HomeMy WebLinkAboutBuilding Permit #406 - 27 OAKES DRIVE 11/24/2009 TOWN OF NORTH ANDOVER
�xt APPLICATION FOR PLAN EXAMINATION
Permit NO: V Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION G kei X17 ve.
Print
PROPERTY OWNER I/1� lei a/n �' o� &
Print
MAP NO: _PARCEL: C ZONING DISTRICT: Historic District yes 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
dRepair, replacement Assessory Bldg Others:
Demolition Other
Septic Well Floodplain Wetlands Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
S f d e f a!r e altef dN Cval,
Ide tification Please Type or Print Clearly)
OWNER: Name: �ilafn l oast Phone: � 7f 7�
Address: 02. 7 QAtey �YiT Ve &14, )d(Vd W //A d I NJ�
CONTRACTOR Name:_D:X0AJ 'Y1(AU ?a,JfiAS Phone: 3 yLD
Address: &y SAA S4JuAt ZAnddufi HA 61[t J_ J
Supervisor's Construction License: 9?jff Exp. Date: /2 -/6 - d d
Home Improvement License: 14 LIS(o 9 Exp. Date:
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: $ - �� • FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
ignature_of 6ggnt/Owner Signature of contractor
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL ,-
Public Sewer Tanning/Massage/Body Art Swimming Pools s�,f ?3 z
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
COMMENTS
HEALTH Reviewed on Siqnature
s
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Siqnature&Date Driveway Permit
DPW Town Engineer: Signature:
* ' "�, .:`• P� Located -384'Os ood,StreAt
FIRE DEPARTMENT - T-emp Dumpster on site yes no �'
Located at 924 Main Street
Fire Department signature/date
COMMENTS
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: Doc.Building Permit Revised 2008
Location
No. Date
�aRT� TOWN OF NORTH ANDOVER
? o
F s
a
Certificate of Occupancy $
E<�' Building/Frame Permit Fee $
s4CNUS
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # / 5 ;
22- 662
uBuilding Inspector
SAO R Tly
Town of : Andover
No. y o (Po , .:��- _� :. .A,,; r..
V �
� d�
0 AE dover, .,
COCMICKEWY'd
DRATED iP�\y�5
l BOARD OF HEALTH
PERMIT T Food/Kitchen
Septic System
b
BUILDING INSPECTOR
THIS CERTIFIES THAT..... .t.�1'!!!�...... OJ��
Foundation
has permission to erect........................................ buildings on .... �— Q. v
...............It-- ...........................
Rough
to be occupied as...... C
.......rt I2 a S I d�. �.... ArA.h. �, ou................................... �: ............. ...�!!! > ... .. Chimney
provided that the person accepg this permit shall in every respect con orm to the terms of the application on file in
this office, and to the provisions of the.Codes and By-Laws relating to the Inspection, Alteration and Construction of Final
Buildings in the Town of North Andover.
PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRU STARTS ELECTRICAL INSPECTOR
Rough
........ ... ...................................................:.-.-...._._....�................... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
Final
No Lathing or Dry Wall To Be Done
Until Inspected and Approved. by the Building Inspector. FIRE DEPARTMENT
Burner
Street No.
SEE REVERSE SIDEji Smoke Det.
��U Ilji
t�0 fdOV 1 ��2U09 U
DAVID CASTRICONE
BY:..""""""" CASTRICONE ROOFING& SIDING INC. /�
ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS Mr,-,-4.9
HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569
200 SUTTON STREET,SUITE 226,NO.ANDOVER,MA 01845
In North Andover 978-683-3420 In Bozjord 978-887-6147 In Haverhill 978-374-7314
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 premises
?below
)described:
Owner's Name.........
/7W.1'.�/.L�.Lrr+►�1./..... �..L1 S.r?-r..........................................Tele one#....G.g :....A.4?....1... ....
1 I1 R lt....... .�1. .ti.V.e.,a..........State.......................
Job Address...... .... ........ .. .....�.5...... ..L`.1..Y..��r...............City......
Specifrcations:
.......................
........... 1.ls............................................................
/. �. ,w �.
..�.. ........
........../Q.0.s4. . ........�,,.�..,.. ...... .,, L.�. :.... �.......
T
....................................................................
. ,
..............................................................................................................................._......._..._._.........._...........................................................
......................................................................................................................................................................................................................
....................................................................................................................................................................................................I.................
................................................................................................................................................................................................I.....................
.................................................................................................................................................................. ................................
Two Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as spec' ed by ma ufacturer
The co actor agr s to perform the work anh the materials specified above for the S of$...,,.5:TFO..... ........
/ ayable , .0?..O..D.......on.... Sd s............
