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Home My WebLink AboutBuilding Permit # 10/19/2016 1 NORT14 BUILDING PERMITpF'7,- i��yO '•.;6 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION l a ' Permit No#: � Date Received 0 --- ----JL-6L- � ��sSgcHuse�{5 Date Issued: �`�_` { @ IMPO TANT:Applicant must complete all items on this page LOCATIONint SGL� r _ PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL:_ ZONING DISTRICT:—Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Non_ Residential Residential ❑ New Building One family [I Addition t]Two or more family L1Industrial [IAlteration No. of units: ❑ Commercial Repair, replacement- ❑Assessory Bldg ❑ Others: 0 Demolition ❑ Other " Watershed District ❑ SeptEcyl l Well ❑ Floadpla�ri ❑Wetlands ❑ � � G ,w� �^-�� `er-✓`�,sr� �� e g ?s'��,N,�r n•. -,�N.sF✓ ^n��' � ` r �� a,4 "� �� y�; � ��F ��`'"x `� �''. DINa#erlSewer� ��.< � ,.7 ., . <.: .. .., :�.� . . ...,, u. ,.,,. . .•.. DESCRIPTION OF WORK TO BE PERFORMED: C, J Identifica ' n- Please or Print Clearly 979 OWNER- Name: u � Phone: Address: Contractor Name: $�. '.� Phone: 3 ` Email: d"" , c Address; i � Supervisor's Construction License: -Exp. Date: Home Improvement License: 16L( �� Exp. Date: �' ARCHITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED cost BASED ON$�PER S.F. Total Project Cost: $ r] ,3 FEE: $ Check No.: �5 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund --- -- --- t%0RTFj own o Anctover 0 0 No. 6 1 C� ver, Mass, / 0 -4PAb C.444'..61 ATE 0 P BOARD OF HEALTH Food/Kitchen ERMI= T . T LI) Septic System THIS CERTIFIES THAT ............0.+....C41401119-1....(WA&A BUILDING INSPECTOR has permission to erect .......................... buildings on ..........It ..........2.6wo......40.71b............. Foundation Rough to be occupied as .......irp .............A.P....4.0.6p............................................... 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO T RTIW ff Rough Service .............I . ..... of "maw".Basso ......... Final BUILDING INSPECTOR GAS INSPECTOR Oceypgynical Permit 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 HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 231 R SUTTON STREET UNIT 3A, NO.ANDOVE=R, 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 youascontractor,to furnish all necessary materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,tetras and conditions,on premises below described: / Owner's Name.....l..kt. .9 1' , ?�L 11��R.1..Y1 r...............................T phone Job Addross........1.. .. .... .Y! .....�R�........................City...1..Y.C7... N. ..Q..ti!.Je .............State.... ...... Specifications: ........ ......... ........... . ......... .................................................................................................................................................................... J/ +trip ex..isting..sltingles,.... �pply new drip edge to all edges. Wi�'rr�S ✓Arpply_ feet 9J tnernbraite to bottom edges of house.3 feet in valleys and bottom edges of any unheated areas of house. ................................................................................................................................................................................................... s,Apply bkt ape-underlayment. ............................ �I2eroof usin shingles-111,;h a_ .,yearwarranty. ....................................�. .................................�..y. � ........................................................................................................................ Counterflash chimney. irfQew vent pipe flashing. T egal disposal of all debris. .............. ....................... . Area(s)to be worked on; .. ..,. .. ......L.GL.L...J .....J fr1, .. �. ........... ................ ...... �....,(........ Ll.LL.... It ..( Rr/.G ? f Li..............................................,.....,........................ . � Roof board replacement if necessary /sheet or /foot. Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as sp tfied by tna ufsct rer The c ctor a¢¢�, es t perf run the work an O, e materials specified above for the S M of$.... 'lr S..Q.......,.... ayable..o'x..WT ....on...4_J.o,1�............ Payable.........4...................on............-._._........Oalance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability while job is in operation. Contractor is not responsible for any damage to the interior of property,including preexisting conditions(i.e.water stains,crumbling pinstcr,exposed nails)or conditions resulling from application ofmaterials specified above(i.c.objects coming loose from walls,crumbling plaster,exposed nails,dust in attic or other living Spam), Items in attic may need to be covered by homeowner.All materials arc property of contractor. Any dumpsler placed by contractor is for his use only.Upon completion ofabove 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 late,contractor shall be paid by the owner(s)all reasonable costs,attorney fees and expenses,in addition to the amount due and unpaid,that shalt be incurred in enforcing the terms and conditions of the contract andlor 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,successors or estates of the parties.The undersigned warrant(s)that he is(they are)the owners(s)of the above mentioned premises and that legal title thereto stands of record in his(their) names(s).There arc on raprcsenmdons,guaranties or warranties,except such as may he 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 of MGL c.142A. Approximate starting date of work................................................ Completion date...................,..................................... Receipt of a copy ofthis contact is hereby 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 panics 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 ofthe below-referenced date.Mail or deliver a signed and dated notice or send a telegram to Castricone Roofing&Siding Inc,23 Sutton St.,No.Andover,MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their names this..1i day of.0. k e-r, Accepted: Owner ... . .... f Signed............................................................................. Owner - David Castricone,President /� The Commonwealth of Massachusetts ra Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, AM 02.111 kv www,mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrieians/Plumbers Applicant Information Please Print Le 'bl Name (Business/Organization/Individual): V_Al .Tl2 i( 6 Nc- R o o F i lq G r .S 1 4 f N G,JL`LL_ Address: A 3 ' R S Q T S"o N S-�2 EE T U N IT- 3/A -- City/State/Zip: A o. m b t u e MA Q1H� Phone k I V A - (o 3 3q) () Are you an employer? Check the appropriate box: Type of project(required): 1 �I am a employer with �- 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL t oof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other 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 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. U 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 joh site information. C Insurance Company Name: I S 14 It tt�S'J (tA N C Policy# or Self-ins. Lic.#E: U V U O 3 6i z ,-,A-� ) 2 Expiration Date: 9 -c�3 -do 1 ll" r f Job Site Address: q z n d Al City/State/Zip:�c) . \&�y! t 111 7 f Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under -n-dd er�thepains and penalties of perjury that the information provided above is true and correct. Signature: r J ..J C7-, �� Date: n Phone#: 9-7 3 3 g d v Official use only. Do not write in this area, to be completed by city or town officiat 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 9AT'27/2i071YY6 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 cerliflcate holder in Ileu of such endorsement(s). PRODUCER CONTNAME:CT Select Department Eastern Insurance Group LLC PHONE14, D (800}572-4538 AJCNo;781-586-8244 233 West Central StAnngrss.selectwork@easterninsurance.com INSURERIS)AFFORDING COVERAGE NAIC 0 Natick MA 01760 INSURERA:Western World Insurance Co INSURED €NSURERB-XUFRE CCn=erce Insurance 34754 David Castricone Roofing & Siding Inc, DBA: -INSURER C:Granite State Insurance Co, 231 Rear Sutton Street, unit 3A INSURER D: INSURER E North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER:Master 16/17 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, INSR AOLYL SLABR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIODIYYYY MMIDDIYYY LIMITS GENERAL LU1BtLJTY EACH OCCURRENCE $ 1,000,000 X COMMERCIAi GENERAL L146#CITY DAMAGE 7" ENTED PREM€SES a occurrence $ 50,000 A CLAMS-MADE aX OCCUR raA GL 2016 9/6/2016 9/6/2017 MED EXP(Any one person $ 1,000 PERSONAL a ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- LOC AUTOMOBILE LIABILITY COMEINrD 77— Ea accident L 1,000,000 B ANY AUTO BODILY INJURY IPer person] $ ALL AUTOS XSCHEAUTOS LED CNGCV /1/2016 /1/2017 BODILY INJURY(Per accident) $ X HIREDAUI-OS X NON-O1M1!•JED PROPERTY DAMAGE $ AUTOS Aar acridenl UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION_$. C WORKERS COMPENSATION X Vrt;STATU- OTH- ANp EMPLOYERS'LIABILITY YIN ER ANY PROPRIETORIPARTNERIEXECURVE E.L.EACH ACCIDEIJT $ 100 000 OFRCERIMEMBER EXCLUDED' NIA (MandeloryinNH] M003989723 - /23/2016 9/23/2017 E.L,DISEASE-EA EMPLOYE $ 100,000 Mdescnbe under RIPTION OF OPERATIONS below E L DISEASE•POLICY LIWT $ 5'500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Addlllonal Remarks Schedule,If more space Ic roqulred) 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/MET - ACORD 25(2010105) O 1988-2010 ACORD CORPORATION. All rights reserved. INS02512os w.w Tho CI^nPr)namn nnrt Innn ora ranicfnrarl marks of ArORD ��a it Cr/r Nrr vrrr•t•rl��r//r'��n,:rrt�rnl•��. Ottice of Consumer Affairs&Qusiness Regulation License or registration valid for individual use only --r fti=HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: 0M0,, T Office of Consumer Affairs and Business Regulation Registration, 104589 Type: 10 Park Plaza-Suite 5170 %i 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 of Public Safety Board of Building Regulations and Standards License: CSSL-089358 Construction Supervisor Specialty DAVID T CASTRICONE 31 COURT STREET 13 NORTH ANDOVER MA 01845 Expiration: Commissioner 12/1612017