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HomeMy WebLinkAboutBuilding Permit #801-14 - 116 HIGH STREET 5/7/2014 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION l� Permit NO: ` I Date Received 114 Date Issued: -1 t? Ix4ORTANT:Applicant must complete all items on this page LOCATION A CA- P - PROPERT�WNER Cote- Print d e-Print 100 Year Old Structure yes no . MAP NO: PARCELI ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Ione family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial IiPlRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: and r i L ✓t mu F � N J Identification Please Type or Print Clearly) OWNER: Name: lT�-I-� / -3C*SLA CA Ie- Phone: 9)E Address: [ (ol c5 Vp.t' Pr CONTRACTOR Name: Q ' Sl r 1 Phone: 13 Address: a3l R � S �,`,w`� A �`/'et0- HA Supervisor's Construction License: ojq3�� Exp. Date: 1e i Home Improvement License: [ 6 4 6� Exp. Date: `- 14 ARCHITECT/ENGINEER Phone: r Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. D Total Project Cost: $ 0 FEE: $ 61 Check No.: �`��� Receipt No.: ��'J.I NOTE: Persons contracting with unregistered contractors do not have access �-tootthe guarantyfund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 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 ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes - f Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Towo Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 MainStreet- 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 - Date ii Doc.Building Permit Revised 2010 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofii,g, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit 1 ❑ 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) 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 app;al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm:tted with the building application Doc: Doc.Bui!ding permit Revised 2012 Location 1��p 4 No. v z' � Date ' t • - TOWN OF NORTH ANDOVER • TLEb�" s • • Certificate of Occupancy $- Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ • TOTAL $ Check# t l Building Inspector r , NORTH _ : w: : . . 2 t � �. . : ver 0 No. LAKI ' = - CO."--.oh ver, Mass, COC NIC Nl WICK%%,�A `% �"OATED S V BOARD OF HEALTH Food/Kitchen PERMIT L D Septic System THIS CERTIFIES THAT .........I... . ..A 4r BUILDING INSPECTOR ........ ............ ....�. ... ......�..... ................................. 6 has permission to erect .......................... buildings on .. 1.1.1*..L+A14bjxM...sjw .� .................. Foundation Rough to be occupied as ...... ...... .... ......................................................................... Chimney ;p 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 TARTS Rough /I Service .......M.............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinje 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. In,$S� �> r' DAVID CASTRICONE, PRES. �, ' CASTRICONE ROOFING & SIDING INC. q 1,18 ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 231 R SUTTON STREET UNIT 3A, NO.ANDOVER, MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314 I/we the owners)of the premises mentioned below,hereby contract with and authorize you as contractor,to furnish all necessary materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on premises below described:Xy...... .................. .T phone Owner's Name...,., #.1../.. ..'.�r. ..J.l { Job Address....... /.�.....d.1.1.... ...c ./.a..................................City...Ala,...,l..l..A!'..G:.'✓...1'e'...............State.... . ..... Specifications: .......................................................................... .....'...... ................ .................. ............ ......�..�t..t..n.�.�...�....�` . . . .©5. ....a.!....:... al i s......................... ...................... ............/1 . .� ......�........ .....,1. ISL .s .1. atz....1ta. zt nf_..e .�4�....... r ��G..... .0...�af` .....) ........... r..�.1`.... .. �ryd C. . ............................................... ......;......... .r..................................................�... ..... ...... -... ' ....... IG.Q .....<a. /..la X9.11, . ......-....1..�N,1'11t�.�/.�',,.....�17•Zi 5.:�. ...�7 ..1..�.1!.1,`�........ . ..... y . .�1.- /ie........................ �{ ..... 10 .........S...r11,.ef�:f'J. . ...............................................................1..........5 �G?. 1? .4..�1..... ................................. Five Year Workman ip Warranty(Not Transferable) Manufacturer's Warranty as specified by m facturer The contractor agrees to perform the work and furnish the materials specified above for the SUM of$....... ... OU-6... .. Payable...:.........................on................................. Payable.............................on.................................. 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). Items in attic may need to be covered by homeowner.All materials arc property of contractor. Any dumpster placed by contractor is for his use only.Upon completion ofabove woik,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.Property may be subject to mechanic's lien if unpaid.It is further agreed that this contract may be assig,,cd 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 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 the Office of Conshmer 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,231R Sutton St.,Yo.Andover,MA 01845. IN WITNESS WHEREOF,the partier,have hereunto signed their names this..sf:J d.day of Accepted: (- / Signed... :5 ..f.'a:.