HomeMy WebLinkAboutBuilding Permit #753 - 21 EASY STREET 5/13/2013Permit NO:
Date Issued:
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
IMPORTANT:
Date Received
must complete all items on this
f 14ORTII
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TYPE OF IMPROVEMENT
PROPOSED USE
..—
Residential
Non- Residential
New Building
-'One family
Addition
Two or more family
industrial
Alteration
No. of units:
Commercial
Others:
*repair, replacement
Assessory Bldg
Demolition
Other
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DESCRIPTION OF WORK TO BE PREFORMED:
eRGR/NkE ITOOF 6 VER 4F?C13TI/V6 S111h6f-( tS
Identification Please Type or Print Clearly)
OWNER: Name: ]�e&81"r WPI-c/4/ha Phone d ,Sad o
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: e� FEE: $__
Check No.: c� T Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Location' S
No. Dat ~ 1 3 '
Check #0
26381
TOWN OF NORTH ANDOVER
Certificate of Occupancy
$
Building/Frame Permit Fee
$ '^
Foundation Permit Fee
$
Other Permit Fee
$ •
TOTAL
$
Building Inspector
Plans Submitted Plans Waived Certified Plot :Plan Stamped Pians
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
C0iviMlE: N i S
HEALTH Reviewed on Signature "
y
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 Drivewav 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.s100-s1000 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
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ lvi
"'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
❑ 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
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 Haverhill 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 premi= below described:
Owner's Name...,.. .1 ... ...... ......d.�t..rF 113 ....................................... Te
r�
70.
one
Job Address......../..... .......................... city ... ...L:.A. 44. #.:ri7.........g....�..
State... f :lih......
/ Specifications:
...................... ..j .
.........................................................................................y. ...........................5 )t,:........t .........
-Strip existing shingles. -Apply new drip edge to all edges l���i,'/�_ S/ ` . ..........................................n�
s \j
/ is fs , u,... .
Apply JMeet ice and water shield membrane to bottom edges of house. 3 feet ice and wter shield membrane
in valleys and bottom edges of any unheated areas of house. 6 r
,"Apply
Reroof using
-Counterflash chimney.
-New vent pipe flashing.
....................... �3 ..................
................................................................................
Legal disposal of all debris. Dors p
eLle
.............. I ..... ., s......................................r / .......
Y. Y o ............................
U J � �1.... . �.L./.... .5 d ............. .
Roof board replacement if ne1sary @ Z? /sheet or /lodk
..............
Year Workmanship Warranty (Not Transferable) Manufacturer's Warranty as sped ed by manufacturer
The contractor agree t perform the work an the materials specified above for the SUM f $...�.�.�y(,�...k.............
Payable ...... on .... ..:. ............
Payable .......:.:................... on........... 1 ................... Balance payable on completion of job
Owner or Owners 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 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 warrants) that he is (they are)
the ownergs) of the above mentioned premises and that legal title thereto stands of record in his (their) namcs(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 Ihiprovement 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 not ce of cancellation)).
IN WITNESS WH REOF, the parties have hereunto signed their names this ..ri ..... day of... jam..........., 20....
�.
V_ .
Accepted: } J �. 1� .k!< ��, xSigned.......... .... a:2 ............... Owner
fSigned............................................................................. Owner
David Castricone, President
4- The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
ii
< li 600 Washington Street
e Boston MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): CIriST R1 LO n t_ 1 `�yt t N(r k SI p t G" N �'
Address: A 3 1 R .50h rl bite.\ 3 A
City/State/Zip: No . 6&0 4t, Ny Phone #: 9-7% (0%3 3 yd b
Are you an employer? Check the appropriate box:
1. ® I am a employer with 8
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. ❑ I am a homeowner doing all work
right of exemption per MGL
myself [No workers' cornp.
c. 152, § 1(4), and we have no
insurance required.] t
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
I I.❑ Plumbing repairs or additions
12.g Roof repairs
13.❑ Other
"Any applicant that checks box #1 must also fill out the section below showing their workers' corn pens at ion policy information.
r 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 grid their workers' comp. policy information.
1 am an employer that is providing workers' compensation insurance for my employees. Below is thepolicy andjob site
information.
