HomeMy WebLinkAboutBuilding Permit #95 - 27 FULLER MEADOW ROAD 8/3/2009..BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
RTANT: ADDlicant must complete all items on this
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LOCATION 29 4 UJ k 0 P -d �ifq-k AA�Cyft R -A olm-
Print
PROPERTY OWNER e -J+
Print
MAPNO: /(Y PARCEL:/�,.") ZONINGDISTRICT: Historic District yes
Machine Shop Villac
ie ves (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:
Identification Please Type or Print Clearly)
OWNER: Name:-?pjULA SAFKr*T-r Phone: 90 9 N 17�7
Address: .2 q Fu I lu M",w evo-d No. Andovet MA iWqf
CONTRACTOR Name: 'h.Cas4-nuaz 'Ru,,kA ci&Ji
Address: �00 Su±Irn &J - SuAg z,2A. , t4o. Ankovet, NA o trts-
Supervisor's Construction License: CS 99 3 1 b —Exp. Date: 11 - I U -aa I I
Home Improvement License: 10 qS"(Oq
Exp. Date:
ARCH ITECT/ENG I NEER 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: $ q5 zo - ", FEE: $ 91
Check No.: Z)�l Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
011
Si ure of Agent/Owner Siqnature of contractor
_ gnaf
f;jje,U
Location
No. Date
� �OR �,,,
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ CA
ACHU Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#
222) �
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
I
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
COMME�TS
DATE REJECTED DATEAPPROVED
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 Dri. Permit
DPW Town Engineer: Signature:
rin Located 384 Osgood Street
rz ULFAK I MEN I - I emp Dumpster on site
Located at 124 Main Street
Fire Department signature/date
MENTS
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 21 A —F and G min.$100-$107o fine
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
Li Building Permit Application
Li Workers Comp Affidavit
Lj Photo -Copy Of H.I.C. And/Or C.S.L. Licenses
u Copy of Contract
D Floor Plan Or Proposed Interior Work
Li Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
Lj Building Permit Application
Li Certified Surveyed Plot Plan
Li Workers Comp Affidavit
Li Photo Copy of H.I.C. And C.S.L. Licenses
Li Copy Of Contract
Li Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (if Applicable)
u Mass check Energy Compliance Report (If Applicable)
Li 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)
Li Building Permit Application
Li Certified Proposed Plot Plan
• Photo of H.I.C. And C.S.L. Licenses
• Workers Comp Affidavit
Lj 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 DEPARTM[ENT:BPFORM07
Revised 2.2008
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V11 Fl� 1 2/1/0
DAVID CASTRICONE
CASTRICONE ROOFING & SIDING INC.
By: ---------------- ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS
HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569
200 SUTTON STREET, SUITE 226, NO. ANDOVEI?, MA 0 1845
In North Andover 978-683-3420 InBoxford978-887-6147 InHaverhW978-374-7314
I/we the owner(s) of the premises mentioned below, hereby contract with and authorize you as contractor, to famish all necessary
materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and
conditions, on pretnisrs below es n
Owner',, ........ 4-1.1 Y ...................................................... )1ephone
Job Address...,17 .... Fillez .. M . 0. L,2 ..... 0 . .............. city ... )-Vo.,,4.) ..................... State ...... ........
Specifications:
existing shinglesf 0 Kpply new drip edge to all edges. Wit r
1ii1iP*** ... ** *"*'*'*** ..... * .... * ........ * ... ...... ********* .... *'*'**""*'*'***'**'*"*""*** ..... ** ...... * .... ******
.............................................................................. I .................. I .......... I .........................................................................................................
t/Apply 6 feet ice and water shield membrane to bottom edges of house. 3 feet ice and water shield memb e
in valleys and bottom edges of any unheated areas of house. F4 AJfX4k0, 6—A— t�C.0-- 11
........................................ ... ......................................................... I.P .... .. I ............... ................................... I .......................................
�Xpply felt papAer un dayment. �tffstall ridge vent to
-—I
..... ................... " .............................................................
............... lr-,Vq ....... / . . .........
4teroof using shingles with a :90 year warranty.
......................................................................................................................................................................................................................
-Counterflash chimney. Aew vent pipe .. flas . h . I . n . g. , . JA% . a . I .. d . i . s . p . a . sal of .. a . I . I .. d . e . b . r . i . s. r-.,. — - -� -4 . I Caaj
................................................................. 4 ....... . . ... . ....... . . dox .. ... uf;..d1S,.z Z'
Area(s) to be worked on:
............................................. k .... .... ..........
J.. ....... 0 . ......
Lr. ....... ...........................................
........ PlY 42 a.l
� fl� 21, ,�' C. ex. 4/
......... . . . . . .......
....................................................... ......... :.,r . .... . ....... ..... . ..... ........
Roof board replacement if necessary @ �/Z) /sheet or /foot Of
...................................................................................................................... arr'.k I . .. .......... �s
Two Year Workmanship Warranty (Not Transferable) Wanufacturer's Warranty as speciri ifacturer
The coAact t 6 1 the work an
or agrees o !Lfurnish the materials specified above for the SUM ,�C,
, pe orrr
Mayable ......... /,:L ............... on .... Sllkz ............
Payable ........ . ............ on ........ .... ...,.....,(XBalance payable on completion ofjob
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 ofpmperty, including pre-existing conditions (i.e. water stains, crumbling plaster, "posed nails) or
conditions resulting from application ofmaterials specified above (i.e. objects coming loose from walls, crumbling plaster, exposed nails, dust in attic orotherliving
spaces). Items in attic may need to be covered by homeowner. All materials are property of contractor. Any dumpstcr placed by contractor is for his use only. Upon
completion ofabove work, all undersigned agree to execute and deliver to contractor, theirjoint note in accordance with his (their) above obligation as requested by
contractor. Upon reft" 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, it"perinitted by law, contractor shall be paid by the owncqs) all reasonable costs, attorney fees and cxpenscs, in addition to the amount due and unpaid, that
shall be incurred in enforcing the terms and conditions ofthe 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 hereofshall bind and apply to their heirs, successors or estates ofthe parties. The undersigned wamint(s) that he is (they are)
the owners(s) ofthe above mentioned premises and that legal tide thereto stands ofrecord in his (their) names(s). nere am no representations, guaranties or
warranties, except such as may be herein incorporated, ifany, nor any agreements collateral hereto, not 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.
r
Approximate starting date of work ... ............. Completion date
X- at the foregoing
Receipt of a copy of this contact is hereby acknowledged, and it is further acknowledged by t e an ersigne th
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).
J.' �
IN WITNESS WHEREOF, the parties have hereunto signed their names this .... Ilig... day of... ........ 20-3....
Accepted: Signed ........... Owner
Signed............................................................................. Owner
David Castricone, President
Town of North Andover t%ORTH
01 t 0
0
Building Department 0
27 Charles Street
North Andover, Massachusetts 01845 V.
(978) 688-9545 Fax (978) 688-9542
'V
-7A HL15t
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 siolid waste disposal facility as defined by MGL c'.1 1, s150a.
The debn's will be disposed of in /at:
Z' /V
Facility location
Signature of Applicant
Date
NOTE: A demolition permit from the Town of N6rth 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.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lepibi
Name (Business/Organization/Individual): 'DALVlh 0-A-SAICOME RooFWr,-Sjhijj& wc
Address: ADO sd7ntz �CrrzU-r SuiT6— Z2-fo
City/State/Zip: N-ANbdvElL NA OiNT Phone #: 911 � 13 34�
Are you an employer? Check the appropriate box:
1.2 1 am a employer with q
4. R I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. El 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.
employees and have workers'
[No workers' comp. insurance
comp. insurance.1
required.]
5. E] We are a corporation and its
3. 0 1 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'
insurance
Type of project (required):
6. E] New construction
7. 0 Remodeling
8. E] Demolition
9. E] Building addition
10.E] Electrical repairs or additions
ILE] Plumbing repairs or additions
12.N Roof repairs
1311 Other
*ADy 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.
