties are contained herein. DO NOT SIGN THIS CONTRACT•IE THERE ARE ANY BLANK SPACES This contract stay 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 Caslricone Rvolinb&Siding Inc,231 R Nttlon St.,No.�m ver,i%jA 01845. IN Wl'rNrSS W11ERE01,,the parties have hereunto signed their names this day of.-S.,' p,....,20.. • Accepted: — X-,Sigued... ... r.... Owner Signed............................................................................. Owner David Castricone,President A CERTIFICATE OF LIABILITY INSURANCE DATE{MM100lY 9/26/20155 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 INSURERS}, AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poticy(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 endorsements). PRODUCER NAMTEACT Select: Dept. Eastern Insurance Group LLC PHorie (800)333-7234 x66807 FAx Na:(7811586-8244 233 West Central St E-MAIL ADDRESS:selectwork@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER A:Western World Insurance Co INSURED INSURER B.COMMerCe Insurance Company 4754 David Castricone Rooting & Siding Inc. INSURER C.Granite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURERD: 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 BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDMG 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. MSR TYPE OF INSURANCE A L SURR POLICY EFF POLICY EXP LIMITS LFR POLICY NUMBER MMIDDIYYYY MMIOD(YYYY GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 �II MERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Eaaccurrence S 501000 A CLAIMS-MADE W OCCUR t4PP1404373 9/6/2015 9/6/2016 MED EXP(Any one person) S 1,000 PERSONAL 8 ADV INJURY _$ 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'!.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X POLICY PRO-JECT LOC $ AUTOMOBILE LIABILITY EOa ILII dept SINGLE LIMIT $ 1 000,000 BANY AUTO BODILY INJURY(Per person) S ALL OWNED rx SCHECULED CNGCV /l/2015 /1/2016 BODILYINJURY(Peraccident) $ AUTOS AUTOS X HIREDAUTOS NON-OWNED PROPERTYDAMAGE S AUTOS Per accident S UMBRELLA L1AB OCCUR EACH OCCURRENCE S EXCESS LFAB CLAIMS-MADE AGGREGATE 3 I OED RETENTIONS S G WORKERS COMPENSATIONX WC 5TATU- OTH- AND EMPLOYERS'LIABILITY Y!N ANY PROPRIETORIP:,RTNE10EXECUTIVEE.L EACH ACCIDENT S 100,000 OFFICEWMEMBER EXCLUDED O NIA ----- €Mandatory in NH) E,L.D18EASE-EA EMPLOYE S 100 000 oyes,describe under 0003989723 9/23/2015 9/23/2016 DESCRIPTION OF OPERATIONS below E.L-DISEASE-POLICY LIMST 5 500,000 DESCRIPTION OF OPERATIONS I LOCA71ONS/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 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(2010105) O 1988.2090 ACORD CORPORATION. All rights reserved. €NS026 r7mnn'u nt Thn A(..nPn nam^nnr4 I^r m er^r^nicf^r^ri marke of Ar:rli7r) I i /�t cNurrrrr rrr�/!r c,/�M";trrr/rr.srl/. License or registration valid for individual use only Office of Consumer Affairs&Bus1l�ess Regulation before the expiration date. If found return to: 141, N?HOME IMPROVEMENT CONTRACTOR e. Office of Consumer Affairs.and Business Regulation } Registration:. 104569 Yp• 10 Park Plaza-Suite 5170 Expiration: 7/14/2018 Private Corporation Boston,MA 02116 DAVID CASTRICONE ROOFING,SIDING& David Castricone 231 R SUTTON ST SUITE 3A — NORTH ANDOVER,MA 01845 Undersecretary Not valid without signature ' Massachusetts Department f Public Standards Board of Building Reg License: CSSL-099358 Construction Supervisor Specialty DAVIT}T CASTRICONE 31 COURT STREET NORTH ANDOVER MA 61845 Expiration: Commissioner 12116/2017 I 3