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Home My WebLink AboutBuilding Permit #554 - 102 BEAR HILL ROAD 4/24/2009 BUILDING PERMITo�No oT"qti TOWN OF NORTH ANDOVER cr 4`'`'` o° APPLICATION FOR PLAN EXAMINATION '- ' 7D Permit NO: Date Received �SSACHU`�� Date Issued: Q IMPORTANT: Applicant must complete all items on this page LOCATION 1! c� C'1�' }-�)I I Ida Print PROPERTY OWNER_ t c -k ted R.0u e-,) Print MAP NO: PARCEL:. 4V ZONING DISTRICT: Historic District yes no 1 Machine Shop Village yes no 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 Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: `�TYYI b ISS1 6.1tybo e? rip vn-- y dor-ne- Identification Please Type or Print Clearly) OWNER: Name: --k� 1c1^0.rd Rpuoer� Phone: 7/ Address: �� N < <� �(i!A(S a ndU�� - 61��l r yYC _ t Phone: X G3 daCONTRACTOR Name: �I Address: 200 SL n S4 Ae 22-� OQo d t Vit' Supervisor's Construction License: CS 9 135-'b Exp. Date: (D4, I�0 a(a I J Home Improvement.License: 4 S(A Exp. Date: MZ �,(� l O 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: $ 0 Dob OU FEE: 02� $ Check No.: �a Receipt No.: I NOTE: Persons contracting with unregistered contractors do not have access to the g arantyfund Signature of Agent/Owner Signature of contractor Location b 1,9e171- 44!16 No. Date NORTry TOWN OF NORTH ANDOVER � w 41 a > ; : Certificate of Occupancy $ �ss,�tMust<�' Building/Frame Permit Fee $ .Foundation Permit Fee $ � Other Permit Fee $ TOTAL $ A Check # /d k 2 1960' - Building Inspector 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 I i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS t Zoninh 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 onsite yes no Located at 124'MainStreet 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 21A—F and G min.$100-$1000 fine 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 ❑ 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/Crossection/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 NOTE: 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 ❑ 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 ❑ 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:INSPECTIONAL SERVICES DEPARTMENTMFORM07 Revised 2.2008 ,Vi) A) DAVID CASTRICONE CASTRICONE ROOFING& SIDING INC. ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS 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 BaverhIM 978-374-7314 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 install,construct and place the improvements according to the following specifications,terms and conditions,on premises below[eswcri /p/ /�Owner's Name.........&J.X ......�••1.e.t<J. .........................................Tel hone#....G:�Y.4....... ..1 .f.(.......... .on /�7� L /d . 17 ..............State... 7.......Job Address......(. .. . Specifications: y vStrip existing shingles j) ,,Apply new drip edge to all edges. t.Jt.`/-, ..................................................................................................................................................................................... ,/'Apply (w 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 �ewT I o w r i`aa - ....... ... ............ ✓Apply felt paper unde,rlaym t +')rnatall ridge vent to ...........It'f/. a ..,....�......................�(qq..y..�.. ............................. ..................................... ..... ...riQ�rJ... eroof using 1 K.lj � 0.�o o1(;I shingles with a 30 year warranty uryry ................................................................................................................................................................................... ✓Counterflash chimney. -New vent pipe flashing. L tQal disposal of all debris. .................................. ............................................................. ..................... .............................................. t,Area(s)to be worked on: J j� ...................................................................................................................................................................................................................... ...................................................................................................................................................................................................................... ................................................................... .�.......................................................................................: . . ��cR:c,.�;, { ............................................................ .. Roof board replacement if necessary@ (D /sheet or /foot. 15 ........ 1000-D ... - Two Year Workmanship Warr ply(Not Transferable)7V�anufacturer s Warranty as speciTi by maputacturer The co actor agrees to pe " the work d ish the materials specified above for the SUM $.............. .. .. .....10^.` �ayable .. .....on...5 ........... e.........: :=.......on.................................®Balance payable on completion of iQb Owner or Owner: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).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 of above work,all undersigned agree to execute and deliver to contractor,theirjoint 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 apply to their heirs,successors or estates of the parties.The undersigned warrant(s)that be is(they 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,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 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 is excluded from the Guaranty Fund provisions of MGL c.142A. Approximate starting date of work.............. Completion date......... .(:?