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HomeMy WebLinkAboutBuilding Permit #854-2016 - 12 RICHARDSON AVENUE 5/1/2018 ( t%ORTH � '�a lI A ` 0 BUILDING PERMIT ?O�ti�eu hbgN� TOWN OF NORTH ANDOVER 00 APPLICATION FOR PLAN EXAMINATION Permit No#: 6 ` � '2 G Date Received AC us Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION a �/G ��!'�J d AjflXle- Print PROPERTY OWNER ./,/'/ YQ/roc 6 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 /Al—one family ❑Addition El Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial �epair, replacement ElAssessory Bldg ❑ Others: ❑ Demolition _ ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: � p1 � sid/n I ��l s Alya� XOL/J-e � y � �i / �l1� n Identification- Please Type or Print Clearly OWNER: Name: t;oa �Gt r-CA Phone: a�3 Address: lo2 -017 Contractor Name,- O J7nt.��e /t d6�ii� �.f 4`hy Phone: 97 �3`�� Email: a-JIQ /Uraw.; Address �2�3/ `f'v7n� 61- Supervisor's Construction License: Exp. Date: /c;� Home Improvement License: /D�fJ�� -Exp. Date: 7-/ `(a 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. e Total Project Cost: $ � �s FEE: $ Check No.: � Receipt No.: �2 571 e6 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/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 PlanningBoard Decision: Comments conservation Decision: Comments Nater& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE,DEP„ATMENT Temp Durnpster on sife: s L=ocatedtat+124MaineStceet "- FireJDepartrrientsignature/date COMME-NTS. 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 - - r 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 4, Photo Copy Of H.I.C. And/Or C.S.L. Licenses ;6 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 :rc 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 ;aF Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of BuildingPlans One To Be Returned to Include Sprinkler Plan And ( ) p 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 Location No. ' G Date ;2r . - TOWN OF NORTH ANDOVER • SST f ED j 46' . Certificate of Occupancy $ h " Building/Frame Permit Fee $ 2 r - Foundation Permit Fee $ IMFOther Permit Fee $ � TOTAL $ _ Check#�D 2 i i 3 0 Building Inspector � NORTIi Town of ndover No. "- h ver, Mass, Al. cocHUMlWICK 1' 7 RATED S u BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT �' � 'C��i ° BUILDING INSPECTOR ...............: 1. �: 1............................................... .......................................... has permission to erect buildings on f� ��.�:��r �'�� �yE Foundation .......................... .. ........... ........ .............. ................................ Rough to be occupied as ... . 5..4 ` /. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the lication 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 CONSTRUCTION STARTS Rough Service ........ ...... ::C::::��/../....�'.' ................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Fih—aI No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. DAVID CAS'TRICONE C %riRICONE ROOFING Sc SIDING INC. ZOOFING,St 1VG& REMODELING REPLACEMENT WINDOWS HOME IM .:'.-VEMENT CONTRACTOR REGISTRATION NUMBER 104569 t W` :j'I-TON STREET, G,NO.ANDOVER MA 01845 In N, r!,,4ndovei,978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314 1/we the owner(s)of the premises met;'oned below,hereby contract with and authorize you as contractor,to furnish all necessary materials,labor and workmanship,to.,:stall,construct and place the improvements according to the following specifications,terms and conditions,on reviises below descri; 1. j (1 t !�'G�(t – �d Owner's Name........ 1... (f, . . L-�..�� - t . ��. � � �. d 1 ... t .........Telephone N....�:.�:�..... : Job Address.... f . .. ..l.l..%...1......../.�....V.`..t..................City.......... � / . ............State... .L .......... Specifications: Areas to be covered: ................................................................ / fpply vinyl sidin-, and corners. Ty. B Y'.............................................................. ....�tiS t?�C:= ,clr'1 .G d t:'t't'CJ _ .... VCover fascia boards and rake boar.: . ,.'install vinyl soft solid / rforatedT t C............................................................................ ............................................................................................................ over wood casings around winds„ �,ya t Replace any gable vents and dryer vents with vinyl. ........................................................... ..................................................................................................................................................... �./AApply underlay in nt- Type: 1} �... ! !� / . .......................................................................................................... Existing siding {c, / go-ov,, t./Legal disposal of all debris. .................................. .�.... 1,,.'I......: .......r............................................................................................................................................... Rotted wood reph,ced S/sI: t oy'�/foot Z t L. I �c..�.� f it 1...x:.1: : . 1...: .at 1...�..U. :.....'�... . ...... ..... -... ..4 . ........................................... ......::' .......{....�......�... .................. A (.................... i..............I. .............. 0��, tr ✓ ... ............................................................................................................................Srh,h �:�....-.. car z r.A.e—A. .... One Year Workmanship Warranty;t4ot Transferable) Manufacturer's Warranty as specified b titter The contactor agrees to rform the.,nrk and furnish the materials specified above for the SUM of$.. !} ✓Payable........... ..............e,:......�J.Q f............ Payable.........................'.o;,.......