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HomeMy WebLinkAboutBuilding Permit #391 - 104 MARTIN AVENUE 11/13/2006 TOWN OF NORTH ANDOVER NORTH PLICATION FOR PLAN EXAMINATION �`t��Eo Atio AP , .�? °` �O z CPermit NO: Date Received Date Issued: r �v SAGHUs���y IMPORTANT:Applicant must complete all items on this page LOCATION Ib'Y Print PROPERTY OWNER PA tL- A� L G Print MAP NO.: PARCEL: D ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ne family ❑Addition ❑Two or more family ❑Industrial ❑Alteration No. of units: repair,replacement ❑Assessory Bldg ❑ Commercial ❑Demolition ❑Moving(relocation) ❑ Other ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) OWNER: Name: reAtti., fim/nT2 Phone: 6 2 Address: 10'V X/4Md 4 VF, , A of AAW)OOEA hl& 6 a J-- u CONTRACTOR Name: D/W l P CAS M160WE )ZF&d Phone:M-1-TS-1 Address: o4 g bt. A) 9(4M .2 2 1 A.,/gr001 EA NA 619'36-- Supervisor's l9'36--Supervisor's Construction License: Exp. Date: Home Improvement License: 16 Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ Ma FEE:$ q& Check No.: 1146k Receipt No.: Page I of 4 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 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 Compliance Report (If Applicable) 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 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 DEPARTMENT:BPFORM05 Page 4 of 4 TYPE OF SEWERAGE DISPOSAL Swimming Pools 11Tanning/Massage/Body Art ❑ g Public Sewer ❑ � Tobacco Sales ❑ Food Packaging/Sales ❑ Well ❑ ❑ Permanent Dumpster on Site ElPrivate(septic tank,etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty and Signature of Agent/Owner Signature of contractor 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 ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS f FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date 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 Building Setback Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA—(For department use) Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 Location/Q No. / Date �aRT� TOWN OF NORTH ANDOVER 10- 9 + ; ; Certificate of Occupancy $ �'7g'"'O•E<� Building/Frame Permit Fee $ SAC Mus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ` Check # 19795 -- Building Inspector tAORTH Town of Andover 0 . ... ......... No. 3�' � * 0 C, LA over, Mass.,44 41, dee �C COCHICHEWICK AT E D S BOARD OF HEALTH Food/Kitchen . PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... ..........now ............1 ................................................. ..��`'� . ............................. Foundation has permission to erect................W"­­­***­­... buildings-on./AP Y.......M 104 Rough to beoccupled as .Alo f 94. ......................................................................... ChimneyTj provided that the person accepting this permit shall in every ret 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 CONSTRUCTION S TS Rough iBUiL�DINSiPECTOR ...... .................... Service 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. .� ✓1tB VIl'/IbIILII'/LUIG(I.K/G Vy.�.''fA.LWCt(:/LiIOGG(p Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 104569 Board of Building Regulations and Standards Expiration: 7/14/2008 One Ashburton Place Rm 1301 Type: Private Corporation Boston,Ma.02108 DAVID CASTRICONE ROOFING,SIDING 8, David Castricone 200 SUTTON ST SUITE 226 NORTH ANDOVER, MA 01845 Deputy Administrator Not valid without signature INIt ACORD, CERTIFICATE 4F LIABILITY INSU RANCE PROOIJCER DATE(mmm� Dlyy)— lnternet In9urance Agency THIS CERTIFICATE I$ISSUED Aa A BATTER OF INFORMATION 6/2006 522 Chickering Road HOLDERONLY ,HI CERTIIF CERTIFICATE DOES N07 AMENHp EXTEND North AndaV@r, BAA 01843 ALTER THE COVERAGE AFFORDED gY Thr POLICIES BELOW, rNauRED INSURERS AFFORDING COVERAGE QAVII7CASTRiCONE 1NsuRERA NO11O<K8DEDHAM MAIC# ROOFING ANLSIDING