HomeMy WebLinkAboutBuilding Permit #670 - 273 GREENE STREET 5/4/2010BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issu4440 y "/49
IMPORTANT: Applicant must complete all items on this page
F -
OCA ION e (Z t i` /U ti L�
Print
:PROPERTY OWNER I� 21 I t.�!'�✓l�iY� `7
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,-MAP 2460' PARCEL'- ZONING DISTRICT: Historic; District
yes no
Machine Shop �ipage 'yes nod
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
,,6ne family
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Repair, replacement
Assessory Bldg
Others:
Demolition
Other
a 'Septic - W6111 ,1
Floodplain Wetlands
Watershed District
`-:V1/ater/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
rrA l-nc rcAr M,4Q tl no f AW ova Fd Ver j u/,e e --►fey
Identification Please Type or Print Clearly)
OWNER: Name: Lo i2RAW e- SAVA S -T1 AJ -0 Phone: q78 t, k30 1. Z
Address: x13 69 -t --E/6 &D(JVU,- MA 64YJ'*'
CONTRACTOR Name: 1 Aja tc.dk. J Q/66Phone: 9)i (c4,� 34
AddreT7W C1 %Z c -W .2 Zt, #V0A-774 *Vhdt1� C1J.JY�t
St pervisor's Construction cense: Y?) Exix .Date: J 1
Home mprovement.License: CU ` S. (a q Exp. Date: 7 `1
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: $ % U FEE: $
Check No.:—1 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
igen 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
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 Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
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)
i
❑ Notified for pickup- Date
Doc.Building Permit Revised 2010
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
o 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: Building Permit Revised 2008
Location
No. /w:9 j Date L
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ J
"us
Foundation Permit Fee
Other Permit Fee
TOTAL
Check # ?2�,Q
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CA
DAVID CASTRICONE
CASTRICONE ROOFING & SIDING INC. Y11.2-2JJ0
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 HaverhX 978-374-7314
Uwe the owner(s) of the premises mentioned below, hereby contract withand 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 prem' s below described:
f //pp22
Owner's Name ............. �.j f`Q irrllL .......� y( G ! ......... Telephone #...... (a..Qs.l "�.1.�
Job Address .... w,2,3 ..... ,h ¢.rz ui ...... :............. city...... ........... State..... M .......
Specifications:
......................................................................................................................................................................................................................
Two Year Workmanship Warranty (Not Transferable) Manufacturer's Warranty as specified by manufacturer
The contractor agrees to perform the work and furnish the materials specified above for the SUM of $.... , j.9..C-�';.............
Payable ......... on
..............................................
Payable ............ on............................:..... Balance payable on completion of job
Owner or Owners are not responsible for Property Damage or Liability while]
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 dumpsta 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
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) names(s). There are no repmmmations, 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.
Approximatestarting 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 noti cancellation . r
IN WITNESS WHEREOF, the parties have hereunto signed their names day of... ! 1 ......, 20....Q
Accepted:
Signed ...»» ..»................................. ........ »... .... — Owner
/ Signed.................»......................................................... Owner
... .. ...... .... ... .
David Castricone, President �_ '
I he Commonwealth of'Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
tvrwv. mass.gov/dia
pensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organizatiort/lndividhtal): AV I ASTR I CO N Oa LI NC:,_ d S jA N Cr I N L
Address: Zola S071-t—pt3 S-c2�-_E--r Sy V -t -e_ -Z-z, k.
City/State/Zip: AtNDO 46 (L MA 0 15 LAS Phone #:
Are you an employer? Check the appropriate box:
I. ® I am a employer with ` 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
3. ❑ I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] f
listed on the attached sheet.
These sub -contractors have
employees and have workers'
comp. insurance.$
5. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, §1(4), and we have no
employees. [No workers'
insurance
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
I1.❑ Plumbing repairs or additions
12. Roof repairs
13.❑ Other
*:why applicant ilial 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 ati'idavit indicating such.
TContractors 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 isproviding workers' compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company Name: 7\C� e OA Vince Co
("I) ,../IC��
Policy # or Self -ins. Lic. 4: \N C 9 9 .rj a, q y (o Expiration Date: cl - r% 3f 20 I o
Job Site Address: a �f_,�� &e c,,) Vre er C4/State/Zip:_40
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 itnprisorunent, 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 .���IL r j C Date: 4( 2t(1 c o
use
City or Town:
not write in this area, to be completed by city or'Aown 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 North Andover
131111ding Depiil'(ment
27 Charles Street
North Audover, 1VIassachuseas 01845
(978) 688-9545 Fax (978) 688-9542
DEBRIS DISPOSAL FORM
e1 a 1+ 71y
O�E�r��u�'; 4,yO
Vl�Q� u .I
SSMCF LJ
In accordance with the provisions of MGL c 40 s 54, and a condition of
:Building permit W the debris reg:,.! I tint; from the -work stuill be disposed
of in a ofoperly licensed solid waste disposal facilit-, as defined by MGL c,l 1, sl 50a.
