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HomeMy WebLinkAboutBuilding Permit #38 - 176 MIDDLESEX STREET 7/8/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION ' Print PROPERTY OWNER . (A 1. Print MAP NO: �l1 PARCEL: 0-7 ZONING DISTRICT: Historic District yes no .Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building L 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 PERFORMED: nI 0,4 (C-3 L-� r1c, i-bo Identification Please Type or Print Clearly) OWNER: Name: -tT 1C tL))lfaG,r�c Phone: ! 3L 0 , /U I Address: -A H i r h VV S� �6 I-h,\Ctue/ flk 0 G k u it CONTRACTOR Name: t J "R(A r\t Phone: 3Y Address: 0 .SLr r\ + . !&U\\,v ZZ WW—P-" Mtn C A`(V- Supervisor's Construction License: 99 Exp. Date: 4 DL- , Home Improvement License: ( ` of Exp. Date: ' f " 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: $ FEE: $ ty Check No.: 13101 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of A ent/Owner - - Si nature of contractor ° °�-� Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tannin g g Y/Massa e/Bod 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 r COMMENTS IV 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: Doc.Building Permit Revised 2008 Location ni No. NORTq TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ ;�ss+cNustt Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /✓ 230 Building Inspector NORTH Town of Andover No. . �( = o dover, Mass., Y O L LAK 2 COCHIC EWICK ADRATED S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............ ... .............:..P............... ®.. ......... ......... Foundation has permission to erect........................................ buildings on .... . ............. ...... 1 . .. .................... .................. Rough to be occupied as.............. �:. .. . Chimney .4 .. provided that the person accept g this permit shall in every respect co m to the terms of the application on file in Final P P this office, and to the provisions of the Codes ar1d';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 CONSTRUC STARTS Rough oil :: Service ..... ..................................................... ................. ... BUILDING CTOR 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. DAVID CASTRICONE ` CASTRICONE ROOFING& SIDING INC. ��; ��t J . b ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 j U 200 SUTTON STREET,SUITE 226,NO.ANDOVER,MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314 YY Uwe the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to furnish allr$sy"""""""""" materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on premises below descri n : Owner's Name...... �4_D .1-.�4Lj4. ...............................Te hone YJob Addr1 .. � .Ciy.... / 7Ml Vol... 4 ZzVex#....A3..../J..7. ..t......-...State t�...... ._'h� .8.f Specifications: 'Strip existing shingles. AgTply new drip edge to all edges. e/ ............................................................................................................................................................................................................... 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. ....................................................:...........................................................•--................................................ ply felt pa er u der ayment. -4--stall ridge vent to r n x, �' LbM pe_. �zJ .................... .a.. ........... . /../............................................................... -Reroof using � � a.,Jtut6 �t�1(,'3r shingles with a Q_year warranty. ...................a..-. -Gounterflash chimney. —New vent pe flashing. --•Legal disposal of all debris. N .�, c/U r Ve ................................................. .....•F•........... ..........................................................................