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Home My WebLink AboutBuilding Permit #272 - 100 CANDLESTICK ROAD 10/6/2009 TOWN OF NORTH ANDOVER NORTH q I� APPLICATION FOR PLAN EXAMINATION o ��• ti t o O A Permit NO: v Date Received < �' SAA 7f0 .P�•�� I Date Issued: �9SSACHus�� IMPORTANT: Applicant must complete all items on this page LOCATION O O Can I e,5- C<< Q0 O'd I 4'i0 nt PROPERTY OWNER ob2r �- N tein [Tint MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 1�New Building One family Addition L1Two or more family 0 Industrial ❑ Alteration No. of units: )C'Repair, replacement ❑ Assessory Bldg ❑Commercial ❑ Demolition ❑ Moving(relocation) ❑Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED ;II Ij S�t'i � and res h�nq tQ.. hb��-e. Identification Please Type or Print Clearly) I! OWNER: Name : A + 1`10 R?bUM-1 Phone: i Address: M o H \ A!`&ave! RA E� CONTRACTOR Name: I d C9�lQ, oo A 1 Phone: (o 3 Lo Address: ZUU . 3 A \ tybr4\ Ar,&,el M A O( � Supervisor's Construction License: Exp. Date: _-- i Home Improvement.License: �6� Exp. Date: 6� ARCHITECT'ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COS BASED ON$125.00 PER S.F. Total Project Cost :$ Ig g . do FEE:$ / Check No.: Receipt No.: 10 66 Page lor4 LocationLO NO. Date . t °f "°"'" TOWN OF NORTH ANDOVER ? ....a , 1,1 - °VF L h 9 Certificate of Occupancy $ cMu Building/Frame ame Per mlt _ Fee $ Foundation Permit Fee $ ----------- - Other Permit Fee $ TOTAL $ Check #— — ss 1963 Building Inspector i TYPE OF SEWERAGE DISPOSAL ri Tannin`*,/Massage/Body Art ❑ Swimming Pools Public Sever Tobacco Sales Food Packaging/Sales Well i Permanent Dumpster on Site J Private(septic tank, etc. i_! Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contracto02 C � Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit t I ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS I d DATE REJECTED DATE APPROVED I HEALTH ❑ ❑ -_ COMMENTS i i Zoning Board of Appeals: Variance, Petition No: ?oning Decision/receipt submitted yes 'lannin- Board Decision: Comments conservation Decision: Comments Nater&Sewer connection/Signature& Date Driveway Permit Temp Dumpster on site yes—no— Fire Department signature/date Building Setback (ft.) Front Yard Side Yard Required ProRear Yard vided Required Provides Re aired Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft..- NOTES .:NOTES and DATA— For department use) ' J Page 3 oto roc:INSPECTIONAL SERVICES DE,ARTMENT:BPFORMU5 eared JMC.Jan._ o6 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 j ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses �. ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan.And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Com liance Report rt (If Applicable) e) � New Construction (Single and Two Family) i I ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And ! Hydraulic Calculations (If Applicable) ; ❑ Copy of Contract ❑ Mass check Energy Compliance Report 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 Dor.INSPE("fIO,NAL SERVICES DEP.Vt'I' IENT:IIPFORNI05 V4ORTH Town of _ Andover No. A72v t _ LA E dover, Mass.00 • �i • aG COCHICHEWICK ��`• �d ADRATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT..... ......*. .....r....... .0. ..v /................................R............................. BUILDING INSPECTOR Foundation has permission to erect........................................ buildings on�Q.d........ / .f1h.10'1 tA.................... Rough to be occupied as............ •jxI/..�....... ...... �ir.. r. .A..*,Conform ........................................................................... Chimney provided that the person accepting rm permit shall in every respec to the terms of theapplication on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration nConstruction of Final Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRU O T S Rough ........... .... ........ . .. ... .............. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. Town of North Andover t%ORTH qq'� Building Department ; 27 Charles Street North Andover, Massachusetts 01845 , (978) 688-9545 Fax(978) 688-9542 40 CHUS�� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. The Commonwealth of Massachusetts Department of Industrial Accidents f Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leiiibly Name (Business/Organization/Individual)::I)tt(J)b (5479(C04 e. Ta,6F/IVC- 'i f1014 6 l/fG Address: 0200 eU77 d/J E S u t7a_ Z L t. City/State/Zip: N0. I &bbV,9X— NA O/Nr Phone #: 179 6 t J J YL0 Are you an employer?Check the appropriate box: Type of project(required): 1.g I am a employer with 9 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. 1 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. [J Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.El Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.[:] Other *Any applicant that checks box#I 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 subcontractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: '��_ • Policy#or Self-ins.Lic. #: V V Y C 10 OO 1 T Q 6 I o�Q b T Expiration Date:___ g•,d 3. Q Job Site Address: 10 0 c4k,(w 71C K- d 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine up to$1,560.00 and/or one-year'unprisonment, 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: C Date: d Phone Oficial 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#• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a4welling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number-listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure:that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. : ..'•., The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia i X61 DAVID CASTRICONE ROOFING,SIDING&REMODELING REPLACEMENTWI M IETM HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 10456 D 200 SUTTON STREET,SUITE 226,NO.ANDOVER MA 01845 SEP 2 8 2006 7 HILLSIDE ROAD,BOXFORD,MA 01921 In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314 B Y -------- I/we 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 install,construct and place the improvements according to the following specifications,terms and conditions,on premisises b low scribed: 1 k.t i / q Owner's Name.../.. ... .. ....... a ,A.Ie.1`L.., ........................ ............3Tephone#....�a..x.�..--:.��,.�....... Job Address.....L.b..V..... 1 S i......City....f�.�..r-0 .a.0 C_J................State....H#.......... Specifications: / vStrip existing shinglesft5....�PPIy new drip edge to all edges.S�,�p•a.Nor..b.icw...................................................................... 64,.. ...............................................................................................:........................................................................ ........... kApply�_feet ice and water shield membrane to bottom edges of house. 3 feet ice and water shield membrane. . . ... in valleys and bottom edges of any unheated areas of house. ............................................................................ .................,.. ly fe t paper derlayment. &i'fistali rid g a vent to n r, o �eroof using �� . o a i r, acs o ta`n�Jf! shingles with a ,'S h year warranty. .................... ....................................................,.................................................................................. ' nterflash chimney. z_*Vw vent pipe flashing. disposal of all debris. Area(s)to be worked on: f .... t.. G ....... ...... ........................................... ... 1... .., tit-.t,a�t.S......... .. ..4'1.A..k4.S.. ....... �h.l.Q.s7.�.. R.... ... ... ... O..tS..... �.......... ....., �... ..... ' .................................... ........................................................................................................................................................-- 1...... ................................. One Year Workmanship Warranty(Not Transferable). Manufacturer's War e" anufacturer Materials and Labor cost�...... .3.:Q�t.`......., Payable '3 ..... .....................on...............f�........... Payable.............................on.................................. Aalance payable on completion of'ob 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 pre-existing conditions(i.e.water stains,crumbling plaster,exposed nails)or 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,water stains when roofing shingles have not had adequate time to cure). Upon completion of above work,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 terms and conditions of the contract and/or any lien in connection herewith. It is further agreed that this contract may be assigned by contractor,and also that the obligations hereof shall bind and 1 B a to their heirs successors or este The undersigned apply estates. tiers ed waren[s that he is(they 8n () ( ey arc)the owners(s)of the above mentioned premises and that legal title thereto stands of record in his(their)names s. There are no ( ) () representations,guaranties or warranties,except such as may 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: Director,Home Improvement Contractor Registration One Ashburton Place Room 1301,Boston,MA 02108 Tel:617-727-8598 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 shall be excluded from access to the Guarantee Fund. Approximatestarting date of work.,................................................................... Completion date..................................I........................... Receipt of a copy of this contract 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 CONTRACT IF THERE ARE ANY BLANK SPACES. Owner has three business days to cancel this contract and incur no penalty. qQQ �'� / IN WITNESS WHEREOF,the parties have hereunto signed their names this.............°281......day of.......'`.'.:�. ....,200..4 ...... Accepted: 'I Signed....P!... ...�? ........................ Signe A1,147 k1 ........................ /. .Owner i Per....................................................................... Representative