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Home My WebLink AboutBuilding Permit #295 - 178 HAY MEADOW ROAD 10/29/2008 i BUILDING PERMIT 00 OORT b;�ao TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: " J Date Received Date Issued:/0 ��SSACH►1 ' �� IMPORTANT: Applicant must complete all items on this page LOCATION l/ G� V a U m e a daL-y PROPERTY OWNER NCL/) T"/ln `1,;JC ea., 61 Print MAP NO: !D PARCEL:O& 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 PREFORMED: r � Identification Please Type or Print Clearly) Y) OWNER: Name: :,v\c-n a r d Phone: 97F ?�O(4 6 Y07 Address: 11 N a me000uJ 1Vo• IYnb 6\fu CONTRACTOR Name: Ph O y one: � 2 � n.e, cx�rte, 7� Address: 200 Su Si So az- 2Zc. LN�o_ A� c �(/h ()Mf Supervisor's Construction License: 0,Ci 3J Exp. Date: 0--1 b 2-0 I Home Improvement License: °C1 Exp. Date: - I q ZO I 0 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: $ y- `� FEE: $ A2 Check No.: d �— Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the g ranty fund gnature of Agent/Owner Signature of contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Swimming Pools Tanning/MassageBody Art 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 r 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 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 I � 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 ❑ 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 2.2007 Location No. J f Date 1 1401tTM TOWN OF NORTH ANDOVER 3: 0 AL H 9 r Certificate of Occupancy $ �'�s'•^° t<� Building/Frame Permit Fee $ k MUS 4 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ t Check # F 2 116 : 9 �- Building Inspector Date.. TOWN OF NORTH ANDOVER 0 I.- PERMIT FOR WIRING WNW ACHU This certifies that ................ ...... Fe T, ............... ..7 has permission to perform ........ .. ... ..P- ................ wiring in the building of................104.6-.8 to.................................... at......1.71. ............-%. North Andover,Mass. 3 ....3. 4............... ....... Fee.. .................. Lic.No. LEcriucAL INsPECT?k Check # 8 6 2 �/ / I COmmonWOag For Office Use Only (Rev.11/99) cc�� cc77 Permit Number: �- 1JtParEnstnt Occupancy&Fee BOARD OF FIRE PREVENTION REGULATIONS APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK (ALL WORK TO BE PERFORMED WITH THE MASSACHUSETTS ELECTRICAL CODE 527 CMR 12:00) PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: Z City or Town of: A ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location: (Street&Number) Owner or Tenant: Owner's Address: SAM Is this permit in conjunction with a Building Permit? Yes' No 0 (Check Appropriate Box) Purpose of Building: 1, Utility Authorization#: f'!I 7:2 (il Existing Service: Amps / Volts Overhead ❑ Underground.❑ T #of Meters New Service: Amps / Volts Overhead ❑ Underground.❑ #of Meters: Number of Feeders and Ampacity: Location and Nature of Proposed Electrical Work: No.of Recessed Fixtures No.of Cell.-Susp.(Paddle)Fans No. of Transformers Total KVA No.Of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool: Above ground ❑ in Ground ❑ #of Emergency Lighting Battery Units No.of Receptacle Outlets No. of Oil Burners Fire Alarms #of Zones #of Detection&Initiating Devices No.of Switches No.of Gas Burners #of Sounding Devices: #of Self Contained No.of Ranges No. of Air Conditioners TOTAL TONS: Detection/Sounding Devices Local❑ Municipal Connection❑ Other ❑ No. of Waste Disposals Heat Pump Totals: Security Systems: Number: TONS: KW: No.of Devices or Equivalent No.of Dishwashers Space/Area Heating: KW Data Wiring,No.of Devices or Equivalent: No.of Dryers Heating Appliances KW Telecommunications Wiring:No of Devices or Equivalent: No. of Water Heaters KW No. of Signs: #of Ballasts: OTHER; #of Hydro Massage Tubs No. of MotorsTotal HP }� INSURANCE COVERAGE:Unless waived by the owner,no permit the performance of electrical work may issue unless the licensee provides proof of liability insu.,rance including"completed operation"coverage or Its substantial equiv nt. The undersigned certifies that such coverage is in forc and ase ited proof of sala.to Ae permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ Please specify: Estimated Value of Electric Work$ (When required by municipal policy) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. 