=t t.. 1:?... .......... Receipt of a copy of this contact is hereby acknowledged,and it is further acknowledged by the undersigned thatlthe 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 (see notice of cancellation). IN WITNESS WHEREOF,the parties have hereunto signed their names this...1 !.day of.A?.4..�A..........20- .. Accepted: Signed........... 15r .^ ............ Owner Signed............................................................................. Owner .. ... . .......... .. ................. David Castricone,President NH ORT TO" Of 4 over No. S y -_ = dower, Mass., ° T O _ LA E �, COC KICKEWICK V 7 RATED '9S E BOARD OF HEALTH Food/Kitchen Septic System PERMIT T BUILDING.INSPECTOR THIS CERTIFIES THAT.......... .... �l�A>t. ............Riwd.400............................................................................. Foundation has permission to erect........................................ buildings on .......1Q.70�.............Ae.,06`..... ......i .. .. . Rough to be occupied as........ ........ ........t.........R1 *.*... chimney ......................................................................... .. ........... provided that the person acce ting this permit shall in every espect conform to the terms 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 CONS TR N STARTS Rough ... .. ...................................................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required t0 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. 7. x The Commonwealth of Massachusetts Department of Industrial Accidents r Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Apulicant Information /� ^p Please Print Lel?ibly Name(Business/Organization/Individual): _b AN I'D C MTRI C.o Nf TRO o F t (DICT � S !D 1 N c, I M C Address: ao p Su -T-roN�, S-ra& .-i` Su i-rE 2 2.10 City/State/Zip: 4.A N p o v e A H Pv O(M Phone#:_ q 7$ Co 3 Y ay Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 8 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' [No workers'comp.insurance comp.insurance. 9. E]Building addition required.] 5. ❑ We are a corporation and its 10.F]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers'comp, right of exemption per MGL 12.[;�Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 1311 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. CoInsurance Company Name:_1ac_`n5u ra_A� o S� ��A Policy#or Self-ins.Lic.#: W C.. 5 8 r1 iRl S 6 Expiration Date: �(�1 1 p 9 Job Site Address:__,L(S Q. �i r 1[�. City/State/Zip: 1'7"ji(6 - )t�`�J 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: g� (� i, p_ Date �Jf f / b9 _ 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#: Town of North Andover VAORTfy s; : . �� 4..,•11 ',. Q Q ` Building Department 27 Charles Street North Andover, Massachusetts 01845 i a� V <OG (978) 688-9545 Fax (978) 688-9542 OQ LANA HI[ryWH N AoR�reo ,TA 05 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 ell 1, sl 50a. The debris will be disposed of in/at: fa L / �' r�'rA /V d Facility location Signature of Applicant zzGz316 9 Date NOTE: A demolition permit from the Town of N6rth Andover must be obtained for this project through the Office of the Building Inspector, Nlassachusetts - Department of Public Safety rim P�� ✓� a arrarrtamr� Board of Building Re-Mations and Standa►'lis - Board of Building Regulatio s and Standards Construction Supervisor Specialty License HOME IMPROVEMENT CONTRACTOR License: CS SL 99358 - - Registration: 104569 Restricted to: RF,WS Expiration: 7/14/2010 Tr# 270265 DAVID CASTRICONE " . Type: Private Corporation 31 COURT STREET ' -r DAVID CASTRICONE ROOFING,SIDING& NORTH ANDOVER, MA 01845 4 , :n David Castricone 200 SUTTON ST SUITE 226 ", -�- Expiration: 12/16/2011 NORTH ANDOVER, MA 01845 Administrator (wnuni"i"wcr Trm: 99358 ACORQ. CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDD/YYYY) 10/3/2008 PRODUCER Phone: 508-651-7700 Fax: 508-653-8089 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION. Eastern Insurance Group LLC -Commercial Lines ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 West Central Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Natick MA 0.1760 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURED INSURERS AFFORDING COVERAGE NAIC# David. Castr,icone Roofing & Siding Inc INSURERA:Citatj n Insurance 40274 200 Sutton St INSURERB: he Insurance Co of State PA Suite 226 INSURER C: North Andover MA 01845 INSURER D: 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 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 19w KM_T1 POLICYNUMBER POLICY EFFECTIVE POLICYEXPIRATION LIMITS GEN E RAL LIABI LITY EACHOCCURRENCE COMMERCIAL GENERAL LIABILITYAOE110REFITL-'LS— PREMISES Caocuwance $ CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADVINJURY $ GENERALAGGREGATE $ GENI AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ POLICY I PRO LOC JECT A AUTOMOBILE LIABILITY 08MMBBTNKT 8/1/2008 8/1/2009 COMBINED SINGLE LIMIT ANYAUTO (Eaaccldenl) ALLOWNEDAUTOS X SCHEDULEDAUTOS BODILY 11) $250 000 (Per person) , X HIREDAUTOS }( NONOWNEDAUTOS (Pataadde )DILY FlY $500,000 PROPERTY DAMAGE (Peraoclderg) $100,000 GAR AGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHER TIIAPJ EA ACC $ AUTOONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACHOCCURRENCE $ OCCUR FICLAIMSMADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND WC5877756 9/23/2008 9/23/2009 }{ WCST TU- OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNCRIEXECUTIVE E.L.EACHACCIDENT $100,000 OFFICER/MEMBEREXCLUDED? II yyes describe under E.L.DISEASE-EA EMPLOYEE $100,000 SPE�IAL PROVISIONS boknv E.L DISEASE-POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENOORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 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 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY MIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108) p ACORD CORPORATION 1988