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HomeMy WebLinkAboutBuilding Permit #469-2016 - 100 VEST WAY 10/13/2015 �A BUILDING PERMIT of"O oT b�ti TOWN OF NORTH ANDOVER 3 _ - 00 APPLICATION FOR PLAN EXAMINATION * Permit No#: Date Received �SSACHU5�4 Date Issued: �b IMPORTANT:Applicant must complete all items on this page LOCATION 103 Ve sr W AV A Print PROPERTY OWNER MAK KE-LLHA N Print 100 Year Structure yesOno 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 Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands 0 Watershed.District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: JTR IA Ak) D k�_-RooF A(_L. S R I W&LC- A(f-Elks Ex c.&Pr (ZEWim. Identification- Please Type or Print Clearly OWNER: Name: Mkgtc HeLi_HAI-) Phone: t 1q -5-o ) Isus Address: f03 VAST 'WAY �b2r�r ��v�`�'w : PIA-- 01 "f Contractor Name: l AsT(Rtc.puc avFi (Cr Phone: q_7� — X 53-3`f ZC Email J0LUr d[1 C' a Mc�ne� ins .cow+ Address: ,131iZ Ayn�e'e,. Supervisor's Construction License: q C1 ,3 5,L--) Exp. Date: i a 1 j - 201 Home Improvement License: T b`�SC Gi Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ L0 U• au FEE: $ Check No.: �l Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 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. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature n 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 :R-Vh1 EPARATMENT Temp DurnpsterontsiteF I 1,66-6to1at,12.4ftii iSt�eet� Firei0.epaate;_ "CbMMENTS, . 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 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) Ll Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks • Building Permit Application • Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit ..T-wjo Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And - Hydraali-C Calculations (If Applicable) 4. Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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:Building Permit Revised 2014 Location No. �b Date . - TOWN OF NORTH ANDOVEFL,w • � sCertificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# `� ` J Building Inspector NORTH A o No. � Z h ver Mass, -del- 0 COCNIC"IWICK S U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT / `/G','X- /`'7c-� 11� 14� BUILDING INSPECTOR ............................................................................................................................ Foundation ........ buildings on ,�Q„3 : -..ff . has permission to erect .................. ..... ' .��....................................... Rough to be occupied as ..................... ��!,/,�.. ........:J. ::..`. .. ................... ............................................ 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S ARTS Rough Service ... �.�r4..r�.T................ ................ ......... .... Final BUILDING INSPECTOR _ GAS INSPECTOR Occupancy Permit Required to Occupy Buildinky 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, 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 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 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 premises below descri ed: Owner's Nanta......... . ... Q .( . ........................ ...........T phone tl..l r��V.`..(.� .............� 3 V ....A..<...................City...�Q.:...�.lt.'l. '.L7..)!�:...............State.... .../A...... Job Address.... ... ....... Specifications: ...............................:....................../............................................................l.... .............................................................I.............................. ZS hip existing shinglcs.,6) Apply new drip edge to all edges. (,{/A11 vg ............................................................................................................................................................. % ,Apply feet ice and water sh'eld membrane to bottom edges of house.3 feet ice anti water shield membrane in valleys and bottom edges of any unheated areas of house. ............................................................................................................................j....................................................... Apply frf pa ter uuderlaymeut.�,�stall ridge vent to ...;. ,............ . vfieroof sing n shingles with a warranty. ...........................................�... ................................................................................................................................................................... VCounterflash chinutcy, viVew vent ripe flashing.✓f egal tlispt)sal of all debris. 1! .......... Area(s)to be worked on: ..........................................., jf... �,D. ...... � . .......r..� E--..su. z�� �...................... V ................... .................... .......,..... r•........ &.(`Yt2l........... Q.�✓......k5......+... .. LL4'P•/G?r... �J....1'1.D.. i............ �...................... ......................................................................................... Roof board replacement if necessary @. j) /sheet 6-t V a,.0/foot. ............................................................................................................................................................................ Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specifie manufacturer The contractor agrees to perform the work qcJfuwisb the materials specified above for the SUM f$.....�.�j�Q............... Payable...:.