HomeMy WebLinkAboutBuilding Permit #177-15 - 18 WOODBRIDGE ROAD 8/19/2014 BUILDING-PERMIT OF NORTy
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION `" ~
Permit NO: ` Date Received4q""""""`"��''
�q�reo frR .(9
_ �SSACHUS��
Date Issued: "'
IMPOR ANT:Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Resid .ti Non- Residential
New Building One famiyl )
Addition Two or more.family Industrial
A_1t ° n No. of units: Commercial
air, replaceme Assessory Bldg Others:
Demolition Other
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DESCRIPTION OF WORK TO BE PREFORMED:
Identifcatio Iease Type or Print CIearly)
OWNER: Name: Phone: q1g M - I o o 7
Address: g W 0 0a IDr, AniL RCS-
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BOLDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ t�Q l d FEE: $ 0Z
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guar my fund
,....=�j�::—,�.T�.•Fzs.,"�.'a". , -...�1,'"�_.• __ _ �t.•,5�:.f wY�:yam^ _ �� � ' q :2��'6,.(yYo�� vlti,,
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Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art Swimming Pools
i
'well Tobacco Sales Food Packaging/Sales
i
Private(septic tank,etc. Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
jDATE REJECTED DATEAPPROVED.
PLANNING &.DEVELOPMENT
I
COMMENTS
I
CONSERVATION Reviewed on Sigrature
Cvi�iviEvTS
- rl
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Bbard Decision: Comments
*
-Conservation Decision: Comments
Water& Sewer Connection/5iLcjnature$Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Os ood Street
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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
I
NOTES and DATA—(For department use)
❑ Notified for pickup- Date
Doc_Building Permit Revised 2010
c
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
I
❑ 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
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ IVI
"'ass 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
❑ Ceified 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:Building Permit Revised 2008
Location
No. t� Dat
oojjj
. - TOWN OF NORTH ANDOVER,'
f Certificate of Occupancy $
Building/Frame Permit Fee $ 00
- J Foundation Permit Fee. $
Other Permit Fee $
TOTAL $
1 '
(Q ICheck# L
27 � 13 Building Inspector
NORThl
Town of 2 s E : 1, ¢ ndover
No. O ��h ver, Mass, g' • •
COCMI(„t WICK
S U
BOARD OF HEALTH
PERMIT TFood/Kitchen
11 Septic System
THIS CERTIFIES THAT .............. ... ............. 1r�ft.'..................................................... BUILDING INSPECTOR
ll
has permission to erect.......................... buildings on ....�.�....... A'..�Vit. .......•••• Foundation
................... Rough
to be occupied as ........�... .. .. .......! .... ...Inr! �.. ....... ...................... Chimney
provided that the person acce t1h this permit shall in every respe onform to the terms of the application Final
p p p 9
on file in 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
vPERMIT EXPIRES IN 6 MON S ELECTRICAL INSPECTOR
I D UNLESS CONSTRUCTION TS
Rough
Service
............................... ............................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display ina 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.
Smoke Det.
DAVID CASTRICONE, PRES.
CASTRICONE ROOFING & SIDING INC. s
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
1/we the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to famish all necessary
materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terns and
conditions,on premises below described:
Owner's Name.......... ..l..l ..C1t22 .� Tel honeN...�. A"�3.�1•..:�.� �
,.... ......................................
Job Address......./..A.......VYl2.L�.G�.h'.J'./..r '.. , .A...........City ).11.�.c7.j�c?-P...............State...
Specifications:
.................................................._........_......._.._..._...T...._...........�`............................./,_..........................................................................
✓Strip existing shingles{ /Applynaw drip crl;,c 10:111 edges.
......................................................................................................................................................................................................
✓Apply_feet ice and water shield membrane to bottom ed'es of house.3 fee t ice and water shield membrane
in valleys anti buuttiu�ln edges of ally unhealed areas of house. /f n1 L';SS�11a beFi /`& r /Cgd(flJT
........,...y... 1... slit ...6', .rrte.l.`.'................
.....:.........
