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Home My WebLink AboutBuilding Permit #259 - 134 COACHMANS LANE 10/14/2008 BUILDING PERMIT of NORTil TOWN OF NORTH ANDOVER O - L APPLICATION FOR PLAN EXAMINATION * _ e.^ Permit NO: Date Received A Date Issued: CHUSEt�� 41%&POO—RITANT:Applicant must complete all items on this page LOCATION 13 4 'CO ACR M R M's L A k6 k 6 9-774 A,Jo 1) 4 Print PROPERTY OWNER A LA> iA 1b C C 1� /N Print j MAP NO: PARCEL:( 4 ZONING.DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family V 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: S-E-I'I p e Sh nr-'i rzo�- &reaj cOJ j Identification Please Type or Print Clearly) OWNER: Name:_ I<&L`P N rJ C tPhone 7 / Address: CONTRACTOR Name: a n t d u o f nG fJ 4c Phone: 9 7� 6B 3 Y10 Address: 266 S u y) J' k t ;r Z Supervisor's Construction License:& Exp., Date- 1 i ('0 -2,0 i 1 Home lmprovement:License: (0141 Exp. Date: `7 y- ) ( 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: $ ` FEE: Check No.: 7 L/ Receipt No.: /S�Jr'Z- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund v. ' T(_ " 5ignnature of Agent/Owner ._�_� SlanafitlrP of rnntrar+ter .�... Location No. Date NORTH TOWN OF NORTH ANDOVER i Certificate of Occupancy $ Building/Frame Permit Fee $ — Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # < r- s o� Puilding 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 60MMENTS 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 Located at 1124 Main Street Fire Department signature/date 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 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 2.2008 ` V4ORT H � Town of tAndover Z S� 01 Z+ L A o dover, Mass., COCHICMEWICK ADRATED PPS` �C S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING .INSPECTOR THIS CERTIFIES THAT .. ..4�..l jQ/")....... 0.0.. .. ..1�a... . Foundation has permission to erect........................................ buildings on ............../„,f'�. .. .. �1 .G..... W -e.h. ! ...... Rough S17 to be occupied as........................ 70..�:Wo.. .®. ....................he............. .........:.:............................... Chimney provided that the person accepting this permit shall in every respect conform to tterms 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 CONSTRUCTION ST TS Rough 7 �-"-�_..,...... .. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. �las�achu�ctt�- Uclru•tnlrnt Of NtlllliC S;1feh � Buartl'td''.$uiltlinl, Kc!�ulatiuns antl titan(lards G/-- `� 9211 'COoirr.%rcaracuNaG[I2 0� Gs and�I1Jrli(Jurde 6 Construction Supervisor Specialty License -\ Board of B,iidin lie ulatiud _ _ c s Standards License: CS SL 99358 _— HOME IMPROVEMENT CONTRACTOR Restricted to: RF,WS x _ Registration: 104569 r Expiration: 7/14/2010 Trig 270265 DAVID CASTRICONE 31 COURT STREET � ;�-: Type: Private Corporation NORTH ANDOVER, MA 01845 DAVID CASTRICONE ROOFING,SIDINGS, David Castricone � Expiration: 12/16/2011 200 SUTTON ST SUITE 226 ` Trn': 99358 Administrator NORTH ANDOVER,MA 01845 � ( uiuuisiuncr y ' Ili ACQRDTM CERTIFICATE OF LIABILITY INSURANCE DATE/200/YYYY) PRODUCER 10/3/2008 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. INSURED INSURERS AFFORDING COVERAGE NAIC# David Castricone Roofing & Siding Inc INSURERA:Citation Insurance 0 7 200 Sutton St INSURERB:The Insurance Co of State PA Suite 226 INSURERC: North Andover MA 01845 INSURER D: COVERAGES INSURER E: 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. ww ADM SRE TVPF OF INSURANCE POUCYNUMBER POLICYEFFECTIVE POLICYEXPIRATION GENERAL LIABILITY OMITS EACHOCCURRENCE $ COMMERCIAL GENERAL LIABILITY -M AGE:[ORIENTED PREMISES Eaoccurence $ CLAIMS MADE OCCUR MED EXP(AnyonePerson) $ PERSONAL&ADVINJURY $ GENERALAGGREGATE $ GENL AGGREGATE LIMITAPPLIES PER: PRO- PRODUCTS-COMPIOPAGG $ POLICY LOC A AUTOMOBILE LIABILITY ANY AUTO 08MMBBTNKT 8/1/2008 8/1/2009 COMBINED SINGLE LIMIT ALLOWNEDAUTOS (Ee acddert) $ X SCHEDULEDAUTOS BODILYINJURY (Per person) $250,000 X HIREDAUTOS X NON-OWNEDAUTOS BODILYINJURY (Peracddem) $500,00() PROPERTY DAMAGE (Peraccldem) $100,000 GARAGE LIABILITY ANYAUTO AUTO ONLY-EA ACCIDENT $ - OTHERTHAN EAACC $ AUTOONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACHOCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS AND WC5877756 9/23/2008 9/23/2009 XWCH- $ EMPLOYERCOMPENSATION A ANY PROPRIETOR/PAMNERICXECUTIVE E.L.EACHACCIDENT $ FFICER/MEMBEREXCLUDED7 00,000 "'e describe under E.L.DISEASE-EA EMPLOYEE $10 O 0 0 0 SPEG�IAL PROVISIONS below OTHER E.L DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SP ECIA L PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED David Castricone Roofing & Siding Inc BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER 200 Sutton St WILL 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 01845 THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORD:ED REPRESENTATIVE ACORD 25(2001108) p ACORD CORPORATION 1988 K The Commonwealth of Massachusetts ` Departttterit of In(lttstrial Accidents Office of Investigations w 600 Washington Street Boston MA 02111 www.ntass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly n Name (Business/Organization/Individual): _D au 1 d lastrr LO l(1 G IQ M_r,AV% { J 1�1!�a - Address: ,VU S ��rx 6krleCA S�-0M 22 rr City/State/Zip: AnLier HA 61 g14 S Phone #: q-A 18 3 J 4 a 0 Are you an employer? Check the appropriate box: Type of project(required): 1.X I am a employer with S 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 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp. insurance. 1 required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself ' right of exemption per MGL y �o workerscorn p. 12.'gRoof repairs insurance required.]t c. 152, §1(4),and we have no 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. tcontractors 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 afri an employer that is providing worlcers'compensation insurance for my employees. Below is the policy and job site information. C Insurance Company Name: 71-C. 1n ,o(a.A(.e. ?A Policy#or Self-ins.Lic.#: �(�( Cr �j $ (p Expiration Date: 9 la3 to 5 Job Site Address: 13 9 C AQ-WA 0'S LN-OL City/State/Zip: 00.111 M)b 0 QG£ M1q d/ Rr 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c i in the pains and penalties of pefjury that the information provided above is true and correct. 1 signahue: 2 Date: Phone#: c1_)� /G �3 J q Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Town of North Andover tAORTly Q Building Department 27 Charles Street North Andover, Massachusetts 01845 o V " (978) 688-9545 Fax (978) 688-9542 'p COCnI[IWNX 1 �$sACNU5 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 c11, s15Oa. The debris will be disposed of in/at: Facility location 17• X Signature of Applicant m Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. 11.E/C7g 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 HaverhUI 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 beKw scribed: \kJ�rp If 3 L Yr D , Owner's NameS ems. ....... ... .......................TeAphon,#....�c�2..'"'`.g 2�.�i.......... Job Address..... �t ....1...8P�., .....h /.............city....NO—. ................State........... Specifications: .�tr,i ................................................................... ........ .... ....................... .................................................................................................... Strp existing shingles.C) r rti'pply new drip edge to all edges. yfld wx 8" ........................................................-.............*--.............................................................:........................................................................ 4p-p* 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. 4 ...............-..... ................................................................................. ..................................................... t piy felt p//a��p---erpunde mens Install ridge ve to .................1J. 1A. ... ...................... ... rReroot using shingles with a �year warranty. .............................................................................................................................................................. coCounterflash chimney. New vent pipe flashing. -Legal disposal of all debris. .................................... 7."...................................:.......... a./`................................................. Area(s)to be worked on: n/ xxlv.ta.a......... . ........J,1..e.l..... .......t.......b.In e`.f-1.......... ............................... ,a..a.�e ....... . ,.,H .e ........... . ..................... ..(Ala.VV',el'.... �.tte, ........................... . ......... p l g�. Jacu....../` ...... ..b. y.S. t�.. rt .. jp.� ..................... Roof boar replacement if necessary @ GD /sheet oi'y o--✓too ........................................ .............. (............................�.�.................................... .......�................... ....... Two Year WorkmanshipWarrantyNot Transferable nufacturer's Warrantyass i6 manufacturer The contractor agrees to orm the work ish the materials specified above for the SUM $...... .�8c�Y!r: 6 Payable-��i7Lbn.....Sfia. ............. Payable.........7-.-&......on............==............... alance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability whm eob.s m ope on. 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.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 dependant upon or subject to any conditions rot 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..(1 Approximate starting date of work.. ..1 L .. QV,� 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 parties have hereunto signed their names this..... .L.A%'.day of.t.l ,20-412 Accepted: ��R Signed`�..�X. .L�1�..ch?5.). .. »»......... Owner r2. Signed..........................................................».....».......... Owner David Castricone,President