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Home My WebLink AboutBuilding Permit #380-11 - 225 MARBLERIDGE ROAD 11/3/2010 BUILDING PERMIT 0*"°oT"qti TOWN OF NORTH ANDOVER c APPLICATION FOR PLAN EXAMINATION Permit NO: `'� Date Received Date Issued: _L/-3 SACHUSE IMPORTANT:Applicant must complete all items on this page LOCATION / d r�le�lC� c acf Pri PROPERTY OWNER t CIle- /aX Print MAP 210 I PARCEL: ZONING DISTRICT: Historic Districtyes 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: r / Mbf 0/(di D 7 4 lease Type or Print Clearly) OWNER: Name: # .,_�entification Ie11e. �jc Phone: Address: cN57 Al/6k// e- ba d A. A/id ever PA dl� SSS CONTRACT=OR Name. ,. Axtn U_AC � 0 a Phone: � tg 3.3 Y�o Address: 6iD S4c 6n JS_= a,I t ZZb r A)U /Yq G/iri' Supervisor's Construction License: �'l��3.s13Exp. Date: Home Improvement License: /d Exp. Date: �. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BA,0FD CON$125.00 PER S.F. Total Project Cost: $ f �5��- a1D FEE: $ `� 1 Check No.: Receipt No.:01.3& NOTE: Persons contracting with unregistered contractors do not have access to the uaa L tyfund Signature of,Agent/Ovvner - Signature of contractor f 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 i - 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 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 i COMMENTS CONSERVATION Reviewed on Signature I COMMENTS 5 HEALTH, Reviewed on Signature r 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 MainStreet Fire Department signature/date COMMENTS 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 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use ❑ Notified for pickup Date Doc.Building Permit Revised 2010 Locati 5l�TT )jer-bL 12o( -1d No. 0 ! Date 4 01 NQRT#q TOWN OF NORTH ANDOVER 9 4 Certificate of Occupancy $ _ ��ssncHusE<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # � 23649 wilding Inspector ORTH Andover TO" of 0 No. 'o2p It o over, Mass., &e I110 LAKE COCM IC EWICK ��• DRATED PPS\ Cl qSS BOARD OF HEALTH Food/Kitchen Septic System .PERM IT T D BUILDING INSPECTOR THIS CERTIFIES THAT ........ ..................................... ............................................. Foundation N1.. ..r!............................. buildings .. �►.�... Rough has permission to erect.................. g •••• to be occupled.as.... �ac�ctiingj .....�......fzoisvChimney .. . ... .......................................................................................... provided that the person this permit shall in every pest conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws re ating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building RegulationsVoids this Permit. Rough. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUO ST S Rough .. ........................................... ............................ Service BUILDIN INSPECTOR Final �. Occupancy Permit Required to Occupy Building GAS INSPECTOR I 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. I ' DAVID CASTRICONE ;Arh o 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 premises below described: Owner's Name......... ........ .... x ........................................ T lephone#...9�8.:.. k .........city ...................FS{tra!te......�.Job Address... 15 Specifications: .......... .. .................................................................................... (Strip existing shingles.(?) "Apply new drip edge to all edges ..................................................................................................................................................................................................................... pply �", 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. ............................................ Apply felt pa .........................��........................................... .......... F ............q..................n.. ....,�q�..„.....�..........•.....,............/......L......1.. .............1.5�.........�...............I.....�....n ..�...............p....�....a.�.... .......... shingles with a year warranty.using (r,, . ...................................................................................................................................................................................................................... 'CCounterflash chimney. '-New vent pipe flashing. —Ieg-al disposal of all debris. a ocl ........ ...... .. Areas)to be worked on. y�/ ........ .. ..(..... A.O. ........, 1 -�•..5....... '✓.............. .... ......� n..f:.t' .....�.A........1.: .tC.J..�`.:...� ..�ia.,wn ..!'C.Gt. ...11.Cr .S..,.... . .,P.r.1l .. ...i7 ..r.. .R............................................................. rrrrt.l ...... � e ......t.N:c .r.:..... ............ .............._....{ .....:....................................... P necessary @ Gv /sheet tr `f r Roof board replacement if necessa /foot. rs ....................................................................................................................................................................................................................... Two Year WorkmanshipWarranty Not Transferable ty( ) IV)[anufacturer's Warranty as speer(/ -by-manufacture The cactor agrees to perform the work a ish a matf{'als specified above for the SU of S.../Z.�M....�........ pJ ayable...�L7..P.0..........on...S..la 24.oa - I +etiie............ .............on............ alance payable on completion of job , (hurter or Owners are not responsible for Property Damage or Liability whi r is to 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 arc 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 owners)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 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)mames(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 notice of cancellation) IN WITNESS WHEREOF,the parties have hereunto signed their names this...VIA.....day of..0G ..,20JD.. Accepted: Signed l�C/lf1,C�-.'�-`--� ...... ................ .......................................... Owner tSigned ................................... Owner David Castricone,President /�� ^ The Commonwealth of Massachusetts Department of Industrial Accidents tI;, ''� Office of Investigations 600 Washington Street _r w Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): I)AV i '[1 AST P i c 0 w P- R o 6 F i N(- 1 S lb/m& f N C. Address: 2 Uy S v-,--r-r0 fJ City/State/Zip:N o A;y o)o v D i S q Phone #: 9'7 8 (o`3 3.3 1,2-11 Are you an employer?Check the appropriate box: Type of project(required): L® I am a employer with `� 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their l0.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12,KrRoof repairs insurance required.]t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must al.:o fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit i Aicating 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 acid 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. Insurance Company Name: C. k Prg T IS Policy#or Self-ins. Lic.#: V' 0- o 0 ,�q 13 EA 3 Expiration Date: 9 Job Site Address: 0A( t ed d c City/State/Zip: go. Ad oye,(AA 640- Attach a copy of the workers' compensation 14licy 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 do hereby certify under the pains and penalties of peijury that the information provided above is true and correct. Signature: ' �! �i �' Date: Phone#• q 9 8 (A-3 30-0 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 tAokTly 01 ' Building Department o ; - ti m 27 Charles Street J° North Andover, Massachusetts 01845 o (978) 688-9545 Fax (978) 688-9542 A0OATeo �Pµ`y�y RSS.yCNU5�4 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 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: 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.