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Home My WebLink AboutBuilding Permit #126 - 23 Belmont Street 8/17/2007 x,40"11'1 BUILDING PERMIT °f�t`Eo "o TOWN OF NORTH ANDOVER 103 i -. o e APPLICATION FOR PLAN EXAMINATION WWI Permit N0:40-0Date Received gSAT•o S �9S AGHU Date Issued: IMPORTANT Applicant must complete all items on this page ;,"Em rpk"R� Al yv, 011,1 ig TYPE OF IMPROVEMENT PROPOSED USE - Residential Non- Residential ❑ New Building �ne family [I Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) phone: �� 7� OWNER: Name: f' III C- / y',/ Address: 02 3 ,� l/�lUh� C�� `'�'' 7�1-4,cJl Ile— i LIM ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. p � � Total Project Cost: $ D �0��0 FEE: $ Check No.: Receipt No.: A05 NOTE: Persons ontracting with unregistered contractors do not have access to the guaranty fund ��""� :�� gra•:;x�'� �, � "f ^' ',�a € f''i -��" ! � s$ :,� �� S� nature o A ent/twr�er I; Location 01::) &(M64t f No. U�C* Date LOATH TOWN OF NORTH ANDOVER ` Certificate of Occupancy $ Eta Building/Frame Permit Fee $ = r s•►CHO v Foundation Permit Fee $ Other Permit Fee $ z TOTAL $ . Check # ,j 20501 Building Inspector 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning,Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments I Conservation Decision: Comments Water& Sewer Connection/Si nature Da to Located at 384 Osgood Street77 Driveway Permit 11 ...... �AR�'MI�NT T�tn ►` ,S 1 ^«£ DF`� �pt�d ', Rob at.,-,24} lair tree E E 12 ift5 } Etreepartrnent � t 3 . natureydate r x 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 useL. I 'i ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 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 Co 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 : All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit NOTE p 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 F V40RTH 0 0 t 4Andover : .� .1. � No. �a =_. Mass. 0 LA dover,, COCMICKEWICK IT RATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR ........................................... .......................... THIS CERTIFIES THAT............... ...... .. ........... ......�.�� .•• Foundation has permission to erect..............�....................... buildings on...��i .......... .!�...�N�.+�!►. Rough to be occupied as4". ...r.. .�. Chimney provided that the person accept! this permit shall in every resp conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-taws 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 Q� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Owupy 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. IF SEE REVERSE SIDE Smoke Det. 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 Haverhi1978-374-7374 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: / I� Owner's Name...... .. ...... .. �l. *W 7777. .....Tel hone#....�.1 :.—.J..211.............. Job Address.... . 7777. ...... }.' . . .....' dz..........city....Iva.•A 1�. j`............State.... ... Specifications: ............................................................ .. ............. ............................................................................... v6�trip existing shingles pply new drip edge to all edges d�Fn r6 �r ..........................-ie-........................................................................g...........................e-t**i....................................................................... [.Apply _feet tee and water shield membrane to bottom ed es of house. 3 feet tee and water shield membrane in valleys and bottom edges of any unheated areas of house. .............g..................................... ........................................... ?L/ ! t�pply felt a er u darns eut nstaII rid a vent to P P yam � CJ,6 ltS.- u�, l .............. . -�..... .............................- I........................ ...... .................... ...............,... .......... ... 7777.. r lleroof using -� shingles with a year warren f Ja•a. o ,,7,77 ..7 �— 6 ................ ..� Y.................. ..... ....... ........... ........ ................................................. ........................................ 7777.. 7777 7777 .. unterftash h' ey �w vent pipe fl hing. -Legal disposal of all debris5 1p��7 t �(�. M1..Ca ..J..l21 ...........10..1:...:5 ......................................................777. .. ..................... ,*rea(s)to be worked on� r ................................... ..., 1f.... .,. . .. .......... ....... x ...p. .... . .. .� ....�:,. ....t�m;rl.rt .�7.t,!Q:t 7777... ... ... ...... ..D.�. 77:77... ...................................................................................................................................................................................................................... .... ................................................... _.......................................... .......... Roof board replacement if necessary@ Gc) /sheet or �---/foot. �o _ 'FRO ...................................................................................................................................................................................................................... Two Year Workmanship Warranty(Not Transferable) Nfanufacturer's Warranty as spec t y ml ti' uUTcflRe The contractor agrges to perform the work a>Z(i fish the materials specified above for the S of$7777,., ...�. �...... ....... on....5. ... Payable.......777.7.................on.................................. 36alance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability whi ejob 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,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 pe milted by law,contractor shall be paid by the owner(s)all reasonable costs,attorney fees and expenses,in addition to the amount due and unpa4 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 warant(s)that he is(they aro) the owners(s)of the above mentioned premises and that legal tine 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 notice f cancellation). IN WITNESS WHEREOF,the parties have hereunto signed their names this...� .day of Accepted: . (.-0w I(Signed... ............................................� ver tSigned............................................................................. Owner David Castricone,President The Commonwealth of Massachusetts a Department of Industrial Accidents Office of Investigations aw 600 Washington Street Boston MA 02111 � e ww►v mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Names ru„c;„PQM/t?rnanization/Individual): IAV I b C-Swat comL ,\Q yO F I N(6- S 1a i NGr INC- Address: a NC'Address:a0O S t yMT .N 6r ek-f„0` Jou (TE— 226 City/State/Zip: Noor-. Ando& NA PITT Phone#: q V AIX Are you an employer?Check the appropriate box: Type of project(required): 1.� I am a employer with q 4. E] I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' insurance. 9. ❑ Building addition [No workers' comp. icomnsurance p required.] 5. ❑ We are a corporation and its 10.01 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.El Other employees. [No workers' 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. /� Insurance Company Name: f'1� -T4 H Policy#or Self-ins. Lic. #: V V Y C � 00?Y 0 00 1 &61V Expiration Date: 9•or es— O Job Site Address: C,� S7 City/State/Zip: 0/p 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 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: !Z:) C�1- C Date' Phone#: 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#: