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Home My WebLink AboutBuilding Permit #539 - 153 DALE STREET 3/24/2008 t NORTH BUILDING PERMIT o�t,.o ,°1tio TOWN OF NORTH ANDOVER c? off APPLICATION FOR PLAN EXAMINATION Permit NO: A5 3 Date Received + O� SS�CHUSfc Date Issued: IMPORTANT:Applicant must complete all items on this page f r Print r 1l� EEI, :, 011 QISST0# IC ISIS x TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building ,KOne family 0 Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: 0 Commercial X Repair, replacement 0 Assessory Bldg 0 Others: ❑ Demolition ❑ Other tic ie11 � x Sr O�odp� �:Wtl�d �a ems ' DESCRIPTION OF WORK TO BE PREFORMED: C/ 1-e 0"4 he 411 Identification Please Type or Print Clearly) OWNER: Name: Da v/'d Phone: �'7� 1Y1� Address: I s' rtst�ol ens Fac fat Su � .. � ., .,.. _ Homi t"n� M4dtti 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. 00 Total Project Cost: $ 7? FEE: $ /,� Check No.:—D Receipt No.: c 2 / 0 j �--- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty nd c Signature of Agentl ner 'y „Signature of contractor Location /S3 No. Date MORT1y TOWN OF NORTH ANDOVER FMw9 Certificate of Occupancy $ CNustt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check It 2 1 0 1 2 v 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 Dum1?ster 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 ❑ ❑ r - COMMENTS G 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 Ft C1�►R" MEIVT tTemp buthpster an site yes nv K Lista#ed.at:ll2411ifki treet 4 Fite Dep ►rrnerit �nat�uretdate �y •'r w !4F Dimension r 4 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 J 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 o 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 f ❑ 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 NORTIy � ® of : over No. S39 o dover,�` Alto. O� 1 Mass., 2 �f COCMICKEWICK\y 5 RATE D BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............ .......I...�........ .. �!!�/�' �................................................... 114.4 •• •••• ••••• Foundation has permission to erect........................................ buildin s on ..4.n......Dolod.......d..rMw.......................... Rough t0 be occupied 8S....... Chimney P s.. .......... .. ..........f!.......... ...... ....IS. ....................................................................... provided that the person accepting this permit shall in every respe onform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating o 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 9� Final PERMEXPIRES IN 6 MONTHS IT UNLESS CONSTRU STARTS ELECTRICAL INSPECTOR 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. � ✓�ie TOo�nvmonwea�.t�t. a�✓ czcfivael>?a -\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration:. 104569 Expiration: ,7/14/2008 ry Type:. Private Corporation DAVID CASTRICGNE.ROOFING;.SIDING& David Castricone 200 SUTTON ST SUITE 226ucCL o�- NORTH ANDOVER, MA 01845 Deputy Administrator QRDrA, CERTIFICATE OF LIABILITY INSURANCE1, 9/2'--/2007 OATE(MMI°D/YYYY) CER Fhone: 508-651-7700 Fax: 508-653-8089 THIS CERTIFICATE IS ISSUED AS A MATTER,OF INFORMATION FNatick ern Insurance Group LLC -Commercial Lines ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE West Central Street. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR MA 01760 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Citation Insurance 40274 David Cast.ricone Roofing & Siding Inc 200 Sutton St INsuRERB:The Insurance Co of State FA Suite 226 INSURER C: North Andover MA 01845 INSURERD: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOP. 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. NSR LrR INSRD TYPEOFINSURANCE POLICYNUMBER POLICYEFFECTIVE POLICY EXPIRATION LIMITS GENERALLIABILITY EACHOCCURRENCE $ COMMERCIAL GENERAL LIABILITY AM R PREMISES Eaoccwenc:e $ CLAIMS MADE r_1 OCCUR -MED EXP(Any onePerson) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATE LIMITAPPLIESPER: PRODUCTS-COMPIOPAGG $ POLICY PRO- JEC LOC A AUTOMOBILE LIABILITY 07MMBBTNKT 8/1/2007 8/1/2008 COMBINED SINGLE LIMIT $ ANY AUTO (Ea acciderrl) ALLOWNEDAUTOS BODILY INJURY X SCHEDULEDAUTOS (Per person) $250000 }{ HIREDAUTOS BODILY INJURY X NON-OWNEDAUTOS (Peraccldanl) $500000 PROPERTY DAMAGE (Peraockfenq $100000 GARAGE LIABILITY AUTOONLY-EAACCIDENT $ EANYAUTO OTHER THAN EAACC $ I) - - . AUTOONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACHOCCURRENCE $ OCCUR FICLAIMSMADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ B WORKERS COMPENSATION AND WC7222278 9/23/2007 9/23/2008 }{ WCYTATU- OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.LEACHACCIDENT $ 100000 OFRCER/MEMBER EXCLUDED? EL DISEASE-EA EMPLOYEE $100000 11 yes PE6dclescribe wider PROVISIONS below SE.L DISEASE-POLICY LIMIT $S0 O OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SP ECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY Y.IND UPON i THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATI ACORD 25(2001/08) t p ACORD CORPORATION 1988 S DAVID CASTRICONE 00 CASTRICONE ROOFING& SIDING INC. ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 BY--------------------- 200 SUTTON STREET,SUITE 226,NO.ANDOVER,MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In AaverhiU 978-3747314 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 belo escribed: Owner's Name...•.1,...6L .``T ......... ........................................�.TIdhone#..... .F�...-./...1...1.Y......... Job Address......is—i....1./ --e.......c..1 j..............................city... .2.,...l I n� a.tl ZJ................State....MA........ Specifications: ............................................................................................................................................................................................................ ��✓Strip existing shingles. 1p ply new drip edge to all edges. WL t- g ...................................................................................................................................................................................................................... Apply_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. ......felt.............n.....:.:......en..............................ent'.....................,..t.�............................................................................................... ply felt paper rode ment. Install ridge vent to�T�j,�„o a� !g..P k, ................................................ ...............�................. Y....................Y• d.. ..... ✓Reroof usin shingles with a ear warrant .............................................................. ........................................................................................................o .................... �j/ •Counterfiash chimney. -New vent pipe flashing. ,.14gal disposal of all debris. r- r Jas c/ e .......................................................... ...... ................................... ...co-O.- Area(s) . , ....��...................... ' c,a.6V Areas)to be worked on: R i � Lk-1-0 \h o a/ ........................................................................................................................................................... ....... . ...... ... ...... ..................... .............. .................................................................... ... 1.9. L>..... ..... �..., .1. .�.... .... ., �... .1� 1.X5.0 ... .../ G..D W�. ..l ......-.. .... ............................................ Roof board replacement if necessary @ ,p /sheetor —/too ...........................................................................................................................................................gt�D ................ Two Year Workmanship Warranty(Not Transferable) Njanufacturer's Warranty as speci The contractor agrees to perform the work and furnish the materials specified above for the SUM .. 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 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 anis or other living spaces).Items in attic may need to be covered by homeowner.All materials are property of contractor. Any dumps ter 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 es this........ day of../144:<......20.L1?.... Accepted: Signed ... .. ...................... ......................... Owner Signedj�:.c" ..... . Owner David Castricone,President The Commonwealth of Massachusetts Department of Industrial Accidents Office o ff .f Investigations g esti aons 600 Washington Street Boston, MA 02111 j www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Busuiess/Organization/Individual): �DAV 1 h C�.l 'i 21 c n N t r l� 114( 5 l'la I rI c. \ N C, Address: ,:�n 0 S u I TOQ S ZE.�_T — 5u 1'('E ;k.a-.(o City/State/Zip: W, 4N D o vek HA . 0 iNg Phone#: Q Z S 6 ?3 3 4 a a Are you an employer? Check the appropriate box: Type of project(required).- 1. required):1.M I a1n a employer with $ 4. ❑ I am a general contractor and I have hired the sub-contractors employees (full and/or part-time).* 6. 11 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. Building addition 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.❑ Plumbuing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. oof 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 alfidavit 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: 1e— ,n,5u'1 ncc. Co of 5+o,*L ?At Policy#or Self-ins. Lic. #: V Y C,7 a a A �7 0 Expiration Date: 9l a 3 Iy e Job Site Address: �Jr3 �QI� f City/State/Zip: IV6. Add f/f VJ, 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 cerdfv under thmpams and penalties ofperjury that the information provided above is true and correct. t — Si nature: -E� Date: ko _ Phone#: 97E (o lI& J ' 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#: