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HomeMy WebLinkAboutBuilding Permit #347 - 1 LACY STREET 10/29/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �7 Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION f} lr Print PROPERTY OWNER N .- Print MAP NO: PARCEL:' t pS ZON NG DISTRICT Historic District yes no Machine Shap Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building vOne family Addition Two or more family Industrial Alteration No. of units: Commercial repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: mshl�) cl-( I rb�F pcei C)f- {jai,-p-, Identification Please Type or Print Clearly) 22 75 OWNER: Name: kGU/�! cNr�-N ey Phone: 9-)W (o b 1 Address: �R�Y Sir iorc�� A tiDdv�ti- MA- 0 1 Qy' CONTRACTOR Name: F IK6 S&I* Phone: 9-? 6 t3 3` IO Address: aTT'a S i / l c til Supervisor's Construction License: 9q357,6Exp.^Date: X—) b 2,10 11 r e Home Improvement License: 10\4 Exp. Date: k ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ i 3 .500 0 FEE: $ 2 bd Check No.: /J, 4/ Receipt No.: 0 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner_ Signature of contractor. Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT h COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature &Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp-Dumpster on site yes. no , Located at 124 Main Street tr � :Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21 A—F and G min.$100-$1000 fine i NOTES and DATA— For department use) ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Li Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New ConstructionSin le and Two Family) � 9 Y) ❑ Building Permit Application o Certified Proposed Plot Plan L3 Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008 Location No. ✓4"7 / Date �aRTM TOWN OF NORTH ANDOVER c��...o ,•1ti 9 + ; , Certificate of Occupancy $ �ssACMUsE<�' Building/Frame Permit Fee $ 16,12 oU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 3 2 2 5 6 / Building Inspector NORTiy TONM Of 0 0 No. --T 1 r", .3 o �` dower, Mass., C21,12 , 610 o — � ,�, COCHICHEMCK V ADRATE D `s BOARD OF HEALTH PE ..RMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THATC'G�f � " ................. ..... ............................ ...... ..................... ........................................................................... Foundation has permission to erect........................................ buildings on ......, .... .G.C..:. ....... ................................................... Rough cry / to be occupied as.............................c.,1. �'t` .r?a ... 1 rpt �,-�.. Chimney provided that-the person accepting this permit shall in every respect conform to therms of the application on file in Final 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 CONSTRUCTT0 ST TS Rough ....................................... ........ ............................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. DAVID CASTRICONE f� -1�� OCTNE ROOFING&SIDING INC. 1 9 2-009 GASTRIC• ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS BY:....................... HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 200 SUTTON STREET,SUITE 226,NO.ANDOVER,MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In HaverhiU 978-374-7314 Uwe the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to furnish all necessary and place the improvements according to the following specifications,terms and materials,labor and workmanship,to install,construct conditions,on premises below described: r _ , .......................Tel hone#......ln. .:...... Owner's Name..... � ` i ��!11'! �)) ..a.J..e.d'-.............State.... /�'.l�T•..... ty..../..1(.o-...�. Job Address........d.••••••• •• Specifications: ....................... ...Y�........................................................... ................................................................................. �.....� -Strip existin shin les.(r �pp1Y"eco drip edge to all edges W�r < g g l� ........................................•....ter of house. 3 feet ice and water shield membrane VPP1y�_teet ice and water shield membrane to bottom edges es A t`moa in valleys and bottom edges of any unheated areas of house. FIN h e yv i��..n / ....................... ..................................................................... s.XPP1Y felt pa er un erlayment Ibstall ridge ven. t to ........ ..............5 ... S.l.�• I� shingles with a .Aeroofusing ' . / �t - h �- r^C?�1/1U .. S year warranty. ....... .... ...,... .................................................. . al disposal of all debris. �rn�� U p r �unterflash chimney. New vent pipe flashing. - P°. © I Co I&I �..s.f Are, to be worked on j ( r ...... _ .. R................ . .... .,,.{r..(..Gt�mk.l.`....... .. R.(�• .•%•G..S.C..t�e...�• � ... / ...G..X:.P�......C./.`...xt1:�:. l..o. �.....,rG•,./7�1 ...................................... ...... .............d. ........... �.U!t.�'/foot. ••�••••• /sheet o Roof board replace ent necessary @ 0 its Two Year Workman torp Warranty the work andNot ansf'sh the materialsaspec fled above Warranty SUct of$....1,.,3620(�&jcturer•••• •••• The contractor agree on... s ............. Payable.......: .i.S .... �galance payable on completion of job � Payable.................:...........on................................... 8 P nails)or Owner or Owners are not responsible for Property Damage or Liability while job is n Contractor is not responsible for any damage to the interior of property,including pre existing conditions(i.e.watplan mblinnails d,expoattic sed or other living application of materials specified above(i.e.objects coming loose from walls,crumblingplaster,exposed by for is for his use only.Upon conditions resulting from aPP property of contractor. Any dumpster placed spaces).Items in attic may need to be covered by homeowner.All materials are p PertY completion of above work all undersigned agree to execute and deliver to contractor,their join[note in accordance with his(their)above obligation as requested y contractor. Upon refusal to all undersigned so,contractor may at its option declare the entire contract price or so much as then remains unpaid,immediately due and payable. It is that this contract may be assigned by �d that,if permitted bylaw,contractor shall be paid pt the owners)all reasonable costs,attorney fees and expenses,in addition to the amount due and unpaid, at that he is(they are) shall be incurred in enforcing the terms and conditions of the contract and/or any lien in connection herewith.It is further ties or nterc are no resentations,guaranties contractor,and also that the obligations hereof shall bind and apply to their heirs,successors or estates of the paries.The undersigned warrant(s) conditions not the owners(s)of the above mentioned premises and that legal title thereto stanenof ll teral h r�nor s the contract dependent upon or subject to any warranties,except such as may be herein incorporated,if any,nor any agreements herein stated.Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all patties. stered and any inquiries All Home d be directed to:Director,nt ctors shall be Home Improvement Contractor Registration, One Asut a hburton Plactor or e,Roomo1301,Boston,MA 02108 shoal Tel:617-727-8598 Any Owner Any and all necessary construction related permits shall be obtained by the Contractor. rmdprovisions of MGL c. construction- Any related permit or deals with unregistered contractors is excluded from the Guaranty A roximate starting date of work.................. Completion date......................................................... PP ct is hereby acknowledged,and it is further ac(mowledged by the undersigned that the foregoing Receipt of a copy of this conta of understood and that no representation or agreement not herein contained shall be provisions have been read and the contents there binding upon the parties and that all of the agreements and understandings of said parties are contained herein. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Owner has three business days to cancel this contract and incur no penalty (see notice of cancellation). ' da of..... ... IN WITNESS WHEREOF,the parties have hereunto signed their names this Accepted: Signed. ,-.7 . Owner ..'�� Signed....................................................................... Owner ... .. ...D... 41 David Castricone,President ` ;I 4d n \ra n.. :.n, 1 11 Pee;VGc� CA\I� I�1Q I�� ` The Commonwealth of Massachusetts k Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 i � . WWW.mass gov/dna Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): C M-ra i c p p R U F I N G- 1 S lb 1 N 6 1 N L Address: 20O Su-rsplJ So V-r-r 221 City/State/Zip: bQ 466, MA 01&LAS Phone#:_°I�� (p 3 2 4 Z, I Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 9 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 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. E] Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.E:1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. ' right of exemption per MGL Y �o workerscomp. 12 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. 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. n L Insurance Company Name:��e HCl r Le, W MD 641 V Policy #or Self-ins. Lic. #: W C 9 9 5 a'1 S b Expiration Date: q-a 3- 2_0► o Job Site Address: �ACEI SfK .�T City/State/Zip: � . n" �d��.. 64- Attach 4 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: iD,3 0- C Date: ID _ Phone 13 13 1 Z.O 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#• Town of North Andover : . . .._ OEs�ao Building Department � °. 27 Charles Street North Andover, Massachusetts 01845 ((978 688-9545 Fax 9 QQ 88 /' ` � 1"aX (97D) �i88^9542 "{' cocncwrcn �. SSACHU50 DEBRIS :DISPOSAL FORM 1n accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit # the debris re!-i.,iLing from the work shall be disposed of in a properly licensed solid waste disposal faeilily as defined by MGL c11, sl 50a. The debris will be disposed of in/at: Facility Signature of Applicant _ 6 �D 9 Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector, /he Cn����.ryaorU0f:?(xCC/. o/./;' 16W6rcfiiee&j 80:11.11 of 8uildinl� Ret!ulatintls and sklndal-ds �`� Board of Building RcgulalioAs and Standards Construction Supervisor Specialty License . HOME IMPROVEMENT CONTRACTOR License: CS SL 99358 F. Restricted to: RF,WS � .�f Registration: 104569 Expiration: 7/14/2010 TO 270265 DAVID CASTRICONE ;r. , ;^ ` Type: Private Corporation 31 COURT STREET { {� DAVID CASTRIC.ONE ROOFING, SIDING 8, NORTH ANDOVER, MA 01845 David Castricone 200 SUTTON ST SUITE 226 Expiration 12I16/2D11 NORTH ANDOVER, MA 01845 Administrator tlunmi. iun'i-- Trr: 99358 i li i i r ° I I * 1 i DATE .��D CERTIFICATE OF LIABILITY INSURANCE 09/2M/2009 "�' 09/28/2009 PRODUCER (508)652-7700 FAX 508-653-8089 :T'HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Croup LLC - Commercial ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 West Central Street HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Natick, MA 01760 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Select Ext.53389 INSURERS AFFORDING COVERAGE NAIL# INVUREP David Oastricone Roo Yng & Siding Inc INSURERA: The, Insurance Co of State PA 200 Sutton St INSURER B: Suite 226 wsuRF,R c; North Andover, MA 0184$ INSURER 0: INSURER E. COVERAGES 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 05 ANY CONTRACT OIZ 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 CONO ITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 40011 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE LIMITS POLICY EXPIRATION I'. GENERAL LIABILITY I1CH GCCURRFNC;[: S COMMERCIAL GENERAL LIABILITY DAMAGE TO RL•NTEU $ ALE51E_.oeeurancel CLAIMS MARC- ❑OCCUR MCD CXP(Any one portion) 3 PERSONAL 6 ADV INJURY $ r31-.NI-HAI ASGRL"GATC $ GEN'L A00KFGATE LIMIT APPLIES PER. 1'RO000 15-COMPtOP AO© S POLICY F7 Pao LOC JECT AUTOMOBILE LIABILITY CAAn01NEDSINGLE LIMIT $ ANY AUTO (1-a Pcadent) ALL OWNU)AIJ7OS SCNEDULEDAUTQS BODILY(Ion)INJ $ 'ei person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Pnr;accident) Pr4CpVA1V DAMAC IP S (Per Accident) GARAGE LIABILITY AUTO ONLY,EA ACCIDENT $ AIJY AUTO OTHERTHAN EAAC� $ AUTO ONLY: AGO EXCESSA)MBRELLA LIABILITY CACI 1 OCCURRENCE $ OCCUR CLAIMS MADE AGGKLGAI'E S OLLAVC YIBLL a FIETENTION 3 - WORKERSCOMPENSATIONAND - WC9752746 09/23/2009 09/23/2010 X I WC STAT,- OT"' EMPLOYERS'LIABILITY TORY El A ANY PROPRIETGRIPARTNENEXECU7fvE E.L.EACH ACCIDENT S 100,000 OFFICERIMEMBER EXCLUDED? IfYo x,dascnbc Vndcr E.L.DISEASE-EA EMPLOYE S 100,QQ� SPECIAl.PROVISIONS below E.I.,DISFASF-Ppl-ICY LIMIT $ OTHER 500,000 OESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT t SPECIAL PROVISIONS TI AT "Mil Mr!o ANCELL6TION SHOULD ANY OF YHE ADOVE OESCRIBEO POLICIES 9E CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINb UPON THE IN$URSR,IYS AGENT$OR REPRE$ENTATIYE5. ' AUTHORIZED REPRESENTATIVE Stace Brice PKG ACORD 26(2001109) ©ACORD CORPORATION 1988