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HomeMy WebLinkAboutBuilding Permit #501 - 293 MASSACHUSETTS AVENUE 3/5/2008BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Jr• o Date Received Date Issued:' IMPORTANT: Applicant must complete all items on this pate LOCATION riSSLe.. lC` rin 'Pt. t PROPERTY OWNER (; I I Z&be,43 PS Print ,MAP NO: 16 PARCEL: I ZONING DISTRICT: Historic District yes Machine Shop Village yes /V-tt�eo .6=•rye\ 0 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 Well Floodplain Wetlands Watershed District Water/Sewer' DESCRIPTION OF WORK TO BE PREFORMED: l V,' f l.c �qd g§jA6'e_ Identification Please T pe or Print Clearly) OWNER: Name: h Phone: Address: 6 H IkYCIV6t° 1x4U%A15 ` m ; CONTRACTOR Name: �91in(1h! - J' hone: iL 6 fc3 p Address: Supervisor's °Construction License: Exp. Date: Home Improvement License: /6 Exp. Date;. d//a/ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $11225.00 PER S.F. Total Project Cost: $ `2 ��(� �� FEE: $ 1 '1 Check No.:&?y 3 �. Receipt No.: �2_©�j NOTE: Persons contracting with unregistered contractors do not have access to the gu ranty fund Signatureof contractor �D_ 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH 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 Located at 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 _._ . .............. ............ _.._................ _................ __.__.................. _...... ... ................ _....................... __...... _................ ..................... __..................... __................... _..._.__...................... ........... ..-.__.... _................... __._.................... __.._................ _.__....a Doc.Building Permit Revised 2007 Location No. Date v� TOWN OF NORTH ANDOVER O A Certificate of Occupancy $ Building/Frame Permit Fee $ s+CHus Foundation Permit Fee $ ik Other Permit Fee $ TOTAL $ Check # d0 3� 20970 Building Inspector �- CA m m C m x CO) CA F, m _ rt y 'O CD CM) Z CD O ar o� CL >to CD o p CL Q CD o Q O CD CO2 10 CD O 0 CO) d _ d C'7 _ CA C!� O CO) Cl) CD CD CD 3 CO2 CD CO) O CSD O CCD O SCJ' ceV'r� 0 Rl't I VJ n O z cnC cn C O O Z 0 CO O m 0 c_ cc �?�0 0 = z N O Q' N = O nco O 0 to .O 0 -4 N m ct Ca . ?-C N ._.►w O O N y O O N . O O C O� 0 0 - •-� O C-3: , om0 :w CL Oac tI O O N ' am NAAV CL Q _ C W a N N �C', p O CD o: / Cl a cn cn ~O z o r ►r1 H N O � O O ,y =m I .. oCD O O zr C MOt CD i n a- 7z O ny O w 0 W c H cn b � Wim: x dd CL -S: C -) C -) R moo: �®. cn cn ~O z o r ►r1 H O O � O O � O O zr C MOt '� O n a- 7z O ny O w 0 W c H cn b � T7 '1(D O � x ;t W M v . u Omi 0 9 O C ACORD,,, CERTIFICATE OF LIABILITY INSURANCE DATE(MMI°D,YYYY) 9/25/2007 PRODUCER Phoiie: 508-651-7700 Fax: 508-653-8089 THIS CERTIFICATE IS ISSUED AS A MATTER, OF INFORMATION Eastern Insurance Group LLC -Commercial Lines 233 West Central Street. Natick MA 01760 ONLY AND CONFERS NO RIGHTS UPON -THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, TYPE OF INSURANCE INSURERS AFFORDING COVERAGE NAIC # INSURED 10UCDATE DATYEXPIRATION LIMITS David Castricone Roofing & Siding Inc 200 Sutton St INSURERA:Citation Insurance 4027 INSURERB:The Insurance Co of State PA INSURER C: EACHOCCURRENCE Suite 226 North Andover MA 01845 INSURER D: COMMERCIAL GENERAL LIABILITYAMA r_1 INSURER E: f`CIVFRA(_CC THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOP. 