HomeMy WebLinkAboutBuilding Permit #417-2017 - 111 BEAR HILL ROAD 10/19/2016 BUILDING PERMIT o� No Dry�ti
TOWN OF NORTH ANDOVER 1,2 yEtit'• 0
APPLICATION FOR PLAN EXAMINATION 4 A
o
Permit No#: 0 Date Received f U f - o l w 'lf�o�RArEo Jr
gSSACHUS
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION 6 C'_3r IAA,`, '�,0 aA
P`in't
PROPERTY OWNER � ree- A(a K c-k Z n
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 >22ne 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
E Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
�+f P av-,C� arc e. Y-6 u�
Identification- Please Type or Print Clearly
OWNER: Name: `Re-neer A ra Kel'i an /� Phone:(q�� 9qg 45 �
Address: �d�rtl� A ✓
o vo4 , MA p l� fi
'
hr
Contractor Name: Phone:
Email: daLild (2Ca,S+ncfpo coo
Address- .13 CZ S tr- ttb n C1 r\,A: a A 06r4-P\ y+e��, M A- u I$ j'
Supervisor's Construction License: Ct q3s Exp. Date: 0-— 1 b'Zo 1 `7
Home Improvement License: 0`� 5�l09 Exp. Date: y1
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: $ ya• 11c, FEE: $ �P
Check No.: 35--7 Receipt No.: 3/ 6
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
u..
Location tl! �� L L
No. 41 7 O U Date /0
• - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
r Building/Frame Permit Fee $
Foundation Permit Fee $
E
Other Permit Fee $
TOTAL $
Check# 3573
.
�y ` !.wilding Inspector
J
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. El Permanent Dumpster on Site ❑ �
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING DEVELOPMENT Reviewed On Signature_
I
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoniy)g Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
I Wafter& Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
FIRE DEPARTMENT Located 384 Osgood Street
`-a Temp�Dumpsteron:site�:�,Y,es -i
+ Located(at i12411V1'am�Str-eet a' , in
'Fire�Departmentsignature/date
COMMENTtS. t y
,: _
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.$10o-$100o fine
f
NOTES and DATA— (For department use)
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i
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❑ Notified for pickup Call Email
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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
:rF 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
4. Photo of H.I.C. And C.S.L. Licenses
,4. Workers Comp Affidavit
Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
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
pORT11
Town of
d ndover
No. :
soh ver, Mass,
COC., NIWIC44 Ot.
�,9 A°gwrEo 0 (y
S V
BOARD OF HEALTH
Food/Kitchen
PERMIT . T LD Septic System
•
THIS CERTIFIES'THAT b.0C. . ,S!. . C............R.... BUILDING INSPECTOR
has permission to erect .......................... buildings on ....... .......ISCAN........16.06........ �o Foundation
Rough
to be occupied as
...........ST .�. ......................... . ..... .•.0............................................... 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
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIO S ART Rough
Service
.................................
............. .� ............ Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building 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.
i
DAVID CASTRICONE, PRES.
CASTRICONE ROOFING & SIDING INC. /0, I-q,�6
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 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 prem' es below described-
Owner's Name.... ....2'.A.... ........................ .........Tele0one#...C�. �.•�.. ...G.. /
Job Address....../1..�..... eQ r �..f f...... .a..................City:.... t7.:./...1. . .v.. ./-..........State... .......
Specifications:
..............................................................................................................................................................................................................
VStrip existing shingles.�l� ✓,<pply new drip edge to all edges. '2 11
(/Apply—4!—feet `t' membrane to bottom edges of house.3 feet
in valleys and bottom edges of any unheated areas of house. Fa/f »'fi12� o P- nIP-M
....................................................... ........................................................................................................................
✓'Apply bft��ape�r underlayment. Install ridge vent to
Reroof usin ' > shingles with a .3n year warranty.
-- ............................................. .....................................................................................................................................................................
i
vCounterflash chimney. eco vent pipe flashing. Legal disposal of all debris.
..................................................,3.-........... —._................ ...............................................................................................................
Area(s)to be worked on: 3.
.......................... ..................
....(�e ptf....f RC1 L?. ........�t /`. '=S,
.... .......................................................
........
.s�LR.G Q✓.. ...1.G......�.�.. /Y ..... ale
......................................................................................................................................................................................................................
......................................................................................................................................................................................................................
Roof board re lacement if necessar /sheet or — /foot
P.................................Y..0..12s-21 ........................................................................
. . ........
Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as s ted by manufacturer '
The ctor agues to erform the work d i the materials specified above for the of$.... 5-2.a..0•'"'�
c/ ayable... 0.0........on..:S.V • •.....
i
Payable.............................on................................. alancepayable on completion Fof job
Owner or Owners.are not responsible for property Damage or Liability wh 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,expo
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,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.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 ownets(s)of the above mentioned premises and that legal tide 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 patties.
