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Home My WebLink AboutBuilding Permit #617 - 25 FIRST STREET 5/14/2009Permit NO: ( fl– Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received I IMPORTANT: Applicant must complete all items on this nage LOCATION 0r, FirS4 Slf rec-4 PROPERTY OWN \„J Print MAP NO: _%[_PARCEL: ZONING DISTRICT: Historic District yes o 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 UE5(;XIPT1UN OF WORK TO BE PREFORMED: 6+60 f1° Ishii jp ,;, S t �` ok colo -if\ a (j� Identification Please Type or Print Clearly) OWNER: Name: -V /rp�AI& IPL)\ � � Phone: 9U bB 20� Address: c2'S F►r3I S reef Na��1\ /�hc�c�J�s NA1 �() CONTRACTOR Name -.b ffi6ViqAe-1CsJc , 1A �t . Phone - 3 3� Address: 91)L t it)n �Wo 2K NA m l s— Supervisor's Construction License: q ` Exp. Date: - Home Improvement License: t 011-i slog Exp. Date: ' iy 6 ) 0 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. Total Project Cost: $ L4 B 0 D , °L' FEE: $ 1 -/ Check No.: /d5®S— Receipt No.: X0 3 NOTE: Persons contracting with unregistered contractors do not have access to the gu anty fund Signature of Agent/Owner Signature of contractor Location C9 1--� Kd T- !;;: I No. Date ,tORTN TOWN OF NORTH ANDOVER 0 4L Certificate Occupancy $ of CHU Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ q6 �- Check#/ 2 2 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED Reviewed on Signature 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: FIRE DEPARTMENT Temp Dur Located at 124 Main Street Fire Department signature/date COMMENTS uocatea 664 Usgooa Street on site yes no 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 2008 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Town of North Andover 00 HOf o Building Department o 27 Charles Street North Andover, Massachusetts 01845 h V." (978) 688-9545 Fax (978) 688-9542°c �„ w�, �R�rao nP`"y,ty 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, sl 50a. The debris will be disposed of in /at: Facility location Signature of Applicant J-/ Y16 7 Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector, The Commonwealth. of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www. massgov/dia workers' U'ompensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/C)rganization/Individual):D) Avg Cit l l f n Nc Address: Q Sra rrn,l� g..r.2 C,&Z Sy I TE. 22(0 City/State/Zip: N. Au4bA 01 Phone #: 41W (Q i d 1¢ 1;1.0 Are you an employer? Check the appropriate box: 1.0 I am a employer with t 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- listed on the attached sheet. ship and have'no employees These sub -contractors have working for ine in any capacity. employees and have workers' [No workers' comp, insurance comp. insurance.$ required.] 5. [] We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t C. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. El Remodeling 8. El .Demolition 9. El Building addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.[J400f repairs 13. ❑ Other UY appuciuu coat U11=8 oox III must also till out the section below showing their workers' compensation policy information. t I-Iomcowncrs who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContraetors 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. am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: f 0.ace 0 tnn tM�p►t O,1 ,� � T71�T�. I�/k Policy # or Self -ins. Lic. #: w(, $ �� Ey to Expiration Date:_ 9. a 3 • OS Job Site Address:�S i�l t-S��f City/State/Zip: Nei �t� I JA 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 $ l,' 9.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250A0 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of In\/petVY9t;-n --r the n A r__ L______ _ . _ . I do hereby certify under theTp� 1s/ins and penalties of perjury that the information provided above is true and correct Signature: t /.✓ C Date S 617 _ Phone #: use only. ,Uo 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 #: • uar CIMMNU/rrrrJ ••-'TN �cn i ir�t,H i C Vi' LIAUILI 1 Y IN5UHiANCE PRODUCER 10/3/2008 Phone: 500-651-7700 Fax: 509-653-8089 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insum rance Group LLC -Comercial Lines ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 West Central Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Natick MA 01760 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURED INSURERS AFFORDING COVERAGE NAIC # David Castricone Roofing & Siding Inc INSURERA:( t' 'e 10274 200 Sutton St InISURERB:The n -ance Co of State PA Suite 2Z6 INSURER C: North Andover MA 01895 INSURER D: COVERAGES IIJSURER E: 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 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE OR OTHER DOCUMENT WITH RESPECT TO WHICH. THIS AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE T LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION GENERAL LIABILITY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 251fLRitD --- CLAIMS MADE 1:1 OCCUR PREMISES Eaucturunce .0 MCDEXP(Anyono xenon) PER SONALBADV INJURY y GEN'L AGGRE GAPE LIMIT APPLIES PER: GENERALAGGREGATE — POLICY PRO LOC PRODUCTS -COMP/OPAGG $ A AUTOMOBILE LIABILITY 08MMBBTNKT 8/1/2008 8/1/2009 ANYAUTO COMBINED SINGLE LIMIT y (Ea ecdcba) ALL OWNEDAUTOS X SCHEDIJLEDAUIOS BODILY INJURY (Petperaon) $250,000 }( FIIREpAUTOS NON�OWNE-DAUTOS BODILY INJURY (Paraacldonl) $500,000 PROPCRTYOAMAGE (Peraociderd) $100,000 GARAGE LIABILITY ANYAUTO AUTO ONLY -EAACCIDE14T $ — OTHEA111AN EAACC $ EXCESS/UMBRELLA LIABILITY AUTOONLY: AGG $ OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE DEDUCTIBLE RETENTION Is $ B WORKERS COMPENSATION AND EMPLOYE RS'UABIITY 5877756 WC ST T $ 9/23/2008 