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Home My WebLink AboutBuilding Permit #553 - 170 LACY STREET 4/24/2009 BUILDING PERMIT 01* NORT1{ q TOWN OF NORTH ANDOVER`': APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 3-G� SSgcHus�� Date Issued: �� INFORTANT: Applicant must complete all items on this page LOCATION d 1--ACC-y !9Tfece i PROPERTY OWNER �R 0 g��-� 1�(l�N�ynt ,� N Ul�t� Print MAP NO: PARCEL: ZONING DISTRICT: "Historic District yes no 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 Water/Sewer DESCRIPTION OF WORK TO BE Pt�FORMED: RIP y �l;Sl+tn(�TI �7 oa 1F �}Cc c P'� ( C-A>` �-&zctj- ` Site-0 Identification Please T e or Print Clearly) OWNER: Name: _Ron.2r 4 Njp�,f,4cy /AeiQu/(-L-C Phone: 9-7 6 �SS*73- Address: 1'10 UA LY S T(Z EST 064711 Ah5bav1z_IZ t`-t/-N- 01 'K CONTRACTOR Name:-D\ Q&5-r(<1coNc '� Ncr ` S a6IIle Phone: 9?8 6 8 3 3 Y2 o Address: z0(7 Su-��u c 2rr�? _ Su,-c 22(0 t� rZ�a AAj�w�� AIA D)d vS Supervisor's:Construction License: G�q�1 3 Scd Exp. Date: Home Improvement'License: 10'1 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. Total Project Cost: $ r7g (.d . FEE: $ /V Check No.: /oZ is—y Receipt No.: 0 NOTE: Persons contracting with unregistered contractors do not have access to the g aranty fund Signature of Agent/Owner Signature of contractor ' 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 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: 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 Main Street Fire Department signature/date 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 NOTES and DATA— (For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 "..�.....-r.. ..a.e_. -.�+w+vmce+ tw:-r cv+w.•r.a` #.. +.r2 .nv.aT .. _ . , Location I J 0 No. S3 Date f r NaRT� TOWN OF NORTH ANDOVER 9 • ; ; Certificate of Occupancy_ $ • �, �'�s�CMUs<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 21 964 `� Building Inspector Town of North AndoverrAORTH F 0 Building Department 27 Charles Street North Andover, Massachusetts 01845 a� . a� o (978) 688-9545 Fax (978) 688-9542 °�° °�w�° ADRAT(D Pppy�y SAC 05t DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, s150a. E The debris will be disposed of in/at: Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. i i f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street r, '} 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): �V 1D C M TitI C d Nur T D O�r l m SID t N�. Address: Ao Q Su -T-roa�, S'I'2�f.'i` �ju 1 T� 2 Z(o City/State/Zip: 4,At4po JE2 $1A O l W Phone#: 918 -(o 8 3J Y,XV Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 8 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.E3 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' insurance.$ 9. ❑Building addition [No workers'comp. insurance comp. required.] 5. ❑ We are a corporation and its 10.r_1 Electrical repairs or additions officers have exercised their 11.❑Plumbing 3.❑ I am a homeowner doing all work g repairs or additions myself. ' right of exemption per MGL Y �o workerscomp. Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 1311 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 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 isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information. p� Insurance Company Name:��c. \n5c_)ra.t Lc_ Co O k S�?��P/ 1 Policy#or Self-ins.Lic.#: W G � � 1 `j� Expiration Date: q a�j 1 O Job Site Address: 11 O L A Ly STKEL7 City/State/Zip: N. A N Db 0/� U I S y6 I 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: J__..J �l �',_, ,�, Date: ��,/p 9 _ Phone#: -l ) U 6�3 c3q ab 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#: t%ORTN own - of ; 4 L over O . -' y 0 -,... -_ E dower, Mass., COCMICMEWICK �d ADRATE D FPS` �5 S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT . r .............. ..... L.Ll. ►./ .................................................................. Foundation has permission to erect..................... .................. buildings on ...../W. C41.0.. >J� ....,...... �....... .. ............................... Rough to be occupied as TPntsof ?........ ia�.. !QA �® Chimney provided that the person accpermit shall in every respe anform to the terms of the application on file in Final this office, and to the provisiCodes 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 qb PERMIT EXPIRES IN 6 MONS ELECTRICAL INSPECTOR. UNLESS CONSTRU O S S Rough ..................... BFinal ervice BUILDING INSPECTOR 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 BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. ACORQ. CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDIVYYY) 10/3/2008 PRODUCER Phone: 500-651-7700 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 David Castricone Roofing & Siding Inc INSURERA:Citatlon Insurance 40274 200 Sutton St INSURERS: he Insurance Co of State PA Suite 226 INSURER C: North Andover_ MA 01845 114SUBERD: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. T POLICYNUMBER POLICY EFFECTIVE POUCYEXPIRATION OMITS GENERAL LIABILITY DATE(MMjDQ/YY1 EACHOCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea ocaal T CLAIMS MADE M OCCUR MED EXP(Any orer.9on) $ PERSONAL a ADV INJURY $ GENERALAGGREGATE $ GENI AGGRE GATE LIMITAPPLIES PER: PRODUCTS-COMP/OPAGG $ POLICY PRO LOC A AUTOMOBILE LIABILITY 08MMBBTNKT 8/1/2008 8/1/2009 ANYAUTO COMBINED)NdertSINGLE LIMIT $ (E ALLOWNEDAUTOS SCHEDULEDAUTOS B ODILYINJURY }( (Parpaisrpersan) $250,000 }( HIREDAUTOS BODILY II4JURY }( NON OWNED AUTOS (ParaccldeN) $500,000 PROPERTY DAMAGE (Peracciderd) $100,000 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHERTHAN EA ACO $ AUTOONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACHOCCURRENGE $ OCCUR FICLAIMSMADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND WC5877756 9/23/2008 9/23/2009 Xony TU- OTH- EMPLOYERS•LIABILITY ANY PROPRIETORIPARR4ER/EXECUTIVE ELE-ACHACCIDENT .