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HomeMy WebLinkAboutBuilding Permit #127-2017 - 12 HOLBROOK ROAD 8/8/2016 BUILDING PERMIT ONORrH '�t`-�o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ~ _ Permit No#: Date Received �RA�R�TED•ea"cy gSSacHus�� lu Date Issued: I ORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER 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 )Rzne family El Addition El Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg, ❑ Others: ❑ Demolition ❑ Other Sept ca O'1Welll�" � ®�FI'oodpl`atnu `. Wetlancls� �,D.Wate�she. tistrict R . �. O�Wate_r/,Sewer _ � t f 1 DESCRIPTION OF WORK TO BE PERFORMED: rI OP res I e roof - r)o e- S �C/ IdentificatiopT, Please Type or Print Clearly � G 80696"J �� � G!_010� OWNER: Name: Phone: 0 Address: o� �b �- Contractor Name:; , • LLPhone: 9-) iJ 3�-a— Email: cbz com Address: a�; l Supervisor's Construction License: q 9, Exp. Date: `f ��� Home Improvement License: Exp. Date: - 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: $ -I (o u , _FEE: $ Check No.: ` 1 Receipt No.: �Orz, NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund RE. ._ 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 m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes 6 f_,'la ping Board Decision: Comments � t f' Conservation Decision: Comments Water& Sewer Connection/Signature& nate Driveway Permit ]DPW Town Engineer: Signature: Located 384 Osgood Street FIRPE DEP I�tT T Temp Du_mp.sfer.on site yes ateci at 1.24 Main Street +�� w I: {Cr�' � t Fire Department signature/date° '.> �� ' ._� *; �-° ,.d'� .r•a„ '�-_.6.=a`4' &:G.f} 1�. s: �"Yf �d• �4tfr.. ,."^z ieb� w. d�M $. a �Ftr��a,,,r .� .*., a .Rrk.. r a h° 'T wt�,.` �+ w ; -F i' r } 7 .C�®MMENTS "t^.,�.."t �.°a � w�;a: ,;,s `fP� r'rl`Fk .ft«�t.....e 1'a"1t ^i r+. � � ri }t-rs '' '."i. ! r ..r t.uawik,«,c-..� x.vn1J...l,. ! x. .l.:''.0ah...f3w..J4, i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land areasq. 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 4. ® 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 4. Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses a 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 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 2012 I ECC 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 Location r No. �! � -' �t Date • TOWN OF NORTH ANDOVER • Certificate of Occupancy $�_ Building/Frame Permit Fee $ � Foundation Permit Fee $ w ` Other Permit Fee $ TOTAL $ Check# i t Building Inspector NORTIy oven of � � 1.. s ndover O No. )L1_7411 ti �;All ver, Mass, g A- COCHICNlWKK �1. 7d AERATED �' ,�50 7S U BOARD OF HEALTH Food/Kitchen IT LD Septic System • THIS CERTIFIES THAT ..... .. .. Ts• a BUILDING INSPECTOR ............. .. .......... ........ ... .. Foundation has permission to erect ....... ................. buildings on ......... ...�.. ....... ....... '...................... . Rough to be occupied as ........... .... ....... .. �. . . .... l �....... . . .. . .. .. �. Chimney provided that the person acce tin his ermit shall in eve respect conform t termAf the application p p p g p � p pp 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 CONST TION Rough Service ....... ..... Final BUILDING IN TOR 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. DAVID CASTRICONE, PRIES. CASTRICONE ROOFING & SIDING INC. ��' ' A� 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 ]/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,cQrstruct and place the improvements according to the following specifications,terms and conditions oil remises below described: > P Owner's Name......�j.�-JI-71..1 : .. . 1� ..%. ..: ,.%...................... ........-Tel one#..977.......9r ..1....'i �1 Job Address..... -/.•/• C.�. .1`L?t3.Ct..... x.............City...6..,_/.411 .45✓..��1-.....:.....State...���.... Specifications: ................................................................................................................... ... `/Strip existing shingles/-�s`lpply nese drip edge to all edges. ! •U .............................................. ..................................................................................................................................................... A(Apply__feet Jam.i'ykr membrane to bottom edges of house.3 feet in valleys anti bottom edges of any unheated areas of house. '.''