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 se,cures 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,
2314Sutton St.,
No.Andover,MA 018845.
IN WITNESS WHEREOF,the parties have hereunto signed their ares this../.d.........day of 20..,,1.�.J/L
Accepted:
Signed! ..... j ..C ! 1........... Owner
+..
Signed..................................................................
........... Owner
David Cas tricone,President ��
The Commonwealth of Massachusetts
Department of Industrial Accidents
kvOffice of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): CL,If-1(A NtF 0 F 1 N G "• _S 10 [ G �
Address: A 3 1 R S&T TO .N Si Z CE T V N IT 3 A
City/State/Zip: N p, A mi)b v M f l 0 Phone #: (o t 3 3q,�0
Are you an employer?Check the appropriate box: Type of project(required):
1. 4. ❑ I am a general contractor and I
,�I am a employer Yer with 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. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their HE Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 1�Roof repairs
insurance required.] t c. 152, §1(4),and we have no
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 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 isproviding workers'compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company Name: G R AN 1 1 E �T 6 i t ( 14,S\.) rZA N C_
Policy#or Self-ins. Lic.#: V V U 6 3 cl vl-� � 2 Expiration Date: 9 "off 3 -cZ o ) r7
Job Site Address:_ 1 I I -Bear Tll� d City/State/Zip: IVu K�-Aowit itA
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 thepains and penalties of perjury that the information provided above is true and correct.
�" J��/
Sig-nature: 9 C Date: 10
Phone#: 9_7b IoD 3g0�()
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#:
,aco CERTIFICATE OF LIABILITY INSURANCE °A `MM,D°'YYYY'
9/27/2016
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(les) 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 NAME: Select Department
Eastern Insurance Group LLC PHONE (800)X72-4538 A1C No:781-586 8244
233 West Central St .Ess.selectwork@easterninsurance.com
INSURERS AFFORDING COVERAGE NAIC 0
Natick MA 01760 INSURER A:Western World Insurance Co
INSURED INSURERB-NAPFRE Ccvzmrce Insurance 34754
David Castricone Roofing & Siding Inc, DBA: INSURERC:Granite State Insurance Co.
231 Rear Sutton Street, Unit 3A INSURER D:
INSURERE:
North Andover MA 01845 INSURER F:
COVERAGES CERTIFICATE NUMBER:Master 16/17 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 POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSR WVQ POLICY NUMBER
MMIDDIYYYY MMIDOl,YY LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 50,000
A CLAIMS-MADE FZ OCCUR rBA GL 2016 /6/2016 9/6/2017 MED EXP(An one erson $ 1,000
PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN1 AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000
X I POLICY PRO- LOC $
AUTOMOBILE LIABILITYED I
Ea ewdent 1,000,000
B ANY AUTO BODILY INJURY(Per person) $
ALL OMED r—"-1 SCHEDULED CNGCV /1/2016 /1/2017
AUTOS AUTOS BODILY INJURY(Per accident) $
X HIRED AUTOSX NON-OWNED PROPERTY DAMAGE
AUTOS Per accident $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE - AGGREGATE $
DED I J RETENTION
C WORKERS COMPENSATION $
AND EMPLOYERS'LIABILITY X VK.STATU- I OTH-
ANY PROPRIETOR/PAP.TNER/EXECU7IVE Y I N JORY LIMITS ER
OFFICER/MEMBEREXCLUDED a N/A E.L.EACH ACCIDENT $ 100,000
(Mandatory In NH) 003989723 /23/2016 /23/2017
l E.L.DISEASE-EA EMPLOYE $ 100,000
ye
DESCs,describe under RIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required)
ROOFING & SIDING INSTALLATION
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS.
BUILDING INSPECTOR
1600 OSGOOD STREET AUTHORIZED REPRESENTATIVE
NORTH ANDOVER, MA 01845
11 John Koegel/MET
ACORD 25(2010/05) O 1988-2010 ACORD CORPORATION. All rights reserved.
INS025(201005).01 Thw ArORn names and Inns ares rwnicfararl mark§¢of ArORr1
%!„• .,,.»,�,,,,.../i/, ��11..,,..�%,,..ai. License or registration valid for individual use only
Office of Consumer Affairs&Business Regulation
t(= before the expiration date. If found return to:
HOME IMPROVEMENT CONTRACTOR
��y Registration: 104569 Type: Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
Expiration: 7/14/2018 Private Corporation Boston,.MA 02116
DAVID CASTRICONE ROOFING,SIDING& /
David Castricone `
231 R SUTTON ST SUITE 3A
NORTH ANDOVER,MA 01845 undersecretary Not valid without signature
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CSSL-099358
Construction Supervisor Specialty
DAVID T CASTRICONE
31 COURT STREET
NORTH ANDOVER MA 01545
CA, Expiration:
Commissioner 12116/2017