HomeMy WebLinkAboutBuilding Permit #628 - 27 SECOND STREET 4/16/2010TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ClIg Date Received Date Issued: _ll.? IMPORTANT: Applicant must complete all items on this nate LOCATION oZ iT 5 cc©nd �}ree.t Print PROPERTY OWNER o b-ovhg. Print MAP NO: 036 PARCEL:y 3 r7 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 Others: .-Repair, replacement Assessory Bldg Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: car OWNER: Name: Address: �17 Jt co nd cStxe CONTRACTOR Name: Please TApe or Print Clearly) N Y Lo Supervisor's Construction License: CJq 5S! Exp. Date: 1A- 16 -110 11 Home Improvement License: ARCHITECT/ENGINEER Phone: Address: Reg. No - 14-A6 1 O FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ , 52 gn. FEE: $ Check No.: 0-7-- Receipt No.-Jc� S 5�_ NOTE: Persons contracting with unregistered contractors do not have access_ to th ,=guaranty and Signature of Agent/Owner Signature of contractor a 7 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 P THE FOLLOWING SECTION` tbkbFFItiIt` 6`A ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS H EAtirH r ` '�� Reviewed on atur(i�• A� N COMMENTS t _ c J J Zoning BUM-& Appe'alsi`Vbriance, Petition No: 't 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 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 n--7 K7 - 0 ",W J- Location-C.1—T _ee- No. Date Z, Check # 0 q-- 2 2 9 2 building Inspector fw TOWN OF NORTH ANDOVER Certificate of Occupancy $ MU Building/Frame Permit Fee $ 9C7 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 0 q-- 2 2 9 2 building Inspector fw ui z o o o � c ` y O _; C2 O, C O O 44' me :t o :oma WA Ea C O v p a O O CD ' O � v rr m c E C6 ate. O m 3 z C O y ca co y C C O O ft --w Em m y O ; C: Z Z O cm cm C C i m CJ p m Me O c o o a : a c Q m ymc .o = m :o 3N O N y CD f- m Z .. c y az W Z ac E s4D .y o COD a' mics = W ` M'= 0 .� �a=m W- la 91 0 co L co Z a O y D c w+ � W I Q co.CO2 co a ffm m co 0 co CL a� c CD env o Q CL D: Q c Cl c �� v J 'o C CD CD CL V y c C C cc CO) LLI 0 U) LLI U) W W W U) x 0 x as u � O w v V) z A ° o co O w O C2 C U x w 9)WU O w q x d cw cn C x x `� p w' G u. W w x 7 cG z V-) o cn ui z o o o � c ` y O _; C2 O, C O O 44' me :t o :oma WA Ea C O v p a O O CD ' O � v rr m c E C6 ate. O m 3 z C O y ca co y C C O O ft --w Em m y O ; C: Z Z O cm cm C C i m CJ p m Me O c o o a : a c Q m ymc .o = m :o 3N O N y CD f- m Z .. c y az W Z ac E s4D .y o COD a' mics = W ` M'= 0 .� �a=m W- la 91 0 co L co Z a O y D c w+ � W I Q co.CO2 co a ffm m co 0 co CL a� c CD env o Q CL D: Q c Cl c �� v J 'o C CD CD CL V y c C C cc CO) LLI 0 U) LLI U) W W W U) ADM,, CERTIFICATE OF LIABILITY INSURANCE Thl 09/28/20 9' PRODUCER (508)652-7700 FAX 508-653-BD89 Eastern Insurance Group LLC - Commercial 233 West Central Street Natick, MA 01760 Select Ext.S3389 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, TH15 CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, INSURERS AFFORDING COVERAGE NAIL # INgURED David Castricone Roo Yng & Siding Inc 200 Sutton St suite Z26 North Andover, MA 0184$ INSURERA: The Insurance Co of State PA INSURER B: IN$VR4R C, INSURER D: INSURER E. rr)vPPAC:KC THE POLIGIES OF IN5URANGE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY k9OUIREMENY, T0M OR CONDITION OK ANY CONTRACY OR OTHER DOCUMENT WIYH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITION$ OF $UCH POLICIES, AGGREGATE LIMITS SHOWN MAY NAVE BEEN REDUCED DY PAID CLAIMS. INSRDDS AUTHORIZED REPRESENTATIVE Stacey Brice PKGC5�iM!