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HomeMy WebLinkAboutBuilding Permit #372 - 1284 OSGOOD STREET 11/12/2009 BUILDING PERMIT o* "ORT" q qT.lD 16 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 32 Z Date Received wreD��' (y �SSACHU`��� Date Issued: - �� O IMPORTANT:Applicant must complete all items on this page LOCATION /a'��y �rjO4 Or htCJ- . { Print PROPERTY OWNER " ur- ir1 a e-f ,-/- Print MAP NO: PARCEL:_ 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: ,3�rip a14 r csh('� �_ Of Ybo� mcpf �f 5e- 4 �y neb Identifica�.ion Please Type or Print Clearly) OWNER: Name: Art kur q e qz- - Phone: q g 6 ��3 Address: 1XN OS wt S fi-rL� �)brt.. Ay\(avr✓' CONTRACTOR Name: _ S?ri'ai e6ohAl Phone: q) f C �3 - V�c Address: U � 11 L �, U Z2G Owft, At atm ( A 6416' Supervisor's Construction License: q ,3 �b Exp. Date: t Horne Improvement License: f3 Cn� Exp. Date: (`{ ?/ 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. J Total Project/ Cost: $_ /7 y 6 0 v FEE: $ Check No.: / 3 2 V I R S eceiNt N�.. NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ignature of 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH' i 4 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 FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date 1 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 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 ❑ 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 2.2007 �ORTfi Town of 4Andover . 0 No. 12 * of 3 Z - o �s A K E dower, Mass.,_ �1 COC.'CMEWICK y^ '7,9500Areo PPS\ (C� E BOARD OF HEALTH PERMIT D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .. ..... ..... / ............ ................... Foundation has permission to erect........................................ buildings on.....................�a.W. ...r/.........Df.O1. ................ Rough • to be occupied as............ ........ .. ... ....�. Chimney . ................................................... provided that the person accepti this permit shall in every respect form to the terms of the application on ile 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 4440ELECTRICAL INSPECTOR UNLESS CONS N ST 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. 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 978-374-7314 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 belowkdescribed: 6.2.6.: Owner's Name........�.f .. ut t. . .........Q./. . .........................................Tel one#12.4.��jj......6.2.6.:.'...I.9lm/ Job Address./A$4.10.. .......... ..:......................city..... r.... 41 !` ............State.... ...... Specifications: ............................................................................................ trip existing shingles. apply new drip edge to all edges. ...................................................................................................................................................................................................................... ,/Apply 6, feet ice and water shield membrane to bottom edges of house. 3 feet ice and water shield membrane in valleys and bottom edges of any unheated areas of house. .................................................................................................... .......................... .,Apply felt paper and rlayment. Install ridge vent to r7�r� v� L`11e.4 � �O ........................../Li..�......................... ...Ar.................. 7 .. ....... ✓Reroof using a - '' shingles with a `year warranty. /3 ............................................................ r. ................. 1 ..........................................................................!............................. —Eounterflash chimney. —New vent pipe-4flashing. Legal disposal of all debris. �y // �}� 1Cet/s 2r / Sul X61 ..................................................4r. .Af............................................................................... ! r...................1.............. ,................ Area(s)to be worked on: t .............................t l..l= '`.�...J. vt ..kat.t... ..... ...� r>. q. . ..D... ............AJ.:........,z,,�.� 1•..1� .n�..�x�.�5: �XCAF. cr.��. ��-�rtz�n!rS.... qq / ... 0 .........................V1 .........�..... ....... ......... ��..........................................v...l..:D...2l0.... ...........................................................e............................................................................................................................................... Roof board replacement if necessary@ 40 /sheet or4/uO/foot. ..................................................................................................................................................................... ............ Two Year Workmanship Warranty(Not Transferable) 11'r'anufacturer's Warranty as specifiy manufpcturer The coctor agreesp perform the work and is the materials specified above for the SUM s......,.,. ............... ayable....... �..............on.. .......... ......................:......on.................................. alance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability while jo 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 arc 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.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 warrants)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:Director,Home Improvement Contractor 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 notia of cancellation). IN WITNESS WHEREOF,the parties have hereunto signed their names this 1t .....day of..,,1.