1 Afify,under the pains and enalties of perj ,that W&Jafoxmation on this application is true and complete, r Firm Name: Licensee: v Signature:_9 LIG.#. (if a I able to "exemp in h licens umbernline)y/�/j ? ft Address / Bus.Tel.#�/�a YJOJ 3 Alt.Tel.# OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) Owner D OR Agent❑ Signature of Owner/Agent: Telephone# PERMIT FEE:S NORTH T01" 0 o Andover 0 0 No. a9� o dower Mass. A�' ` O O _ LA 1 COCKICKEWICK %, ADRATED PC3 `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR j THIS CERTIFIES THAT............ . ..r!�........................... .................................................................. ................................................... Foundation has permission to erect........ ............................... buildings on ..,r)OF....... . ........ .. ► r. ................ Rough to be occupied as........ ....�/�. `t..... .�. . . .......... � ..... 1!! ..... Chtmn y e provided that the person accepti this permit shall in ry respect conform to the terms of th pplication 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 PERMIT EXPIRES IN 6 MONTHS ^ D ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TARTS Rough .................. Service BUILDING 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. Massachusetts - UCllartment of Public Safm Board of Building Rc!„ulation.s and Standards � a� �}� ✓/ae .60-1111,iraarzcua�'✓Gl.ct�:�cze�uu�ef�it ' Construction Supervisor Specialty License �-\ Board of Building ttegutatiods and Standards License: CS SL 99358 _- __ HOME IMPROVEMENT CONTRACTOR Restricted to: RF,WS x, Registration: 104569 Expiration:. 7/14/2010 Tt# 270265 DAVID CASTRICONE " Type: Private Corporation 31 COURT STREET NORTH ANDOVER, MA 01845 DAVID CASTRICONE ROOFING,SIDING& David Castricone 2DD SUTTON ST SUITE 226 - - -�� Expiration: 12/16/2011 NORTH ANDOVER, MA 01845 ` ( unnii��inrr Tr-': 99358 Administrator i ACORDr„ CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDD/YYYY) 9/23/2008 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 INSURER A:C i t a t i o Insurance O David Castricone Roofing & Siding Inc INsuRERB:T e Insurance Co of State PA 200 Sutton St 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 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 TERMSr EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICYNUMBER POLICY EFFECTIVE POLICY EXPIRATIONDATE(MM/nQ1YYi DATE(MM1QQ1YY1 LIMBS GENERAL LIABILITY EACHOCCURRENCE $ - COMMERCIAL GENERAL LIABILITY PREMISES EaoNcurD $ CLAIMS MADE F-I OCCUR MED EXP(Any ore arson) $ PERSONAL&ADV INJURY $ GENERALAGGREGATE $ GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ POLICY PRO- FIJECT F]LCC A AUTOMOBILE LIABILITY 08MMBBTNKT 8/1/2008 8/1/2009 COMBINED SINGLE LIMIT $ ANY AUTO (Ea ecdderll) ALL OWNEDAUTOS LY X SCHEDULEDAUTOS (Peaper-)CRY $250000 X HIREDAUTOS X NON-OWNEDAUTOS BODILY INJURY (Peraacident) $500000 PROPERTY DAMAGE (Peraockwfi) $100000 GARAGELIABWTY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACHOCCURRENCE $ OCCUR F1 CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND TBA WC 31969 9/23/2008 9/23/2009 X I WCS ATN- OTH- EMPLOYERS'LIABILITY - _ - ANY PROPRIEIOR/PARTNER/EXECUTIVE E.LEACH ACCIDENT $100000 OFFlCER/MEMBEREXCLUDED? E.LDISEASE-EAEMPLOYEE $100000 II yyes db.dbe under SPEG�IALPROVISIONSbelow E.LDISEASE-POLICY LIMIT $5 OTHER DESCRIPTION OF OPERATIONS/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 & S1d1riJ Inc BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER 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 N. Andover MA 01845 THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) 9 09 9 NMI,Ml MIA Mi A CORVOi I i I 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 978-683-3120 In Boxford 978-887-6147 In Naverhi l 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 below desc' d: J� Owner's Name......rCc 11`1n.Yu......... .. ....................................................... ephone/1.... .. Job Address.... .................... A tl� /� ...........city.... o....l..l'. .0 d':..................State......MA...... Specifications: ..............r .............. 5 .. : .... ............................................................................................. ....................... 