$100,000 OFFICERIMEMEER EXCLUDED? II yyou describe unrku E.L.DISEASE.EA EMPLOYEE $1 Q Q Q Q 0 SPEGr1AL PROVISIONS below E.L DISEASE-POLICY LIMIT OTHER $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SP ECIA L 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 KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/09) p ACORD CORPORATION 1988 Massachusetts - Depal-thrtcnt of Public lafm � �//L a�✓Gla.vurc� a ✓he o�mrrrw�rurauael7ii Rom-(] of Builllin!, Regulations and Stantlm-ds �_ Board ofBuildingRegulatio sand Standards +" Construction Supervisor Specialty P Y License �.i ._.._, HOME IMPROVEMENT CONTRACTOR License: CS SL 99358 Registration:. 104569 Restricted to: RF,WS A, - Expiration; .7/14/2010 Tr# 270265 DAVID CASTRICONEfR' 1""` Type: Private Corporation y3... 31 COURT STREET C DAVID CASTRICONE ROOFING,SIDING& NORTH ANDOVER, MA 01845 -*# David Castricone 200 SUTTON ST SUITE 226 �--�-- -� Expiration: 12/16/2011 NORTH ANDOVER,MA 01845 Administrator ( uwni iuncr Tr': 99358 I I i I DAVID CASTRICONE CASTRICONE ROOFING&SIDING INC. ROOFING,SIDING&REMODELING REPLACEMENT WIND(ffS--- -------- 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 Haverhl/1978-374-7314 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 remises bel w ribed: �� C-0 P Owner's Name...... `. J .Gt-l+ ^k` ./F. ....... r:�.n. �.�.l.�Tele one#...LF4�.....:...t .......... City....., �,...J..(.. .o.tl.e(1.`..............State...AIT.. ...... Job Address....... .. �........y .. ............................. Specifications: ............................................................................................................................................... -Strip existing shingles.Of� .Apply new drip edge to all edges. Q1b w;ti, . . .................. ................................................................ ............... ✓Xpply _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 ............... .......................................... ..................................................................................... ✓Apply felt paper underly crit ✓Install ridge ... a vent to r, 4 < �� q o ....................... ... .. .... ....... ... ................................................... ............................................. .•R'eroof using [ogles with a 3 Q year warranty.pt JJ ................................................................................. e .......................................................... .e6unterflash chimney. INI.-w-vent pipe flashing. legal disposal of all debris. `� ...... ,/ ..... .. ........................................... a... . .................................................... Area(s)to be worked on: ...Jl.erA..r............�La.P..7>r�1.'.....l.�t.vf. ....w�.....f�l../... ............. I [7 z Y oc....... f-7.. •d(. .........................F••L.(v�bW•....�.......µc.a--ii :l•.v,..................... .. a. / . .4.. C.ilc ...... ................. r�:o...... ..�((R.u.('... ........ ... r... Roof board replacement if necessary @ /sheet —/foot. ............................::................................................................................................................................... . ............. Two Year Workmanship Warranty(Not Transferable) 11'M'anufacturer's Warranty as sped by maoufact rer The c9agactor apes to perform the work an a materials specified above for the S of$.....7-72.0. •......•• Q)Payable...L/.J>..Q.D...........on.....5 ...... Payable......: .............on....:..........................�Balancepa able on completion of `. Owner or Owners ate not responsible for Property Damage or Liability while jc6 ism operation. Contractor is not responsible for any damage to the interior of property,including pic-existing conditions(i.e.water stains,crumbling plaster,exposed[tails)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 paries.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,not 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 panics. 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 patties 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 It signed their names this..... ...�.........day of�L!Z .............20e.$ .. Accepted: ,�� SigneV=Utv,��. ..S.rl.lf o.... Owner Signed............................................................................. Owner David Castricone,President