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HomeMy WebLinkAboutBuilding Permit #1019-15 - 110 BLUE RIDGE ROAD 6/8/2015 ,� NORTH BUILDING PERMIT D��qED TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: I I Date Received gSSACH�s��� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION nt PROPERTY OWNER U S'�I 1 �3T �ux,.) Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building U One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial [a'Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain p Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: a u Identification- Please Type or Print Clearly OWNER: Name: �Ros&CO Phone:569 6733 60 O Address: o IIUe- nsty, Contractor Name: b 0A(bJ(bd ChoQD0h(k t SidtlX, Inc. 9 ) F to 3 3Y,;LO Address: A3 R SANIKo o4&-, Supervisor's Construction License: Iq 9 35— Exp. Date: I Home Improvement License: O 4 Exp. Date: 7 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.000 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ I o o a FEE: $ ��� LTU Check No.: Receipt No.: ��Sb NOTE: Persons contracting with unregistered contractors do not have access to the ggua\rra'nty-`f�und / Signature of Agent/Owner Signature of contractor Location © No. ,O1 d"�� Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ t Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# r Building Inspector Plans Submitted ❑ Plans Waived El 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature QOMMENTS f oning 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 Fire Department signatureldate 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 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 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 o 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 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 Li Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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:Building Permit Revised 2014 NORTH Town of t EAndover a p =M%V.x 4 "W - h ver, Mass,LAKI IS COCHIC«!WK« �d AERATED �'P���S S U BOARD OF HEALTH Food/Kitchen PERM T L D Septic System THIS CERTIFIES THAT .. SSrw�l.. .. BUILDING INSPECTOR ..................... ................. .�............................... Foundation has permission to erect .......................... buildings on .. �.0...... . �J!R....... ... . .. ...... Rough to be occupied as ...."accep� ... e. .................................:............................................. Chimney provided that the perg 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN NNR ELECTRICAL INSPECTOR / UNLESS CONSTRUCTI Rough Service ............... ....... ....................................... Fina BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinm 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. �l CASTRICONE ROOFING & SIDING INC. ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 231R 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 owncr(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to famish all necessary materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on premises below described: Owner's Name......./...).(rl-.S.S.... Q1. .......................................T e hone Job Address...... . . .�,.>�...... j. . ..... ,t........city... . .0.4. ............State... ..... .. ...... U Specifications: . . .............................................................................................................................................................................................................. Strip existing shingles.�'J ^ ply new drip edge to all edges. ,�f����� .......//....................``............................................................................................................................................................................... Apply co feet ice and water shield membrane to bottom ed-es of house.3 feet ice and water shield membrane in valleys and bottom edges of any unheated areas of house. .......................................................................................................... (Apply felt paper un rlamgnt. ✓install ridge vent topie i/pli& .................................. ......................................... 1Feroof using shingles with a warranty. ....................................................................................... .. .......................................... �omuerflash chimneys New vent pipe Clashing. egal disposal of all debris. Q l .................................................. i� , .•`� ......................... 1.1X�I�l1tttL/1Jf R�G�� �L%QCt '.s..... Areaon: Area(s)to be worked ll r 1.. T ... . ..........Gt.GI. ..- l.................................................................... r r v t••%•••••••. .�'E......./>S. r............. ..................... L. .............................. . . ...... . . .. . . ... .. . . .. ... .. .......... �...... � �?C..._ ... S .�t. V i..Yk� .. .. .c.. ...s............................... fit, .. ......... ............. ...... r..................................... Roof board replacement if necessary@ /sheet or _ ot. ............................................................................................................................................................. .................. Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as speby manufact'u'rer The ctor a88pto perform the work d ish the to ial s ecified above for the S of$..., � Q()..�,r`� I ayab)0..,�C�((J..�.......on. ....r"O.A. Payable......:=:...............on............... ...Cra........ B lance payable on completion of job $ C7 Owner or Owners are not responsible for Property Damage or Liability w 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,ex 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 ofabove 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 entre 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.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 parties.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 arc 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 the Office of Consumer Affairs and Business Regulations,Tel.(617)973-8700. 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......................................................... 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 Sutton St.,No.Andover,MA 01845. IN WITNESS OF,the parties have hereunto signed their n es this�.�--day of.. . ..........20.. Accepted:f�DOC) sg ,9Cr Signed............. .......... .»(.. ........ ..... ......... Owner Signed.... %`.. .� V:. . . ... Owner David Castricone,President The Conrmonivealth of Massachusetts ---�� - Department of Industrial Accidents Office o f.lnvestiaations fJ J b 600 ffa.clzrnatonStreet Boston 11:IA 02111 +T= *' wfvmtnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly ( Name (Business/Orgacizadon/ladividuat): /�\{ 1D C 1JS r,1 eovt RUGi ( 1V J( D f N�'� 1W L Address: _�3 i R SU-FT O N S'i RE e-T UN i i 3A City/st.m /7_ip: No, A NOOyi;(: �A 61-W. Phone ": 9 7 i--0 3 & �1�U Are you an employer?Check the appropriate box: Type of project(required): 1.® 1 am a employer with 1 4. ❑ I am a general contractor and I employee (full and/or part-time).* have hired the sub-contractors 6. F-1 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. E] Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working forme to any capacity. employees and have workers com insurance.$ 9. ❑ Building addition [No workers' comp. insurance p. required.] 5. ❑ We are a corporation and its 10.0 Electz-ical repairs or additions officers have exercised their 3.❑ I am a homeowner doing all work 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12Roof repairs insurance required.] t c. 152, §1(4),and we have oo 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 amcbed an additional sheet showing the name of the sub-contractors and state wether or not those entities have employees. U 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. Insurance Company Name: _ R A N 1 TL J —) ATE I N J 0 A N C l; co : Policy # or Self-ins. Lic. #: W 0-0 6 39 11 q J�3 Expiration Date: Job Site Address: �I City/Staff: p: N U. N)Ac,.te✓ HA 0If�f 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 51,500.00 and/or one-year imprisonment; as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DLA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Siznature: -� J C ....� Date: Phone#: �J A 3 9 L-0 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#: DATE OrfYyy A� CERTIFICATE OF LIABILITY INSURANCE 9/10/2014 ' 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 pollcy(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 Susan Donnell NAME: Eastern Insurance Group LLC PHONE (800)333-7234 Fv No: 233 West Central St EMADDREIL .sdonnell@easterninsurance.com A INSURERS AFFORDING COVERAGE NAIC b Natick MA 01760 INSURER A:Western World Insurance CO INSURED INSURERS.Commerce Insurance Company 4754 David Castricone Roofing S Siding Inc, DSA: INSURER CGranite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER D: INSURER E North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBERMaster 14-15 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 )NSR ADDL SUBR POUCYEFF POLICY EXP LTR I TYPE OF INSURANCE POLICY NUMBER MM/DO/YYYY) IMwDONyYYI UMITS GENERAL LA.BILJT'Y EACH OCCURRENCE S 1,000,000 DAMAGE TOX I COMMERCIAL GENERAL LIABILITY PREMISES EaEoccurrence S 50,000 A CLAIMS-MADE a OCCUR NPP1388404 /6/2014 /6/2015 MED EXP(Any one person) S 11000 PERSONAL&ADV INJURY $ 1,000,000 UI GENERAL AGGREGATE $ 2,000,000 1:__E1'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X I POLICY I17 jrCl r7 PR4 LOC S AUTOMOBILE UABIUTY EBIdCOMBINED SINGLE LIMIT S 1,000,000 ANY AUTO BODILY INJURY(Per person) S �ALL OWNED X SCHEDULED CNGCV /1/2014 8/1/2015 ALTOS AUTOS BODILY INJURY(Per accident) $ i NON-OWNED j X =;ILEO AUTOS X AUTOS PROPERTY DAMAGE S I II Peracudenl UMBRELLA UAB OCCUR —, EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE S I DED I I RETENTIONS S C WORKERS COMPENSATION WC STATU- 0TH, AND EMPLOYERS'UABILRY Y/N IQ8Y LIMITS V. ?ROPRIETOWPIRTNER/EXECUTIVE OFF:C=R/MEMSER EXCLUDED? NIA E.L.EACH ACCIDENT S 100,000 (Mzrdrory in NH) C003989723 /23/201& /23/2015 If yes 66 scnioe undef E.L.DISEASE-EA EMPLOYE 3 100,000 OESCRI?TION Or OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 TI , I i I ' i DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it more space is required) Roo`i�g b siding contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE Castricone,f oofing Siding NDATETHEREOF, PROVISIONS, NOTICE WILL BE DELIVERED IN Unit 3A ACCORDANCE W THPOLICY 231 R Sutton Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 John Koegel/MET ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 nn:m n Tho Af'nRn nnmo�n f)nnn aro roniefern rf marl a of&(,no11 Massachusetts - Department of Public Safety Board of Building Regulations and Standards C.I)nctructiun Sulrcr1 iwr Slieci;llt\ i_+cense: CSSL-099358 DAVID T CASTRItONE� f 31 COURT STREET jr NORTH ANDOVER MA018f 5 Expiration Commissioner 12/16/2015 =-_Office of Consumer Affairs& Business Regulation hi - q,OME IMPROVEMENT CONTRACTOR ( registration: 104569 _ Type: ,',Expiration: 7/14/2016 � Private Corporatie DAVID CASTRICONE ROOFING,SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undersecretary