4mas to be covered; /i ll s: �toys..z. ....a...................... ......................................................................... ................... pply vinyl siding and corners. Type: M it r ✓Cover fascia boards and rake boards. stall vin 1 soffit - solid / iterated � ' ✓rsc.✓ °t+�6od casings around windows.,Db,;r3 Replace any gable vents and dryer vents with vinyl. w�.. i .K...................................................... vX ply underIayment. TyPe.... ......................................................... i �� r,,M1 . .... ....... s. S.•c�w.. ..... P yam,/ sting siding - st p / go-over al dis 1 of all debris .... ........ P� - ............................................ ............................................. PJ:►xy..... ...... .............. ..... [. .ems.......... Rotted wood replaced @ Gjj /sheet or 3f /foot .... ....... o,.........s rs ..�Cyfltl-� .. .... . ... ..... ...... ...... ...... ?e ..... .� �.... . .. ,.,. ... .. �.E..l.�....�....wl.rAF.A../.M..�h�Y.....cA'•' 'Rr�i..tt....Cyl.�L .�.i.. ....is?�...�rai.4.rt1.:s�l..Q.t�..i.',..2.�. " :..« .......................................................................................................................................................... ... ... ..,-. j .M.. M One Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specify c u The crgnquacor perform the work 44d ish the materials specified above for the SUM f _77f ${a Cayable.. t2Ca........on....5. ............... Payable.......'.`................on.......—.................... (Z;Oalance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability while/ob is in operation. Contractor is not responsible for any damage to the interior of property,including pro-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).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 warrants) that he is(they are)the owners(s)of the above mentioned praniscs and that legal title therero 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: Any and all necessary construction-related permits shall be obtained by the Contractor. An Owner who sec h' related permit . y ores his own construction- p t 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)). ,4 IN WITNESS WHEREOF,the parties have hereunto signed their names this *41L' day of.. c dl .....,20..4 $.. Accepted: Signed..» ». .. ....................».»»...... Owner Signed.....................»...................:....»..............»....»..... Owner David Castricone,President The Commonwealth of Massaclz ttsetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston MA 02111 w s mg ,n.�., iv>v. ass. ov/iia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): —Dal l d Cas t('1 LOn e. --6 rw, " Sia 1 t, 1 h., J 13 Address: aLoc> S ,� 4- �., S}rx L:�- %-kL 22 t. City/State/Zip: 9. An&,rej HA C�t $<{S Phone #:AA 18 3 ,j 4a O Are you an employer? Check the appropriate box: Type of project(required): p I� 4. I am a general contractor and I 6. New construction 1.� I am a employer with 0 ❑ g ❑ employees(full and/or part-time).* have hired the sub-contractors 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. F-1 Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I 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.] t c. 152, §1(4), and we have no employees. [No workers' 1 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. tContractors 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 worlcers'compensation insurance for my employees. Below is the policy and job site information. /� C Insurance Company Name: �C. \+nSV(p�/'1(,e c� a J t4. A Policy#or Self-ins.Lic.#r �(�( C. 5 8 �'S (p Expiration Date: Job Site Address: 1`1 b W 6 w City/State/Zip: n, 6\,e, W 0 1 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 c ender d a ains and alties ofperjury that the information provided above is true and correct. Signature: Date: 20 Z,0-Zo R 3y-Lb — Phone#: q l 3 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 tAoRTN of Building Department o - E 27 Charles Street North Andover, Massachusetts 01845 iL l!yyRR��. (978) 688-9545 Fax (978) 688-9542 A�Rwrao ,Pµy,��J �Q�SNCWUS�� 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 cl 1, sl 50a. The debris will be disposed of in/at: Facility location Signature of Applicant /a � Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector, f