Insurance Company Name: (2 �s _
Policy # or Self -ins. Lie. #: w 0-0 031 N I 3 Expiration Date: q • o, 3 • olo 13
Job Site Address: oll 46AS Y 5 zjui-T City/State/Zip:_/ 0, AN20 ✓l:R 1q&Q/fyj",,
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.
1 do hereby certify under thepains and penalties of peljuty that the information provided above is true and correct.
Signature: E) . C Date: w
Phone #: 01 -?J 413 3 q�_o
Official use only. Do not write in this area, to be completed by city or towix 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 #:
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Town of North Andover NORTH
041�to ,6'41,0. ...
Building Department �6� �6 °
o
27 Charles Street
North Andover, Massachusetts 01845
(978) 688-9545 Fax (978) 688-9542
�R�reo hfµ`y
� 1 ACHUse
DEBRIS DISPOSAL FORM
In accordance with the provisions of MGL c 40 s 54, and a condition of
Building permit # the debris resulting from the work sliall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL c.11, s150a..
The debris will be disposed of in /at-
4'�' -�- E
41
Facility location
Signature of Applicant
r •Y•J
Date
NOTE: A demolition permit from the Town of North Andover must be obtained for this
project tluough the Office of the Building Inspector,
0 DATE (MM/DUIYYYY)
ACORD CERTIFICATE OF LIABILITY INSURANCE
L -�9/24/2012
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(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 the
certificate holder in lieu of such endorsement(s).
NT
PRODUCER
EACT Select Dept e)d 66807
astern Insurance Group LLC Main a°Nro En:508 651 7700 ac No: 65 80 9
1.33 West Central Street E-MAIL
Jatick MA 01760 ADD RESS:S rni c m
INSURERS) AFFORDING COVERAGE NAIC /1
INSURED 31969 INSURER 8:
David Castricone Roofing & Siding Inc INSURER C
231 Rear Sutton Street, Unit 3A NSURER D:
North Andover MA 01845
URER F:
COVERAGES CERTIFICATE NUMBER: 14ARSnt%a7 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO 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 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR I
LTR
TypE OF INSURANCE
AD
INSR
WVD
POLICY NUMBER (
POLICY EFF
MM/DDIYYYY
POLICY EXP
MMIDD/YYYY
LIMITS
AUTHORIZED REPRESENTATIVE
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS-t•A.ADE u OCCUR
EACH OCCURRENCE $
PREIIISES '111Ea occmr.,oe $
MED EXP (Any one person) $
PERSONAL R ADV INJURY $
j�
GENERAL AGGREGATE $
j-GEN'L AGGREGATE LItvIIT APPLIES PER:
POLICY PRO LOC
PRODUCTS - COMPiOP AGG $
$
AUTOMOBILE LIABILITY
H' ANY AUTO
ALL OWNED SCHEDULED
j AUTOS AUTOS
I 11011-0'rVNED
HIRED.AUTOS AUTOS
I
I
Ea accidern $_
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
Pei a xdent
$
UMBRELLA LIABHCLAIMS-MADE
EXCESS LIAR
OCCUR
EACH OCCURRENCE $
AGGREGATE $
DED RETENTIONS
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNERIEXECUTIVE ❑
OFFICERiMEMBER EXCLUDED?
(Mandatory In NH)
II Yes, desci be undet
DESCRIPTION OF OPERATIONS below
N ; A
WC003989723
/23/2012
h/23/2013
I
X WC STATU- OTH-
E.L. EACH ACCIDENT $100,000
E.L. DISEASE - EA EMPLOYEE $100,000
E.L. DISEASE - POLICY LilAIT , $500,000
DESCRIPTION OF OPERATIONS; LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, 11 more space is required)
r.;:PTIFIr BTF Nr11 nFR 1"erJCF1 I ATInN
V 19BB•2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
David Castricone Roofing & Siding Inc
ACCORDANCE W(TH THE POLICY PROVISIONS.
