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HomeMy WebLinkAboutBuilding Permit #856-14 - 20 ELMWOOD STREET 5/28/2014Permit NO: BUILDING` PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION �._ Date Received 12-9 I 1 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 .yuv4xCUN- �1_ �a'1t'h , R �_'S ' _4� _J "i"C[`.`�m�_-,L-,l I i3._,'1- t _�'a. � w3�Ly-�� 1 L. �.:? -vy :S�N 5e`�a�L.--, 4w:�..t.��.^ce^`�Xr:;-stiF '- M. =T,ej.'.#-�.- S�,�°1 ,.'�Y-%''`.-�'tf+��Y'4r�e�� YYE.�cr�-.�-:r -•'^.Y.YY.h 3�_ •+'c•^F..tTn .�;J'..,A"T '.4�t'N.y,�i3'., ]-^]:4,L,+x�'•v•5'iir-'lJ��-1 :�tir.e�°'Y_L.'-. =6T:S�. �-��'.�:.r,.r���-:� `1rs�}''�-J^, :��_= ;FL;.�._.1� ,✓h;',;�.-._'.�`ui�C.,{-_.l+ 7�-.-�'f..`�* �R L�5r{na� 4-'-�.4.f�P.•� �.�.�.. �4^f*f. ='�SS'}` ,:,,T:n�e�w� "lc:Pv'_.e:",? ;_- �Y� •J_Y.r �.'^,F..1riY.s�e�-�Y���5. rW.- 3C"�k_c�:t�l.�i.4,':a,.`v�,�+ Yt' _ r_._ _�.:�.-�. •t ;��.s_, 1�-Y^ ..`..,[�_;57 :���� i8�.S'v?`s, _.a�xy.. _:�1�..L _.i�_ _�., :�,:�':,,. _..r—ms=�?3�-eu'.r_,,..,od:_..r.=r �y,�ap.��.l,a:7s-t.� _ -��=4'�z:,°: .'.�_'a,�.YY;{ge�..�:_'F� _ DESCRIPTION OF WORK TO BE PRFFORMFn, o(— Id" tific on PIease Type or Print Clearly) OWNER: Name: 3c—s6 n j Phone: 403 oda 102Y y ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULD/NG PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ ®(�O O Uy FEE: $ 1 �� Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guar anty.fund Location 2-0 No. Date' TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Pe - rmit Fee Foundation Permit Fee Other Permit Fee TOTAL Check#24(-oo 27616 l3bilding Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer ,Well Private (septic tank, etc. Tanning/MassageBody Art Tobacco Sales Permanent Dumpster on Site Swimming Pools Food Packaging/Sales THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Sigriature uulvl vlE vTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Snature Qate Driveway Permit DPW Town Engineer: Signature: 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 Doc.Building Permit Revised 2010 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 o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ iviass 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 ❑ Ceifie d 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 thebuilding application Doc: Building Permit Revised 2008 cn CD 0Z C Cr C � CQ. O 00 (D CL a� CD O CD CL o CO CD S' CD r -9b O Owe U) O U) a F O y M CD I O O CCD O CD n Z i E- �ix cn z Z /2 0 0.10 sv 2 a f/1 —A �• 0 `CD. 0 � ,nf C , f r 3 -% O VJ „Of M' O. O — �7 O CL�a• rn , CD W n CD N 0 cn N CD 0: m 2 = C 1 �• CO CL N ®rO O 0 -ter W rt N CD CD O O C ,a O N rt O � ' 0 N - =CD OZ Oma, Cr o D CD Q it a 0 0 cQ I CL CL < <D :dropCL CD .� _CD CL W� CD �Ch Os p v ppN` O O rt S ^� C CD CD : 46 CD N n 5-0 a: Da m -aa 0 O CL a a Ln Ln WT v .Z7 T N Zo T x T rt O 3rDO 7 O 3 S O O m O ° 01 °i °� m aC ao QQ ao :3 Q m- � n 3 5 Q O ID rt m M 3 S m m C CO 3 C 00 7o G) � D Z �cl O Z D H r O n Lei N m z n n = 0 0 0 0\ 0 s I v ¢ �O C 0 s DAVID CASTRICONE, PRES. CASTRICONE ROOFING & SIDING INC. 6,^11 'z/���j( 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 I/we 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: . / r q Owner's Nam e.......1.t:L S..ZF J ...� .1.y1 Z7.�.L r. .1.d[.! 13 ................... •........... Telephone #. ?t�3 J` .. ..TKS 1 Job Address.. r�c�aLl.....t1.YiJ..tat...Zt.lj�.................. Ci /�j ry... t7.1... •yl .p..4!.�.