The debris will be disposed. of in /at:
Signature of Applicant
Date
q1 .Lj /1a
NOTE A demolition permit from the Town of North Andover must: be obtained. for this
project tluough the Office of the Building Inspector,
p
.�CCfiD CERTIFICATE OF LIABILITY INSURANCE
1M1I
09%29/200
PRODUCER (500651-7700 FAX 505-653-8089
Eastern Insurance Group LLC -- CoRmercial
733 West Central Street
Natick, MA 01760
Select Ext -53389
_
: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
NAIL #
INVUReo David Castricone RooTing & $%ding In[
200 Sutton St
Suite 226
North Andover, MA 01845
INSURERA: The Insurance Co of State PA
.�-
INSURER B:
IN$URFR G;
GENERAL
INSURER D:
INSURER E.
rnAIGD A!: r C
THE POLIGIE5 OF IN5URANGE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORT) i� POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY 128QUIRSM914T, T0M OR CONDITION OK ANY CONTRACY OR OTHEk DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED 013
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 HAVE BEEN REDUCED BY PAID CLAIMS.
INSRDD'
1715
IjOAYIi
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
MM.A(p[t
LIMIT5
EACH UCCURRFNGF
$
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITYM
DAACE TO I&WE U
_
ISU.; tr., mr=.Oq
$
I��
CLAIMS MADE I L OCCUR
l—
MCD CXP (Any one Peraon)
S
PERSONAL & ADV INJURY
$,
1jl:M-RAI AGri1LGArc
$
GLN'L AOGHEGATE LIMIT APPLIES PER,
r'HODUC I5 - CUMPfOI' AOO
$
POLICY PRO LOC
JECT
AUTOMOBILE
LIAAILIYY
ANY AUTO
COM01NE0 SINGLE LIMIT
(1-4 Acadenl)
$
ALL OWNED AU1OS
SCHEDULED AUTOS
BUDILY INJURY
(Ilei OerGonl
$
HIRED AUTOS
NON -OWNED AUTOS
BODILY INJURY
(P19 =e1derll)
$
PriOr'1 rIVY f)AMAGF
(Pee err,Ident)
$
GARAGE LIABILITY
AUTO ONLY, EA ACCIDENT
$
PA ACG
OTHER THAN
$
ANY AUTO
g
AUTO ONLY,
AGO
EXCESSIUMBRELLA LIABILITY
CACI I OCCURRENCE
S
OCCUR D CLAIM$ MADE
AGGHL-GAT6
$
v
.-- T
5
17tUVC1'IBLt
$
RETENTION E
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
WC9752746
09/23/2009
09/23/2010
X WI. STATU- OTH
T
E.L. EACH ACCIDENT
$ 100,000
A
ANY PROPRIF-TORIPARTNFPoEXFOU'fivE
OFFICFRWEMBER EXCLUDED^
If 5, doscnbc under
E.L. DISEASE - EA EMPLOYE
g 100,000
Ej., DISFA5E - P01 ICY LIMIT
$ 500 000
SPECIAL. PR0Vf8I0NS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
David Castricone
200 Sutton Street
Suite 226
North Andover, MA
SHOULD ANY Or YHI1 ABOVE 0165CRIBEU POLICIES 0E GANOELL0 serm YHE
Roofing & Siding EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
01845 OF ANY KINb UPON YHE INSURER, IYS AGENTS 011 RUPRESkN'I'ATIVE5. _
AUTHORIZED REPRESENTATIVE 1114
Stacey 6ricerPKG
ACORD 26 (2001108) CJACORD CORPORATION 1988
Construction Supervisor Specialty License
License: CS SL 99358
Restricted to: RF,WS r°9
DAVID CASfRICONE
31 COURT STREET
NORTH ANDOVER, MA 0.1845
C rrnuni..i,rni•r
Expiation: 12/16/2011
Tr,-: 99358
�:—�..rr.,a v, nunumg KcGutnliohs and tit:uulards
HOME IMPROVEMENT CONTRACTOR
Registration; 104569
t7
Expiration: 7/1412010 Tr# 270265
Type: Privale Corporation
DAVID CASTRICONE ROOFING, SIDING &
David Castricone
200 SUTTON ST SUITE 22.6
NORTH ANDOVER, MA 011145
Adurinisfr;llor
0
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