9/23/2009 OTH- ANYPROPRIETOR/PARTNEIEXECUTIVE OFFICERIMENDER EXCLUDE p7 ELEAChIACCIDENT $' OO 000 r lips desetlbe under SPELtIAL PROVISIONS bokmv E.L. DISEASE - EA EMPLOYEE 6 1 O O U O U OTHER E.L. DISEASE - POIJCV LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS ! VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION '- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO (NAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER 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. AUTHORIZED REPRESENTATIVE H"urtu C5 tzUU1108) O ACORD CORPORATION 1988 �lassachusctt., - DepiU'tmwnt of PUblic tialCIN ofBuilding„ Re-ulations anti S'tandards0Bom'd Construction Supervisor Specialty License License: CS SL 99358 Restricted to: RF,WS ra DAVID CASTRICONE 31 COURT STREET NORTH ANDOVER, MA 01845 Expiration: 1 2/1 61201 1 t'n uuui..inuci' Trm: 99358 ✓he "&1mmo7uoea411,, o AaaialJWZel/d Board of Building Regulatiods and Standards HOME IMPROVEMENT CONTRACTOR Registration: 104569 Expiration: 7/14/2010 Tr/t 270265 Type: Private Corporation DAVID CASTRICONE ROOFING, SIDING & David Castricone 200 SUTTON ST SUITE 226 NORTH ANDOVER, MA 01845 Administrator 15-/1110 Y 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 978-683-3410 In Boxford 978-887-6147 In HoverhX 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 th conditions, on premises below described: e following specifications, terms and Owner's Name ...... .,✓..v(.y......c5.... .v.... ephone #... ............................................T Job Address ..... �..... ._L1............................ Ci ty...•d•a'...r.a........rc.... ..a.Q..(lD..pp State....,t%......... Specifications: .................................................................... trip existing shingleVo PP1Y new drip edge to all edges .. I ........................:...................... g ........................................................ ..................... .................................................. . PP y 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....f.elt....pape� nA....... erlay�ent rPnstall ridge vent to Alleroof using ..........^......_............................................. shingles with a , ?t2 year warranty, ................................................... .....Q... ...fig Po ..................... . ounterflash chimney- ........... debris. .....••.•..•...••..•.................... •..•••.• y. ✓New vent,pipe as al disposal of all debris. ......gr%, '�.. P....'<.......... reals) to be worked on .............................................�./. ..,r 5......t't..........Ykkcrxx,rJ.... ta........................................................................ l..c .�...... faxrx,.l.� —�—� .......................................................................................................................................... ::::::z.. ............... ................................... ........................................... ........... Roof board replacement if necessa ..... .......................................................... rY � �D /sheet o � /foot. .................................... aa................................................................................................................ Two Year Workmanship Warranty (Not Transferable) M'anufacturer's Warranty as specified by manufacturer The contractor agrees to perform the -work ish a materials specified above for the SUM of $.... dj(g s!,Q„ QPayable .,�v.cll.Q.......... on ....Sa.� ............... . .............. ......•..:• `............. on................................. (Ohlance 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 ofmaterials 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 shall that, h aired in coercing the terms by law, contractor shall ldbe paid of y theo owner(s) all and/or any ablllien in costs, an connection tnit is min addition to the amount duc and unpaid, that contractor, and also that the obligations hereof shall bind and apply to their heirs, successors or estates of the >+8ced �atthis may assigned by the owners(s) of the above mentioned premises and that legal tide thereto stands of record in his (their) names(s�9here are no rrer resentgned wations, g That he is (they ) warrantics, except such as may be herein incorporated, if any, nor an P guaranties a herein stated. Any subsequent Y agreements collateral hereto, nor is the contract dependent upon or subject y all parties. to any conditions not All Home Improvement Contractors shall I be registered band any Imqu a tiaabo t a con g and signed btractor 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 .uA ... day of... . , ..........., 2o ... a.Y Accepted: % P ' Signed..... ...� ` ner Signed...................................................... .......... Owner .., David Castricone, President n O z O b W w c w- ••m 0 0 w c 0 a c � 0 a o � p c h O � o w° � C/)w° � � � a � U w O � w '� W m c�0 .0 V) w -Cao. 1:4 .,.. co w ui CL 911 0 z O U W Q O Q O z d O y D C I C� Q■� ca Q 'O O ca i O O Z O� O � CD CD O cc o a 0. CL ca c = c .v eaca J ■0 d 049 � zCD �..± y O C � C _Q a COD 0 z cit D 0 LLI U) Im W uj W N c w- ••m 0 c c � o � c h O r.+ C O V V —CL. CLc CL O c y a CD E a o •. m `E c o 0 o �• c CD E N R ��m m a C •; N N ID z .r N �: •�•�m .0 = C y N O O `E o r aC m y m ; J O :CoQ p� •� C t O O m w h o o �ZCD c Q ` i m c _o •c = m N F - :ago •O.■ N w~ o O W C4;r=. =0 w IL ■ MIS c " N O c o cr-O:s W •E v . •N Z O C.3 a o0 c y O O'p g oo=coo . CL, - 911 0 z O U W Q O Q O z d O y D C I C� Q■� ca Q 'O O ca i O O Z O� O � CD CD O cc o a 0. CL ca c = c .v eaca J ■0 d 049 � zCD �..± y O C � C _Q a COD 0 z cit D 0 LLI U) Im W uj W N