�7 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRFNCI: $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RL•NTEU $ RFAA I�IyS /f--. ^-GGIlLGf7GL• CLAIMS MADE 1:1 OCCUR NICD CXr (Any one parson) g PCRSONAL 6 AOV INJURY $ 13I:NI-14AI AGCRLGATL $ OtN'L AGGREGATE LIMIT APPLIES PER. V RODUC I5 - COW1OP AGO $ POLICY PRO LOC JECT El AUTOMOBILE UABILIYY ANY AUTO CONeBINEDSINGLEI.IMIT $ (1-a Pccndem) ALL OWNED AV'I OS SCHEOULEDAUT05 BODILY INJURY (Pei verganl HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Par :accident) '$ PROPERTY DAMA01' E (Per ecrldent) GARAGE LIABILITY AUTO ONLY • EA ACCIDENT $ ANY AUTO 07HERTHAN FA ACG $H — AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY CACI I OCCURRENCE $ OCCUR FICLAIMS MADE AGGRE'GAT'E $ $ IytvvcTlBLt � s RETENTION E WORKERS COMPENSATION AND WC9752746 09/23/2009 09/23/2010 X WL, STATU- OTH EMPLOYERS' LIABILITY E.L. EACH ACCIDENT 8 100,000 A ANY PROPRIF,TORIPARTNEFLEXECUTIVE OFFICERIMEMSER EXCLUDED'? I a, ascnbc under yo E.L. DISEASE - EA EMPLOYE g 100 ,000 _:_ SPECIAl. PROVISIONS below E.I., DISFASF - POLICY LIMIT $ 500,000 OTHER OESCRIPYION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS C ER lIF (COTE HOLDER In At•.nCi 1 AT. L. David C a s tr i c one Roofing & Siding 200 Sutton Street Suite 226 North Andover, MA 01845 SHOULD ANY 00 YHE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 GAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE 94ALL IMPOSE NO ORLIGAYION OR LIABILITY OF ANY KINb UPON YHE INSURER, IYS ArFNYS OR REPRE5ENYATIYE5. AUTHORIZED REPRESENTATIVE Stacey Brice PKGC5�iM!�7 ACORD 26 (2001108) @ACORD CORPORATION 1988 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 _ www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlicant Information Please Print Le i� bly Name (Business/Organization/lndividual): AV I C ASTR I CD N R pQ EI N(,- d S IA 1 N (`T I N L Address: zoca S(j-rtSarJ S --r Su V C -e_ 'Z2 b City/State/Zip: h - AcNbo J6 K MA o t & L1S Phone 9:37) $ (e 6 3 3 `4 20 Are you an employer? Check the appropriate box: l: ® I atn a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors ?. ❑ 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.t required.] 5. ❑ We are a corporation and its 3. ❑ I ant 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 required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.XRoof repairs 13. ❑ Other *Anv 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. 1Contractors 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 Insurance Company Name: 7V)e-5, -cc, Co mT,,1y 6- 54A -e 3 ft Policy # or Self -ins. Lic. #: NN C 9 7 5 a. ` Lj _to — Expiration Date: q�- c�%!3 2a l o Job Site Address: 021 1��.(.� f%& V City/State/Zip: . TV1Q.t%& %YA d l t � 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 certifyunder the pains and penalties of perjury that the information provided above is true and correct Signature: 5D_2 C,*,�, Date: use City or Town: area, to or Town official 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 Norte Andover Building Dcp:u't.uie,It 27 Ctwles Street North Andover, Massachusetts 01845 (978) 688-9545 lax (978) 688_9542 DEDIUS DISPOSAL FORM �a,0t+71y ~�;I;� tjT ��•� O V. SSAc 1Jl 5�4 In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit. # the debris reg .-i.:l ting from the work sluill be disposed of in a properly licensed solid waste disposal facilil., as defined by MGL c1l1, s150a. The debris will be disposed of in /at: ZN 2�v Z)_ Facility lo��,,iltotl Signature of Applicant Date NOTE A demolition permit from the Town of North Andover must be obtainedfor this project tluougli the Office of the Building Inspector, N ' Board of Buildiw, Re,-ulatiuns ;uttl "tuntlartls C -� onstruction Supervisor Specialty License License: CS SL 99358 Restricted to: RF,WS DAVID CASTRICONE ;,..,� ,, 31 COURT • ti ^f STREET NORTH ANDOVER MA 01845 ;0 J.ii _. Expiration: 12116/2011 l' nuni..iiwrr Tr.: 99358 �%K6 lr:'r1Y//.YYcil1'I/U4'cLLC/tt��. �:%(lildCtG�illdl'•CCD _ "\... Board or IBuiitling Regulations ;till Standards HOME IMPROVEMENT CONTRACTOR ff� Registration: 104569 Ex it V,> p ation: 7/14/2010 Trit 270265 Type: Private Corporation DAVID CASTRICONE ROOFING, SIDING & David Castricone 200 SUTTON ST SUITE 226 NORTH ANDOVER, MA 01845 Administrator. 