�- Area(s)to be worked on: / ( , ........................................... [..... ..Z?.Q.........� El*�­ ...... ........ ....................................................................................: q� ,........V."-&V. ......._.... ��................ �....... .r►a t. ... . . -.. a .l?C1j.................. r ....................................................................................................... Roof board replacement if necessary@ 6D /sheet of V_E/foot. ................................................................................................................................................................... .......... ...................... Two Year Workmanship Warranty(Not Transferable) Wanufacturer's Warranty asspecifi by m u c rer The contractor agrees to perform the work sh the materials specified above for the SUM $...... .`. . Payable..P Z ...............on... .. .......... Payable.......'Y11°E�h ?�?..on....:,7- :�J L?........... 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 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 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 he 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 tmregist,:red contractors is excluded from the Guaranty Fund provisions of MGL c.142A. i /�Gti�.'lr r-�' Approximate starting date of work.-..lIr.x..11.................. ..... 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 r.ontents 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). rT , IN WITNESS WHEREOF,the parties have hereunto signe th ' names this... !,J..day of.Q.U,�:�...y.......,20.1'.0..Accepted: Siged. . .. ........................ ..................... Owner Sied........... ................................ ....... ..................... Owner D... ..CA;t r David Castricone,President �.�/ire z�_=s�ys�i✓� ���,�� ��s�°,�C.��l�� r The Commonwealth of Massachusetts Department of Industrial Accidents `i Office of Investigations 600 Washington Street Boston, MA 02111 jvivm mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Busiiiess/Organization/lndividual): 1�AV I C ASTR I C O N R pp F I i�l�r S IA I y�T I N Address: ZC>o Su--V-rnt3 Sy City/State/Zip: h.AcNbQ V6 t, h-1A 0 4&itS Phone #: °I")g (p 3 3 4 20 Are you an employer? Check the appropriate box: Type of project(required): 1.® 1 am a employer with 4. ❑ 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]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 working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t 9. E] Building addition oration and its 10.0 Electrical repairs or additions required.] 5. ❑ We are a corp 3.El 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.® Roof repairs insurance required.] .r c. 152, §l(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box 91 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. lContractoi s 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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. n Insurance Company Name:_V�e (�C�1 r r' c e Mp 6-/1_ \j G Policy #or Self-ins. Lic. #: 1N C 9 9,C1 a,`1 y (o Expiration Date: 9 a 3 20► o Job Site Address: -7(o I-) S td��p 9,)C SA Ci /State/Zi / _� _ ty p� �o l�n���.r�r �� 6 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 and the i and pe aloes of perjury that the information provided above is true and correct. .,. � C� Signature: Date' ��ba _ Phone#: -O 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 Anidove><- OQ t1,_wn ib r� ]LTiiildii�g Dcp;ia'Ix11cr►i: -L' - � . - 27 Chaxles Street ° .r; a " ;J!�t' I'4or1h Audovff, 1Vlassachusetts 0.18 45 (978) 688-9545 1'ax (978) 688-95<12 ,� „ort r'`•,, h '31NCHU`� DEDIUS DISPOSAL F01W In accordance with the provisions of MGL c 40 s 54, and a condition of. f3uitdint permit W. the debris rc;:.:Itinp, from the work shill be disposed of in a oioperly licensed solid waste disposal faeilil.) as defined by M.G1, c11, sl 50a. Tke debris will be disposed of in/at: I-acilAy lGt atiotl -- Signarure of Applicant Date NOTE: A demolition pernut fi-orn the Town of North Andover must be obtained for this project thiouglithe Office ofthe Building Inspector, �._,��._.... .,I / e 1f�tlI�%aIx -AI�0..*A� --� 09/29/2009 Pa I t l 11.//'1 A � �4,,/t 1.t/"'1 l..P A L PRODUCER (5001551-7700 FAX 5118-653-8D89 THIS CERTIFICATE IS ISSUED AS A MATTER OF INIfORMATION Eastern Insurance Group LLC -- Commercial ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 west Central Street HOLDER,THIS CERTIFICATE DOEIS NOT AMEND,EXTEND OR ALTER THE COVERACF-AFFORDFD HY THF POLIGIE.i BELOW. Natick, MA 0].760 — --- Select Ext.53389 INSURERS AFFOROING COVERAGE NAIL# INUVREV Vavid Castricone Roq lnq $r Sidinq Inc INSURERA: The In5uranl e Co or-state, PA 200 Sutton 5'C INSURER B� sJY'1 te 226 INSURGR G; North Andover, MA 01845 INSURER 0: INSURER E. COVERAGES 4 _ THE POLIGIE5 OF IN5URANGE LISTE=D BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER100 INDICATED.NOTWITH5T,6,NDING ANY 99OUIREMENT,TET�M OR CONDITION 05 ANY CONTRACT OIC OTHER 00CUM9N f 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 POLICI[5.AGGREGATE LIMITS SI-TOWN MAY HAVE DEEN REDUCED BY PAID CLAIMS. INSR 00' POLICY FFFECTIVE POLICY EXPIRATION LIMITS OF INSURANCE POLICY NUMBER DATE I M112 �A,�-wmLanM GENERAL LIABILITY --- EACH UCGVRRFNGI--- $ COMMERCIAL GENERAL LIAEILITY DAMAGE TO NLNTFU J clnlMs MAD r_ LOCCURNICO EXP (Any one pamonj S PCRSONAL r ADV INJURY g' rh:NF RAI AGORUGArl $ GtN'L AGOPiLGAT Ic LIMIT APF'UCS PEO. I'RUUUC I5-t:UMYIQI'A00 POLICY PRO- F-1 RO LOC .ICCT _ AUTOMOPILE LIADILIYY CbA49INCD SINGLE LIMIT $ ANY AUTO l I-a pCrldnm) ALL OWNr-u AIJIQ.S BODILY INJURY $ SCHEDUL-DAUTOS (I'Ai p915on1 HIRED AUTOS BODILY INJURY $ NON-OWNEDAUTOS (Pur:.F drlvm) PNOPFHYY f)AMAL'r $ (Pat Arddanq GARAGE LIABILITY AL,ITO ONLY,PA ACCIDENT $ ANY AUTO OTHER THAN PA At,G $ AUTO ONLY: -ACC 8 EXCESWUMBRELIA LIABILITY CACI I DCCURR=NCC OCCUR ElCMM$MADE AGGNEC,ATIZ $ $ t "rTENTIUN I - ^� WORKERS COMPENSATION AND WC9752746 09/23/2009 179/23/2010 )( I WC STATU- I TH EMPLOYERS'LIABILITY 13Y.LIML7 A ANY PROPRIF,TOR/PAR'TNF.IVFKFCU'TIvc E.L.EACH ACCIDENT 3 100,000 OFFICf_RIMEUPf_RtY,CUJDFO? E.L.DISEASE-FA EMPLOYE $ 100 000 Ilya",dosCnbC V�dc� v PECIAI.PROV6$IONS Nelaw F.I.,DISFASF-PQI.IGY LIMIT $ 500,000 OTHER 0WRIPYION OF OPERATIONS I LOCATIONTI I VFHICLEA I EXCLUSIONS ADDED By ENDORSEMENT 1 SPECIAL PROVISIONS r-FRTIFICATF-1-I(L&DER-- -- N SHOULO ANY Or TMC ABOVE' SCRIBED POLICIES',112 0ANGELL0 SET`URT:YHE David C a s t r i c o n e Roofing & Siding EXPIRATION DATE THEREOF T!1E ISSUING INSURER WILL ENDEAVOR TO MAIL 200 SuttOn Street 10 DAYS WRITTEN NOT.L;F TO TMF CERTIFICATE HOLDER NAMED TO THE LEFT, Suite 226 BUT FAILURE TO MAIL SUOM i.'i•YIGE SMALL IMPOSE NO OnLIGATION OR LIABILITY North Andover , MA 01-845 OP ANY KINb UPON YHE IN$L,.TL:R,IY$AGGNTS pR REPRES1!NYAYIYES. AUTHORIZED REPRESENTATIVE ( y, Stacey Brice/FKG ACORD 25(2001108) rIACORD CORPORATION 1988 ,�,• u/�tt 'l�'O I14YILUItG.i:Q.�l� R f.�,.''!(-LIJilCGf..fLClJ6oGd OfGcc of Consumer Affairs&Buswcss cgulalion l 1, ,HOME IMPROVEMENT CONTRACTOR IRegistration: 104569 Type: DAVIDExpiration: 7/14/2012 Private Corporatio STRICONE ROOFING, SIDING& David Castricone 200 SUTTON ST SUITE 226 NORTH ANDOVER, MA 01845 llndcrsecrct:u y \I;u,u�'hu,rtt, Uclial-tolcot uC Puhlll afcr� + lour I of, Builtlin, kc ulaliuu.. :ui(I Slantlartl, Construction Supervisor Specialty License License: CS SL 99358 Restricted to: RF,WSa ., DAVID CASTRICONE ;ti... ,,,.z.;,,,,� • 31 COURT STREET s - RAti` NORTH ANDOVER, MA 01845 ' Expiration: 12/16/2011 ( uuuiii..iuiirr TM: 99358 ,vI r.'v.