The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 11/9/2016 ,A0 RTki BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received Permit No#: — e -gcwus�t Date issued: I - � i tO IMPORTANT: A plicant must complete all items on this page LOCATION 11ye r�f AL 0PROPERTY OWNER Print �O Print 140 Year Structure yes bno MAP PARCEL: ZONING DISTRICT: Historic District yes Machine Shop'Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 'One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial .sem Repair, replacement-- ElAssessory Bldg ❑ Others: ❑ Demolition ❑ Other II Flood Iain i]Wetlands ❑ 1111atershed Distract ❑Septic ❑1N�Il p, � , ' .� � � � � �- DESCRIPT[ON OF WORK TO BE PERFORMED: Ie S/L Identification- Please Type or Print Clearly r OWNER: Name: / 11,k,-La L Phone: Address: `" `. Contractor Name= Aaald % (04e Phone: Ali Email: ��✓cf � .�Q Address: Supervisor's Construction License: Exp. Date: /A Home Improvement License: 5/J_6 i' Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.,BULDING PERMIT,$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$1 5.00 PER S.F Total Project Cost: $ FEE: $ 11 Check No.: 3 5� Receipt No_: 3 i 15�` NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ................ T t%ORT#1 own of Andover 4 0 No. h ver, Mass, COCHIC"IWICK BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ....b*#%b... ..... ....... rt&......... BUILDING INSPECTOR has permission to erect................. buildings on ...... �.....PfAtoo.....4k, *40—FW... Foundation Rough to be occupied as ..........so &A ........ OROPAW.........r..Coo . .................. Chimney provided that the person accepting thi-f-e-r�li-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 CONSTRUCTION START Rough ................ Service Final BUILDING INSPECTOR GAS INSPECTOR Oeeupaney Permit Required to 0eeuj!E Building Rou'gh 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, FRES. CASTRICONE ROOFING & SIDING INC. ROOFING, :SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104559 231 R SUTTON STREET UNIT 3A, NO.ANDOVE=R, MA 01845 In North Andover 978-583-3420 In,Boxford 978.8875147 In Haverh111978-374-7374 Uwe 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 instal I,construct and place the huprovements according to the following specifications,terns and Owner's Name,........ ribcd: conditions,on premises below de'c d, 3 �../.. ��...,.. t„�.. `.k,�:,l�`7,--y................................ .......Tele Job Address......` ....1 d rz..t (t''�. . ...................City.... .fr�C2.:. 17LrG..C7..1 . ..�`........State..../ ..... f/ Specifications: .......................................................................................................................................................... . . ............................... }4,11)existing shingles(�� A_lril/11�4j/¢r'Jll��%�S�N t�tgas._ / � -- r ter' Ji V r; v. /%.'... �f G��..�................... r/Apply _feet I-L Ld�y,i'cl membrane to bottom edges,of house.3!'cel ill valleys and boltonl edges of cloy unhealed areas of house. ............... ................ ................ ............................................................................,( ..,..",.,.....,...�.s ,.,, .r ,......,..,....,.. .,.,....,. Apply f'rlpt );`k wi-underlaIrls l`tuent. (1.AI ridge t end to y �_ r, .....�...�.............. Rer'oof usiu r r H �/ ' ' _shut les with It s�, ) 6 , ,,y ess�r".�t r ty }, ? year ................................................................................................................................................................................. YLl'ountertlash chimney, VNICIv veal pipe jlashing, —t.egal disposal of lilt debris, .................................... .(�t..' .....".... Area(s)to be vaor•ked oil: } .......................................... . .......r ?..C?.�,..C. ':r. 5..... :' .. G�..L.�.5 ! e...................................... ...f•••r�4) ?.��n::'.�i"t1 .. �'.. .:r.?....�-�a.....5:. a.�Tc��,�....�',�L/Ll:.?�"��1.G" .... ............... ,..,..............,.. ..�...i..�-.kir:..,s � 1,�..t:..