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HomeMy WebLinkAboutBuilding Permit #215 - 15 BRADFORD STREET 9/21/2009 BUILDING PERMITo�"°DT bgti TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit NO J Date Received Argo ��SSACHU`���� Date Issued: Q IMPORTANT: Applicant must complete all items on this page `LOCATFON � a �.1=n�TTn A Print ROPERI'Y OWNER 1 GT6(� NNDR Gd+�-_+ Print MAP NO:- PAI:tGEL: ZONING DISTRICT: Historic District . yes � . '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 1/0ter/Sewer r DESCRIPTION OF WORK TO BE PREFORMED: "r an4 reps h( Ag I'L t�0 Identification Please Type or Print Clearly) OWNER: Name: t L-ru 2 Phone: 50 8 a(95 Yf VO Address: 1 �r0��or� S IUB �Ylr)Cv2� M o l �(f a . a CONTRACTOR Name:. ktwlco►3t &F tNCr Phone:t ' $- e$.3.3.Y2a Address 10-0 Su" b S -T _18.t su�� 7-2-4a J�J'�� J Supervisor's Construction License,: ' $ Exp. Date.: 1f(o ia.o IJ- 'Hometlrnprovement License: t 6 .4E S-OExp. '_Date:, r1_1'4•d41 u' 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: $ 3 0 0 • ° FEE: $_ &11�� Check No.: 2Z—q--c Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to he guaranty fund gignature o#Agent/Owne'r; :Signature of contractor . c mw f, LocationA� No. Date` v TOWN OF NORTH ANDOVER F A A Certificate of Occupancy $ NuBuilding/Frame Permit Fee $ �" s,+cse Foundation Permit Fee $ ' Other Permit Fee $ TOTAL $ Check # 22427 Building 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH 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 f 1=II2E DEPARTMENT. ;Temp•®umpster on site 'yes no Located at 124°Main;Street ' Ire Department signatureldate . t A ',COMMENTS p. 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 y 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 o 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) o 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 ermit Application o 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 o 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 Doe:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 XAORT#q 01M . 0 4Andover . o No. Y _ ;F: :; 0 �I LAK dover, Mass., f jfH COC NIC ME WICK V ADRATED `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......1.11470PA......... A W". .. 4.1.......................................................................... Foundation has permission to erect........................................ buildings ont ....pT.-................. Rough to be occupied as �........... . .:....... .........✓.... /'i'i� Chimney p ................................................................................ provided that the person acceptin his permit shall in every resp t 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 I V� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU STARTS Rough .......................................... Service BUILDING INSPECTOR------ • -Final w� 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 h Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /� .p Please Print Legibly Name(Business/Organization/Individual): _DAV(b C,flSTt2I W NE 1700 F 1NGr 4 SID 1 N G INC Address: All 6 Su'1to N,-," Sr2f.f.-t 6o 1Tt Z2to City/State/Zip: N. A N OVE-A HA 4 I NS Phone#: 9 78 (o$33 q Ao Are you an employer? Check the appropriate box: Type of project(required): 1.X I am a employer with S 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. 9. E]Building addition required.] 5._❑ We are a corporation and its 10.E] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself No workers' com right of exemption per MGL Y [ P• 12.[)Ooofrepairs insurance required.] t c. 152, §1(4),and we have no // employees. [No workers' 13.❑ Other comp.insurance required.] *t;ny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. t Contractors that check this box must attached an additional sheet showin the name of the sub contractors and state whether or not those entities es have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: l f tJ 12P.M(.L V 6E S'MT$-- Policy#or Self-ins.Lic.#: w C,5(a Ir7r? Expiration Date: 9.A 3 •Q 9 Job Site Address: ��� U12 �1%�(� �'`( t.( City/State/Zip: �)Q Mf- 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 andpennaalt-ieess�of/perjury that the information provided above is true and correct. Signature: Date: Z2f b 4 _ 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): 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 Building Department 27 Charles Street °' '� I. � ll Noah Andover, lvlassaehusetts OI845 49 (978) 688-9545 Fax (978) 688-9542 �, o •,IL,wK ,. �` �' °Rnrao nPwy,�? S•4CFIu5"- DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit # the debris resi.dting from the work shall be disposed of in aproperly licensed solid waste disposal faei.1111 as defined by MGL c11, s150a. The debris will be disposed of in/at: ° L Facility l4 i'.:alion Signavnre of Applicant lealof Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector, Nyassxchvyxn^ ' U,pxnmrotId' PoNic -su6,) @oxn| o[ 8oiNin� Rr�u|x/ioxxxm� ��xxdun|x ~^'~^'~~'"""u�"uo/mwn omum:mmnm ' ~�~ Construction Supcn/inorSpecialty License WEI- HD�E |�PR0VE�ENTCONT�ACTOR ' License: CS 99O5O . Registration:hon' 104568 Restricted to: RF��3 Expiration: 7n4/2010 Tr# 270205 DAVID C�GTR|CONE Type: Private Corporation 31 COURT STREET D4VDCAOTRCOmE ROOFING, SIDING& NORTH ANDOVER, MAO1845 David Cayhioone 2UOSUTTON STSUITE 226 Expiration: 12/16/2011 NORTH ANDOVER, MA018w5 Aumimotmm, T,,-: 99358 ` ' ` ' � � ` � � � � ^ ` ' ' | / | �! � � � ACORD CERTIFI ATE F LIABILITY INSURANCE DATE(MM/DDlYYYY) rM CERTIFICATE O 8/5/?