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 I5 SUBJECT TO ALL ThE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. S LTIT NSRC TYPE OF INSURANCE POUCYNUMBER POLICY EFFECTIVE I.MtQDIYYI 10UCDATE DATYEXPIRATION LIMITS GENERAL LIABILITY EACHOCCURRENCE $ COMMERCIAL GENERAL LIABILITYAMA r_1 O N PREMISES E 811ce - $ MEDEXP(Anyoneperson) $ CLAIMS MADE OCCUR PERSONAL& ADV INJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATE LIMITAPPLIESPER: POLICY 171 z LOC PRODUCTS -COMP/OPAGG $ A AUTOMOBILE LIABILITY ANYAUTO 07MMBBTNKT 8/1/2007 8/1/2008 COMBINED SINGLE LIMIT (Eaaccfder6) $ ALLOWNEDAUTOS X SCHEDULEDAUTOS BODILY INJURY (Per person) $ 250000 X HIREDAUTOS X NON-OWNEDAUTOS B INJURY (Peer raoci aocider�) $500000 5 0 0 0 0 0 PROPERTY DAMAGE (Per accident) $ 100000 GARAGE LIABILITY AUTOONLY-EAACCIDENT $ ANYAUTO 2 OTHER THAN EAACC $ $ AUTOONLY: AGG EXCESSIUMBRELLALIABILITY OCCUR CLAIMS MADE EACHOCCURRENCE $ AGGREGATE $ $ DEDUCTIBLE $ RETENT1014 $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY LIABILITY WC7222278 9/23/2007 9/23/2008 ,Y WCYTATIJ- im E.L. EACHACCIDENT $ 100000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? -- If yes describe SPEGr1AL PROVIunder SIONS below E.L $ 100000 ._. E.L. DISEASE - POLICY LIMIT $ 5 0 0 Q OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS /�C DTI rIf ATIS ME! SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 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 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REP RESENTA ACORD 25 (20011081 w nvvnv vvnrvnM 1 1017 1700 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ISR 00' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION UMRS GENERAL LABIUTY _ EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 5 0 0 0 0 CLAMS MADE n OCCUR L001319-01 9/6/67 /6/08 0 8 _ A MED EXP (Any one Person) $ 1000 GEM'. AGGREGATE LIMIT APPLIES PER POLICYn JECT n LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LWBILTY ANYAUTO EXCESSIUMBRELLA LABILITY OCCUR 1:1 CLAIMS MADE HDEDUCTIBLE RETENTION i WORKERS COMPENSA,TKIN AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTHER/EXECUTIVE OFFICERIMEMBER EXCLUDED? K yes, describe urder OTHER DESCRIPTION OF OPERATIONS I LOCATK)NS 1 VEHICLES !EXCLUSIONS ADDED BY ENDORSEMENT/ SPECTAL PftOYIS{ONS ACORD 25 (2001108) PERSONAL 6 ADV INJURY $100000.0 GENERAL AGGREGATE i PRODUCTS - COMPIOP AGG 41000000 - COMBINED 1000000 COMBINED SINGLE LIMIT I i (Ea U B(OOILP) INJURY I i (Per aarILY INJURY is I PROPERTY DAMAGE (Per acd&,d) i AUTO ONLY - EA ACCIDENT i OTHER THAN EA ACC AUTO ONLY: AGG i i EACH OCCURRENCE i AGGREGATE _ i S A i E.L. EACH ACCIDENT i EL DISEASE - EA EMPLOS E.L. DISEASE -POLICY LIMIT i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED ©ACORD CORPORATIO14 1981 Residential contractors and service providers doing business in Massachusetts must be registered. If the contractor or subcontractor isnot registered, you will not be entitled to compensation from the state if something goes wrong with your job, This firm has met RPI's qualification criteria for experience, reputation and dedication to professionalism. Through special training programs available exclusively to Alcoa Master Contractors, they learn how to be experts on quality installation and how to build and conduct business in a highly professional manner. ��itC l../O'/IY//Z4%NUP.C6G��C1L ..'!/�.CYc9JI.GCiiva�cFli Board of Building Ilegulalions and Shu►da rds, HOME IMPROVEMENT CONTRACTOR Registration: 104569 Expiration: 7114/2008 Type: Private Corporation DAVID CASTRICONE ROOFING, SIDING & David Castricone 200 SUTTON ST SUITE 226 NORTH. ANDOVER, MA 01845 Deputy Administrator DASTp\'TP-DtgP P\.Q4E�'iq�.: C`' Sx'1? 1 a'�' OF,'sll T, ,•� , � . , �#�If) Fr?rr,� ���a �t�iltin� �lnirtar�gn .41h�r.` �' .I ,a;'tFt,.hagR1(!�l'q'��AojT A �' T DAVID CASTRICONE D CASTRICONE ROOFING & SIDING I, D. No,: A01921 D -A er Since 1996 Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM IAORTII a 0 ma'' S.1i.1 a o ��. lAM1 ,O pOLOL NI[ry. WN:N Ny OAr,Fin ,w,�h �SSArm 15E� In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL C',11, s150a. The debris will be disposed of in /at.