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Home My WebLink AboutBuilding Permit #723-11 - 128 JOHNSON STREET 4/29/2011 BUILDING PERMIT Olt "°oT" qti TOWN OF NORTH ANDOVER a? APPLICATION FOR PLAN EXAMINATION X23 - r I Permit NO: Date Received 4 ��SSACHU`-+E�� Date Issued: I IMPORTANT:I I Applicant must complete all items on this page LOCATION - v J0 AA,5 4n Jree f ' Print PROPERTY OWNER PCr7t�r/ v Print MAP 210 0q_7 PARCEL: Cwz ZONING DISTRICT: Historic District yes no 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 /Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed 'District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Rear ry6bv ma and boo- .tlJe of lower wood oil'' Identification. Please Type or Print Clearly) OWNER: Name: ae �OdrrGrlC't Phone: Address:__12,1 Johrwn Sore+ 'nw4i_ �4ovier - oApA omf' CONTRACTOR Name: }.Lh(_bN &C(N(y �S tb j&)& Phone 9'?8 G83 3VI Q Address; ZOO ,�u Mt) - Supervisor's Construction License: qc3S25 Exp. Date: 1: —Ao -20 II Home Improvement License: -I' ( Exp. Date;. 7 - 1+ 2-a 1' 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: $ ��.D FEE: $ Check No.: ( Receipt No.: go- I NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature _q Agent/Owner Signature of contractor 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 s Z�nirig 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 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 i 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 I I i I. i r ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 gnature of contractor 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 ❑ 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) t ❑ 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:Building Permit Revised 2008 Location No. Date NORT1r TOWN OF NORTH ANDOVER O � M i Certificate of Occupancy $ �' bo��ao•A« �ssncNusEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ i Check #/a/ s 24 1 62 Building Inspector ORTH Tovm Of Andover . o LAK -O dower, Mass., 1 99 COCMICMEWICK t 7�AD)�OATED `s BOARD OF HEALTH Food/Kitchen .PERM IT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......... .... / . t .... ................. ............................. ................................... . ...................... Foundation . ....... .... . has permission to ere buildings on t Z ......... ... !rr...... ... •.. Rough ....................................... ...................... t0 be OCCupled aS..... ... �. .� I..................................................................................�........ Chimn y e provided that the per on accepting this permd shall i very 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC STARTS Rough ...................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocaipy 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 - www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ,UAV 1I CAsToc1c oNt Roo F (N6- ' Si o/ow INC. Address: 2O G Su,TTao STr2t&-r Su ;tz ZL� City/State/Zip: N o. R N ao,tE fc. NA d 114 5 Phone #: 9G%L3 42- c Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑ 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-El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.;] Roof repairs insurance required.] t employees. [No workers' 13.❑ Other 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. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors a»d their workers'comp.pol icy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 1. A tZTI S Policy#or Self-ins. Lic.#: ig COQ d q b TW Expiration Date: Job Site Address: /,2 Xi ;�,fAAi ori !�d City/State/Zip: / /J. n�d Vr, 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 certifyunder t e pains and enaId of perjury that the information provided above is true and correctSi nature: -�-� C= Date• Phone#: 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): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: I ACORD CERTIFICATE OF LIABILITY INSURANCE DATE/201lYYYY) ra 9/241"LO10 PRODUCER Phone: 508-651-7700 Fax: 508-653-8089 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. I INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERAiCitatiol7l I-suranc . 40274 David Castricone Roofing & Siding Inc 200 Sutton St IwsuRERB:CHART I5 Suite 226 INSURER C: N--i:th Andover MA 01845 INSURER D: _-- INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW' 'HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOP. 