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Home My WebLink AboutBuilding Permit #163 - 120 SALEM STREET 8/31/2009 BUILDING PERMIT of "°RTM q TOWN OF NORTH ANDOVER or � '` °�, APPLICATION FOR PLAN EXAMINATION Permit NO: VO Date Received sq goq�To'pP��y SSACHUSE Date Issued: r IMP RTANT:Applicant must complete all,items on this page LOCATION l 19-l Jt/e , ;Print PROPERTY OWNER 1 6 s � ^� Print MAP NO: V7 PARCEL: J ZONING DISTRICT: Historic District, yes Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial f/Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer '/ DESCRIPTION OF WORK TO BE/PREFORMED: 5717-/e ' /eS16Ce le-64 `� /-iG�� rl rJej 61 Identification Please Type or Print Clearly) OWNER: Name:� a 6-1-7fkf� Phone: 9��01l1�Dorf 6 Address: /o�� a,�P/� (f` ec / �lll�a�e�, /Cl/F Ol�sl�• CONTRACTOR Name: eJfi-le -1/�1 Phone: f7 0 s'3 Z _e Address: Z-00 J�&n J7 C,e -A0/ 224 Supervisor'sConstruction LicenseD ?7,_Q 3 Exp, :Date: lc, A Home Improvement License: Exp. `Date: lft� G 1 a ARCHITECT/ENGINEER Phone: } Address: Reg. No. r FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00O�THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 0'0 Total Project Cost: $ <S g?0 FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access t the guaranty fund ignature of Agent/Owner Signature of con#ractor 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 ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 2.2008 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 Signature COMMENTS HEALTH Reviewed on Signature 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 DPW Town Engineer:`Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp-Dumpster on site yes no m Located at 124 Main Street Fire'Department signature/date 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 Doc.Building Permit Revised 2008 Location 42 54(�, S� No. Date01 52� / HORTN TOWN OF NORTH ANDOVER h 9 i * ; ; Certificate of Occupancy $ J�cMus`� Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ ' TOTAL $ Check # 22 � '� C� Building Inspector yyl t v 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 978-887-6147 In Haverhill 978-374-7311 Uwe the owner(s)of the premises mentioned below,hereby contract with.and authorize you as contractor,to fiunish 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 Nam e....... J..rA<S. f...................................................T ephone#...� Job Address......lr . eh .. .. a.:t al�..............State...... !2 � .... Specifications: ..................................... ..................... ....................... ................................. ......... 17 ... it A ..��:��.5..�. .rz........e.�l.�..r..z.a.r.--:.....cr.�.... � .�..a.t�..r...... .. ......� ... �� r ' k. ...... ..Zt3 �....1`tr�.X2......1. 51.�P_1....p. .�1 .t........................ .................................................................. 1 TY�— Cc.r.......S..i'. 4. . ........ ..!......�•i.S.. ..n r-e 1.......dd............ 1.. �e - .5......... ...........................�... ..... .. ... /..j� . .f. ..........1 �✓ ...... ... ..r... ...F•, l� a /` �„a/�rc,�'L?A. ST otL t. ..y..v.. .. .ylF$P.4cP - ! / ccu. Soflw -� ............ ... . .....j/kt.D. ..� .....arr......0.. . .�2l....l.`.Ls1:1:...a .... .r. .............. e........ C; ......... R s ,Jr ' a145....... Z. 1... ........is w174. Saute sr s�c�S v ........... ....................................................................................................................................................... ...................,�c�.................. U Two Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as speciti y mi f turer The c ctor agrees�tg perform the work an the materials specified above for the SUM o .. . .. payable......l. ...............on....5A . h...... Payable.............................on..................................�Zhalance payable on completion gf inh Owner or Owners are not responsible for property Damage or liability while joti rs in operation. Contractor is not responsible for any damage to the interior of Property,including pn:<xisting conditions(i.e.water stains,enunbling plaster,exposed nails)or Um, th conditions resulting from application of mate ials 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 oontractor.Any dumpster placed by contractor is for his use only.Upon (L�4 completion of above work,as undersigned agree to execute and deliver to contractor,their joint note in accordance with his(their)above obligation as requestedby contractor. Upon refusal a do so,contractor may at its option declare the entire contract pri much as then remains unpaid immediately due and payable. k&4ee the own s)of the above mentioned premises and that legal title thereto stands of r000rd in his their n Tee a no rep�waions,g that he is(they are) at15 D, warranties,except such as may be herein incorporated,if arty,nor (their) athes(s).There are no representations,guaranties or herein stated An subsequent any binding my collateral hereto,nor is the contract dependent upon or subject to my conditions not Any bseq 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 Contractor Registration, One Ashburton Place, Room 1301,Boston,MA 02108 Tei: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 worl�........................................... Completion ................................................. Receipt of a copy of this contact is ereby aclmowledged,aced it' further aclmowl ed by the undersigned that the fofegoing 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 parties have hereunto signed their names this ',� .......day of.. ...........201�j..... Accepted: - / Signed ...».»