( .......... State....C.A ............. Specifications: ................................................................................................................................... rr r-�.............................................................................. I�tr•ip existing shingles( 4rply new drip edge to all edges. f t%% t e ............................. I....... ,............................... ....................................I......................................................................................................... ✓Apply % feet ice and water shield membrane to bottom edges of house. 3 feet ice anti water shi ld membrane in valleys and bottom edges of any unheated areas of house. rw11 v iL/ rf,,o r ;PL -f pooF, .......I ............. ✓App1y felt pi ✓Rcroof usure ........................................................................................................................................... Counterllash chimney. "New vent ipc flashing. •fgal disposal of all debris. 1 1 ................................................... K..�z!..._................................................................. ....1.. �............ Arca(s) to be worked on: ................... .................................................................. xu.�t to tr......tt �•xr n..> l �. /!b t.1t� {� P ...................... ....... ....... ............�..1''r.%..N'�.t.•tt.•••••••..(;..�....f.�'!. ...W.. ..�- .I...��••......Ci.��f..... Roof board replacement i necessary @� /sheet t1f �a /foot. .......i......................................................................................................................................................,�:. ,.......... .... Five Year Workmanship Warranty (Not Transferable) Manufacturer's Warranty as spec' y manufacturer The for a riles t erform the work d f r-ish the materials specified above for the SU j ayable ...,�..,d�....... on. / V Payable......... ................ on ................. ..............aalimc. payable on completion ofjob Owner or Owners are rrot responsible for Property Damage or Liability w n 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) of 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 ofabove woik, 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. 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 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 Impro4ement Chtractors 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 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 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, 23pkSu#Ori St., No. Andover, MA 01845. IN WITNESS WHEREOF, the parties have hereunto signed theirT1.4 es this... Y.S. ..... day of ..... la ........... 20...H. p ted: Acce Signed ...............t.�G. :.�.... Owner LLYCLILSigned............................................................................. Owner David Castricone, President !:� The Commonwealth ofiMlassachusetts Department ofIndustrialAccidents Office of Investigations 600 Washington Street UIF Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): A\/ 1;D L ,/�S TR I ( 6 N E (I \ tE 19 lT Address: &L) TTdo N i T 3A City/Rate /Zip:N o, 11NbNw MA MY)' Y) Phone #: 97& (off 3 -3 �4y Are you an employer? Check the appropriate box: 1. RT I am a employer with _ 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 1011 Electrical repairs or additions 11. E] Plumbing repairs or additions 12.N. Roof repairs 13.