Agim6 w........—............on..................................(9�alance payable on completion of iob_
Owner or Owners are not responsible for Property Damage or Liability whilejo Isis 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 del ivcr 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 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)namcs(s).There are no representations,guaranties or
warranties,except such as may be herein incorporated,if any,not 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.
r
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....J ......day of
Accepted:
Signed.................................-::..—: ............... Owner
—�—� Signed............................................................................. Owner
David Castricone,President
The Commonwealth of Massachusetts
Department of Industrial Accidents
"— Office of Investigations
600 Washington Street
Boston, MA 02111
�y www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): _DAV `1 C MTR i C o N a R OO FINC, I S JD 1 N 6 i N L
Address: 2oc) Su-t-Tt,1Sy v,c-r-- -2
City/State/Zip: N.ANDO 46 MA 0 19 NS Phone #: 9-)t (P 6 3 3`4'Lo
Are you an employer? Check the appropriate box: Type of project(required):
1.® I atn 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.❑ I 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 the in any capacity. employees and have workers' 9 ❑ Building addition
[No workers' comp. insurance comp, insurance.
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Phunbing 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
employees. [No workers' 13.y
Other
comp. insurance required.]
*Any applicant that checks box#t 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.
icontractors 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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. n f
Insurance Company Name:7V)e_ n�tLr-ice C6 MD, G111� Gt� STS-{P A
Policy #or Self-ins. Lic. #:_W C 9 q5 a,q y Expiration Date: 9-d,3- 20 I o
�� 6�bj �fii �e �- fiOLvee
Job Site Address: City/State/Zip:
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 m 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, `- ' `/nn ; Cb
� $ Date: /�Zgy/G�
Q---�'—� a>= by roG —
Phone#: 10
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#:
ACORD, CERTIFICATE OF LIAQILITY INSURANCE 09/28/200'
PRODUCER (508)651-7700 FAX 508-653-8089 :THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Eastern Insurance Group LLC - CoDmercial ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
233 West Central Street HOLDER,TH15 CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Natick, MA 01760
Select Ext.53389 INSURERS AFFORDING COVERAGE NAIL#
INevRev David Castricone Roo Ing $r Siding Inc, INSURER A: The In5urance Co of State PA
200 Sutton St INSURER B:
Suite 226 IN$URF,R C;
North Andover, MA 01845 INSURER D:
INSURER E.
COVERAGES
THE POLIGIE5 OF INSURANCE L15TED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TI-1E POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMgNT,TERM OR CONDITION 05 ANY CONTRACT OR OTHER DOCUME,N'r 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,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY V.ACH UCCURRFNCf; $
COMMERCIAL GENERAL LIABILITY DAMAGE TO lIL•NTEU $
ccurancnl
CLAIMS MADE ❑OCCUR MCO CXP IAny one portion) T,
PCRSONAL fi ADV INJURY
GLW-RAI AGGRCGATC $
GLN'L AGGREGATE LIMIT APPLIES PER. r'NbUVC I5 COMPIOP AOG $
POLICY f7 Pao- LOC
JECT El
AUTOMOBILE LIABILIYY
ANY AUTO (i
Town of North Andover
Building Department
m
27 Charles Street
North Andover Mass
achusetts 0.1845
(978) 688-9545 Fax (978) 688-9542P
a°R�reo �N`•y,tih
�S5.4CFIU5�'�
DEBRIS DISPOSAL FORM
In accordance with the provisions of MGL c 40 s 54, and a condition of.
Building permit # the debris r&,-;.!I ting from the work sluill be disposed
of in a properly licensed solid waste disposal facility ;is defined by MGL cl 1, s150a.
The debris will be disposed of in/at:
Facility lo,:agion
Signarw-e of Applicant
1I
Date
NOTE: AL demolition permit from the Town of North Andover must be obtained for this
project tluough the Office of the Building Inspector.
/,e -Ccorni�enruara<C/. n..",;(Za 4zChederZ
Board of Boildinl- Re!-tilatinn.ti ;Intl Skintlartls �� Board of Building Regulalio s and Standards
-+ Construction Supervisor Specialty Licensef=:=r==
��- = HOME IMPROVEMENT CONTRACTOR
License: CS SL 99358
- `'- — Registration: 104569
Restricted to: RF,WS JI n
; � ti•, Expiration: 7/14/2010 Till 270265
DAVID CASTRICONE ` `'F �" Type: Private Corporation
31 COURT STREET ±`' `` DAVID CASTRICONE ROOFING, SIDING 8
NORTH ANDOVER, MA 01845 ? � David Castricone
200 SUTTON ST SUITE 226
Expiration- 1 211 61201 1 NORTH ANDOVER, MA 01845 Administrator
l'',unnii. i,nu•i Tri: 99358
0