Loading...
HomeMy WebLinkAboutBuilding Permit #176 - 120 BERKELEY ROAD 9/4/2007 BUILDING PERMIT 0`tt``D "o TOWN OF NORTH ANDOVER p APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received 3 p0,ATLD Date Issued: ,-, (; �SSACHUS�� IMPORTANT Applicant must complete all items on this page c .. •:e: &``xr' ". .,�°� e.F_*,. a, yaz ^' a�y^ "". ,s'�° w"?�.E sr,�' � x �, � a ��s a x � ` ., e mg-& v*$ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building -f�n e family ❑ Addition ❑ Two or more family . ❑ Industrial ❑ Alteration No. of units: ❑ Commercial � epair, replacement 11Assessory Bldg o Others: ❑ Demolition ❑ Other � � �etaad �� � a 11T4 DESCRIPTION OF WORK TO BE PREFORMED: J�/U L�ccJ Qf c/�t Identification Please Type or Print Clearly) OWNER: Name: ,/i m /" Phone: Address � N a s PEI • p. .'c 'i^'• S � ' -- �J-)3U ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ SOU, 614) FEE: $CheckNo.: M-7-Ld Receipt No.: D � NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund vrs/02 a 4 kR e3 J "� r-,3' eti4° �,€ x�"'`� , � i--�,P t Y R'O�/i a�vx3 .�,P4,-b, s� SQ Vii,. a.�'i" - .F I.�-'kd=•�m I'?s. wr> 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.s1o0-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 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 u 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 ❑ 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) ❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 12007 Locationy No. Date V l ,.oR,►, TOWN OF NORTH ANDOVER F 9 Certificate of Occupancy $ • .._._. s�►CNust`� Building/Frame Permit Fee $ v Foundation Permit Fee $ Other Permit Fee $ TOTAL $ y- Check # 20562 Building Inspector 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ---------------- COMMENTS Zoning 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 Located at 384 Osgood Street FIDE3EPA#�TMN 'e04DtYiptrohifi �yes a LOCtB 924NIaIn Street ' s r s a Fr`Ft�#''�D@��I'�17tet1t C "°�� �--�'�'�i � -,a..�„�,�>�`���� ,�. ,.�U2'S`i`r a* �"; ,�5�' 'r Y�,me° F s na a. � r� �;.'� ?•-a �y 9 p 7kC/�09)l/I7LCYJU'I/P�A�2' ✓�2�z��G!C�I�P 'C�C9•� Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 104569 j Expiration ,11412008 Rrivke Corporation DAVID CASTRICCvNE ROOFING =SIDING& David Castricone, ', � 200 SUTTON 5T NORTH,ANDOVER,MA01i845 I)eputy Administrator NORTH Town of 1 No. o._ dover, Mass., o �. COCMICMEWICK V �d ADRATED P'Pa��y `S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System *•. BUILDING INSPECTOR THIS CERTIFIES THAT le.s................................................................................ ............ Foundation �► ,� k.. has permission to erect buildings on .. ... ............ . ............ ... Rough g Q� Chimney to be occupied as....... .�. ��......4r......................... ..... ............................................................................................ provided that the person accepting this permit sh I in every respect conform to the terms of the application on file in Final 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 a .00 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU TS Rough .................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. Town of North Andover AORTA Building Departmento ., �, 27 Charles Street North Andover, Massachusetts 01845 a n V (978)688-9545 Fax(978) 688-9542 ' RATED I- .(GJ SAti IU5 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 shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 50a. The debris will be disposed of in/at: VAJ Facility location Signature of Applicant of Sf 07 - Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector, The Commonwealth of Massachusetts Department of Industrial Accidents }. Office of Investigations 600 Washington Street Boston, MA 02111 s www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Informationnn-- Please Print Legibly Name(Business/Organization/Individual): �F}O 1 b t_AsTl2 t c n!l E ko o f Address: jk. w S te.r City/State/Zip: IVO Arxaw . N A Sy Phone#: Are you an employer?Check the appropriate box: Type of project(required): I I am a employer with f 4. ❑ I am a general contractor and I 6. ❑ New construction / _ employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 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. F-1 Building addition [No workers'comp.insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152,§1(4),and we have no employees. [No workers' 1310' er comp.insurance required.] *Any applicant that checks box 41 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: V WC �d Q J1 `t! F00 i 200' Expiration Date: o1e3 < Job Site Address: /C�y bet/kirV to a.o' City/State/Zip: a- f ,OIG- M-4 01M 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 the pains and penalties of perjury that the information provided above is true and correct. Signature: Z)2 0"— C Date: Phone#: U ff io Oficial 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#: DAVID CASTRICONE CASTRICONE ROOFING&SIDING INC. ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 200 SUTTON STREET,SUITE 226,NO.ANDOVER,MA 01845 In North Andover 978-683-3420 In Boxford 97&887-6147 In HoverhIM 97&374-7314 Uwe 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 premises below described: Owner's Name........ ✓ Q...... ..e-S- ................................................T phone#....r ry cry p 9�...... `Y1iCity... ..fJob Address . /., . {... .U0.1/4-9 .................State........... Specifications: ✓t.C..r..e..a..s..t.o...b................... ................................................................. , L........................................................................................... �/l -f 11 . ... .. �a- s ,,Apply vinyl siding and corners. Type: r, ......................................................................... d4 ?.t- ...`1.................................... x:............ Xtiver fascia boards and rake boards. ✓.Install vinyl soffit - soli / perforated ...................................................................................................................................................................................................................... i.Co er wood iugs around w!'Idows. ✓Replace any gable vents and dryer vents with vinyl. l�uo.r1Gm U.uad3........ „Apply underlayment. T pe:/� b�' 4?�4 4rxt: Ser -'••=f.`.•••... .......................................................I.........I................ Xxisting siding - ripped go-over ✓Legal disposal of all debris. ............................................4i..........................y..................................................... Rotted wood replaced @ 0 /sheet or 3== /foot. C ",I`................ ..t.�r.....ry.. o, ........................................,................................... ......................................I................. ...................................................C ><, r��3..........................,................................................................................................................. .................................................... .................................--.--............................................................................................... . "1 One Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as sped Ii y man Re / The c tractor agrees t rf rm the work��41��.f�..'R�'h�the materials specified above for the SUM f$... ��Payable.... o.....on....:i:.l.�H t............. 'file,.......... :........on..................................©Balance payable on completion of job Owner of Owners are not responsible for Property Damage or Liability while job is m operation. Contractor is not responsible for any damage to the interior of property,including preexisting conditions(Le,water stains,crumbling plaster,exposed nails)or conditions resulting from application of materials specified above 6.e.objects coming loose from weals,crumbling plaster,expowd nails,dust in attic or oma living spaces).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 owners)all reasonable casts,attorney fes and cxper6xs,in addition to the amount due and unpaid,that shall be incurred in enforcing the terns and conditions of the contract and/or any lien in connec'ion herewith.It is father 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 warrent(s) that he is(it"are)the owners(s)of the above mentioned premises and that legal title thereto stands of record in his(their)nemes(s).There are no repmentedons, 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 stat.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:Director,Home Improvement Corm-actor Registration, One Ashburton Place, Room 1301,Boston,MA 02108 Tel:617-727-8598 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 Owner has three business days to cancel this contract and incur no penalty (see notice of cancellation). IN WITNESS WHEREOF,the patties have hereunto signed their names this..ssS..R.11n,day of..A .. ..,20...v.� Accepted: Signed.... ,(/1 ..d ,2 r -u...� Owner ».S:i.. �.: `;r::»»......... .... .......... r SignedI.».»»..,........................................................... Owner David Castricone,President