......................................:...................................... y�l I J' Pa cr de lavmenl. Install ridge vent to I•JLi Yir2�-I _5.� p ..3�= fj .:...�.. ............ .........` � :................... ............................................................. vAeroof using ttiieriL a .7 r';�i� hingles with a }'ear warranty. . ...................................................................................................................... l�Comtfertlash chimney. ►Nesv vent pipe flashing, i;1 egal disposal of all debris. Areas)to be worked on: r + // JJ A�r..� .�. . • ........... ......................:....C..�'�l...,�.:la.x�. : :e,�. '`-l.` �...�c�r' :�- .......,�,.. .ter.......... tr� � l..r f'k:�i.l........: : .....1........-�.}1. .. .. .....f. c<...... l~:L..r. W ? ................ .. .................� ,......,......... .`, .....S.h. 5...... ..LcicacJ ......:Ul"..... .Ji"r?tzt -.W-4 ........................ 01.. ........................................................................................................................ Roof board reglacenient if necessaly(a).� ./sheet ,o ;Ifo.4t:....................:................................. Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as spec' y manufacturer The tractor agrees rto perform the work and is the materials specified above for the SU of$....... 4.8.0....... ...... Thr Payable�t.��•0.C?.t?.,.......on.x5. •6.1`................ Payable.............................on.............................. . ',y��'alance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability,wAJe* is in operation. Contractor is not responsible for any damage to the interior of property,including preexisting 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 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 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 he 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(,,).There are no,representations,guaranties or warranties,except such as may be herein incorporated,if any,nor any agreements collateral hereto,nor is the contractdependent 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 bit directed'fo 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 con tors,is excluded from the Guaranty Fund provisions of MGL c.142A. Approximate starting date of work .. t'. Completion date. j019*t..�.19..L1 ta.124 S.1M ,! �IIti�'�'` PP g /...o Z�� i.... Receipt of a copy of this contact is he y 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 elate.Mail or deliver a signed and dated notice or send a telegram to Castricone Roofing&Siding Inc,23 R Sutton St.,No.Andover,MA 01184.5, IN WITNESS WHEREOF,the parties have hereunto signed their names thi' .... .:!....day of- t..t_�.. ........20.. .4.. Accepted: nn'v Signed...... .... s�........... Owner jSigned............................................................................. Owner David ne,President Tl:e Co: -anonwealth oj"Ala.-sachu.-eas Departinew sof Industrial Accidenfs i }-tt=. `` ". Ice df IlttreStlbG1110115 600 Rlashin;ton Street L �. ' Boston, MA 02111 �`;�,-��-sem" t V 1 V ZV.11 itISS.�OI r�Clrl R Workers' Compensation Insurance Affidavit: Builders/Co>irte-actor-s/Eiecti-icians/Plumbet•s kpplicant Information Tease Print Legibly (Business/Organization/Individual): -DAV l n�As72 t u Nom- p 1=iNt { St b l r)6 hU(. ,TameY address: 023 1 1Z Su T 1 5T , U�J IT .3A :ity/State/Zip: . ��. ANDog EK 4J_ Phone #: 00$ 6 3 3�2-0 re you an employer? Check the appropriate box: Type of project (required): I am a employer with S 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors . 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.t required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions I am a horneowner doing all work. officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGI_ 12�Roof repairs insurance required.) t c. 152. 1(4): and we have no 13.F1 Other employees. [No workers comp. insurance required.] I applicant that checks box ttl must also fill out the section below showing their workers' compensation policy utformation. meowners who submit this affidavit indicating they are doing all%work and then hire outside contractors must submit a new affidavit indicating such. itractors that check this box must attached an additional sheet showing the name of the sub-con ITactors'and state whe0ter or not those entities have oyees. 1 f the sub-contractors have employees,the},must providc their X,orkeu'comp.policy number_ ti an employer that is provirliug worlrers'compensation insurrttce f r mi, ernplovees. Below is the policv and job site ,rinat fo ii. trance Company Name: G RAN I-Ff. SEAT-1 f IJs�12r�N�E cy # or Self-ins. Lic. b: IN C46 3 9 S 9 a3 L-xpiration Date: -o7d � �0 Site Address: ) a 4 l,► YboL_. t�[�IN� City/State/Zip:O ach a copy of the workers' compensation policy declaration page (shoving the policy number and expiration date). Lire to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 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 !p to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of 2stigations of the DIA for insurance coverage verification. hereby certify trri�de�r the pains and-p�e-n_a—l-tiae's of peijury that thein rination provided above is true and earrect. nature: .`J C°"^"�""" Date: me 9 -1 7�j (OB .3 46�Q Official rise only. Do not trite in !his area, to be completed by citi:or tate;: offtciaL City or Town: P ermit/Licctise 9 issuing Authority (circle one): 1. Board of Health 2. Building Depari-anent 3. Citty/Tov,,n Clerl, 4. ;'lcetrical inspector S. Plum Inspector A� CERTIFICATE OF LIABILITY INSURANCE 9i28i2o15) 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(iss)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 Select Dept. NAME: P Eastern Insurance Group LLC PHONE (800)333-7234 x66607 FNACX No (781)586-8244 233 West Central St EMAIL ADDRESS:selectwork@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER A:Western World Insurance Co INSURED INSURERS Commerce Insurance Company 4754 David Castricone Roofing 6 Siding.Inc. INSURERC:Granite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER D: INSURER E: North Andover MA 01845 INSURERF: COVERAGES CERTIFICATE NUMBER:CL159964794 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 TYPE OF INSURANCE A L SUER POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIYYYY MWDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 �fCLAIMS-MADE MERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence S 50,000 A ❑X OCCUR NPP1404373 9/6/2015 9/6/2016 MED EXP(Any one person) S 1,000 PERSONAL B ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 }{ POLICY PRO- LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 1,000,000 BANY AUTO BODILY INJURY(Per person) S ALL OWNED X SCHEDULED CNGCV AUTOS AUTOS /1/2015 /1/2016 BODILY INJURY(Per accident) S Ix HIRED AUTOS X AUTOS PeNNON-OWNEDPROPERTY DAMAGE r accident S $ UMBRELLA LIABOCCUR EACH OCCURRENCE S EXCESS UAB HCLAIMS-MADE AGGREGATE S DED I I RETENTIONS S C {WORKERS COMPENSATION WC STATU- - OTH- AND EMPLOYERS'LIABILITY YIN X Li ANY PROP RIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT S 100,000 ER OFFICER/MEMBER EXCLUDED? D N I A (Mandatory in NH) It yes,tlesmbE.L.DISEASE-EA EMPLOYE S 100,000 e under DESCRIPTION'OF OPERATIONS below C003989723 9/23/2015 9/23/2016 E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is regwred) ROOFING 6 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 John Koegel/KH3 = --gr�� " ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 mmnn..;i m Tha A( ()Pn n�mn nnrf Inns 2rc raniafarerl mnr4e of nr npn Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099358 Construction Supervisor Specialty DAVID T CASTRICONE 31 COURT STREET No- NORTH ANDOVER MA 01845 (�.�n Expiration: Commissioner 12/16/2017 Office of Consumer Affairs&Business Regulation n -.'moi --•r HOME IMPROVEMENT CONTRACTOR Registration: 104569 Type: - Expiration: 7/14/2018 Private Corporation DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undersecretary