4 P, Ua; uv; Zulu uy: s5 r'a,'L U1770UM)19 FU'1'NAM 1NVESTMENT,> DAVID CASIMICONE CASTRICONE ROOFING & SIDING INC. ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 200 Sl- r1'ON STREET, SUITE 226, NO. ANDOVER, NIA 01845 In North Andover 978-683-3420 1h BoAford 978-887-6117 In HiaverhX 978-374-7314 L.J U t12 APR 0 'i 2010 Uwe the ownw(s) of the premises mentioned below, hereby contract with -and authorize you.as contract., to filinisb 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 ....A -14M-1....... 1 rt.;�'.................................T hone#....4 r.�?.sxe..:.ii �.L... .. .4 ....... a .................... City .. ti..... ails l ..........-._: State_... Job Address..... ........ Specfcations1 _.. ...... - .. .......--......feta ...................actarer' .. ................. ...... ............ Two Y-ur WO Fltaatans ois-Wafts Mal taeturer's Warranty a9 spec inannlSc ter The r agrees toorm the work ��YY�' hbo _...... .-- the materials specified ave for the S of S,_...t3.2 ,�.Z1 J gable ............ on ....S .......... . 44.73 ftsbie ............................. on............ ........ .... i Balance payable on completion of Job Owner or Owners are not responsible for Property Damage or Liability o Ism opta9tion. Contractor is not responsible for any damage to the interior of property, including pnredsting conditions (i.e. water steins, crumbling' plastcr, exposed nails) of conditions resulting from application of matcrials spoeificd above (i& objects coming loose from walls, crumbliag plaster, cupwod nails; tidal in attic or other living spaces). Items in sunt may need to be twvcW by homeowner. All materials we property of connector_ Any dumpatn placed by contractor is 1hr his use only. Upon completion of above work, as undersigned agree to execute and deliver to contractor. their joint note in accordance with his (their) above obligation as requcAcd by contraoto[. Upon refusal to do so, x;oPMMr may at its option dacluc the cobra cermet[ price or so much as thm mains unpaid, i mnediately doe auufl payable it is ogreed that, if ponuittcd by law, contractor AM Ire paid by the owner(s) all amsoaabie costs, attorney foes and ptpenscs, in addition to the amount due and unpaid, flue. shell be incurred is eafotaing the trams and conditions of the contract andlor any Wall in connection herewith. It is further agreed that this contract may be assigned by contractor, and also that the obligations huoofshatl bind and apply to their heirs, svcoessots ore4i8k9 of the parties. The undersigned wMant(s) flint he is (fbty art) the owners(s) ofthc above mattioned pmnises and that legal title thereto stands Omani in his (their) names(s). There we no representations, guaranties or wnramties, except such as may be herein ImcorporaK if any, nor any agecments collakral hereto, nor is the cona" dcpondcm upon or subjtwt to any conditions not herein stated. Any subsequent agreement in reformat bcrao shall be binding only if in writing and signed by all partics. An Home Improvement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, dome 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 MGI, c. 142A. Approximate starting date of work..... .. ............................. Completion date ......................................... I ........ ..,.... Receipt of a copy of this contact is hereby acknowledged, and it is firther 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 patties 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 nogre of cancellation). IN WITNESS WHEREOF, the parties have hereunto signed their names .................. day of ............. ........», 201L..- Accepted: ' Signed ...»»...«..................... .-..-.,........;Owner Sigaed............ ..... .........................»»....»».........»....Owner David Castricone, President