_009 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. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:The Insurance Co of State PA David Castricone Roofing & Siding Inc 200 Sutton St INSURER B:Citation Insurance 40274 Suite 226 INSURERC: North Andover MA 01845 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREPIENT, 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. ADDT T POLICY NUMBER DATE(MMJDQ/YY1 DATE(MMIDDIYYI POLICYEFFECTIVE POUCYEXPIRATION LIMITS GENERALLIABILITY EACHOCCURRENCE $ _ T N COMMERCIALGEtJERALLIABILITY PREMISES Eaoocmerrc� $ CLAIMSMADE D OCCUR MED EXP(Anyone poison) $ PERSONAL a ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMPIOPAGG $ POLICY PRO LOC B AUTOMOBILE LIABILITY. 09MMBCNGCV 8/1/2009 8/1/2010 COMBINEDSIIAGLELIMIT $ ANY AUTO (Ea acdder d) ALLOWNEDAUTOS BODILY INJURY $250,000 2 5 0 X SCHEDULEDAUTOS (Per person) ,000 X HIREDAUTOS BODILY INJURY X NONOWNEDAUTOS (Peraodderl) $500,000 PROPERTY DAMAGE $100, 000 (Per acclderd) GARAGE LIABILITY AUTOONLY-EAACCIDENT $ ANYAUTO OTHER THAN EAACC $ AUTOONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACHOCCURRENCE $ OCCUR L_J CLAIMS MADE AGGREGATE _ $ DEDUCTIBLE $ RETENTION $ $ TH- A WORKERS COMPENSATION AND WC5877756 9/23/2008 9/23/2009 X WC'YTATU- 0ER EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCIDENT $100 000 OFFICER/MEMBER EXCLUDED? E.LDISEASE-EAEMPLOYEE $100 000 Ityes,describe under SPECIAL PROVISIONS below E.L DISEASE-POLICY LIMIT $500,00 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL 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 g g WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE 200 Sutton St CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO Suite 226 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON North Andover MA 01845 THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108) p ACORD CORPORATION 1988 �l�X09 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 HaverkX 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 bidave Owner's Name........V. (,{ ... jj�)Z..........................................T�hone#...�? ..���© Job Address.... 1J J �/ ...........city... p.,... a lo.ti4t/"...............State.......... Specifications: ........... ... ......................................................................................... ✓Strip existing shinglesOj -.9pply new drip edge to all edges.Wk '7",S ...................................................................................................................................................................................................................... ,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. ..........................................................................................I......... ..................... Apply felt pap unde ayment. Ifistall ridge vent to71 X" .. a ................................................�G.... ....... .... ...... .. .... ... .. .... ....... .. ,Reroof using shingles with a year warranty. ...................................................................................................................................................................................................................... ,Gounterflpsh mney. _bIeW vent pipe O�shing. L42 disposal of all debris ... .............................. ......:............................ ................ Areas) or II n � ..............to....be be.w... r .... e .......on:.......�.�l......pal. 2 ........ ........Ca .............. . .Q..ld is-{� 1e.............................. ............ �"•'f••^.'.....(II...�.........//C...Q.rt�.t, '1.(,. .... ......•••••�••+V.•4Y...X.1.».......... .A................................................................. ......................................:............................................................o....................................... ................... . .................................................................... ................... ...../-^........ys. ;/ �X Y Roof board replacement if necessary @ 60 /sheet or V /toot. ................................................................................................................................................................ r . ....................... Two Year Workmanship Warranty(Not Transferable) IVTanutacturer's Warranty as spec' y manufactu kAr The c ctor �js/t�yo rform the work an furnish the materials specified above for the SU of$.... �.." .1 �ayabl !•i/ ...on..... ��f���.......... Owner orOw Payable ers are not ............on............- .................�alance payable on completion of job off"'.' responsible for Property Damage or Liability while j 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 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 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: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 notice of cancellation). IN WITNESS WHEREOF,the parties have hereunto signed their names this.....lday of.... L....,20...Q..1? Accepted: Signed . , . ...................................... Owner Signed............................................................................. Owner David Castricone,President /7