HomeMy WebLinkAboutBuilding Permit #737 - 206 OSGOOD STREET 5/21/2010Permit NO:
Date Issued:
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
I IMPORTANT: Applicant must complete all items on this naize
LOCATION Q G DSG 006
fyAP..�Print
PROPERTY OWNER 0 (�,
Print
MAP 210 PARCEL: 3_ ZONING DISTRICT: Historic District yes
Machine Shop Village yes
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
res KI
OWNER: Name:_
Address: aU
CONTRACTOR
DESCRIPTION OF WORK TO BE PREFORMED:
00 � S
1
a e&wf rear da Inv
Type or Print Clearly)
I E40 (0.00
t
Address: Zoo JU 1+6 K DM f SL z 2 ` `�^ V' � 0 y r
Supervisor's Construction License: Exp. Date: to _
Home Improvement License: Exp. Date: -7
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: $ ��� S FEE: $ �o
Check No.: I � 5- 9 Receipt No.: a3�
NOTE: Persons contracting with unregistered contractors do not have acc o t a1^ ntmfund
Signature of Agent/Owner Signature of contractor
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/Massage/Body Art
Swimming Pools
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
COMMENTS
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 364 Usgood 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
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
❑ 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: Building Permit Revised 2008
Location �U
(-� ��1ypu s i—
No. 3
Date
NORT1
TOWN OF NORTH
ANDOVER
.•,MO0L
Certificate of Occupancy
$
�'�s''•° • E<�
JACMUS
Building/Frame Permit Fee
$ �—
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
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23 1 L4
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DAVID CASTRICONE J- -/rbv
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 AaverhX 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 -
Owner's Name...... tu.fi.....�1 .... .. C'_►°........................................................ Tel one
Job Address..... kr.....> 5.. ?Et ......-L-4*... ................. city..... 1..... tea ............... State...
Specifications:
..................... I............................................................................................................................................................................................
✓btrip existing shingles.-.Kpply new drip edge to all edges. Y" j)LL )e,
......................................................................................................................................................................................................................
/Apply _feet ice and water shield membrane to bottom edges of house. 3 feet ice and water shield m brane
in valleys and bottom edges of any unheated areas of house. CX' ✓rt _ Q� 074- 4 r :vav�- S /e«�i
................................................................................................................... ........I............................
.........................................................
✓Apply felt paper underlayment. - stall ridge vent to .� p V
......................
-Reroof using
shingles with a ?D year warranty.
......................................................................................................................................................................................................................
-Counterilash chimney. -New vent pipe flashing. -Legal disposal of all debris.
.......................................................44........................................................................................... ..............
-Area(s) to be worked on:
...... ... ... ..................
.......................................:% �L.l....l r. ......a ......... �j .a.r t � ...... C sa .....
1.,r1`xrL� ......... I..v...x ,�.......j.r1 s �. A ............................................................................................................................
..................................................................... f7.................................................................................,.......................................
.................................................................. � ....................................................................................................................................
Roof board replacement if necessary @ 4C) /sheet of vv=' /foot.
......................................................................................................................................................................................................................
Two Year Workmanship Warranty (Not Transferable) Manufacturer's Warranty as speci6 y man'ufacctt!{e "
The cgptractor agrees to perform the work an�" i h e materials specified above for the SUM ol�fi_i...L/ ...........
i Payable ...o!i, GQ........ on ....S.T.& .....
Payable ............................. on ..................................
,Balance payable on completion of job
Owner or (Tuners are not responsible for Property Damage or Liability while 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.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 warrants) that he is (they are)
the ownets(s) of the above mentioned premises and that legal tide 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 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 noti of cancellation).
IN WITNESS WHEREOF, the parties have hereunto signed their names this ..t. day of ... . ........... 20../C)..
Accepted:
Signed...................... ..�..................... Owner
Signed............................................................................. Owner
............... ....... ... ... . Y.1 ...
David Castricone, President
I he Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
+vww. mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(l3usuless/organuatioiVIndividual): -DAV 11) C AST i C O p E R UE NL `1 SID ► N 6 1 P L
Address:
City/State/Zip: A(Nbo JF, IC "/\ 0 1 & uS Phone #: 9-) t 3 q 20
Are you an employer? Check the appropriate box:
® I ani a employer with 4. ❑ I am a general contractor and I
employees (frill and/or part-time).* have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
3. ❑ I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
listed on the attached sheet.