�...p...»....».............».»»»»».»..»»»......... Owner ID- 2 Signed...»....».»....»....».....». ...........».».......».............. Owner David Castricone,President NORTH ovm :o t 4Andover 0 No. LAKE ar dover, Mass.,- 63 o COCMICKEWICK A0RATE0 S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System /�,, BUILDING INSPECTOR THIS CERTIFIES THAT fir'/ c :::::::: Foundation has permission to erect................................R buildings on ......��JC ..........CS6'T.............. trough to be occupied as....... .. .�rsf.�.f[!..L................. f/./J.........�/..Y<....`IF'..��1.�1J.�:R...........:Q her.... . . Chimney �j provided that the person accepting this permit shall in every respect conform to the terms of the appyation 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU STARTS Rough .... .................................................. .:::...... ... Service BUILDING INSPECTOR Final Occupancy Permit:Required W Ocmpy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massach usetts - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 � v r www.mass.gov/dia WorkersCompensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name(Business/Organization/Individual): 1AlrV I n O-ASTRI CO KIE Ro0h M(r ,• Sl n1u&il)e Address: ADO Sy-rnN S-MU-T Su 1 T r,- z City/State/Zip: N-AN kVeIL NA 6itif Phone#: 911 03 342 0 Are you an employer?Check the appropriate box: Type of project(required): 1.2 I am a employer with 9 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E] New construction 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' [No workers'comp.insurance comp.insurance. 9. LJ Building addition required.] 5. F1We are a corporation and its 10.E] 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' 13.X Other 51 b /M 6- 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. iContractors 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: \ft5Qf6AM CQfl, f Policy#or Self-ins.Lic.#_ WC68` ? `1/ 7 77 5L Expiration Date: /q-d,3 • 0 Job Site Address: /OIry:j.1 �,L/�,a-kl fC� ,City/State/Zip: /YU,04A )IllAlle'/ 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: T 1�.-2 CJ Date: Phone#: q7i (o E 3 31,Z-q 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 M Town of North Andover � e,�►�r,Y ;,. oE�s��o Building Department 27 Charles Street °- A North Andover, Massachusett s 01845 � 9 '* ( 78) 688-9545Fax (978) 688-9542 ��sSHCNu5�; DEBRIS DISPOSAL FORM In accordance with the provisions of MGL e 40 s 54, and a condition of. Building permit # the debris rer;uIting from the work sluill be disposed ofin a properly licensed solid waste disposal faeilit as defined by MGL c.11, s150a. The debris will be disposed of in/at: �- /V d n Facility location -�- IL _; — Signavare 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, I ACORD,,, CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 8/5/2009 PRODUCER Phone: 508-651-770D Fax: 508-653-9089 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC -Commercial Lines ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 West Central Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Natick MA 01760 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:The Insurance Co of State PA David Castricone Roofing & Siding Inc INSURER B:Citation Insurance 40274 200 Sutton St Suite 226 INSURERC: North Andover MA 01.845 INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSRn TVDr OF INSURANCE POLICY NUMBER POLICYEFFECTIVE POUCYEXPIRATION LIMBS GENERALLIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY A PREMISES Eaoecurenw $ CLAIMS MADE OCCUR MED EXP(Anyone person) $ PERSONAL&ADV INJURY $ GENERALAGGREGATE $ GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ POLICY PRO- LOC B AUTOMOBILE LIABILITY 09MMBCNGCV 8/1/2009 8/1/2010 COMBINED SINGLE LIMIT $ ANY AUTO (Ea acclder6) ALLOWNEDAUTOS BODILY INJURY $2 5 0 X SCHEGULEDAUTOS (Per person) $250,000 X HIREDAUTOS X NONOWNEDAUTOS BODILY INJURY (Peramidern) $500,000 PROPERTY DAMAGE $100,000 (Peritodderd) GAR AGE LIABILITY AUTOONLY-EAACCIDENT $ ANYAUTO EAACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACHOCCURRENCE $ OCCUR E]CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ A WORKERS COMPENSATION AND WC5877756 9/23/2008 9/23/2009 XWCSTATU- OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? E.L DISEASE-EA EMPLOYEE $100,000 It yyes tlescr(be under SPECIAL PROVISIONS below E.L DISEASE-POLICY LIMIT $5 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT/SP ECIA L PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED David Castricone ROOf1ri & Siding IncBEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER 9 9 WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE 200 Sutton St CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO Suite 226 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON North Andover MA 01845 THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108) p ACORD CORPORATION 1988 . ' }|ass^zho^cny ' Uqunm"ntil' PuWic Su[c,> ' Board ofUoiNix� Rr�v|x/ioxx ^oU �uoUxn|, � ov», vrouomnxa,xx|mm�000m�vov�m— c�nstruobpn5uper,iso, Specialty License License: CS SL 89358 HOME IMPROVEMENT CONTRACTOR ' ' Restricted to: RF,WS N*A(auat|on: 104508 Expiration: In4/2010 Tr# 270205 DAVID CAOTR|CONETYpo Private Corporation 31COURT STREET ' NORTH ANDDVER DAVID CAOTRC0NERO0�N(� SIDING& MA . David Caetriouna ~~~~ 2O0SUTTON STSUITE 22O sxp"unvw 121l6/2011 ^ NORTH ANDOVER, wmO1ew5 A«mm/umm, Tn:: 90358 ~ ` ` ' ' ' ` ' . � ` � . ` ` ' - . |