HomeMy WebLinkAboutBuilding Permit #436-15 - 29 MAGNOLIA DRIVE 11/5/2014 (3) t%ORTli
BUILDING PERMIT °��tLED -bgtio
TOWN OF NORTH ANDOVER �= rye''`- 4` °�
A PLICATION FOR PLAN EXAMINATION
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Permit No#: ; Date Received
gDRATED
SSACHUS�
Date Issued: ��
IMPO TANT: Applicant must complete all items on this page
LOCATION
i - Print
PROPERTY OWNER L,[1 11:_3 C
Print -l06Year structure yes o
MAP PARCEL: ZONING DISTRICT.Historic District yes no
_ Naehine Shop Village yes, no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building lZne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
epair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic. ❑Well ❑ Floodplain, ❑Wetlands ❑ Watershed_ District
_ ❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Sri g3� ;o le_
Identification- Please Type or Print Clearly C
OWNER: Name: ('t COL,i��a i Phone: 97� qy ,6J'O
a9 �� M\'(6,- i� fq)�6 Ve ��
Address:
r Name: C_ I °S(r�\_- -- - 3 9__ J' 0)0 y
Address: �a �R. -SerAc1. <S� U Clt V_J A _ t W Afl�6Vff
-
Supervisor's Construction License. -_ �5� Exp. Date:
Home Improvement�License -___) D_4—S (,.,9" Y---,-....,.� _n ..-Exp. Date: .
ARCHITECT/ENGINEER Phone:
z
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST B ED ON$125.00 PER S.F. a
00Total Project Cost: $ ��CLI�V.
FEE: 45 C7__ �
Check No.: � Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Age e - __ __ Signature of contractor
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
o Workers Comp Affidavit
Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
o 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
a Building Permit Application
o Certified Surveyed Plot Plan
u Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
o 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)
u Building Permit Application
o Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
Li Workers Comp Affidavit
u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
u Copy of Contract
u Mass check Energy Compliance Report
u 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 2014
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
I
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department use)
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❑ Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
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Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans
p ❑
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 Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
i
HEALTH Reviewed on Signature
COMMENTS
I
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
' Conservation Decision: Comments
i
j 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
Location
r
No.
Date Y/5
i
e - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#Q 62
2v22u .
Building Inspector
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own of �• : n over
O
45
LAKE ver, Mass f
T O ' I
COCMICKEWICK
�.9 A
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT ....................6&('............... -r..�":r�t..�.'.. .1!..... .. ........................... BUILDING INSPECTOR
has permission to erect ............. buildings on a. 1. �a. .N.0 r.jqw .................... Foundation
.............. ..... ...... ............ .....
Rough
.... ....": ................ ...... Chimney
to be occupied as .....................�.. .......'r' .... . . .c7. ... ..... ................. y
provided that the person acce tin this ermit shall in eve res ect colfForm to the terms of the application pro p p g p ry. p pp Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION,I TA S Rough
Service
...................... .... ................................................ Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy'Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of.Investigations
600 Washington Street
Boston, A&I 02111
ww►v.rnass.gov/dia
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Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information ( Please Print Legibly
Name (Business/Orgaaiza6on/ladividual): D M 1 b C AJ S p,1 C.ONt, 'RU b f C x 6 " Si i b I N 6 INC..
Address: �3I R SvT'1'0 N S-1 RE C:7 UN i 3A
city/state/zip--No, AN b oy e.r,, _ _
Are you an employer? Check the appropriate box: Type of project(required):
1.M I am a employer with 4. E] I am a general contractor and I
employees (full and/or part-time).*
have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for mein any capacity. employees and have workers' 9 ❑Building addition
[No workers' comp_insurance comp. insurance.$
5. We are a corporation and its 10.❑ Electrical repairs or additions
required.] ❑ P
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12;pj�Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any 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.
'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state ether or not;hose 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.
Insurance Company Name: G R A N l T I A j e- N,S U C^N C c; C0 _
Policy#or Self-ins.Lic. #: W CO Q 39 19 2 d3 Expiration Date:
Job Site Address: c - 1 �np`� �, � jU�, City/State/Zip: N 6A yT
o.
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 the pains and penalties of perjury that the information provided above is true and correct.
Sitrnature: Date:
Phone
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#:
A`c„��® CERTIFICATE OF LIABILITY INSURANCE 9%10/20114
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT SusanDonnell
NAME:
Eastern Insurance Group LLC PHONE (800)333-7234(AICNo FAI, No:
233 West Central St EMAILADDRE .sdonnell@easterninsurance.com
INSURERS AFFORDING COVERAGE NAIC k
Natick MA 01760 INSURER A:Western World Insurance Cc
INSURED INSURERB:Commerce Insurance Company 4754
David Castricone Roofing & Siding Inc, DBA: INSURER C 4Granite State Insurance Co.
231 Rear Sutton Street, Unit 3A INSURER D:
INSURER E:
North Andover MA 01845 INSURER F:
COVERAGES CERTIFICATE NUMBER:Master 14-15 REVISION NUMBER:
THIS IS TO CERTIFY THAT 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 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 TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
(LTR TYPE OF INSURANCE ADOL UBR POLICY NUMBER MM1D0 EFF POLICY
LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED 50,000
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $
A CLAIMS-MADE Fx_1 OCCUR NPP1388404 /6/2014 /6/2015 MED EXP(Any one person) $ 1,000
PERSONAL 8 ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000
X POLICY PRoT LOC $
AUTOMOBILE LIABILITY EOMB�INeDISINGLE LIMIT 1,000,000
B ANY AUTO BODILY INJURY(Per person) $
A��ED X AUTOSULED CIIG(.'V /1/2014 /1/2015 BODILY INJURY(Per accident) $
HIRED AUTOS X NON-OWNED PROPERTY DAMAGE
AUTOS Per accident $
r $
UMBRELLA LAB OCCUR EACH OCCURRENCE $
EXCESS LIA CLAIMS-MADE AGGREGATE $
DEO I I RETENTION$ $
C WORKERS COMPENSATION WC STATU• OTH-
AND EMPLOYERS'LIABILfTY Y I N
FR
ANY PROPRIE 0R/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000
OFFI ❑CER/MEMSER EXCLUDED? N I A
(Mandatory in NH) C003989723 /23/2014 /23/2015 E.L.DISEASE-EA EMPLOYEE $ 100,000
If yes:describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
Roofing & siding contractor
CERTIFICATE HOLDER CANCELLATION
�; D a ��nn� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Castricone-Roofing Sicfing THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
unit 3 ACCORDANCE WITH THE POLICY PROVISIONS.
231 R Sutton Street AUTHORIZED REPRESENTATIVE
North Andover, MA 01845
John KOegel/MET
ACORD 25(2010/05) O 1988.2010 ACORD CORPORATION. All rights reserved.
INS025 onrrvKl n, The Ar:ORn nnmo nnri Inn^oro ronielowri marlre of A(rlfifl
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction SulicrN i+nr Slrccialt
License: CSSL-099358
DAVID T CASTRICON.E. _.
31 COURT STREET w / ri
NORTH ANDOVER 1VI Q018 ,5
•rr�r.
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Expiration
Commissioner 12/16/2015
:� ��e �a��a»r,n�uue�a�l�a`��/ ��Jcic�trJe�1•J
\. Office of Consumer Affairs&Business Re'gulation
SME IMPROVEMENT CONTRACTOR
egistration: 104569
Type:
xpiration: 7/14/2016 Private Corporatio
DAVID CASTRICONE ROOFING,SIDING&
i
David Castricone
231 R SUTTON ST SUITE 3A
NORTH ANDOVER, MA 01845uv �� n
Undersecretary
Town of North Andover N�H7
o
Building Department o
27 Charles Street '� p
Nonh Andover, Massachusetts 01845
(978) 688-9545 Fax (978) 688-9542
7 Q�R�reo' P"yq`7
�SSHC14U5��
DEBRIS DISPOSAL FORM
In accordance with the provisions of MGL c 40 s 54, and a condition of
Building permit 9 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 50,q.
The debris will be disposed of in /at:
r s l
Facility location
Signature of Applicant
01
, .
Date
NOTE: A demolition permit from the Town of North Andover most be obtained for this
Project tluough tie Office of the Building Inspector.
DAVID CASTRICONE, PRES.
CASTRICONE ROOFING & SIDING INC.
ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS
HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569
231 R SUTTON STREET UNIT 3A, NO.ANDOVER, MA 01845
In North Andover 978-683-3420 In Boxford 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 furnish 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.........h.. p...w
`4.......5..J��LGd�.�r. .......`..
// L Tehone#...pry :-. qD...................
.............. V. ..............State....
. ......q.1..]ob Address..... ....1...1a I1b .
Specifrcalions:
......................................................................................................................................................................................................................
4trip existing shingles( -.Kpp!y new drip edge to all cdges.'k41Z, 91
..............................................................................................................................................................................................................
vApply G 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.
.................................................................................................................. .. ............... ................................I...............................
.
e�pply felt paper underlayment. °frstall ridge vent to S�.cirit5 t
................5..�.x.. Wiz.. .........-. ......... ........_'1....... . .. ......... .
Reroof using � � 'yluC shingles with a�wananty.
.....................................................................................................................................................................................................................
kebunterflash chimney. New vent pipe flashing.6'Legal disposal of all debris.
......................................................... .............................................. ............
Area(s)to be worked on: b r
......................................
tzl......... . .!. ' .......... ................ ................. "........................... .� ! .w...................................
.........I.......... I t^...�., ...Fra. r..r�rr��"'....�.G..��............................ ..........................................
............ ........ ...r .. �,`� �...r. .C. ...................... ...` ... ..cS'C?..=.. r. 0.:.: ..
i7�r '���"—""
ml �-....i.i�
(f ..... .. ...... .................... ............................... ........... �. .g
Roof board replacement if necessary @ /s..he..et or-� 0/foot, `
Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specific y anufactur
The contractor agr®¢s to perform the��-w. ork and furnish the materials specified above for the SUM f$.... ......�C,
Payable!... �4A11 ,�.. ... ......
Payable..,, .. ..r�.......on...S..l.a. .:k.......... Balance payable on completion of j O�
Owncr or Owners are not responsible for Property Damage or Liability while job is in operation. P
Contractor is not responsible for any damage to the interior of property,including pre-existing conditions(i.e.water stains,crum 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 ofabove woik,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.Property may be subject to mechanic's lien if unpaid.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
panics.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 representations,guaranties or warranties,except such as may be herein incorporated,if any,nor any agreemutts 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 sINII be registered and any inquiries about a contractor or subcontractor relating to a registration
should be directed to the Office of Consumer Affairs and Business Regulations,Tel.(617)973-8700.
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 the 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
This contract may be cancelled,without penalty or obligation,within three business days of the below-referenced date.Mail or deliver
a signed and dated notice or send a telegram to Castricone Roofing&Siding Inc,231 utton St.,�N n over,MA 0I845.
IN WITNESS WHEREOF,the parties have hereunto signed their names this.. ay of( l(�� >L •,20. .10
Accepted:
Signed.�' l` Owner
Signed. ..... ............... Owner
David Castricone,President