> bo......,cn..5.. / ............... Payable.............................oe...................I.............. Balance 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 o the interior of property,including pre-existing conditions(i,e.water stains,crumbling plaster,exposed nails)or conditions resulting from application of maleti+ds 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 dumpster placed by contractor is for his use only.Upon completion ofabove work,all undersigned ag ee 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¢,ay 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 shidi 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 coaditions of the contract and/or 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 patties.The undersigned warrants)that he is'hey are)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,guarai.ties or warranties,except such as may be herein incorporated,if any,nor any agreements collateral hereto,tar is the contract dependent upon or subject to any cor..,itions riot herein stated.Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all parties. u All Home Improvernent 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 allpecessary construction-related permits shall be obtained by the Contractor. Any Owner who secures his own construction- related permit or deals with unregiste.ed contractors is excluded from the Guaranty Fund 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 CONTRACT 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,231 R Sutton St.,,cNo.Andover,MA 01845. IN WITNESS WHEREOF,the,partics have hereunto signed their names this.... .!......day of.. J... ..�.........201.S.. Accepted: A Signed .. ......................... Owner Signed............................................................................. Owner ................................................................... David Castricone,President 4-N The Commonwealth of Massachusetts I I Department of Industrial Accidents -1 �j;' I1� Office of Investigations 600 Washington Street Boston, HA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): DAV LD ('ASYI(CQNC Roo fir' K& + SI b(P&r 11U4 . Address: ► (Z 5o-r-n IJ n sc-r t l)ti t T 3 A City/State/Zip: N�0. "A b ot,& HA d 1 W Phone#: 9-)Z (oZ 3 3q1,0 Are on an employer?Check the appropriate box: Type of project(required): 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.El atm a sole proprietor or partner- listed on the attached sheet. t E] Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ 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.gRoof repairs insurance required.]t 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors acid 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.#: w WU 713 Expiration Date: -d,3 - Zo i Job Site Address: d is-t W Pro City/State/Zip: NO. ril�b�'�� 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 ofpei jury that the information provided above is true and correct. Signature: -�Jw�✓ C Date: Phone#• 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#: 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 a dwelling house having not more than three aparhnents 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 confinnation 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 pen-nit 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 permitilicense 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 pen-nits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or pen-nit not related to any business or commercial venture (i.e. a dog license or permit to burn 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 0 DATE (MMIDONYYY A� CERTIFICATE OF LIABILITY INSURANCE 9/16/2015 ) 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(ies)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 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Select Dept. Eastern Insurance Group LLC PHONE (800)333-7234 x66807I FAC.No:(781)586-8206 233 West Central St E-MAIL ADDRESS:selectwork@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC p Natick MA 01760 INSURER A:Western World Insurance Co INSURED INSURERB:Commerce Insurance Company 34754 David Castricone Roofing & Siding Inc. INSURERC..Granite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER O: INSURER E: North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER:CL159964794 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 EXP LTR TYPE OF INSURANCE A L POLICY NUMBER SUBR MMIJDDY� MMIDOY/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 ! DACOMMERCIAL GENERAL LIABILITY MAGE TO RENTED PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE a OCCUR P1404373 9/6/2015 9/6/2016 MED EXP(Any one person) 5 1,000 PERSONAL 8 ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 X POLICY PRO- LOC S AUTOMOBILE LIABILITY EOMaBIINdEDtSINGLE LIMIT S 1,000,000 B ANY AUTO BODILY INJURY(Per person) S ALL OWNED x SCHEDULED BCNGCv /1/2015 /1/2016 BODILY INJURY Per acadent $ AUTOS AUTOS ( ) X }{ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident S S UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE 5 DED RETENTIONS S C WORKERS COMPENSATION x WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE� NIA E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) C003989723 /23/2014 /23/2015 E.L.DISEASE-EA EMPLOYEE S 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below C003989723 9/23/2015 9/23/2016 E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORO 101,Additional Remarks Schedule,i1 more apace Is required) Roofing 6 siding contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Castricone Roofing & Siding THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Unit 3A ACCORDANCE WITH THE POLICY PROVISIONS. 231 R Sutton Street AUTHORIZED REPRESENTATIVE 'North Andover, MA 01845 John Koegel/KH3 ACORD 25(2010105) ©1988.2010 ACORD CORPORATION. All rights reserved. INS025 r7nlnmini Tho Arl1011 n- of AR110r1 Massachusetts - Department of Public Safety Board of BuildingRegulations g ahons and Standards CiinNtructi m Sulmr%iN �r Slmcialh ,_ cense: CSSL-099358 DAVID T CASTRICONE 31 COURT STREET ;ts NORTH ANDOVER RA?01 98 5 l s � � it 111 \ .� ..�.,—� � `x ;ratio n Commissioner 12/16/2015 Office of Consumer Affairs& Business Regulars orn E�OME IMPROVEMENT CONTRACTOR I-" ration: 104569 ;,"Expiration: 7/14/2016 Private Corporatic DAVID CASTRICONE ROOFING, SIDING& i David Castricone 231 R SUTTON ST SUITE 3AB NORTH ANDOVER, MA 01845 Undersecretary