lContractors 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 insurancefor my employees. Below is thepolicy andjob site
information. '?N
Insurance Company Name:_ \ft5Qf0AU— LrADCAAM 0
Policy,# or Self -ins. Lic. #: W 60177 5(, Expiration Date:
Job Site Address: A Fi I I& M&LZ 9J &� City/State/Zip: U&zmA- 4A 6411'
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 thepains andpenalties ofperjury that the information provided above is true and correct
Signature: Date: e6 /0
Phone #:
use only. Do not write in this area, to
City or Town:
or town official
PermittLicense #
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 #:
PRODUCER Phone: 500-651-7-700 Fax., 508-653-0009
Eastern Insurance Group LLC -Commercial Lines
233 West Central Street
Natick MA 01760
INSURED
David Castricone Roofing & Siding Inc
200 Sutton St
Suite 226
North Andover MA 01845
I LU/..5/ZUU6
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC #
INSURE - Rk Ci tat j,g.0 Insurange U274
IN6URERB:The_1D3urance Co -of. State PA
INSURER G:'
COVERAGES .......... - I I
THE POLICIES OF INSURANCE LISTED BELOW HAVE, BEEN ISSUED TO THE I14SURED 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
7TERMS, 7' EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY FIAVE BEEN REDUCED BY PAID CLArms.
rN
T
SDR C
POLICYNUMBER
POLICY EFFECTI�_E
DATE
POLICY EXPIRATION
GENERAL LIABILITY
(MmiantyY1 nA _IAAMjDf)fyyj LIMITS
commcncIAL GENERAL LIABILITY
EACNOCCURRENCr
b7C)v RM-- I M I L-7, I T 1- 0
CLAIMS MADE OCCUR
PREMISES (En cjmuien�JL_ $
MID EXP (Anyono porqw) $
PERSONAL A ADV INJURY $
GCNE�IAL AGGREGKI'L
GLN`L AGGREGAI E LIMITAPPLIES PER:
PRD-
POLICY LOC
PRODUCTS - COMPIOPAGG $
A AUTOMOBILE LIABILITY 08MMBBTNKT
8/l/2008 8/l/2009
ANYAUTO
COMBINED SINGLE LIMIT
(Ea acdclorl)
ALLOWNEDAUTOS
X SCIIEDULEDAU1OS
BODILY INJURY
(Parpenon) Z50, 000
X HIREDAUTOG
NON�OINNEDAUTOS;
BODILY114JURY
(Peracdclont) $500,000
PROP[nTYDAMAGE
(Peramidard) $100,000
GARAGE LIABILITY
ANYAUTO
AUTO ONLY - EA ACCIDENT !N
OTHERTHAN EAACC $
AUTO ONL Y: AGG $
EXCESSIUMBRELLA LIABILITY
OCCUR CLAIMS MADE
EAGI-loccunRENCE $
AGGREGATE $
DEDUCTIBLE
$
RETENTION
I; —
B WORKERS COMPENSATION AND W6587MG
EMPLOYERS'LIABILITY
WC STATU- 1
9/23?2008 9/23/2009 X Tony I imlis 1j0_TnY_
ANY PROPnIErOR/lIAIT"4EIIAEXECUTIVE
OFFICERIMEMBER EXCLUDEJ)?
_L
E.L. EACHACCIDENT 1100,000
ndosedbo undar
5 JALPROVISIQIlSbok)w
E.L. DISEASE - EA EMPLOYEF, $ 100 0 00
OTHER
E.L. DISEASE - POLICY LIMIT )00 OQO
DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES I FXC LUSIONS ADDED BY CNOORS EMENT I SP ECIA L PROVISIONS
URTIFICATE HOLDER
CANCEL L ATION
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 BOLDER 14AMED TO THE LEFT, BUT FAILURE TO DO SO
SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
THE INSURER, ITS AGENTS OR REP RESENTAT IVES.
2bpuiloe)
AUTHORIZED REPRESENTATIVE
ACORD CORPORATION i9ea
Dclim-Imcitt Of PLII)IiC SitfON
Boat'd of Boilding Re --tilations and.�tjjjj(1�11-ds
Construction Supervisor Specialty License
License: CS SL 99358
Restricted to: RF,WS
DAVID CASTRICONE
31 COURT STREET
NORTH ANDOVER, MA 01845
mmuk�imwr
Expiration: 12/16/2011
Tr—,: 99358
-;R—\\ Board of Building Regulati " and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 104569
Expiration: 7/14/2010 Tr# 270265
Type: Private Corporation
DAVID CASTRICONE ROOFING, SIDING &
David Castricone
200 SUTTON ST SUITE 226
NORTH ANDOVER, MA 01845 Administrator
t