These sub -contractors have
employees and have workers'
comp, insurance.t
5. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, §1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12. W Roof repairs
13. ❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowner who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
1Contractors 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 tate 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: Mn e On j) ,41C f
Policy # or Self -ins. Lie. #: _N] t` 9 9 a, `]Nis Expiration Date: q a 3 2a ► o
Job Site Address: b ( OSQWU S+reef- City/State/ZipAX uyy-, MA 00yr
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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of die DIA for insurance coverage verification.
1 do herehy certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: -�--'-^^~� C Date:
use only. Do not write in this area, to
City or Town:
or town official
Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other e
Contact Person: Phone #:
Town of North Andover
Building Dep,irtment
27 Charles Street
North Andover, Ivlassachuseils 018 15
(978) 688-9545 Fax (978) 688-9542
DEBRIS DISPOSAL FORM
In accordance with the provisions of wtGL c 40 s 54, and a condition of.
Building permit: W. the debris re�:i.,lting from the work sluill be disposed
Of in a properly licensed solid waste disposal facilit.-, as defined by MGL c.11, sl 50a.
The debris will be disposed of in /at:
I'ttGility lc:>.�iitioll �--.
Sigaature of Applicant
Date
NOTE: A demolition permit from the Town of North Andover must be. obtained Cor this
project thiotugh the Office of the BuI-Lding Inspector,
1.1 ucinstruction Supervisor Specialty License
License: C5 SL 99350
Restricted to: RF,WS
ti
DAVID CASTRICONL
31 COURT STREET
NORTH ANDOVER, MA 0.1845
Expiration: 1211612D11
C unmi. i n"'
Ti-,-,: 99358
._. r _, ■, a ui uunumg Rct;ulatinds and Slaud:u ds
rr� ^ HOME_ IMPROVEMENT CONTRACTOR
Registration: 5
1045'9
f,
Expiration: 7/14/2010 TO270265
v
Type: Private Corporation
DAVID CASTRICONE ROOFING, SIDING &
David Castricone
200 SUTTON ST SUITE 22.6 ,
NORTH ANDOVER, MA 0111,1[5
Administrator
e
AL -00, CERTIFICATE OF LIABILITY INSURANCE I
OATE(MwDDIYYYY►
PRODUCER FAX THIS CERTIFICATE I$ ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIGATE
TEND OR
WILLOWS' INSURANCE AGCY ALTERTH COVERAGE AFFOHIS CERTIFICATE RDEDB THE POUES NOT AMEND, CIESBELOW.
43 JETWOOb ST
N ND VER N A 01845' INsuReRs AFF.�R�INc CovERacE NAIC
INSVRED I+suREaA: SPECIALTY
David Castricone Roofing & Siding Inc INSUREa9
200 Sutton St #226 ►NSURER0.
N Andover MA 01845 WSVRERO.
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTYYTTHSI P nmi
ANY REQUIREMENT, TERM W 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, EXCLVI()HS AND CONDITIONS OF SUCH
POWCS. AWUGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CUUMS.
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200 Sutton Street
Suite 226
North Andover, MA 01845
BNOULD ANY Of T"E AF.OVE OESMOE0 P'OLLCIES HE CANCELLED BEFORE THE
EXPYtArKM bATE THERHOF, THE I9BVING INSURER WALL ENDEAVOR TO NAIL
�0. PAYS WRITTEN H07ZE TO THE GFRTIFICATF tiON.V-R NAMED TO TNF LEFT,
OUT FAILURE TO NN4 f+:ICH NO ,1A4L fMPO - ny 09LIGAM4 OR LKWLF Y
OF AA4116-UPON THE WtUR1 R R.. AgEfmTATIVEs.
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I VI;MICLES I EXCLUSIONS ADDED BY EN00RSEMEW 1 Sp,
David Castricone Roofing & Siding
200 Sutton Street
Suite 226
North Andover, MA 01845
BNOULD ANY Of T"E AF.OVE OESMOE0 P'OLLCIES HE CANCELLED BEFORE THE
EXPYtArKM bATE THERHOF, THE I9BVING INSURER WALL ENDEAVOR TO NAIL
�0. PAYS WRITTEN H07ZE TO THE GFRTIFICATF tiON.V-R NAMED TO TNF LEFT,
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