❑ Other *Any applicant that checks box fi 1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they 6e doing all work and then hire outside contractors must submit anew affidavit indicating such. #Contractors that check this box must attached an 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. A Insurance Company Policy # or Self -ins. Lic. #: Expiration �, r Job Site Address; a2 b E 1, MCO U i) c5TU-e T City/State/Zip: ' `i0. & b0\16_A, NA d 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 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. Ido hereby certify under theepains andpenalties ofperjury that the information provided above is true and correct. Signature:;/ r� Date: Phone #• 9 / K W 3 � aO 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 S. Plumbing Inspector 6. Other - - Contact Person: Phone 9: ACS � CERTIFICATE OF LIABILITY INSURANCEF01-7-;2013DATE`MrA.'DD`YYYY) THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI! CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE`. BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZES REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thi certificate holder in lieu of such endorsement(s). CONTACT PRO=UCEA NAME_ Eavern Insurance Group LLC Main PHONE No E508-651-7700 (grC.No).7R1 -586-8244 233 'Ales! Central Street EMAIL Natick MAO 1760 ADDREss:sI rk erninsur nce.corm INSURER(S) AFFORDING COVERACE ! NAIC # INSURER A,CCMMerCen5wrance Company '.34? 4 INIS uRee 31969 INSURER 8 Commercer _ It 94 i>Q- Davic Caslricene Roofing & Siding Inc INSURER C: n World insurance Co. Casuicone Roofing inc INSURER D �l 1 Rear Sul'on Street, Unit 3A -- or'h Andov2r MA 01845 INSURER E. _. I I INSURER F i COVERAGES CERTIFICATE NUMBER: 17nini iC1A7 RF-VISInN NII64RFR THIS IS Tu CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIM INDICATED. NOTV;ITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS Cr;.TICICATc MtaV BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLU51ON5 AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I.VS.<' TYPE OF INSURANCE r INSR WVD POLICY NUMBER POLICY EFF POLICY EXP MMIDD!YYYY MMIDDIVYVY LIMITS I,C 'C_.l'FFGLU431LiTV PP1350515 it;l2013 6/2014 EACH OCCURRENCE I S ti 000,000 i COi.Ir:1ERCJa.LGENER.wlLL4d41Tr f (�fUt 10HtNT PREMI Ea occurrence) 550.000 rv1ED EXP (A(y 0I -Q person) S 1,000 C! AlkiS-(RADE OCCUR I I PERSQN.AL t ADV INJURY S1.000.00.0 = I 1 GEHERAL AGGREGATE $2,000.000 =. ,GGREGATE UNIT APIDUES PEP.' I I I PRODUCTS . COMP -(7P AGG 52.000.000 in I)LIfY PRrI. I ! .... . 15 .I, . Loc ` 6UTO.,1031Le LIABILITY 9C:NGCv /1120 i3 b11 201JI LIMIT I/ Ea as+dew $ ),000,OCO :In� =.0 T::, ! B')DILY INJURY iPeL,gersan) y L!_rt,'%NSDK S-HEDULED IAUTOS — ----- _ BODILY INJURY 1Pe, ami *'I) ( S -- ;aREU?.U;t�!S Fj� AUTOSLVNED I PROPERT'1DAN.IAGE rPe' axdenq _I S ---- -- I IS U.ISREI_Le LIA9 OCCUR � EACH E>CCURRENCE -XC e3S uaS S — CLAINIS MADE AGGREGATE --'—'- pEo I i gETEtiTIOt.IS _ /Cn':{r,rSCOrdvcLS81LIT LIABILITY WC003989?23 S 1.%23!2013 ri23/201d N/CST.>TU I OCH' I Y;N .-��"� F�J:'A!ETOR:?.ARTNE R%E XECUTI ,'E ^-r :01 -'cH6ER EXCLUDED' N / A Y Mff I R ._ i E.L E.4Ch ACCIDENT 5100 000 I E L i. Cs cescrte 1g; - C�'IPTI:?I,'t:IrOPERATC)PISU61ow DISEASE EA EMPLOYed 5100,000 i II IE.L.DISEASE PrjLIrl LIT-1RISS00.000 1-1Lca 1Anacn A1,UnU 101, Addillonal Remarks Schedule. If more space is required) MULUtF4 Castricone Roofing & Siding Unit 3A 231 R Sutton Street North Andover, MA 01845 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AU IhURIGtU REPRESENTATIVE © 1988.2010 ACORD CORPORATION. All rights reserve. AC09D 25 (2010x05) The ACORD name and logo are registered marks of ACORD Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM � NOf+Tty�q , n SAC U5 In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit 9 the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MOL cl 1, sl 50a, The debris will be disposed of in /at: /'Z'7- E 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,