✓A tl> .}�.►1 I ce_I_a,/...ymcuL�nstall1idgc vent to shingles with a ; `R warranty. �i rni/e-�/=
NI e lt 1 •� rn t e1-.,
12croofsin^ Cir n l�e= �dinar .T��. ..................................................... .....................................................
6
✓Gountcrtlash tinutcy. /1\'ew vent pipe clashing.r�Legal disposal of all debris.
Area(s)to be worked on: (� `
( ..../ 6.C,�. .�1 .kS.: ...�c.�,g.... .a,t.. .. .. .............................................
� r.. r ()
..l?t,.�upn..°...... ..�r..,.p.a� ,..........................
.....5:1f��i.X1. /.rte&.�S:L'la f. A-t...
.......................y...a,................................ 1`�'
Roof board repm
laceent if necessary @ /sheet m'j /foot. te
........................................................................................................................................................................................ .............
Five Year•Workmanship Warranty(Not Transferable) Manufacturer's Warranty as spec*
y manufacturer
The ctor agrees to perform the work a dflw�is�h the materials specified above for the SU of$.....7a -UL?..�r! Z?.........
ayable•'d...&AO.....on..S ru-.!•..............
Payable........:.' ...............on........... ................... alance payable on completion ofjo
Owner or Owners are not responsible for Property Damage or Liability whi a 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.c.objects coming loose from walls,crumbling plaster,exposed nails,dust in attic or other liviag
spaces). items in attic may need to be covered by homeowner.All materials are property of contractor. Any dumpstcr placed by contractor is for his use only.Upon
completion ofabove 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 owners)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 be 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 sliall bind and apply to their heirs,succossors or estates of the
parties.The undersigned warrant(s).that he is(they arc)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,tar 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 co tors is excluded from the Guaranty Fund provisions of MGL c.142A.
JJ � c_ � z.
Approximate starting date of work.�.7yt .. � 2h.�y..5 Com�lon date.........................................................
Receipt of a copy of this contact is herly, acknowledged,and 4t 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
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,231 R Sutton St.,No.And ,M�L 01845.
IN WITNESS WHEREOF,the parties have hereunto signed their names this. L„•day of.A.(i!. ..1 t�
Accepted: r—' +
Signed .. ............................. Owner
Signed"...... ..... ... Owner.
Da ..........................
,
David.
Castricone,Prtxident
The Commonwealth of Massachusetts
- Department of industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leizibly
Name(Business/Organization/Individual): it A\U D (OA 1 T21 C h��(l" -'&E
M6
Address: Su T--r-6 0Nit 3A
City/State/Zip:N o, hjwO g MA Q 1 jq Phone#: 7 (o 3 3 Y,,,)-y
Are you an employer?Check the appropriate box: Type of project(required):
1.0 I am a employer with _�_ 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner-
listed on the attached sheet. ?• Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp.insurance. 9. E]Building addition
[No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
required.] officers have exercised their
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑plumbing repairs or additions
myself. [No workers'comp. c. 152,§1(4),and we have no 12.XRoofrepairs
insurance required] 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.
Homeowners who submit this affidavit indicating they ate doing all work and then hire outside contractors must submit anew affidavit indicating such.
#Contractors that check this box must attached az additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: 0 H M F t?( f t N bU i I
Policy#or Self-ins.Lic.#: W C 6 6 139 Md3 Expiration Date: A,,,AA .
Job Site Address: g 0 1 City/State/Zip: �7t14wt f, &4
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A of MGL o. 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 certifyu er the ins and enalties of perjury that the information provided above is true and correct.
Sienature: Date:
Phone#: q /Kj �%3 34)-L)
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#:
i
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards _
Cnnctruction Supcn isor SpccialtN
License: CSSL-099358 `
DAVID T CASUUtONE_.._..