��.,;:..l�L�./.NC.L.1.....{.�R!�."�.G.�:..A�.-.....�.�5..�.I:�:1:.1:t.:i.i.7�... .Ci�„�..f.1.f..1�t ��.lr.'`.7!:P....C.tli!d.^...1.1.,♦��.4r1.�.• '.. ........................ �. .r...... ..,. -......................... Roof board rctrlrlce3it,cnt if t,cc cs„lir' ri, Jshcel ar w ltirtrf. c — } Five Year Workmanship Warranty(Not•Transferable) Manufacturer's Warranty as spcci red'by manufacture Theotfjraclor ago s ' �o perforun the work a ul tnrhh the materials specified above for the StJ of$..,�..�'. �a...,1........... 'PayabieL-1 ?......:. :.............. t ----'” Payabla...... .�...............on............ ..,............. balance payable on completion ofjob Owner or owners are not rosponsible liar Noperty Doruagc or Liability whi e�ob is in operaliun- '.. Contractor is not responsible,for any dans;a to the interior orprupcdy,inchtding pre-existing conditions(i.e.watur stains,crumbling plaster,exposed nails)or condilioas resulltmh from application of rn:;crixls specified above (i.e.objects coming loose from walls,crumbling plaster,exposed nails,dust in attic or alher living spaces). Items in attic may need to be coveiO by homeowner.All materials arc property of contractor. Any dumpsler placed by contractor is for his use only.Upon completion of nbovc work,all undersigned agree to execnle and deliver to contractor,theirjoint note in accordance with his(their)above obligation as requested by contractor. Upon nTusal 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,ifperrailted by law,Contractor Aail he paid by the ow•trer(s)all reasonable costs,atlomey fees and expenses,in addition to the amount due slid unpaid,that shall be incurred it enforcing the term arrr conditions of the contract and/or any lien in eomaectiou herewith.Property may be subject to mechanic's lien ifunpaid.It is further agreed th..t this contract nsay be::s:,sgned by contractor,and also that the obligations hereof shall bind and apply to their heirs,successors or estates ofthe padies,The undersigned warraot(s)that he ie(they are)site owners(s)or the above mentioned premises and thus legal title thereto stands of record in his(their) natnes(s).'there arc no representations,gvW sones or warranties,except such as may be herein incorporated,if any,nor any agreements collateral hereto,nor is the contraet dependent upon or gobjeci to any:oudioons not herein stated.Any subsequent ngreensent is reference hereto shall he binding only if in writing and signed by all panics. All Honte lmprovemtrnt Contractor3 shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be direbted to tWOffice of Consufuer 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 eonstruction- related permit or dents with unregistered contractors is excluded from the Guarwty Fund provisions of MGL c.142A. Approximate starting date(if work...1.!/!./.r................................. Completion date.....r.'.f�.L�..,....,..................,...,,.,...... 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 end the t ontents thereof understood and that no representation or agreement nut herein contained shall be binding upon the parties and that all of the ag€eenrients and understandings of said parties are contained herein. UO NOT SIGN THIS CONTRACT IN 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 hoofing&Siding Inc,2311 Sutton St.,No.Andover,NIA 01845. �rr��,jj /C IN WITNESS WHERTOF,the parties have hereunto signed their nlunes this..sf1�17 day of..L lC ?t:l'`.,20..I�c.. Aceepted: Owner } (� Signed............................................................................. Owner David Castricaae,President 9 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 0.2111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Appticant Information Please Print Legibly Name (Business/Organization/Individual):� DA q I D 0A s TKI( d NE ,goo F i NG 2 S t P Address: A 3 1 R S..Q T TO N Sq(Z EET O N IT 3 City/State/Zip: No, A b a u e MAS 1 �q� Phone #: `VA - 6% Are you an employer? Check the appropriate box: Type of project(required): 1. 