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Home My WebLink AboutBuilding Permit #559 - 200 MIDDLESEX STREET 3/19/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: PORTANT:Applicant must complete all items on this page LOCATION cL1 IIC Prpt PROPERTY OWNER `- C "�1✓?. LJ Print : M MAP NO:' � PARCEL; �5 1 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 C/Repair, replacement Assessory Bldg Others: Demolition Other Septic- Well Floodplain Wetlands ` Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: oIdentification Please Type or Print Clearly) OWNER: Name. j6h/1 ,i/ Phone: �� i� 11�� Address: aOb /Q(a e0x ��e� A)v Ad6ves Guff J� CONTRACTOR -Name: ook Y Phone. q19k(11 Address: �ItAwl t � -C�Ut 2ZL / _ Alliott Supervisor's Construction,License; sy Exp: Date: 'Home Im rovement License: l�Y 20.9 "Exp. Date; _ ��/ �•' 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: $_ Check No.: /3'!r7 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund � �.y.� Signature of.Agent/Owner Signature of'contractor 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 ` o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o 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 Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL - I Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site M THE FOLLOWING SECTIONS FOR OFFICE USE ONLY I INTERDEPARTMENTAL SIGN OFF - U FORM f DATE REJECTED DATE APPROVED y PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature ` COMMENTS I - Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments i Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - TempDumpstec 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 y ' i e i ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 Location No. r Date MOR7M TOWN OF NORTH ANDOVER f 1 ` Certificate of Occupancy $ J Mus<� Building/Frame Permit Fee $ Foundation Permit Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22 £ 64 wild ng Inspector DAVID CASTRICONE 3lj�ljn 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 HaverhiU 978-374-7314 Uwe the owner(s) f thepremises menti n 1 omentioned below,hereby contract with and authorize you as contractor,to furnish all necessary Y Y materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on premises bel w described: Owner's Name.........°�. .......I....t.C,. .... ............................................. ephone#....... .Y.Z..- .26.. �........ Job Address...rr n 4......./..:(.i.tl p.t t+�.�?C........... '..r................City...��'.r..�n i!o..t/ed..:....................State....41A........ Specifications: .........................................................................................:.......................................................................................................................... .. 'trip existing shingles. .Apply new drip edge to all edges. S(rl ...................................................................................................................................................................................................................... -Apply_ L 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. ..................................................................................................... ......................................................................................................... -�pply felt paper and rl yment. 4nstall ridge vent to Y�o N. L9 / 1`Js gi Jne�as rs:,)L�� ...............................1J .1 .. ... . .......... -T-.... ................. .....U............................................................ ` - -Reroof using ('a:2�kZ rA k, anck; ,, Y shingles with a year warranty. ...................................................................................................................................................................................................................... `Counterflash chimney. New vent pipe flashing. -*gal disposal of all debris. Areas)to be worked on: ; �.1....... �.. 1.............................................. ......a ........ . ...................................................................................................................................................................................................................... ...................................................................................................................................................................................................................... ..................................................................... ..................-..................................................................................... ...........................:...... Roof board replacement if necessary @ (? /sheet ----- = - ...................... Two Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as spe ted by manufacturer The co actor agrees toperfiorm the work an sh the materials specified above for the SUMJo $.....f Z � s _ 'n - ayable... S? Cl........on.....5 d i ------ l a 3f. © Z - ......:.... on.............................. (g. I alance payable on completion of job 9 Owner or Owners are not respcjnstibl for Property Damage or Liability while job is m operation. J� Contractor is not responsible or y damage to the interior of property,including pre-existing conditions(i.e.water stains,crumbling plaster, xposed 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,theirjoint 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,attomey 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 maybe 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,not 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. 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). qq� IN WITNESS WHEREOF,the parties have hereunto signed their names this........ ,,`day of.....1.!.!,�'�kl...:t....,201 ... Accepted: P Signed......../:................... .rt••. G_� Owner Signed........ ................................................................... Owner ................................................................... David Castricone,President z µ The Commonwealth of Massachusetts Department of Industrial Accidents f' Office of Investigations N 4� r 600 Washington Street � rya Q Boston, MA 02111 }a � f www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Informationnn Please Print Legibly Name(Business/Organization/Individual): _DAV 11) C Am I C 0 pa R OO F I NCs I S lA 1 N 1s 0 N L Address: 20o Scj-T-rn1J S-c(Z-E-E-T- SU rc-e- Z2t� City/State/Zip: N.ANM VE 1C MA 01&uS Phone#: 9-)9 (P 3 3`F 20 Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with � 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I ani 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 an capacity. employees and have workers' y p ry� 9. E] Building addition [No workers' comp. insurance comp. insurance.t re uired. 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions q ] 3.❑ I am a homeowner doing all work officers have exercised their I L❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.R Roof repairs insurance required.] t c. 152, §1(4),and we have no i employees. [No workers' 13.n 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. $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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. CoInsurance Company Name:M) C _(tce �o MD G 11 Li G Policy #or Self-ins. Lic. #: )N C 9 9S a 14 G Expiration Date: Job Site Address: 0206 fil/C�(��lC S t/CCt City/State/Zip: N &Lel, A/A QIN! 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 I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. ' Signature: 13- C Date: _ Phone#: 13 13 110 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 ��Y�� Q4 E aI's o ]3nildiiag Del h.. 27 CharlesStreet ►° wa N1'` �`Q` l'1 North Andover, Massachusetts 01845 v� � �; ��4� 4 (978) 688-9545 Fax (978) X 88-9542 Cr, s.w.« + �SNCHU0- DEDRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit # the debris r&-:i.!I ting from the work sluill be disposed of in a p►operly licensed solid waste disposal facilit._, as defined by MGL c,l1, s150a. The debris will be disposed of in/at: � Y11 A)J Facility 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, i I %iee lr:wminev c,/.-1,:/Zajac'/iiideCCd 13081-t1 of 13ui1diw, Re-ulatinn.s pint) tifjintlai-dS ardof BiflidinglicgulxtiO and Standards -� Construction Supervisor Specialty Licenser �; HOME IMPROVEMENT CONTRACTOR License: CS SL 99358 Restricted to: RF,WS f� Registration: 104569 Expiration: 7114/2010 Tri! 270265 DAVID CASTRICONE _' i'' Type: Private Corporation 31 COURT STREET DAVID CASTRICONE ROOFING, SIDING& NORTH ANDOVER, MA 01845 David Castricone b"``' 200 SUTTON ST SUITE 226 Expiration: 12/1612011 NORTH ANDOVER, MA 01845 Adminishitor l'unn�i..i w'i Trp: 99358 i 0 i d DATE(MMIDDMTY) ACOR m CERTIFICATE OF LIABILITY INSURANCE � 09/28/2009 PRODUCER 05081657,-7700 FAX 508-653-8089 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Croup LLC - Commercial ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 West Central Street HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Natick, MA 01760 Select Cxt.53389 INSURERS AFFORDING COVERAGE NAIL# INOURED David Castricone Roofing $r Siding Inc INSURERA: The Insurance Co of State PA 200 Sutton St INSURER B: Suite 226 INURE R C� North Andover, MA 01846 INSURER D: INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 1I.1E POLICY PERIOD INDICATED.NOTWITHSTANDING ANY R9OU1R6M5NT,T9RM OR CONDITION OF ANY CONTRACY OR OTHER DOCUMEN('WIYH 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 POLI CIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRFNC(c $ COMMERCIAL GENERAL LIABILITY DAMAGE TO IIL-NTEU r rz.. I CLAIMS MADE- ❑OCCUR MCD CAP(Any one person) $ PERSONAL S ADV INJURY $ /j I;NI-KAI AGGRL"GATL $ GtN'L AGGREGATE LIMIT APPLIES PER. r'HODUC I5-COMPIOP A00 S 17 POLICY 7 PRO- LOC JECT AUTOMOBILE UABIUYY ANY AUTO (1OaAPOcc denntj INGLE LIMIT $ ALL OWNEq AV70S BODILY INJURY $ SCHEDULED AUTOS (Ilei person) HIRED AUTOS BODILY INJURY S NON-OWNED AUTOS (Por accident) PROrF.RYY DAMACH $ (Per acelden) GARAGE LIABILITY AUTO ONLY,EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO S EXCESSIUMBRELLA LIABILITY CACI I OCCURRENCE. $ OCCUR CLAIMS MADE AGGREGATE $ OLUVCYIBLL RETENTION E WORKERS COMPENSATION AND WC97S2746 09/23/2009 09/23/2010 X WC STATU- OTH EMPLOYERS'LIABILITY II ER A ANY PROPRIF,TORIPARTNENEXECU'fIVE E.L.EACH ACCIDENT $ 100,000 OFFICERWEMBER EXCLUDED? IIy 5,dascnbc undCr E.L.DISEASE-EA EMPLOYE S 100,000 SPECIAI.PROVISIONS below E.L.DISFASF-POI ICV LIMIT $ 500,00 OTHER OESORIPITON OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTiricATF goLpEg C.ANCELL61ION SHOULD ANY 00 THE ABOVE CESCRIBEO POLICIES BE CANCELL0 BEFORE TME EXPIRATION DATE THEREOF,THE 1S9UING 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 09 LIABILITY OP ANY KIND UPON YHE IN$URFN,IYS AGENTS OR RUPRESENTA'FNES. AUTHORIZED REPRESENTATIVE State Brice PKC ACdRO 25(200110$) CEACORD CORPORATION 1988 tAORTH Town Of, .tAndover No. �..�. .. , = AKE = dover, Mass., COC NIC ME WICK �� ADRATE D i'? ,�C2 `r BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT /�f' ��..........................G.....�'.. ..............................................................................: Foundation has permission to erect............................... buildings on ., ....: - .. /moi.' 1WZ. . f Y.......... ................ Rough tobe occupied as.................................s ...... ... d�� ......................:.................................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application 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 ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough e ce y .... .. ........... .. ... ...... S rvi ...,. . .. ...... ........... ... ....... BUIL INSPECTOR Final Occupancy Permit Required.to Ow ipy 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. E I F :SEE REVERSE SIDE Smoke Det.