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HomeMy WebLinkAboutBuilding Permit #740 - 145 BEAR HILL ROAD 5/21/2010 BUILDING PERMITOf No DT 6Ati ? 4E.,, tp O TOWN OF NORTH ANDOVER - - APPLICATION FOR PLAN EXAMINATION 0 C Permit NO: Date Received q°j+wreo cy �SSACHU`��� Date Issued: �'Z'�' [0 IMPORTANT:Applicant must complete all items on this page l! > LOCATION Print PROPERTY OWNER gMU&- 2 Y Print MAP 210 (© `f PARCEL:__ZONING DISTRICT: Historic District yesCno) Machine Shop Village yes 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: Identification Please Type or Print Clearly) OWNER: Name: `.5amue% Phone: 7F (f-"2 Address: /�4S 3-ffy ,��a� /� a b61o1Z1 CONTRACTOR Name:2)* 0ai M601172 Phone: 3 }� Address:,219-,0 c yr c�,5c /2� 2Z(( /Ily r' a/jp�j— Supervisor's Construction License ' Exp. Date: /pZ /E Home Improvement License: /d57o Exp. Date: 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. D� Total Project Cost: $ FEE: $ SZ Check No.: Receipt; No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner . Signature of contractor Location I If- &4r' �i 'I )1j" No. Date NORTh TOWN OF NORTH ANDOVER O�t•�ao a,h to p Certificate of Occupancy $ — �'�s Building/Frame Permit Fee $ s�cHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 23 1 t.7 Building Inspector i 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 I PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS r t 1 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 124 MainStreet Fire Department signatureldate COMMENTS Dimension Number of Stories: Totals square feet f q o 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 2010 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:Building Permit Revised 2008 1.1pRTM Town ofAndover . . 0 No. qU v dover, Mass. �' Z� • 1� O > COCHICHEWICK ADRATED S V BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........... ..................... . a. ... . ............................... .. "" Foundation has permission to erect............... ... bwl gs on ..1... ..r ��Nir..........�...(..... Rough 1� Chimney to be occupied as........ ^� ` ..."'r..........................�.�L....�a . .............................................. ......................... y provided that the person accepting this permit shall in every respect con rm 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 CONSTRU STARTS Rough ..... ... ... ..... ............... Service BUIL 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. _ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street g t Boston, MA 02111 a 3 wwrv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): AV I e AS-ra I C O Nc_- R 06 FELT 15 I't>I N Lr N L Address: ZOO Su-tSpt3 S-v R 'r Sy v- ->; -2-:Lt. City/State/Zip: h.ANDO SIE IC MA 0 18 NS Phone#: 9-)t (p g 3 3 42o Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with rd 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 workingfor me in an capacity. employees and have workers' y p ry� 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We 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.X] Roof 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. I 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: G S 7�1P OSUr_"_ce (26 t1(1D Policy #or Self-ins. Lic. #: W (_9 l S a,7 y G Expiration Date: Job Site Address: I 4,S 13e ar A I1 004 City/State/Zip: Off, AYx(1U,,e . 17A 61W 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: C Date: _ Phone#: u) 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 � gtOfa7ly ... O ,� y� i 4. Buildin D 27 Chaules Streetd, u North Audover, 1VlassucJ�usetrts U18 * ' 4 5 978 688-9545 �� ��4�`" �� ( ) Fax (978) 588-9542 uR�rcn tiP`�,��3 V' SA C m)50 DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit. # the debris icing from the work shill be disposed of in a properly licensed solid waste disposal facilit._, as defined by MGL c.11, s150a. The debris Will be disposed of in/at: Z—)I�aGility :Ic>�:iilion -- Slgzaature of Applicant Date NOTE- A demolition permit from the Town of North Andover must be obtained Cor this project thio-ugl.the Office of the Building Inspector, I� �(1j, HOME IMPROV- _NTCON-113ACTOR License: CS SL 993' f J Restricted to: RIP, 4 ^G^!ity J Rec istratiotl: 1045G9 ,, 1 f : . ��• '!