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Home My WebLink AboutBuilding Permit #171 - 19 BOXFORD STREET 9/9/2002 BUILDING PERMIT NORTfi Ll D.$6 gtiO TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION '- 1 D Q ea Permit NO: Date Received 91-- Date Issued: �-l� AC US IMPORTANT:Applicant must complete all items on this page fLOCATIONS/ S`� PROPERTY OWNER rLP ��/#�-~ Print MAP NO: -%�PARCEL:_a 3_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: ef // dentification lease Type or Print Clearly) OWNER: Name: f-e a , � Phone:)—e f Address: /�� /2tC/bio` r� ►-�-� ALS- CONTRACTOR Name: ^ &1h7 ddtf Phone:. Address: el � U Supervisor's Construction license: Exp. Date: v� Home Improvement License: Exp. Date: 7 /I/ d-a P ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: q I& Persons contracting with unregistered contractors do not have access to the gu •anty fund 5i nature of Agent/Owner f- Slflnati gra ....�.�..,�_ a. Location r I r V Y No. �_L Date �aRT►, TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ : Other Permit Fee $ TOTAL $ Check # C 2 ; 486 Building Inspector 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 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 i I 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 2 1 A—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 � NORTy � TONM of No. =- * - `±- LA Q dower, Mass., • 0 COCHICKEWICK 'V ADRATED '9S BOARD OF HEALTH Food/Kitchen PERMIT � T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT /`� .. ............... V �✓ .............. .... ...... ......�...... ........................ ........... .......................................... Foundation r �Jrrr� has permission to erect.................................i4- ildings on ....�yr::.,r.............................. .....................,�.......... Rough to be occupied as..... �..... .. Chimney provided that the person a% piing this permit shall in every pest conform to the terms of the application on file.............. n 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 r PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU ST TS Rough ................ ........... .................................................................... Service BUILDING INSPECTOR 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. A CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) i PRODUCER FAX THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION i Willows -Insurance Agcy ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4 3 J e t w o o d S t - HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW." N Andover MA 01845 INSURERS AFFORDING COVERAGE jNAIC# INSURED INSURER A: P N SPECIALTY David Castricone, Roofing & Siding Inc INSURER B: C;t r.: INSURER C: 200 Sutton St Suite #226 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDIN 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. INSR A.DDTTYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE 6100000 COMMERCIAL GENERAL LIABILITY L O 01319—01 9/6/0 7 /6/0 8 DAMAGE TO RENTED I 50000 CLAIMS MADE OCCUR _$____r0_0_0 0 0 MED EXP An one S 1 V U v (Any Person) A PERSONAL L ADV INJURY $ 100000C GENERAL AGGREGATE S GEML AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AMG S 1 0 0 0 O 0 0 POLICY )ECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT I (Ea aocideN) ALL OWNED AUTpS BODILY INJURY = SCHEDULED AUTOS (PC(Person) HIRED AUTOS BODILY INJURY I NON-0WNED AUTOS (Per accidem) PROPERTYDAMAGE _ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN TA ACC I AUTO ONLY: AGG = EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE I OCCUR EICLAIMS MADE AGGREGATE $ i DEDUCTIBLE I RETENTION I I WORKERS COMPENSATION ANDWC STATU- O _ EMPLOYERS'LIABILITY — ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT I OFFICERIMEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE S SPECIAL PROVISIONS below E-L DISEASE-POLICY LIMIT I OTNER DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL 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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILP,Y OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTH ORIZED)REPRES ENTATIVE ACORD 25(2001/08) OACORD CORPORATION 108 Town of North Andover 01 tkORT Building Department O : - .. - °m 27 Charles Street North Andover, Massachusetts 01845V. s (978) 688-9545 Fax (978) 688-9542o o ,�x;K. i. gOR�^re0 "?VS AC7 ISACHUs�-- I DEBRIS DISPOSAL FORM In accordance with the provisions of MGL e 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, s150a. The debris will be disposed of in/at: ��t1 �S'. A Facility location Signature of Applicant 9'16 Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through th P J g e Office of the Building Inspector. j Department of Industrial Accidents Office of'Investigations 600 Washington Street Boston, MA 02111 xww mass.gov/dia WorkersCompensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print: Legibly Name (Busuiess/organization/Inclividttal): �DAy 1 h LA,, 21 c,N t Al t, `` 5 L T.,1 N c. \ N C. Address: ae 5 u 7`rON S TI2U.T — Su ITE. City/State/Zip: W, A-N b o vtr2 VS A 01 94J Phone #: Q 19 (o 3(4,;Z a Are you an employer? Check the appropriate box: Type of project(required): 1.2 I attt a employer with ? 