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HomeMy WebLinkAboutBuilding Permit # 10/19/2016 BUILDING PERMIT OFttLEo '�w�ti0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION " Permit No#-, � If� �� � � Date Received 10 i !�4 `ti4� ArED RSSpCHus�`� Date Issued: Q IMPORTANT: Applicant must complete all items on this page LOCATION I t o C 7t PROPERTY OWNER C_ A(a 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 NZOne family Li Addition ❑ Two or more family Li Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑5eptic� �Welf �Floodpla�rt ©Wetlands f <�'1l�fatershed DEstrict, ' ' .,,'❑�at�r/�BWir?C ,_ ..-., .,- ✓,,.,.... ,:., c..,...� ,,. .r <<.,rn.. . .. .. -r^;...".'.r, r, ,x :r"' 2. DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly 7 OWNER: Name: � ra Ke_ c ars Phone: ' ` Address: -be,a q- k+k\\ ��- ��'NA&,i cv, PA Contractor Name-.1- 0_a!swq 30 c k,'APhone: ° Email: Lt r Address: � ccI� �A Cil 11' Supervisor's Construction License: 9 93 Exp. Date: t - 16 -6 Home Improvement License: 04 pct Exp. Date: v1 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. Total Project Cost: $ � C FEE: $ (0 G Check No.: 3 5-7 Receipt No.: 31 o 4:, NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund .. , = ------------ Min ORT#t own of Andover 0 J_. 7n No. 4 C r Mass, # 0 % C mc�twxK ve Agwllft� U BOARD OF HEALTH P 1111111111MOL Food/Kitchen ERM T T %j L W� Septic System I '# THIS CERTIFIES'THAT „ BUILDING INSPECTOR.......b.0......CASTY!1...(a. ........4t has permission to erect .......................... buildings on ...... Foundation Rough to be occupied as ........... !R. ........................................................ Chimney ST ............ 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 S 4ART4S .,,, Rough Service .... . .. .... ................ ... ..........BUILDING. . . .INSPECTOR.. Final GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be one FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. DAVID CASTRICONE, PRES. CASTRICONE ROOFING & SIDING INC. ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 231 R SUTTON STREET UNIT 3A, NO.ANDOVER, MA 01845 In North Andover 978-683-3420 Jn Boxford 978-887-&147 in Haverhill 978-374-7314 I/we the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to famish all necessary materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on prem• cs below described- 'Name �'Gske_L,��................. ale ono#i...Owner'sN ? ���:T.�st .t,...•.. / ' .(. i ex,�f �`.......... tate............. Job Address...,.... .....r �•'f...... ..r..................City:....1..{f"o,"he. S Specrffcalions: /trip existhtg sltingles. �pply new drip edge to all edges. 211 ................/,..,......,....,..: ,............. . .... ........................,.................... ....,....,......,...,............................................................................... V/ 4r Apply feet `t mem. brane to bottom edges of house.3 feet in valleys and bottom edges of any unheated areas of house. �� YYl t.Wt� YtrC✓ OW�OrfY1 /" . .. . ..................................................................................................................................."".................... ✓'Apply Fi llapet underlayr............n..eiit...... Install ridge vent to Reroof usin shingles with a._.,, _year warranty. -- ................................... .... ..,.......................,............................ .-.........,............ ............................. ............ ..... r�otutterflash chimney, l�ety vent pipe fiashhtg, Legal disposal of all debris. .. ................................................c, ..............----...-...... ...-... .....,.;............................................................................................ Area(s)to be worked on: h + ...f�.G7.b. .......Cit../.-. 'Gl�e....9; ..... �........... ` ................ . .�?.�Cv G fir, 1.G...... ..�.L:t�'fI/Y. ?..££3. 1.. /cl .t5 ll.'0, .............­­.................I——.............................. ..........1.111...... 1-11111.....11 ........................... ........... .............­....................­­......................................... .......-..."..'..".1.11.11.......­­.................. .................-11.......I........ Roof board replacement if necessarX @ /sheet of. -./foot. 1. ........ Live,Year Workmanship Warrauty(Not Transferable) Manufacturer's Warranty as s ted by manufacturer ' The 1ctor Ogr es to erform the work a d is the materials specified above for the !`��J•. ayable...; use..,....on..:S. ia�.L........... Payable.............................on..-...............,ia. j........ alance-payable on completion of job Owner or Owners arc not responsible for Property Damage or Liability whiz is in operation. Contractor is not responsible for any damage to the interior of property,including praexisling conditions(i.e.water stains,crumbling plaster,expos conditions resulting from application of materials specified above (i.e.objects coming loose from walls,crumbling plaster,exposed nails,dust in attic or other living spaces). Items in attic may need to be covered by homeowner.All materials are property of contractor. Any dumpstcr 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 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 tents and conditions of the contract and/or any lien in connection herewith.property may he 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(they are)the owners(s)of the above mentioned premises and that legal title thereto stands of record in his(their) nerrtes(s),There arc 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 patties. 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 Find provisions of MGL c. 142A. Approximate starting date of work................................................ Completion date......................................................... 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 CON'T'RACT 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,2314 Sutton St.,No.Andover,MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their aures this../.�........day of.6d"A t..."20..,1..4er. Accepted: I /� Signed/ . . . .., GGG Owner t Signed.............................................................. Owner David Castricone,President ��� f The Commonwealth of Massachusetts Department of Industrial Accidents 129 Office of Investigations 600 Washington Street Boston, MA 0.2111 UIV www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AvyUcant Information Please Print Legibly Name (Business/Organization/individual): DMID UVsIPM6NEr S 1 P t N(r JM- Address: ;1.� S R -_S J T TO N S-12 GE'T V M V 3 A City/State/Zip: o 1� mb o v� 1vlA S ` 5 Phone #: 1'\ 3 3q J Are you an employer?Check the appropriate box: Type of prosect(required): 1. I 4. ❑ I am a general contractor and I ,� am a employer P Yer with b. E] 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 subcontractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp.insurance comp. insurance.t 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 I l.❑ Plumbing repairs or additions right of exemption per MGL myself. [No workers' comp. 1�Roof 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 trust 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 am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: 1 ' S i,1 tiJJ (4A N C_C Policy# or Self-ins. Lie.M V V Q Ci SC1 3 Expiration Date: 9 -c�3 -02 L , rl Job Site Address: _Bea c City/State/Zip: qu 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: � Date: U t Phone#: R j� (A3 3qJ0 Official use only. Do not write in this area, to be completed by city or town official City or Town: Per•mitlLicense# 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#: f3iG[>R0� CERTIFICATE OF LIABILITY INSURANCE DATE{MMl00lY 9/27/2016 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 pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the farms 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 NAME: Select Department Eastern Insurance Group LLC PHONE ( 800)p572-9538 Al No:751-566-6249 233 West Central St .selectwork@easterninsurance.com ADDRE INSURERS AFFORDING COVERAGE NAIC f Natick MA 01760 INSURERA-,Western World Insurance Co INSURED INSURERS-NAPFRE CCnCiL7erce Insurance 34754 '.. David Castricone Roofing & Siding Inc, DBA: INSURERC;Granite State Insurance Co. 231. Rear Sutton Street, Unit 3A INSURER INSURER E North Andover IxA 01845 INSURERF: 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 VMICH THIS CERTIHCATS 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 TYPE OF INSURANCE A DL SUBIR POLICY EFF POLICY 6XP LTR POLICY NUMBER MMIDDIYYYY MMIDDIYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE 10 OCCUR raA GL 2016 /6/2016 9/6/2017 MED EXP(Any ane arson $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE L#MIT APPLIES PER PRODUCTS-COMPIOP AGG $ 2,000,000 X1 POLICY 11 P110 0Loc AUTOMOBILE LIABILITY COMBlRr5 Ea accident) 1,000,000 B ANY AUTO 130D1LY€IJJURY{Par person)ALL $ AUTOS SCHEDULED CNGCV /1/2016 /1/2017 BODILY INJURY(Per accident) $ HIRED AUTOS X NON-OVMED PROPERTY DAMAGE AUTOS Peraccident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION C WORKERS COMPENSATION ' 'A4'S AND EMPLOYERS'LIABILITY YIN LAX 7 #.T q I R R ANY PROPRIETORIPARTNERIZ)(ECUTWE E,L.EACHACCIDENT $ 100 000 CFFICEWMEMBER EXCLUDEp? N!A (Mendalory In NH) 003989723 /23/2016 /23/2017 E L.DISEASE-EA EMPLOYE $ 100,000 IF yyeas,deswbe under flESCRIPTION OF OPERATIONS below F.DISEASE-POLICY 1-1MIT $ 500,000 DESCRIPTION OF OPERATIONS!LOCATIONS I 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/MET ACORD 25(2010105) a 1988-2010 ACORD CORPORATION. All rights reserved. INS025 f2fr10051,01 ThA❑r nRn names and Innn era rctnil;tnrrai marks of Ar()Rn } r'J/rC License or registration valid for individual use Only -= Office of Consumer Affairs&Suslne9s Regulation before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Registration, 104589 Type; Office of Consumer Affairs and Business Regulation r }+ 10 Park Plaza-Suite 51.70 Expiration: 7/14/2018 Private Corporation Boston,MA 02116 DAVID CASTRICONE ROOFING,SIDING& David Castricone f 231 R SUTTON ST SUITE 3A — NORTH ANDOVER,MA 01845 Undersecretary Not valid without signature Matsachusetts Department of Public Safety W. Board of Building Regulations and Standards License: CSSL-099358 Construction Supervisor Specialty DAVID T CASTRICONE 31 COURT STREET NORTH ANDOVER MA 01845 i��/►, CA, Expiration: Commissioner 12/1612017