�............................................. Owner Signed............................................................................. Owner David Castricone,President The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 U1 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly � �,p ,rt A Name(Business/Organization/lndividual): i )L \T2f C dNE �MEAA6 Address: SU TTbt3 N 1 T 3A City/State/Zip:N u: A N 1a0V E(C HA 61M' Phone#: 0178 (A 3 -3 �-,20 Are you an employer?Check the appropriate box: Type of project(required): 1.M 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 am a sole proprietor or partner- listed on the attached sheet. 7. F1 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.❑P mbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 1� Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.❑Other '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 a?e doing all work and then hire outside contractors must submit anew affidavit indicating such. lContractors 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 thepolicy and job site information. a Insurance Company Name:. 06HHGkCk__ Policy#or Self-ins.Lic.#: W C l) 3 �7 Expiration Date:'-� � Job Site Address: �, int�Ta City/State/zip: O- vhf Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 hivestigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjuiy that the information provided above is true and correct. Siemture: Z ,9 [J C Date: Phone#: 9 7 K W 31 )-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#: ACS 1 CERTIFICATE OF LIABILITY INSURANCE DATE I'm x-OC YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI! CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE`. BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE[ REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT ff 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 Thi certificate holder in lieu of such endorsement(s). CONTACT °n^v�UCER NAME:___ �Psiern Insurance Group LLC -Main PHONNo Ert 8(51 7700 I Lc N�L/_R,_586 82x4__ 233 b1ie51 Central Street EMAIL Na!ick MAO 1760 ADDRESS: I c rk erninsur nce.com INSURER(S)AFFORDING COVERAGE ! NAIC INSURER A.QQ_MMerCe Insurance Company 34754 3?969 INSURER S Commerce & Industry __- !:)Rviv CasiNcone Rooting& Siding Inc INSURER C Western World losurance Co `asirIcOne �cofing Inc INSURER D 2 .1 Rear Sutton Street, Unit 3A --— I Andover MA 01845 INSURES E INSURER F: COVERAGES CERTIFICATE NUMBER: 170101 1967 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIO[ INDICATED NOTV'YITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO (WHICH THIS CEPTIFICAT:: I`.A,4Y BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS MVD CONDITION5 OF SUCH POLICIES.LIMITS 5HOVYN MAY HAVE BEEN REDUCED BY PAID CLAIMS. AODLISUBRI POLICY EFF POLICY EXP 1,L TYPE OF INSURANCE INsp WVD POLICY NUMBER MM/00!YVYY b1M1001YYYY LIMITS t_LiIABIDTYIN PP1350515 i612013 6/201u EACHOCCURREtuE Is,,000,000 x �..,-,- r L ED—-- — C x.a,•tiL IAL GENER L IIANLIT t PREMISES iEa occur, 15.0.000 C MMS.HADE X 110008 —1 r 1E D EXP(Any one pers-0n) S t,000 PERS,)NAL X ADV INJURY I S 1.000;000 1 I �GEI•IERAL.aGC:REGATE ($2,000.000 r!;GGREG ?E Ur.lIT APPLIES PEP. I I I ?FtPRODUCTS COMRt}P AGG �`5 2 0G0 000 —1 ' .,l POLICY I � Ir .T 71I LOC I I — 6UTOM031L=Lit BILITY QCNGCv n/1'2013 '811;2010 C I� I i �Eaaaicse�� 5t O.,O,000 �Iw'UT":' I ! BODILY INJURY iPei person) I S -- Li-TI-NcD X SCHEDULED -- -.-TOS I AUTOS I &)OILY INJURY(Pei acc iSenq S r1S (�P10NOt4NEp I I PROPERTY DAMAGE I$ ----- iUTOS 'Pe,amadenin i U!SREi_Ld LIAR i OCCUR XGGU..RENCE _ i — I EACH, o c Xc ess uAs CLAIMS MADE I AGGREGATE S I (OED I I RETCHT10tIS S OnxE+SCOtnvENSATION W0003989'23 i23!20t3 ri23,2016I T/9YT'T J=H RS'LIABILITY Y i N ^---:-'O?AI_TOP:'RTNERrEXECUTi E I — •.,_•R�:IEi.iSEAExCLUDED? � N/A ,E L.EACH ACCIDENT 15100.000 _ iit6ar:oa:C! I I E L DISEASE EA EMPLOYEd S100,000 ,PTI:)rJ r>:OPERA i 011S beWw I E L DISEASE POLICY OUT I S500.000 I O:SC-IPTIONOF OPERATIONS;LOCATIONS r VEHICLES (Attach ACORD IN.Additienal Remarks Schedule.li more space is required) 1 I i CERTIFICATE HOLDER CANCELLATION Castricone Roofing & Siding SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Unit 3A THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, 231 R Sutton Street North Andover, MA 01845 4UTHORIZEO REPRESENTATIVE ©1988.2010 ACORD CORPORATION All rights reserve ACORD 25(2010:05) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Suhcr%i.ur Spccialth License: CSSL-099358 DAVID T CASTRICONE,.. } 11 31 COURT STREETi NORTH ANDOVER MA^'018' 5 ��• Exp!rateon Commissioner 12/16/2015 SCA t is 20M.05/11 Office of Consumer Affairs&Busirde s Regulation ;") 001h.40ME IMPROVEMENT CONTRACTOR R : 104569 egistration x .b =,.: Type: xpiration: 7/14/2014 Private Corporation DAVI?CASTRICONE ROOFING, SIDING 8 David Castricone 231 R SUTTON ST SUITE 3A _ NORTH ANDOVER, MA 01845 � L—� Undersecretary Town of North Andover N�krN a� p Building Department o 27 Charles Street '� A Nort11 Andover, Massachusetts 01845 10 (978) 688-9545 Fax (978) 688-9542 p�R17lD fPM`y�� CSAc11u`✓E< 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 sliall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, 51502- The debris will be disposed of in/at: (f, Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector,