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HomeMy WebLinkAboutBuilding Permit #005-2016 - 143 MILL ROAD 6/29/2015 • 1 I ✓ t%ORTFl BUILDING PERMIT o`��LeD ,bgro TOWN OF NORTH ANDOVER - APPLICATION FOR PLAN EXAMINATION * z Permit No#: J Date Received gSSACHU`��� j Date Issued: `t✓ [/ ` IMPORTANT: Applicant must complete all items on this page LOCATION 93 Mm rR c5a Print PROPERTY OWNER C ( b \�1 t Co dc's i Print 100 Year Structure yes . no MAP-PARCEL: ZONING DISTRICT: Historic District yes no it Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building KOne family ❑Addition D Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial A Repair, replacement 0 Assessory Bldg ❑ Others: ❑ Demolition ❑ Other D Septic Q,Well ❑ Floodplain ❑Wetlands D Watershed, District 0 Water/Sewer- DESCRIPTION OF WORK TO BE PERFORMED: f �J-e" Identification- Please Type or Print Clearly OWNER: Name: Q10 VAi r-6 los I Phone: Address:) I t aid Nor+ v Avt/ i r- Contractor Name:, VIQ , Phone: q)S ' (oB J 0 Email: o Address: Z31 k --,L).46y, Sk L) r\.. 3 goAr4 dye. (1A U/&I/.i Supervisor's Construction Licenser Exp. Date: 1 ' o Home Improvement License: ID Exp. Date: -7 --(Y- ARCH ITECT/ENGINEER -(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: $ 1 G 9 �6 ;6b FEE: $ 2--G 5— Check No.: M L(q Receipt No.: a,f�t6' NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund _( .__� 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 OTE: 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/Cross Section/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 OTE: 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 2012 I ECC Energy code Engineering Affidavits for Engineered products OTE: 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 2014 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/Massage/Body Art ❑ Swimming Pools ii Well ❑ Tobacco Sales ❑ Food Packaging/Sales� Private(septic tank,etc. ❑ P ❑ ermanent Dumpster on Site j THE FOLLOWING SECTIONS FOR OFFICE USE ONLY � INTERDEPARTMENTAL SIGN OFF m U FORM 7 I PLANNING & DEVELOPMENT Reviewed On Signature_ � 1 COMMENTS l CONSERVATION Reviewed on Signature y� COMMENTS HEALTH Reviewed on Signature i II COMMENTS I I i ?oning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i fE Planning Board Decision: Comments i Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town]Engineer: `ignMure: Located 384 Osgood Street FRE DEPAMENT� TemVDurnpster on setae Located at 124 Marn Street '� kt - '`" , n Fire"Departmesignat rel ate 'ik tii®M M E � y.w,..,�,r',,,,,,,.,,`_.-,'. „ •' p +e y..--r,ixc.7.—..ASF-� 4 t i . I �I Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL.: Movement of Deter 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) A i I y D Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Location s tq� � �� • No. Date 612nl ICS 1 ' . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ r� Arco TOTAL $ Check#` t i 23995 UB ilding Inspector NORTH own oAndover 0 : .0y � No. bD!5 2b l p 41 t _- h ver, Mass, COCMICKl WICK p�4A,rEO PP�,`�C5 S tl BOARD OF HEALTH Food/Kitchen PERMIT T .. LD Septic System THIS CERTIFIES THAT ..... I�.o....` ®`�/�.. /Ore"..................................................................... BUILDING INSPECTOR has permission to erect buildings on Foundation Rough to be occupied as ............(S ... .... .. .... . ....... e................................................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 CONSTRUCTIO ARTS Rough ................. ........... ............................... Service '�� Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy.Buildin 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. Smoke Det. DAVID CASTRICONE, PRES. 3- /r CASTRICONE ROOFING & SIDING INC. 16 ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 231 R SUTTON STREET UNIT 3A, NO.ANDOVER, MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314 I/we the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to famish all necessary materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on premises_b low descr fled, Owner's Name...... l..t?......1..1t.L.GL?. $ ....................................................T ephone#...la�!•.1. �.....-.. .GG Job Address..... .... 11::1.f... t.................................Ci { ►� �'- ty.......U.r.... t1 .O...S..G'T.................State....,( 1A Specifrcaiions: .......................................................................................:......................../.................................................................................................... '/Strip existing shingles�/) vApply new drip edge to all edges. //...................................................................................................................................................................................................................... ✓Apply fect lee and water shield membrane to bottom edges of hot{,e.3 feet ice and water m shield brane in valleys and bottom edges of any unheated areas of house. � f, I c V`� i. C,t�c�K�n .................n pply fel ')'T *u tderlaymcnt. "sta11 ridge vent to ...... S//rt .t.P..i.,z......(..1...........�........... ......... .......... ....... l .....................L�— il2eroof usin . rte Jy �1shingles with a warranty. .................................................................................................................................................................. ........... .......... ... ,/Counterflash chimney. ✓New vent pipe flashing.✓j,egal disposal of all debris. ........... . ............................................�.."..)...... 3 tYl/..........C' /...t'r ..../•/ll. to s Area(s)to be worked on: r ................................... t .: ..Lt,t't'c?-r�'...t?.......:. 1.zz. . . .................................. I•�.f ..: I..�r/ . e_..... .. .L1.,SLr+ •Y...........!•%•)4.l'rF....i7 ,, fit.: .-e..... {4�.�........ . te:S ......�,...��. . .......... Rc­ . Yy.l t oof board rm placeent if necessary @ �� /sheet�r E_z D. /foot. ..................:.�a.1�..r.r.......... ...................... .... Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specifie by ipanufacturer The contractor agrees to perform the work and fu ish the materials specified above for the SUM $..../t V.9.0....... Payable...:.. .. .. on.... ............... 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 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.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 arc 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. w All Home Improvement Oontractors 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 donstruction-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 the 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,231R Sutton St..,No.Andover,MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their names this. ... ..day of... ......,20... Accepted: Signed ............ ... ... ........ .. ......................... Owner Signed............................................................................. Owner ....... . . . ......... .............. ..... David Castricone,President '.'.� The Commonwealthof Alassachusetts - Department of Industrial Accidents ==ti; Office of.Investigations 600 Washington Street Boston, 1111 02111 Mov.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeEibly Name (Business/Oraanizatioo7ndividual): Dm 1D C 11.,,5 R 1 C.0N1t. RUGS( 1x is " Si D 1 NC) Address: �,31 Su-FTC N Si REL 7 UN i i JA City/Stiltc/Zip: N0, AN 60\i LPhone h': 9 7 13 ��U 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 (fiill and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.El 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 wor ' kers [No workers' comp. insurance comp. insurance.1 9. Building addition ❑ We are a corporation required.] 5. oration and its 10.0 Electrical repairs or additions 3.❑ 1 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' 131-1 Other_ comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their a-orkers'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 v�hether or not those estiies have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I an: an employer that is providing it,orkers'compensation insurance for my employees. Below is the policy and job site information. InsurancPCompany„ Name:_CRFlNtTE TATE ( NJU CANCQ Co : Policy#or Self-ins.Lic. #: W 0_0 O 3 9 19 q 03 Expiration Date: I I Job Site Address: �m l b I iw City/Stafe/Zip: I b. arv�tr 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 5250.00 a day against the violator. Be advised that a copy of this statement may be fon arded to the Office of Investigations of the DLA for insurance coverage verification. I do hereby certify under th(e�pains and penalties of perjury that the information provided above is true and correct. Sigmature: .`J.,.../ �J C Date: Phone#: 05 3 VL0 Official use only. Do not write in this area, to be completed by city or town offzciaL Citi- or To) n: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone#: DATE(M DNYYY AC"RO CERTIFICATE OF LIABILITY INSURANCE 9/10/2014 ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Susan Donnell Eastern Insurance Group LLC PHOIAJc.NE Ex, (800)333-7234 PAID No: 233 West Central St EMAIL .sdonnell@easterninsurance.com A DRE INSURERS AFFORDING COVERAGE NAIL N Natick MA 01760 INSURER A:Western World Insurance CO INSURED INSURERS-Commerce Insurance Company 4754 David Castricone Roofing 6 Siding Inc, DHA: INSURER CGranite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER O: INSURER E: North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBERMaster 14-15 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 1NDICATED. 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP TYPE OF INSURANCE LTR I POLICY NUMBER IMWDONYYYI IMWDDtYYYY) OMITS �I GENERAL L1ABfLr Y EACH OCCURRENCE S 1,000,000 I DAMAGE TEN ED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence S 50,000 A CLAIMS-MADE ❑X OCCUR P1388404 /6/2014 /6/2015 MED EXP(Any one person) S 1,000 t—I PERSONAL 8 ADV INJURY $ 1,000,000 - �I _ GENERAL AGGREGATE $ 2,000,000 L---FN"L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG S 2,000,000 X 1 POLICY I17 P,O- JrCT LOC g AUTOMOBILE UABIUTY EOTSIINdeDISINGLE OMIT ANY 1,000,000 B �I NY AUTO BODILY INJURY(Per person) S �.ALL OWNEDX SCHEDULED CNGCV /1/2014 /1/2015 i.aL I OS AUTOS BODILY INJURY(Per accident)I S NON-OWNED j K LPED AUTOS X AUTOS PROPERTY DAMAGE S Per accident UMBR`.LLA LAB OCCUR `-1 ��UAB HCLAIM EACH OCCURRENCES-MADE I AGGREGATE S I I DEO 1 1 RETENTIONS C I WORKERS COMPENSATION _ITWC STATU- OTH S DRY I'M AND EMPLOYERS'LABILITY A,VY?ROPRIETOR/PA.4TNER/EXECUTIVE YIN 100 000 os=,c_R EMxRExGLuoED? NIA E.LEAC HACCIOENT E (!yes, esc rn NH) 0003989723 /23/2010 /23/2015 E.L.DISEASE-EA EMPLOYE S 100,000 Ii yes oesaiba under OESCM:=TION OF OPERATIONS Delo. E.L.DISEASE-POLICY LIMIT S 500,000 I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,A more space is required) Roo=ing S siding contractor I CERTIFICATE HOLDER CANCELLATION Castricone fZoofing & Sidhrfg SHOULD ANY OF THE ABOVE DESCRIBED POLJCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Unit 3A ACCORDANCE WITH THE POLICY PROVISIONS. 231 R Sutton Street --- AUTHORIZED REPRESENTATIVE North Andover, MA 01845 John Koegel/MET ACORD 25(2010!05) ©1988-2010 ACORD CORPORATION. INS026nn.rm,n, All rights reserved. Th.ArnRfl r,emo�nrl Innn aro ronia�nror�mar4lro nr ern+an g Massachusetts - Department of Public Safety Board of Building Regulations and Standards tandards C,nctructiun Sulun i�nr Shrii:�lh License: CSSL-099358 DAVID T CASTRICONE,, 31 COURT STREET NORTH ANDOVRR NUA7) 5 �- Cxp�ration Commissioner 12/16/2015 . Office of Consumer Affairs& Business Regulation _ OME IMPROVEMENT CONTRACTOR 1' registration: 104569 expiration: 7/14/2016 Type: - r' Private Corporatic DAVID CASTRICONE ROOFING,SIDING& David Castricone 231 R SUTTON ST SUITE 3A _ NORTH ANDOVER, MA 01845 Undersecretary