231 Rear Sutton Street, Unit 3A
North Andover MA 01845
AUTHORIZED REPRESENTATIVE
V 19BB•2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
09/11/2012 18:01 FAX 978 475 3165 EASTERN INSURANCE
IM 002/002
ACO CERTIFICATE OF LIABILITY INSURANCE siiii�o '
PRODUCER 978 273 6368 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Willows Insurance Agcy ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
51 Cochichewick Drive ALTER THE COVERAGE AFFORDED BY. -THE POLICIES BELOW.
North Andover MA 01845 INSURERS AFFORDING COVERAGE__ _ NAIC #
INSURED INSURER AYE STERN WO?= INSURANCE C�
DAVID CASTRICONE ROOFING 6 SIDING INC & INSURER B;
CASTRICONE ROOFING & SIDING INC 1 wSuRERC;
231 Sutton $t: #3A INSURER D; _ ...... _ .
NORTH ANDOVER MA 01845 I INSURER E:
nnvren wncc
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR IMF POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
AOD'� 1 TYPE OF INSURANCE POLICY NUMBER POIJCI EFFECTIVE POLICY EXPIRATION
INSR DATE IMM1bQ1yYyY1 LRi11T5
GENERAL LIABILITY
EACH OCCURRENCE 5 1000000
' I
_
TO RENTED — ,
50000
COMMERCIAL GEWRAL LIABILITY '
I PREMISES (Es occurreRReJ....._.$ .
A CLAIMS MADE 1: X j OCCUR I pp7.332999
9/6/2012 9/6/2013 MEDEXP (Any one person) _ 1000
_
PERSONAL d AOV INJURY $ 1000000
j I GENERAL AGGREGAIL a $..._.. 200000b
_...... .
GEN'L AGGREGATE OMIT APPLIES PER: I
PRODUCTS - COMPIOP AGG is 2000000
POLICY PR - i ' LOC
I i AUTOMOBILE LIABILITY I
COMBINED SINGLE LIMIT �
$
I
(Ee accidonq
ANY AUTO
.
ALL OWNED AUTOS
BODILY RQURY
$
(Per pereaf)
_ SCHEDULED AUTOS
_
-•-----
_ HIRED AUTOS
i
BODILY INJURY
S
(Per acddem)
NON-OWNEDAUTDS
_
-'
PROPERTY DAMAGE
5
(P&- eccldenl)
GARAGE LIABILITY j AUTO ONLY - EA ACCIDENT $
__ _. __ .
i ANY AUTO I EA ACC $
OTER T14
AUTO ONLY, AGG $
i
EXCESS f UMBRELLA LIABILITY
EACH OCCURRENCE--__ S_
OCCUR CLAIMS MADE
I AGGREGATE $ ._....... . .
DEDUCTIBLE
RETENTION $
$
WORKERS COMPENSATION
WC STATU OTH-
I TORY.LgdL7$. ER
_
AND EMPLOYERS' LIABILITY Y 1 N
ANY PROPRIETORIPARTNERlEXECUTIVE
OFFX)ERWEMBER EXCLUDED?
E_L EACH ACCIOENT
$
I (Mendetm In NH)
E.L. DL4EASE - EA EMPLOYE
---- ... .E ..._..
S ...._-
11 yyEa8 deacAbe under
SPECIAL PROVISIONS 4elw+
E.L DISEASE -POLICY LIMIT
8
OTHER
I j
DESCRIPTION OF OPERATION 1 LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
AGORozs(ZUUVIUT) ...... .. ......... ..... _._....— --- --
INS025 poogoi0i The ACORD name and logo are registered mark9 of ACORD
--
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 MOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZEDREPR ATI
�a
AGORozs(ZUUVIUT) ...... .. ......... ..... _._....— --- --
INS025 poogoi0i The ACORD name and logo are registered mark9 of ACORD
t '- u.aLhu>ctt.� Uclt;trttttrrit ul I'u111i� �afct
Bu;trtl nl Builllirt, F2r,ul,t[iuii..inrl St;lnrl;lrtl
Construction Supervisor Specialty License
License: CS SL 99358
Restnciee to: RF,WS
DAVID CASTRICONE
31 COURT STREET
NORTH ANDOVER, MA 01845 ><s
Expiration 12/16/2013
( uuni..i„n�r
TrF 7924
SCA 1 (i 2010"05/11
;�%�!' '/'in iniirri •aur!/� �.
_. Office of Consumer Affairs & y Re ulr tioi'n
Business Regularion
;,,HOME IMPROVEMENT CONTRACTOR
E2xeistration: 104569
Type: gtration: 7/14/2014
Private Corporation
DAVID CASTRICONE ROOFING, SIDING &
David Castricone
200 SUTTON ST SUITE 226
NORTH ANDOVER, MA 01845
Undersecretary