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑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 workingfor me in any capacity. employees and have workers' Y P h'� 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ 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.❑ Plurnbutg repairs or Additions j myself. [No workers' colnp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no 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. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors tnust submit a new allidavit 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. Insurance Company Name: �1/C. \n,5J C10.(1LCC. CO O S}" C. VA Policy#or Self ins. Lie. #: V Y C, Expiration Date: Job Site Address: f/7 Jr l/G{OTIJ� V City/State/Zip: N•f/71(/Q � /7 �f�y�� 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 unprisormient, 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 hereM)yfiindera pains and penalties ofperjury that the information provided above is true and correct. Si natureDate: Z ko 0 _ Phone#: 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#: 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 978-683-3420 In Boxford 978-887-6147 In IlaverhX 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 described: Q cy Owner's Name...........e. 4`.g,........ . �. .........................................TelephoneL....-..b/�: .. Job Address....lq,5.... .� .. ...... ..............City... .-. a.yw.....................State....it. ....... �rH6pITA,,C S PIES Sff/t?CCE-S /H ACTED woo D t!30--s,-)) Specifications: ...................................... .................................................................................................................. IStryp gist(pg shingl;4) 4pply new drip edge to all edges. Pl �r....................................................................... c/App ly Jot ice and water shield membrane to bottom edges of house.Sphot ice and water shield membrane \\S in valleys and bottom edges of any unheated areas of house. .................-...�................. ..) .... . !-`s....�.......n..T..Y..._...... .... �y �... Install ridgevent.to. . q ........................... `Reroof using .,,.u0 /- SLnt lB C�r r shingles with a 1�0 year warranty. ...................................................................................................................................................................................................................... -Countertlash chimney. 4Xew vent ipipe flashing. .legal disposal of all debris. ....................................................... ....,3.............................................. ................................................................... Area(s)to be worked on: /I/( Gri,..l"' .:.5........0 .......... ...U..ut.,t..sz�..�.. .................. ................................. .........................................1 .4.f••..... ......... . .....��.. .[,t'..!..... ...C..,.f.�.lh^..e'.....f.....�.A.l ./..J./�....W�.....��J.6�...ur'........�j.o, ..�.t.. � ..C.F.1..: .... .. ............ � h.l ......jjt ,.... .... f ,.............................................................� .-..' 15'�'.�f��.. ..................................................................... pp� ,.............................................. ...................... ..o�.................. Roof board replacement if necessary @�C6./sheet or, �=/foot /�G / �� .. 17, .................................................................................................................................................................................................................... Two Year Workmanship Warranty(Not Transferable) Nfanufacturer's Warranty as sped y anufactur The con actor agr�es to perform the work ish the materials specified above for the S of$..... tS$..g. .... .... 'ayable...g(�1.�'�7........on ,.rla;r;............. Pule::........................on....... t.—................. , Balance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability wffffjob 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 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 wamint(s)that he is(they are) the o)whers(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,not 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 unregistered contractors is excluded from the Guaranty Fund provisions of MGL c.142A. k .BQ•�or.(, wint2r-1007 V 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). G IN WITNESS WHEREOF,the parties have hereunto signed their names this... .day of.f . .....,20..0..4.. Accepted: , Signed �2 . ............ ...... .. . .. . .. ........................ Owner Signed.... ... .............................. Owner David Castricone,President r_ Massachusetts - Department of Public Safet` e � a � ✓�ie Lnoruorzararuecar!lLc ��,rtalarfucaelt6 Board olBuildin�g Re!,ulations and Standards Construction Supervisor Specialty License hoard of Buitdiug Regulations and Standards License: CS SL 99358 — HOME IMPROVEMENT CONTRACTOR Restricted to: RF,WS Registration: 104569 Expiration: 7/14/2008 DAVID CASTRICONE Type: Private Corporation 31 COURT STREET NORTH ANDOVER, MA 01845 Davin cAsrR,cGNE ROOFING;SIDING& David Castricone. 200 SUTTON ST SUITE 226 J Expiration: 12/16/2011 P NJR-rii ANDOVER, MA 01845 I)cp„ty Adr.;i,istr:;tor ('uun,is i ncr Tr=': 99358 . I ti i