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 RA%'E BEEN REDUCED BY PAID CLAIMS. I SR D POLICY NUMBER POLICYEFFECTIVE POLICY EXPIRATION LIMITS GENERALLIABIUTY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY AM ESE PREMISES Eaoccwencel $ CLAIMS MADE OCCUR MED EXP(Anyone person) $ PERSONAL S ADV 114JURY $ GENERAL AGGREGATE $ GEN•LAGGREGATE LIMIT APPLIESPER: PRODUCTS-COMP!OPAGG $ POLICY 7 PRT LOC A AUTOMOBILE UABIUTY BCNGCV 8/1/12010 8/l/2 O1 1 COMBINED SINGLE LIMIT ANYAUTO (Eaaccideru) $1, 000, 000 ALLOWNEDAUTOS BODILY INJURY $ Y, SCHEDULEDAUTOS (Per person) HIREDAUTOS BODILY INJURY $ X NONOWNEDAUTOS (Per accldern) PROPERTYDAMAGE $ (Per aocldein) GARAGE UABIUTY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHER THAN EAACC $ AUTOONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE ' S RETENTION $ $ B WORKERS.COMPENSATION AND WC003989723 9/23/2010 9!23!2011 }{ WCSTATU- OTH- EMPLOYERS'LIABILITY1 FR ANY PROPRIETOR/PARTNER'EXECUTIVE E.L.EACHACCIDENT $100, 000 OFFICER!MEMBER EXCLUDED? Ilyyesdesaibeunder E.L.DISEASE-EA EMPLOYEE $ 100, 000 SPECIAL PROVISIONS below OTHER E.L.DISEASE-POUCYLIMIT $ 0 0 0 0 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED David Cast.ricone Roofing & siding Inc BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER 200 Sutton St V7ILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE Suite 226 CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON North Andover MA 01895 THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) A m CORD CORPORATION 1988 I y .11;t��ailtu�rtt> - Drli;u'Irn�•nt ul• I'uhlir �uf•cr� � /./ f Board ()I* liuildin hc,ulatiun� ant! �t:uularr►� �: //� "rfu..a.rcuvauyai///. o`..•LL�.ujurXlw_Je&J Construction Supervisor Specialty LicenseOffice 01,cunsuInc r Atl•xns&III&SIeSS ItcguIRtiou Y� License: C5 5L 99358 yHOME IMPROVEMENT CONTRACTOR Registration: 104569 YP Restricted w: RF,WS Type: "'" Expiration: 71/4/2012 Private Corporatio` DAVID CASTRICONE i�<A. .: vu i DAD CASTRICONE ROOFING,.SIDING 8 31 COURT STREET NORTH ANDOVER, MA 011345 ;;• �7i David Castricone 200 SUTTON ST SUITE 226 NORTH ANDOVER, MA 01845 V Undersecretary Expiration: 1211612011 ( nuuii.ciunrr Trg: 99358 At i DAVID CASTRICONE,PRES. CASTRICONE ROOFING& SIDING INC. ROOFING,SIDING&REMODELING REPLACEMENT WINDOW'S) Y"iT: HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 1,. 1 ' 200 SUTTON STREET,SUITE 226,NO.ANDOVER,MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverh111978-374-7314 I/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,construct and place the improvements according to the following specifications,terms and conditions,on premises below described: Owner's Name...:./...`?c!....... /.1uL' .................... .........................Telephone#....... Job Address....l? . ..4 JP.h!1 Ott✓!....�r�T:......................................City.......l.Y,.........11n94Yi'..................State.....M�..... Specifications: ..[�..........:.................../.............................................................`.,.....,..................t..........,.......... ................................./................. ............................... er:••""<( .....Gu? Kl....( ..s3 .... ?! ...$2r+'�... ..JctW(l':...1n/0 �..;7TL .��Ll�t...S l.WF4`.. ................... v�, 1�y5...... ... ,.s�.u � ..................1.......................................................................................................1...../.............................. .......1...... ..:�� ' � �..i..r..T..�I �...... .,...............":S�....................... ......... �:. � ''. . 4 ...... lly..0u ........................................ ............. ..... ... r � . ..................;Q......✓ dl, s.... � C... /... .............raw ?...... .... ...gj... :... ..... /. y.�� ' �,� _...�� t�kl?Y��.....G;lfa�?�?C?�,? S%c3 tc+�..:.. ri ✓Psi:. �...Tu �� +�j�?....,J4.t1............ ............. .? al... ! c,...i!271.... PrP..st��......................... ... ...' .. ..... / 'Srci...S � ....u,j�C.:.' r�Yre—/ ir 5 w cvt c cz......... f.................. .... . . j�lliz c�S ............ ............................................................................................................................................................................ ........................ ............................................................................................................................................................................................I........................ Two Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specified by manufacturer The contractor agrees to erform the work and furnish the materials specified above for the SUM of$...........4 .on............. Payable.iZ!y�..............on....:;� :r............... 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 are property of contractor. Any dumpster placed by contractor is for his use only.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 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 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(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 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 contractors is excluded from the Guaranty Fund p�rvovision of MGL c.142AA.. y� Approximate starting date of work... :.3..A .................... Completion date..... l......... �(J t6K plc 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,200 Sutton St.,No.Andover,MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their names this...Z. ......day of..AP .1.........20.(.1....... Accepted: �-- Signed ......................... Owner p_ . Signed.................................... ....................................... Owner . c o,ems,..,, 1 ................................................................... David Castricone,President i