4• ❑ I am a general contractor and I ,�I am a employer Yer with 6. F1 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 $, ❑ Demolition workers'h employees and w working for me in any capacity. 9. [-] Building addition [No workers' comp. insurance comp. insurance.l required.] 5. ❑ We are a corporation and its 10.Ll Electrical repairs or additions 3.F-1 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 12,%Roof repairs insurance required.] # c. 152, §1(4),and we have no employees. [No workers' 13.0 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. $Contractors 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: G U ti dr, ST 1 if_ I ri (�A N C_E Policy#or Self-ins. Lic.#: V 1/ r 3 Expiration Date: 'C�3 -c� Job Site Address: City/State/Zip: Y6 , A146yril 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. Si ature: bow- Date: Phone#: 9-7 q d D 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): ].Board of health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACaCERTIFICATE OF LIABILITY INSURANCE DA27/zol00lY 9/ 7/ 6 �--'" s 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 requiro an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER E:NAMSelect: Department Eastern Insurance Group LLC PHONE (800) 72-4538 81- 06-8244 233 West Central StADDRESS.selectwork Rea sterninsurance.coim INSURERS AFFORDING COVERAGE NAIC t Natick NA 01760 INSURER A:Western World Insurance Co INSURED INSURERB rXAPFRE Colmnerce Insurance 34754 David Castricone Roofing 5 Siding Inc, DBA: INSURER C:Granite State insurance Co. 231 Rear Sutton Street, Unit 3A INSURERD: INSURER E North Andover NA 01845 INSURER COVERAGE5 CERTIFICATE NUMBER:Master 16/17 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUER 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. tLTR TYPE OF INSURANCE ADOL SUBB POLICY NUMBER POLICYEFF POLICY EXP M IDDIYYYYL imm#DD#YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIA6fLITY PREMISES Ea occurrence I $ 50,000 A CLAIMS-MADE a]OCCUR raA GL 2016 9/6/2016 9/6/2017 MED EXP(Any oneperson) $ 1,000 PERSONAL 8 ADV INJJRY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPIOPAGG $ 2,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITYEa BINE t 8INGLE LIMIT 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BCNGCV /1/2016 AUTOS AUTOS /1/2017 BODILY INJURY{Per acclde11I $ X HIRED AUTOS X NON OWNED PROPERTY DAMAGE AUTOS Paracciden! $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ T EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION C WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY Y!N X T1hC,YLIMIT ITR ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100 000 OFFICERIMEMBER EXCLUDED? N❑ NIA (MandaloryInNH) RC003989723 /23/2016 9/23/2017 escribe under EL.DISEASE-EAEMPLOYE $ LOQ 000 If s.d DESCRIPTION OF OPERATIONS below-T IE.LDISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS?LOCATIONS#VEHICLES;Attach ACORD 1e1,Additional Remarks Schedule,Ir 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 OE NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS, BUILDING INSPECTOR 1600 OSGOOD STREET AUTHORIZED REPRESENTATIVE NORTH ANDOVER, M& 01845 John Koegel/MET ACORD 25(2010105) O 1988-2010 ACORD CORPORATION. All rights reserved. INS025 oo1oww Tho ACORn nAMA Arnrl Innn Am raniptArwi rnarkw of AC_nAn .i- ///!' f�C�IrgMN/r•rrrl/�r•�('/�rr,.;nl�ri.rr//, � office of CansnmerAtfairs&Business Regulation License or registration valid for individual use only =j fig HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 104569 Type: office of Consumer Affairs and Business Regulation i 10 Park Plaza-Suite 5170 �`J }} Expiration: 711412018 Private Corporation Boston„MA 02116 DAVID CASTRICONE ROOFING,SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undersecretary riot valid without signature Massachusetts Department of Public Safety vBoard of Building Regulations and Standards License: CSSL-099358 Construction Supervisor Specialty DAVID T CASTRICONE 31 coURT STREET NORTH ANDOVER MA 01845 i��/►�,,� Expiration: Commissioner 1211612017 i • E I fi fi