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Building Permit #915-2016 - 166 DUNCAN DRIVE 2/25/2016
I DIly Permit No#: 11 Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IM ORTANT: Applicant must complete all items on this page LOCATION 2)rk,ye-- PROPERTY OWNER 1 t M Prinb,,s,, , 1 l�. Print 100 Year Structure MAP I PARCEL:0 ZONING DISTRICT: Historic District Machine Shop Village yes no ye no ve no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 6 ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial cef�epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other_ ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF VVUKK I U tit FtK1-UK1v1tu: Identification - Please Type or Print Clearly OWNER: Name: e - SCD s � P`hone: �n -.3�3 Q % Address �O Doc an J ilV� 1�0 � aY�A- 01 q � Contractor Name: oajfhCone, �U<6C6 Phone: o1 �' (0 3 qa C) Address: Supervisor's Construction License: q q, -3 J Exp. Date: I "� I Home Improvement License: o-4 0 Exp. Date: , 41 ARCHITECT/ENGINEER Phone: rsr. Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COS- BASED ON $125.00 PER S.F. d0 Total Project Cost: $ % g 8O . / FEE: $ C1; '5,6D Check No.: Receipt No.: 00 NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fund Location No. Date 2 Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL $ Building Inspector r, C, Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL, Public Sewer ❑ Tanning/Massage/Body Art ❑ Swfinu'iug 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 PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Com Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street_ FIRExDEPARATMENT TempDurnpster on{site eyes,. -- -- Located,ata.2.MMairitStieef , Fire;Department;signature COMMENTS 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 NU I LS ancil UA1 A — (tor clepartrnent use ❑ Notified for pickup Call Email Date Time Contact Name Doc.Bnilding Permit Revised 2014 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 ;rt Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks TOTE: Building Permit Application Certified Surveyed Plot Plan ;,. Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses 4. Copy Of Contract :r.. Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 4. Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products 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 IECC Energy code Engineering Affidavits for Engineered products TOTE: 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: Building Permit Revised 2014 v. N C � N 0 O �0 CL r— e•�F Q �• C O vCD CD CL �a a CCD O w Im CD C o N- F C � v O Z CD 0 .�-r O ;o �CD 0 0 n A 0 = vi 0 0 " N O 77 y =� <cap -a N CDCCD m n CL O m n 3 T O S w L! O 0 � � MO vi 0 0 = in s;, � N O 77 CD _T 7 O O rt Q Z7 DQ 3 m . 0 N O rt N � rt T O S w L! O CD O'N O —i cp m O 2 071 CD C• O '-' v m D 0 rt CQ N O O • n �(C S� D CD .0 O < (O 0N O S_ O 0 cn � �. cn z CD rt � o Q CL - n co O — CD y CD O M < O W � ch ■ N U cp `p " rt o a O N X- O Or _ 0 0 00 C .Z7 O OA 3 CD _T 7 H O Z7 DQ 3 . 0 N O -+ n _S G � rt T O S w L! O VI (D N N CD C� '-' v m D 0 rt O O O 7 Q C W z V N X- O Or O z o W O T 7 D) .Z7 O OA 3 _T 7 V1 O � Z7 DQ 3 . ;:o . 07 T n _S G w O QQ s T O S w L! O VI (D N N T O O_ n '-' v m D y r m n n M C W z V O W C G z V m (D 3 N 3 W > O O m 70 0 0 0 2 . ow 0 c DAVID CASTRICONE, PRES. / /. /�7 CASTRICONE ROOFING & SIDING INC. 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 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 prem' ties below deicQble& Owner's Name ..... ..................................................... ephone #.. . 6. Sq. .0..V Job Address....... -V 1 '14- ...... V, - " Y. AJA ............... State... x Specifications: ............. I ......................... .................................................. I .............. . V/(A) Strip existing shingle VAppily new drip edge to all edges.'"'"' .......... * .............. ........ * ........ ............... t/Apply _feet eet in brane .. to bottom. . . edges of .. house. 3 .. feet . . ............................................................................ in valleys and bottom edges of any unheated areas of house. ................. :'"* p'y�tArer y�e.�.4os a ridge vent to24- L�. . .......... .......... . ........ ............. eroofsin shingles with a .................................................................................. .................................... 11?.'u"* *' nte'r11"a",sh* ...chimney."' ...'**.....* & A"", ..., *'event -"'p"i pipe ... fia**shing. Legal disposal of all debris. ...... ....................................................... .... .... .......... * ......... ...... ** ........ * ...... ...... VArea(s) to be �orked on: ............ ............... .. ......... ...................................... .................................. I ........................... ............................................................. .......................................... ............................................ ....... ............................................................................................ ............. ................................................ . ..................................... Five Year Workmanship Warranty (Not Transferable) Manufacturer's Warrant s spec'by n fact rer a a I __;K. The contractor a s to perform the work and,filipish the materials specified above for the S . _9,�$ ............. .... g o .... Man P ayab I e4.r,�q ............... Payable....... � ............... on .......................... I .......Balance payable on completion ofjob 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 are property of contractor. Any dumpster placed by contractor is for his use only. Upon completion ofabove woik all undersigned agree in 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 he 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 be is (they are) the owners(s) of the above mentioned premises and that legal tide 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 the Office of Consumer Affairs and Business Regulations, Tel. (617) 973 -8700. 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 ......... &t ... .... 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 ' reof 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: /I Signed ....... &ti� .... /./ ..... 41 .... Owner Signed............................................................................. Owner David Castricone, President \ The Commonwealth of Massachusetts z v Department of Industrial Accidents d 1 Congress Street, Suite 100 t Boston, MA 02114-2017 V www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print 1Leeibly Name (Business/Organization/Individual): ej,S 10 k-� (C,` Address: -.;23 ( St.i pr ) City/State/Zip: I bU lkM64Y NA b lIg Y Phone #: 9-)8 (o U -30-0 Are you an employer? Check the appropriate box: I. PI am a employer with _employees (full and/or part-time).' 2.❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.M I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.M I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.1 6. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. F1 New construction 8. ❑ Remodeling 9. ❑ Demolition 10 ❑ Building addition I I.Electrical repairs or additions 12. ❑ Plumbing repairs or additions 13-9,Roof repairs 14. F] Other 'Any applicant that checks box #1 must also till 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. $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. S� j - Insurance Company Name: G nLn %�Q D. TQ 1 S , Policy # or Self -ins. Lic. #: WO -00 39o9 -7o\_3 Expiration Date: -( as I j Job Site Address: I L 6 l (,1 n Ltd Irlye City/State/Zip: IV 0, 1)rjelx, HA b q) - Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. 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: .`J2 I',-- C Date: Phone #: 9 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 #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia AcoRDr CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDO/YYYY) 9/16/2015 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 Select Dept. NAME: P Eastern Insurance Group LLC 233 West Central St PHONE (800)333-7234 x66807 F� No:(781)586-8244 E-MAIL ADDRESS; selectwork@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC p Natick MA 01760 INSURER A: Western World Insurance CO INSURED INSURERB:Commerce Insurance Company 34754 David Castricone Roofing 6 Siding Inc. INSURERC,4Granite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER D: INSURER E 9/6/2016 North Andover MA 01845 INSURERF: COVERAGES CERTIFICATE NUMBER:CL159964794 RFVIRIr1N NI Jul TH:S IS TO CERTIFY THAT 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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILEFF TR TYPE OF INSURANCE L INR NSR U W`VD POLICY NUMBER MMOVUDDY MOLICMIDD/YYYY LIMITS GENERAL UABILITY EACH OCCURRENCE $ 1,000, 000 A M"cRCIAL GENERAL LIABILITY �17CLAIMS-MADE a OCCUR qPP1404373 9/6/2015 9/6/2016 DAMAGE TO ENTED PREMISES Ea occurrence S 50, 000 MED EXP (Any one person) S 1,000 PERSONAL 8 ADV INJURY S 1,000, 000 GENERAL AGGREGATE S 2,000, 000 GEN L AGGREGATE LIMIT APPLIES PER: X I POLICY PRO- LOC PRODUCTS - COMP/OP AGG S 2,000, 000 S $ AUTOMOBILE X LIABILITY ANY AUTO AU OS X SCHEDULED AUTOS AUTOS HIREDAUTOS I X NON -OWNED AUTOS Cp7G(-y /1/2015 /1/2016 COMBINED SINGLE LIMIT Ea accident S 1,000, 000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERTY DAMAGE Per accident S S UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE S DSD RETENTIONS C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE STATUS X WC � OTH- E. L. EACH ACCIDENT S 100,000 0-',c EXCLUDED' (Mandatory in NH) IN I It yes. desrnoe under DESCRIPTION Oc OPERATIONS below NIA KC003989723 C003989723 /23/2014 9/23/2015 /23/2015 9/23/2016 E.L. DISEASE - EA EMPLOYE S 100 000 E.L. DISEASE - POUCV LIMIT 5 500,000 DESCRIP TON OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORO 101, Additional Remarhs Schedule, A more space Is required) Roofing 6 siding contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Castricone Roofing & Siding THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Unit 3A ACCORDANCE WITH THE POLICY PROVISIONS. 231 R Sutton Street AUTHORIZED REPRESENTATNE North Andover, MA 01845 ACORD 25 (2010/05) John Koegel/KH3 ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 r:n+nnc+n+ Tho Ar`r1Rr1 name and Inn^ aro rnniatarnrl marka ^f Ar'.rwr) Massachusetts Department of Public Safety ® Board of Building Regulations and Standards License: CSSL-099358 Construction Supervisor Specialty DAVID T CASTRICONE 31 COURT STREET NORTH ANDOVER MA 01845 13- lr-/ Zn ILA— Expiration: Commissioner 12/16/2017 4� Office of Consumer Affairs & Business Regulation =?i=EIOME IMPROVEMENT CONTRACTOR egistration: 104569 Type: ;.Expiration: 7/14/2016 Private Corporatic ;.` ... DAVID CASTRICONE ROOFING, SIDING & David Castricone 231 R SUTTON ST SUITE 3AB` , J� NORTH ANDOVER, MA 01845 Undersecretary