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HomeMy WebLinkAboutBuilding Permit #292-15 - 29 NADINE LANE 9/23/2014 BUILDING PERMIT of "O pTH qti qt 64 � TOWN OF NORTH ANDOVER o� APPLICATION FOR PLAN EXAMINATION " a coc Permit No#: Date Received SSACHus� Date Issued: �� I M ORTANT: Applicant must complete all items on this page LOCATION' _ _q N—A D I lit✓ _LA1V � i_ Print PROPERTY OWNER __ �_ t Cit n l �0.�h Print 100 Year Structure yes no M-AP PARCEL: 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 Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic, ❑We117 ❑ Floodplain. ❑Wetlands ❑ Watershed District El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: njo reskiNie . yvoF Identi kation- Please Type or Print Clearly OWNER: Name: \, Phone: Address: 02� GtYI Y\2� ne �IO�(, A(lkv&, Contractor Name: r. r�►C)I 00.5 �7� a Vo o F?T Si d I q7 �, _3V _. _ - - - . Address: _(:2). R, o)Hr Supervisor's Construction License _ Exp. Dater__ a- Home Improvement License .s__ Exp. 'Date;_ _ -7_�� ARCHITECT/ENGINEER Phone: z Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. c� Total Project Cost: $ 5906-OL) FEE: $ U It Check No.: `Z?Q o Receipt No.: 2bA(0_ NOTE: Persons contracting with unregistered contractors do not have access to the kuarantyfund Signature of Agent/Owner _ _ _ Signature of contras _. , Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiimning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent DumP ster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ i COMMENTS I I CONSERVATION Reviewed on Siqnature COMMENTS j HEALTH Reviewed on Signature i COMMENTS r� Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes PlanningBoard Decision: Comments c Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit r DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Durnpster on site yes_ _ _ - _ no _ Located at 124 Main Street Fire`Department si -hature/date COMMENTS_ __ _ l 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 Call Email Date Time Contact Name Doc.Building Pen-nit Revised 2014 Building Department The followinga list of the required forms to be filled out for the �is q 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 I 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/Cross Section/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 i 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 2014 i I Location N r" No. '! Date e - TOWN OF NORTH ANDOVER • •�1�EL1�rb�6• � Certificate of Occupancy $ a b Y Building/Frame Permit Fee $ Foundation Permit dee $ Other Permit Fee $ TOTAL $ iP Check# 1 ' ' y 28046 Building Inspector NORTI-� Town of 2 t E ,, ndover 0 No. Ltwo ver, Mass, o I K. 1. U BOARD OF HEALTH Food/Kitchen PERM LD Septic System • lama S BUILDING INSPECTOR THIS CERTIFIES THAT ...................... ... 1. . ........... ......�!!V.!. . ............... .......1to Foundation ........................ has permission to erect ............ buildings on ......... �G , sera b .................................................................. Rough to be occupied as .............. . . .. . .... ........................ Chimney provided that the person acce tin thi ermit shall in eve respect conform to the term f h i p p p g p every p s o the application 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 , ONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU.C ,' �.. ' STA TS Rough .. �. Service Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin-e 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 01- Department of lndustrialAccidehts Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): b A\/ );D CA 1 T2 I(Me- I\UDE W 6 Address: �vtJ �2� T Uti T Tb City/State/Zip:N u. A m bN&K MA 61 �q Phone#: Q17 (o 3 Are you an employer?Check the appropriate box: Type of project(required): 1.M I am 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.El am a sole proprietor or partner- listed on the attached sheet.# ?• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.El Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.�%Roofrepairs insurance required.] employees.[No workers' comp.insurance required.] 13.❑ Other *Any applicant that checks box 4l must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they aie 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ;i Insurance Company Name:. 6 H H G k L W b(} Policy#or Self-ins.Lic. 03 9 �j70 Expiration Date: C Job Site Address: ac1'f y,�Ab l oc Lko� City/State/Zip: N C." Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 tl�gpains and penalties ofperjury that the information provided above is true and correct. Sienature: `- "� C� Date: Phone#: 9 / Kj ��3 3� a( 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#: ACO® DATE(MMIDDrMY) CERTIFICATE OF LIABILITY INSURANCE 9/10/2014 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 Susan Donnell NAME: Eastern Insurance Group LLC PHONE (800)333-7234 IF M, No: 233 West Central St EMAIL .sdonnell@easterninsurance.com ADDRE � INSURERS AFFORDING COVERAGE NAIC k Natick MA 01760 INSURER A:Western World Insurance Cc INSURED INSURERB-Commerce Insurance Company 4754 David Castricone Roofing S Siding Inc, DSA: INSURER C:Granite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER D: INSURER E: North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBERMaster 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. INSR ADOL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DDNYYY) IMMIDDIYYYYI LIMITS GENERAL UABf J7Y EACH OCCURRENCE $ 1,000,000 _UAWAGE RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE 7 OCCUR NPP1388404 /6/2014 /6/2015 MED EXP(Any one person) S 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 n PERoT 71 LOC S AUTOMOBILE LIABILITY (Ea �OMBINEDtSINGLE LIMIT 1,000,000 S ANY AUTO BODILY INJURY(Per person) $ ALL OWNAUTOS EO X ASUTOSCHEDULED CPIGI:.'V /1/2014 8/1/2015 BODILY INJURY(Per accident) $ �� XHIRED AUTOS NON-OWNED X PROPERTY DAMAGE AUTOSPer acddent $ 5 UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION WC STATU- OTK AND EMPLOYERS'LIABILITY YIN ER ANY PROPME 0RIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100 000 OFFICERIMEMSER EXCLUDED? LJNIA (Mandatory in NH) WC003989723 /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 p J. SHOULD ANY OF THE ABOVE DESCRIBED POUCIES.BE CANCELLED BEFORE & Cas cosec f� Sid�rig THE EXPIRATION DATE THEREOF, N0110E WILL BE DELIVERED IN Unit 3A ACCORDANCE WITH THE POLICY PROVISIONS. 231R Sutton Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 John Koegel/MET — �- ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025oninKlns Tho Af'f)Qn ammo-1 Inns oro ronialororimarlro�f Sf.Mirl Massachusetts - Department of ?ublic Safety Board of Building Regulations and Standards C mstructiun Super1 isur Spcciultl License: CSSL-099358 I -` DAVID T CASTRICONE .._ 31 COURT STREET x NORTH ANDOVER MA'10. 5 'I nr�• Expiration Commissioner 12/16/2015 Office of Consumer Affairs&Business Regulation r( /J ME IMPROVEMENT CONTRACTOR egistration: 104569 I xpiration: 7/14/2016 Type: s Private Corporatie DAVID CASTRICONE ROOFING,SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undersecretary Town of North Andover F N�k7 0 sjt.i' '•6 O Q Building Department o m 27 Charles Street Nonh Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 QOR1 T!D �'PSHCHus�� 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 slIall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c1 1, s150a. The debris will be disposed of in /at G� Z- Facility location Signature of Applicant Date NOTE: A demolition pernut from the Town of North Andover must be obtained For this Project tluough the Office of the Building Inspector. DAVID CASTRICONE, PRES. CASTRICONE ROOFING & SIDING INC. 9 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: T�h .... . 1.................. Owner'sNanrc...... .�.f..I ; ....a'"". (✓lam t�................................. / f Job Address..�"� .... 1 cam...11_ le ..........................City... Q.r.. i1.`l L?.►/.c�l`..............State.../.v1 Specifications: ..........................................................................................:...................... ................................................................................................... (/Strip existing shingleso) apply new drip edge to all edges. ...................................................................................................................................................................................................................... I/Apply _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. . ....... ...................................................................................................... Apply felt paper mtdcrlayment. Install ridge vent to ............. .........J�....................... ................ ............................. -IReroof using shingles with a warranty. ..................................................................................................................................................................................................................... Couuterllash chimney. vFlew vent pipe flashing, tugal disposal of all debris. . ... ... ..................................................... Areas)to be worked 0 I l ;. 1 f /Lf.f1.�{. .�:. .t ...C?........ .L?.k1.:5.. /.�...................................................:.. 6............................................................................................................ .............................................................. . ......................: �... . r Cs.� f �. 1......................... s.............................' Ft e.�,..;v..j..... ... '. ... .cr�/ a��.� i�> Roof bo rtl replacement if necessary @ Gn sheet or ........................................................................................................................................................................................................... . Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specified y m ufactu The ctor ag;pes to perform the work aed i�h the materials specified above for the SUM 1 Dyable� LQ.0..........on..S.j.`` . ............... Payable.........................on.........=................... alance payable on completion ofjob Owner or Owners are not responsible for Property Damage or Liability wh job is in operation. Contractor is not responsible for any damage to the interior of property,including preexisting 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 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 mechanics lien if unpaid.It is further agreed that this contract may be assigned by contractor,and also that the obligations hereof shat l 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 tide 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 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 ImprodemeAt C&itractors shall 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 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 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 J utton St.,No.Andover,MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their names this.. day of... ,\ \..t.r.....,20...L.1. Accepted: XSigned............... .:.........�............................................ Owner �JI Signed............................................................................. Owner David Castricone,President i%