/ Expiration: r 7/141 010 TO 270265 DAVID CASTRICONE Type: Privatr-,Corpor,.;llian 31 COURT 31REE-f i` NORTH ANDOVER, MA 0.184 `�;�^t�+l!'Ir�, DAVID CAS-I-RICONE- ROOFING, SIDING& David C2slricone 200 SUTTON ST SUITE 226 _ NORTH ANDOVER, MA 018,115 i=xpuntion: 1J"I C%?011 ------• i\Umiuistrator C nuni..ii n•'/ Trr: 99358 it LI,rV/.>,YI.1 v6_1♦ �� I%drr% I L_ %,fI 1 Illp"k"IILIS i e 1111+11%.-Alkilxr-ml.i%0L I 09/2(4/21)O9 If PRODUCER (508)651-7700 FAX 508-653-8089 -THIS CERTIFICATE IS 1,55UED AS A MATTER OF INFORMATION Eastern Insurance Group LLC - Commercial ONLY AND CONrERS NO RIGHTS UPON THE CERTIFICATE 233 West Central Street HOLDER,TH15 GERTIF!CATS GOES NOT AMEND,E.KT�ND OR ALTER T� HE GQVERACr_AFFORDED BY THE]POLICIES EJELOW, Natick, MA 01760 --- -- Select Ext.53389 INSURERS AFFORDING COVERAGE NAIL# INeuREd Pavid Castr,cane Roq ,ng iding Inc INsuRFRA: The In5urarce Co Df State PA 200 Sutton St INSURER E: -- Sul to 226 INSURER C', North AntigvQr, MA 01845 INSURER D: INSURER C. COVERAGES THE POLIGIE5 OF INSURANCE LISTED BELOW HAVE BEEN 155UED TO THE INSURED NAMED ABOVE FOR TI11_POLICY PERIOD INDICATED,NOTWITHSTANDING ANY PgOUIREMEN7,TI(QM OR CONDITION Or ANY CONYRACY OR OTHER DOCUMEN r WIYH RESPECT TO WHICH THIS CF_RTIFICATL MAY BE ISSUED 013 MAY PERTAIN,THE-INSURANCE.AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS ANL)CONDITIONS OF$UCH POLICIES,AGGREGATE LIMITS SI-IOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. II OD' TYPE UF-INSURANCE POLICY NUMBER POLICY F_FFECTIVE POLICY EXPIRATION LIMIT, --- MIR FAGH OAYg(D4MdlAR GENERAL.LIALSILIIY GCCURRFN(;f: COMMERCIAL GrNLRAL LIABILITY f AMACE TO RLNTEIJ `- CLAIMS MADE I DCOUP MCD L51G�nnccuratic>: CXP(Any one pnmon) x PCRSONAL&ADV INJURY $ Cit:r0-I:AI A(CORL"GAM q GtN'L AGOKEGATI"LIMIT APFLIES rER. r'NVUUC I S-COMP101'AGO $ POLICY FRO LOC JFCT AUTOMOHILF LIADILIYY Coe,eiNr_n�INr,L[LIMIT $ ANY AUTO II-a d[ad[nQ ALL OWN;-p AIJ10% BODILY INJUHY $ SCHEOULEDAUT05 (Ilei vo)m ) HIRED AUTOS ROOII.Y INJURY $ Pur:accidcrli NON-OWNED AUTOS ) PROPFR)YhAMAGf (Per Acefdent) GARAGE LIABILITY AUTO ONLY,EA ACCIDENT $ ANY AUTO OTHER THAN I;A A" $ AUTO ONLY: AGO g EXCE99AIMHRELLA LIAMILITY - CACIIOCCURR.NCF :L OCCUR CLAIMS MAOI AGGREGATE y 17tlwc,)DLp ^^ 1 RETENTION S S WORKFR4 COMPENSATION AND WC9752746 09/23/2009 -co-09/23/20 )( I WC STATLI- OTH EMPLOYERS'LIA131LITY E_y_UMLT A ANY PROPRIF:'rOR/PAR'TNER/EKECII-rive E.L.EACH ACCIDENT S 1QO,000 OFFICFRIMEM,FR 0,0imDr O9 It YYe�soscnbc Wdrr E.L.DISEASE-EA EMPLOYE 5 100,QQQ xC6,dSAt.PPOV18IONS below F.I„DISEASE_POI IUY LIMIT F 5QQ QQQ OTHER —-— 069CRIPYION OF OPERAYION4 I LOCATIONS I VEHICLE4 I FXCLURION9 AODEO RY FNDORREMENT 1 SPECIAL PROVISIONS CERTIFICATE I ER---- Q ANQE-"_11OO - SHOULD ANY Or-YHC AOOVC'.?t.�.CRIBEU POLICIES',`1C CANCELLCD$ErORE YHE David C a s t r i c o n e R o o F i n g & Siding EXPIRATION DATE THEREOF THE ISBUINC INSURER WILL ENDEAVOR TO MAIL 200 Sutton Street 10 DAYS WRITTEN NOTIOT TO THE CERTIFICATE HOLDER NAMP_D TO THE LEFT, Suite 226 HUT FAILUME TO MAIL SUI'H h'GTICE SMALL IMPOST NO OALIGAYION OR LIABILITY North. Andover , MA 01845 OF ANY KINK UPON YHE IN54 rR,IYS AG@NY$Ort r¢t:PRES@NYA7IVES. AUTHORIZED REPRESENTATIVE 1 �j s ACORD 25(2001108) (K)ACORD CORPORATION 1988 I� DAVID CASTRICONE }} CASTRICONE ROOFING&SIDING INC. /o-w/ � ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS, HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 !r�' 200 SUTTON STREET,SUITE 226,NO.ANDOVER,MA 01845 ; In North Andover 978-683-3420 1n Boxford 978-887-6147 In HaverNZ!978-374-7*1 , 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 below des LL 'bd ocan.e(�#.... ....... . ............................ ........Tele !�'.� Owner's Name...... arx4. .... ..t. ..........State ..' T•........Job Address l.l..��•• � . Specifications: II ...................................................................................................................................................................................................:............ ll i. � rVVStrip existing shingleski) -Apply new drip edge to all edges. Gtifhi�c�0 i s//V-C;, ...................................................................................................................................................................................................................... rPFpply _feet ice and water shield membrane to bottom edges of house. feet ice and water shield membrane (1 in valleys and bottom edges of any unheated areas of house. F.-ill h+e o ............................................................................................................ ... ........................................................!p`...... :.4..................... Apply felt paper unteerllaymenn ... [s'.t r........... ...... ......... r. ..w s req>X• 7� et 4nstall midge vent to .... ... ................................................................................................. Aeroof using (7 e r lL ` /ow n �` ti ; rl.3' shingles with a .S C? year warranty. ...................................................................................................................................................................................................................... Counterflash chimney. ,Mew vent pipe flashing. Legal disposal of all debris. .......................................................,3...................................................................................................................................................... Area(s)to be worked on: Ail.... /�/)/) (�/� �•%•L./....... ...61 t4�ru.5......Ca�......{:L.D...il.5.: ............CO.�!.............f. f .:?..5...� ...................................... 4 �) .RX7A o �,,r......f.n�......••`•l't.r>x ... t�s.�i..,s i f! a. ..ri 5... A..S. l fit. a .............. .. .................................................. ......... ................... o _ ` ' �.Z .................................. .... :J Root board replacement if necessary@, ti 0 /sheet o I /foot. .................................. �., Two Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as sped by manufacturer The cor�ractor agrees 4o perform the work and furnish the materials specified above for the SUM f$....L.y?,, ���•.•. payable..... . ..................on...s.l-ir,7------& Payable.....!f.3..................on.... ,t..`�y^�+ 3 alance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability while job s 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 u completion of above work,all undersigned agree to execute and deliver to contractor,theirjoint 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 wa nu t(s)that be 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 aro no representations,guaranties or warranties,except such as may be herein incorporated,if any,not 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...............f=� ...................... Completion date......................................................... Receipt of a copy of this contact is hereby ac owledged,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 nam this....... .C.....day of.... �� ..., Accepted: `! C Signed � ..............�................ Owner Signed.................................................... ............... Owner ' ................................................................... ,&'Z C.+v is/i2 ✓�El%'cuv "` �TYt David Castricone,President /�J2 !