—...................... alance payable on completion of job Owner or Owners are n-A responsible for Propr:./Darnage or Liability while job is in operation. Contractor is not respo":,.aible for any damage t;. �c interior of property,including pre-oxisting conditions(i.e.water stains,crumbling plaster,exposed nails)or conditions resulting froli application of mater i....specified above (i.e.objects coming loose from walls,crumbling plaster,exposed nails,dust in attic or other living spaces).Upon cwmp4:ti:n of above work,all u..,e,sigted agroc 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,-ono actor may at its option declare the entire contract price or so much as then remains unpaid,immediately due and Payable, It is agreed thw,if permitted by law,..ntructor shall be paid by the owner(s)all reasonable costs,attorney fees and expenses,in addition to the amount due and unpaid,that shad be incurred in cnfbrcing;l c terms and conditions of fire contract and/or any lion in connection herewith.It is further agreed that this contract may be assigned by cor;ractor,and also that 11. 'dthgalions hercof shall bind and apply to their heirs,successors or estates of the parties.The undersigned warrant(s) that he is(they are)ttc..wuers(s)of the above. cutioncd 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 b '.erein incorporated,if any,nor any agrecmatts collateral hereto,nor is the contract dependent upon or subject to any conditions not herein si.,ted.Any subsequent at:;.cement in reference hereto shall be binding only if in writing and signed by all panics. All Home Improvement Contractors sl";ndJ he registered and any inquiries about a contractor or subcontractor relating to a registration should be directgd to:,Dirgptor,Home improvement Coni!actor Registration, One Ashburton Place, Room 1301,Boston,MA 02108 'fel:617-727-8598 Any and all necessary cons(ruction-reLaed permits shall be obtained by the Contractor. Any Owner who secures his own construction- related permit or deals with tmregistef,:.1 contractors is excluded from the Guaranty Fund provisions of MGL c. 142A. Approximate startirtg 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 cona:nts 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 CONT PACT 1F THERE ARE ANY BLANK SPACES Owner has three business days to canet;l this contract and incur no penalty (see notice of cancellation). IN WITNESS WI iLREOP,the parties ;taus hereunto signed their Warnes this.....: .�5...day of....Y .. 5 Accepted: .__ Signed.... .... ..,..................... /.� /--;! wner Signed..............................................................1.............. Owner David Castricone,President The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 y www mass.gov/dia V V Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibiy Name (Business/Organization/Individual): ?JA(J/.b ClU7XIc0,(1, &1)U 11)6- pcf/,A//JG /lec Address: =Z�/ 7-70A) SI-2ZEEi �//yiTc3fi City/State/Zip:/Z)d,/g/y,7jQ U6/1 IV A 0/i W Phone#: Plf(a 12&ya o Are you an employer?Check the appropriate box: Type of project(required): l6I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp,insurance required.] 9. El Demolition 3.F_1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t p 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other S12)11) 6- 152, /,b//J6- 152,§1(4),and we have no employees.[No workers'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 andjob site information. Insurance Company Name: C" AJ7i: cSixt-/rl— �/1 cl U/L/-3/7C '9— Policy#or Self-ins.Lie.#: IVC,00&9 P 9 7vZ,3 Expiration Date: 9'0�?,3_1210/ (o �� �� )d vt� 1#0 di'Fyjr Job Site Address: /0? /?/C�17/Z.i).fU� City/State/Zip: /00-An Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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.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 the pains andpepn_alties ofperjury that the information provided above is true and correct Signature: JD �J Co dX.«�...�a� Date: " O Phone#: 5P)F &�& �� a 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#: A CERTIFICATE OF LIABILITY INSURANCE 9/16/20115) 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(ies) must be endorsed. If SUBROGATION 1S 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 NAME: Select Dept. Eastern Insurance Group LLC PHONE . (800)333-7234 x66807 F- C N0 I781)586-8244 233 West Central St E-MAIL ADD E .selectwork@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC k Natick MA 01760 INSURER A:Western World Insurance Cc INSURED - INSURERB:Commerce Insurance Company 34754 David Castricone Roofing & Siding Inc. INSURER CGranite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER D: INSURER E North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER:CL159964794 REVISION NUMBER: TH:S 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 LTR ICY EXP TYPE OF INSURANCE I L U POLICY NUMBER MWDDPOUCY/YYYY MEFF MIDOrr(YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE a OCCUR NPP1404373 9/6/2015 9/6/2016 MED EXP(Any one person) S 1,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/DP AGG S 2,000,000 X I POLICY PRO- LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 1,000,000 B ANY AUTO BODILY INJURY(Per person) S ALL OWNED X SCHEDULED CNGC-V /1/2015 /1/2016 AUTOS AUTOS BODILY INJURY(Per accident) S X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident S S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTIONS S C WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN X AVY PROPRIE70WPARTNER/EXECUTIVE OFFICER/MEMSER EXCLUDED? NIA E.L.EACH ACCIDENT S 100,000 (Mandatory in NH) WC003989723 /23/2014 /23/2015 rop under E.L.DISEASE-EA EMPLOYE S 100,000 DESCRIPTION ON 0 OPERATIONS below KC003989723 9/23/2015 9/23/2016 E.L.DISEASE-POLICY OMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,d more space Is required) Roofing & siding contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Castricone Roofing & Siding THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Unit 3A ACCORDANCE WITH THE POLICY PROVISIONS. 231 R Sutton Street AUTHORIZED REPRESENTATIVE `North Andover, MA 01845 John Koegel/KH3 �J ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025e:ninnsinl Th.Ar:l1R1'1 name and Inns aro roni..oror4marLe nF ARr1pr1 i i 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 01845 Expiration: Commissioner 12/16/2017 =, Office of Consumer Affairs& Business Regulation ftROM' E IMPROVEMENT CONTRACTOR j'E— registration: 104569 Type: Expiration: 7/14/2016 Private Corporatic DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undersecretary