INC. INSvm a; NORFOLK$DEDHAM 200 SUTTON STREET,STE,226 INSURER c; AIM NORTH ANDOVER, MA 01$45 INSURERD; COVERAOQS INEURER_; THE POLICIES OF IA' SJRANOE 1;8TiaD 91rLOW HAVc$FEN ISIIIIIIII ANY REQUIREMENT.TERIA OR CONDITION OP ANY CONTRA ED TO T--,E INSURGD, PERTAIN,THE INSURANCE AFFORDED 8Y T C T^OR OTHER DOCUMENT WITH RE Tp WHf�Of,ICY PERIOD INJI ?OLlCIEB.A(3GREpATE LIMITS SHOiVN MAY HAVE BEEN Rc ES�IBED HEREI\'($BUaJECT TO HIS Crag IF � `�''V`�rn1TN8TANDiryC3 DUCCC 3Y PAI 4LL THE TeRM9,EXCLUSIOW IOATE MAYBE ISSUED QR rMgY L IY9R0 D CLAIMS, S AND COND TIONS OF SUCH TYPO at�(NSuRAhcs A GRNGRAL III POLR:Y NUM6o( >~ J COMMERCIAL GENERAL L10 ILRY NO-P-009867 8/12/2008 8/12/2007 LiMrrS EAC-i OCCURRENCE d 1,000,000,00 CLAIMS MADE OCCUR P C n g 57,000.00 j I 20 RXP(An One fin) g 0,000.0p PERSONAL S AQ'v INJURY i 4.Dc0,o0.00 OWL AGGREGATE LIMRAPOLIESPER; GENERALA03izEGA� g I,00p,070.00 POLrCY PROJECT L00 PRCDUCTT•CCMp�OPA6;, b 1,000,000,00 B AUT0I+IOBILE uA@ILRy 44508400001 08;01/2006 06/0112007 ANVAu;c � I A.L OWNED AUTOS cc eM gmeINID&INGLE Lim s SCHEOULED AUTOS hIR<ip AUTOC erpersonURY i 20,000AD NON-OVVNEC AUTOd IRp r 0001 JMURY i 60D,Ocq,00 GARPRERAGEbIAR11,11y (ParaOPedden')T�Yy DAMAGE g 100,000.00 ANY aU70 I AUTO ONLY.=A ACCIDEVT 8 OTHER AN EAACC i EXGESSgJpgBRELLk LlaelLlTY AUTO ONV AGO OCCUR 0 CLNMS MADE � EACH OCCURRENCE i AGO EGATE i DEDUCTIBLE � 8 "NTION b + E C "P RomND umrryVWC 6009480012004 49/2312008 09/23/2007 ANY PRROppRIETOR/paRTNERlEXECuTIVE TRY MITS Otyye�F,IC6RJM MAER EXCLUOED7 douNibe under E L EACH ACCIDENT i Io0,000.00 BPGCWLPROVIBIDNB bele" Bl a3CASE-EA EM�_CYEE i 5D0 000,00 OTHER E•L,b18r4SE•POLICY LIM i "00,000 G0 CERT7FICAT$HOLDER cANCE�I�AT1oN SHOULD ANY OF THE ABOVE DEBCR M POUOIE9 eE CANCR I W BEFORE THE OATS THEREOF,THE 48UNG INSURER WILL,ENCiAVOR TO MAIL 030 ��YJRRfEN �(P(RA N NOTICE TO THE CERTIFICATE HOLDER NAMEDTO THE LEFT,BUT FAILUR9 TO 00 80 SPIAL. WOBE N0 COLQATION OR LAXLRV OFMy WNd UPON THE INSURER,ITS A4iNTS OR REPRESGNTATIYEg, A(1TMORI2ED RGPRESENTATn ADORI, 25�zoalrog� GIA RD CORpORA110N 1988 DAVID CASTRICONE ROOFING,SIDING&REMODELING REPLACEMENT HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104F 200 SUTTON STREET,SUITE 226,NO.ANDOVER,MA 01845 D 7 HILLSIDE ROAD,BOXFORD,MA 01921 UV 0�9 X006 In Nords Andover 978-683-3420 In Boxford 978-887-6147 In Haverh111978-374-7314 BY:-------------------- 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 be ow des ribed: Owner's' r��j oo ..... �./`..............................................................Tei hone#.....�..�.�........S�.4r.L..:A.......... Job Address....../'.O..1:...... ,! r�.....,(.1:.ve....................city.....1.U.an....A .v.t.h,ex..............state.....i.." A......... Specifications: ✓strip existing shingles y new d'r'ip edge to all edges.li(,��...g.��..............................:......................................................... ...................................................................................................................................................................................................................... VApply ` feet ice and water shield membrane to bottom edges of house 3 feet ice and wa r shield membrane in valleys and bottom edges of any unheated areas of house, FV 6-7, o���` ............ . ,............,........................... to +apply felt p//ap`er under yment. sTstall ridge vent to ,�� c Toni „r o n ra x L`�, .................../.V..... .A ... f'{ .. .. .. .... ............................. 'teroof using �...1�e P^ ......A 1, "shingles with a _year warranty. ''Counterllash chimney. �w vent pipe flashing. "Legal disposal of all debris. Area(s)to be worked on:... n����......r. .......I..................... f ..............................................I.............. ... .............A ... 1.. l.S(.d`ii7�..... {1 .............................. 