31 COURT STREET
NORTH ANDOVER MA1110 ' 5
'
17
0
J..�.:, �J . '; ;,r Expiration
Commissioner 12/16/2015
dF11ea��zi�civaea/�r./�/�lz.tacu�nl�
_Office OfConsumerAffairs&Business Regulation
SME IMPROVEMENT CONTRACTOR
eegistration: 104569
xpiration: 7/1 Type:
4/2016 Private Corporatie
DAVID CASTRICONE ROOFING,SIDING&
David Castricone
231 R SUTTON ST SUITE 3A
NORTH ANDOVER,MA 01845
Undersecretary
I I
I
i
DATE(MM/00%YVV'V) i
ACORa CERTIFICATE OF LIABILITY INSURANCE 10;7;2013
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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditlons 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).
oPO��UCER CONTACT
NAME.___
Eastern Insurance Group LLC Main PHONE No E 508-651-7700 lA!C No):781-586_8244
233 West Central Street EMAIL
Natick MA 01760 ADDRESS: elecerninsurance.com
INSURERS AFFORDING COVERAGE NAIC M
INSURER A:Commerce '347s4
NsuRe° 31969 INSURER 8:Gornrrerce&Industry _
David Castriccne Roofing&Siding Inc INSURER cNestern World Insurance C
tCaslricone roofing inc INSURER D
231 Rear Sutton Street,Unit 3A ----
North Andover MA 0184S INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER:1701011967 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 70 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 PRAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR i TYPE OF INSURd NCEADDLISURIP POLICY EFF POLICV EXP
L7P, INSR WVD POLICVNUMBER MM!DO!YYVY MM/00!YYYY LIMITS
C !C-NEPAL LIABILITY NPPi35O5i5 1612013 16/2014 EACH OCCURRENCE 5i,00D,000
IX !
CID,INIERCIAL GENERAL LIABILITY PR M ,ur 17errer— 550,000
j CLAIMS.MADE lJ OCCUR ME EXP(Any ong person) S1,000
PERSONAL P.AO'V INJURY St,000,000
I.
GEFIERAL AGGREGATE $2,000.000 _
EiPL
AGGREGATE LIMIT?.PPLIESPEP, i i PRODUCT$ CpMPipAGG 52,000000
IX P,IUCY 1-1 FRO. I LOC ._._._ �$—
A i AUTOMOBILE LIABILITY 9CNGCV /1.'2013 .1;2014
iEaaccidara• $1,000,00 _
j_*tdY SU T(.r BODILY INJURY iPer person S
ALL C)"NEOSCHEDULED
x &.ODILY INJURY(Per accoem) S
MON-OWNED PROPERTY DAMAGE 5
HAE0 xU TC'S ,x AUTOS /Pet accoent)
(U648RELLA LIAB OCCUR EAGh 1�GOJJ?FEraGE j S ____
xcEssLIAB CLAIMS MADE I AGGREGATE S
DED RETENTIONS S
g V7o RK E R5 COMP E N5ATI0N 6V0003989?23 2312013 9i23/20t4 N!CYTATf O7H-
A.N�D EMPLOYERS'LIABILITY Yi N
ANY P.POPRIETOR.'PARD KECUTIvE O E.L.EAC'�H ACCIDENT 5100,000
, OFFICERA:iE FABER EXCLUDELUDED? NIA I
u
(I':65.t dSrory in E.L.DISEASE-EA EMPLOYEE $100,000
'I j II dOE SCt'L�f i116r ._
DES,:RIPTLII•JnFOPEPa.,KlldSbolow I I E.L.DISEASE-POLICY LIMIT SSOO.000
I I I
DESCRIPTION OF OPERATIONS;LOCATIONS!VEHICLES(Artach ACCRD 101,Additlonal Remarks Schedule.If more space is required)
i
CERTIFICATE HOLDER CANCELLATION
Castricone Roofing & Siding SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Unit 3A THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
231 R Sutton Street
North Andover, MA 01845 AUTHORIZED REPRESENTATIVE
01988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010;05) The ACORD name and logo are registered marks of ACORD
Town of North Andover o� N�k7H
�1�ro
3� o
Building Department o m
27 Charles Street
Norili Andover, Massachusetts 01845 * I v
(978) 688-9545 Fax (978) 688-9542
DEBRIS .DISPOSAL FORM
In accordance with tyle 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:
ZN(f— S' fie , N 11
Facility location
Signature of Applicant
Date
NOTE: A demolition permit from the Town of Narth Andov
project through the Office of the Building Inspector, er must be obtained for this