\Lkl ........20...Of. Accepted: Signed.. .. ....... xs. ..c.�L..>t.. ........ -..�1!.......r^-...... Owner t Signed............................................................................. Owner 4k..Y.1r.4cx...... .... David Castricone,President The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street t g � Boston MA 02111 f www mass.gov/dia ~Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlicant Information 1 Please Print Legibly Name (Business/Organization/Individual): .V AV I C Am i C O X118 R OQ F I NL_ d S ID 1 N C- I P L i Address: ZOc) Su-t-rnlJ Sy V^c-e- Z2b City/State/Zip: MbO J6IC MA 0 1 NS Phone#- (p 3 3 4 20 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 I employees (full and/or part-time).* have hired the sub-contractors 6. 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' 9. Building addition [No workers' comp. insurance comp, insurance. required.] 5. 0 We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.Q 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.El Other I comp, insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ��11 Insurance Company Name:S _� C U f-(ice C45(YAD, -11 ki G� Policy #or Self-ins. Lic. #: W C 9 9,;a.q y (O Expiration Date: q-a,3 20► � Job Site Address: O-S . o d Sji-ec_t City/State/Zip:�4oye/ HA. 61 Hj 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 cruninal 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 coveral4e verification I do hereby certify un�deerr the pains and penalties of perjury that the information provided above is true and correct. Signature: E) � C Date: Phone#: ZO 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#• i • Town of North Andoveri�Y F Building Department � s... _ a p .. a m 27 a Charles Street e .�' u North Andover, Massachusetts 0.1845 * �� 1+ 978 688-9545Fax � ) 978 O'?Arco S sACE1U5'E DEBRIS DISPOSAL FORM In accordance with the rovisions of MGL c 40 . p G s 54, and a condition of Building permit # the debris re!.4,I ting from the work shall be disposed of in a properly licensed solid waste disposal faeilit.; as defined by MGL c.l 1, sl 50a. The debris will be, disposed of in/at: Facility to;talion -- signature of Applicant Date NOTE: .A demolition permit from the Town of North Andover must be obtained for this pro] tluou h the Office of the Building P Ins ector, P 1 g lfffl e C�n�nrreaniucrr/l/ (Y'"16aucecfueeez BOarll of[Wilding Kc1!ul;tfiunti ;tau t inll;u'lls �� Board of BuildingRegnlatioeisandStandards Construction Supervisor Specialty License i HOME IMPROVEMENT CONTRACTOR License: CS SL 99358 Restricted to: RF,WS Registration: 104569 ��. , t, ��= • Expiration: 7/14/2010 Tr# 270265 aal! DAVID CASTRICONE ""''F °''' ' Type: Private Corporation 31 COURT STREET ( DAVID CASTRICONE ROOFING, SIDING& NORTH ANDOVER MA 01845 ' I David Castricone 200 SUTTON ST SUITE 226 Expiration: 1211612011 NORTH ANDOVER, MA 01845 Administrator l''lunmi..iuu• Tr,-: 99358 Y I I . CORD. CERTIFICATE OF LIABILITY INSURANCE b9�28�Z� YY) PRODUCER (5087651-7700 FAX 508-653-8D89 .THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC - Commercial ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 West Central Street HOLDER,TH15 CERTIFICATE DOES NOT AMEND,EXPEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Natick, MA 01760 Select Ext.S3389 INSURERS AFFORDING COVERAGE NAIL 9 INmrw oavid Castricone Roofing & Siding InC INSURERA: The Insurance Co of State PA 200 Sutton St INSURER& Suite 226 INSURER C; North Andover, MA 01845 INSURER O: INSURER E. COVERAGtS THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT,TERM OR CONDITION OK ANY CONTRACT OR OTHER DOCUM5Nr WIYH PESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED 013 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. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCIIRRENCQ $ COMMERCIAL GENERAL LIABILITY DAMAGE TO I&NTED PR9MISES1rrL0acmaBGCL__ $ CLAIMS MADE LLLL�OCCUR MCO CXP(Any one parson) S ���� PCRSONAL 6 ADV INJURY $ 'jL:Nt-8AI ACfdRL'CArc $ GI_N'L AGGREGATE LIMIT APPLIES PER. F'RODUC I5-CGMYlOP AOG $ POLICY PRG LOC JECT AUTOMOBILE LIAAILIYV COAA8IN0 SINGLE LIMIT $ ANY AUTO (I-a d:cident) ALL OWNED AIJi00 BODILY INJURY $ SCHEDULED AUTOS wee person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Por mccidenQ $ PROPr'R'IV DAMAC12 $ (Per Accident) GARAGE LIABILITY AUTO ONLY,EA ACCIDENT $ ANY AU O PA ACU $ OTHER THAN AUTO ONLY: AGO E EXCESS/UMBRELLA LIABILITY CACI I OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ OLUVCYIBLk T $ RETENTION S WORKERS COMPENSATION AND WC97S2746 09/23/2009 09/23/2010 x W1STATuU 0TH. EMPLOYERS'LIABILITY A E.L EACH ACCIDENT _$ 100 000 ANY PRgPRIF,7rJRIPARTNEfUEXECU'flvE r OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ 100,000 Itq* dascnbc Vndcr SPECIAL.PROVISIONS bBIoW F.I.,DISFASF-POI ICY LIMIT $ S00,00 OTHER OCOCRIPYION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS r-ERTIFICATE tjOLDER CANCELL61ION SHOULD ANY OF THE ABOVE OESCR19ED POLICIES BE CANCELLED 9EFORE YHE David C a s tr i c one Roofing & Siding EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 200 Sutton Street 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Suite 226 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY North Andover, MA 01845 OF ANY KIND UPON YHP INSURER,IYS AGENTS OR RI5PRESCNVATIVES. AUTHORIZED REPRESENTATIVE y��� � �y Stace Brice PKG ` ACORO 26(2001108) ©ACORD CORPORATION 1988 Location / ;'l i7'No. 3q Z.-- Date �oRTM TOWN OF NORTH ANDOVER • 0 ' • i ; , Certificate of Occupancy $ Building/Frame Permit Fee $ sic HU Foundation Permit Fee $ Other Permit Fee $ ,TOTAL $! Check # �` 3 7 g 226 i 5 ��--�- Building Inspector