1t�1 ......11../ L.✓In 5.7.....Gl ilea .......l.11 A . 4 gtJ...... ...................................................................................................................................................................................................................... ...................................................................................................................................................................................................................... Tido Year Workmanship War of Transferable) anufacturer's War Da ecified b an turerj Materials and Labor t cos ..g.�. ............ . Payable...� b$29.......on.... ..... Payable.....-.................... ........... 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 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 than 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. The undersigned warrant(s)that he 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 Ono 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. Q, Approximate startingdate of work... ol v. mM ...... a.... °�( Completion date.....:f T 1 en kr l / 7 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. qq 3 h N IN WITNESS WHEREOF,the parties have hereunto signed their names this............1.............day of..........................�..,.,20.A..4....... Accepted: Signed................. ....M_._.11............. ...................Owner J, ................Owner Signed........ .........................:..{e....:..................`.. Per....................................................................... Representative Town of North Andover * tAORTH Building Department o ; 27 Charles Street North Andover, Massachusetts 01845 1* (978) 688-9545 Fax (978) 688-9542 .,co.—AM. 0R^reo �V CHU5 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, s15Oa. The debris will be disposed of in/at: 10q A,�k7-1,V A+VF,q IV A � Z' Facility location Signature of Applicant rs�L6 Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 - J www mass.gov/dia Workers' Compensation Insurance Affidavit: Build ers/Contractors/Electricians/Plumlbers Applicant Information Please Print Legibly Name (Business/organization/Individual): i d +1 Cpne— a©A6nG v —S Address: TUU &4t r, S+Y,ec_+ - Sur . ZZ(. City/State/Zip: N 6. WOW M A O�I qS Phone#: 9- (o S 3 3 Yz o Are you an employer? Check the appropriate box: Type of project(required): 1) I am a employer with__%__ 4. ❑ I am a general contractor and 1 6. El New construction employee's(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑ 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.El 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.©o of repairs insurance required.] t employees. [No workers' 13. _1 Other comp. insurance required.] *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 sub-contractors 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: rr • �_ � Policy#or Self-ins. Lic. #: y VV C 1 OQ q q 0 OO I oWy Expiration Date: Job Site Address:—.... �j AVF_ City/State/Zip:40,AdDo ILE & JVLA dCg ctt� 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$1,500.00 and/or one-year"unpnsonment, 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 certi unde he pains and penalties of perjury that the information provided above is true and correct r Signature: Phone#: 4jftial 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 S.Plumbing Inspector 6.Other Contact Person: Phone M ✓/LC -100'I)L))NY)LUX.'ILGL/y 4�✓��Qcto[4 Board or Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 104569 Board of Building Regulations and Standards Expiration: 7/14/2008 One Ashburton Place Rm 1301 Typo; Private Corporation Boston,Ma.02108- DAVID CASTRICONE ROOFING,SIDING& David Castricone. 200 SUTTON ST SUITE 226 NORTH ANDOVER,MA 01845 Deputy Administrator Not valid without signature