- Z - Facility location Signature of Applicant �s 08 Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. C�Z_/l S/a 8 DAVID CASTRICONE CASTRICONE ROOFING & SIDING INC. 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 Haverhill 978-374-7314 Uwe 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, trams and conditions, on premises 41ow des ibk Owner's Name ....... 1..Z ........ I.Y...�..L S.Gt? I% ....................... Telephone #.....� .t�.3..-f.. Job Address... `1172 .... 14,0-4.9 ....... 4.11te.....r................... City......t7a. > la.t/ RSA......... State...., 4..... Specifications: ..... ../1.......a........Z......I................................ ......................................................................................... �reas to be covered:..........11.... t�pply vinyl siding and corners ./. Type: ...... 4 .*** +^over fascia boards and rake boards.... .......................................................... over wood casines around win .............. ,..., s...�,.o.. tXpply underlayment T e: V/ vinyl soffit - .............................................................................................. 4eplace any gable vents and dryer vents with vinyl. ................... ..-.:..-.. ... .......................................... ........................................................................................ zis in siding stripped go -over ✓lCegal disposal of all debris. ���x�,......................... Rotted wood replaced @ �,,eb /sheet or,?—/foot. / L......¢ 1.1�....... rte. 1.....S�.e /''......^....L`................................................ ....................................T ..........:......., ... ... .................................................... ...............'r/',��..t....... ................. ................................................................................. ........................................................................................................................................... . .... ,�3. ................ One Year Workmanship Warranty (Not Transferable) Manufacturer's Warranty as specifi b]anufactu The r agreps to perform the work h the materials specified above for the SUM s. ....,1.�$. (,). co ... Payable ...... ..=.............. on ..... ............................ nA alance payable on completion of job Owner or Owners are not responsible for Property Damage or liability wh`de)6b 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 Spam). 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 representation, 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. My 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 pt>mtit 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 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 ............ day of ..�J ....., 20,,, n1 Accepted: 0 % ,yJ XSigned. ....... 4 ner Signed............................................................................. Owner David Castricone, President The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass gov/dia pensation Insurance Affidavit: BuildersIContractors /Elect><•icians/Plumbers Applicant Information Please Print Legibly Name(Busuiess/Organization/Individual): ' AV 1% C.l '► (\1 nNC 0FiN[, SllJI ti -, \ tVL Address: o-0 d 5 u 7TTQQ S ?12U_ -T — 5u 1TE, �t :L -G City/State/Zip: W, 4N6 OVL-e, NA 01 NS Phone #: a Z 9 Are you an employer? Check the appropriate box: 1. 511 am a employer with $ 4. ❑ I am a general contractor and I employees (full and/or part-time).* 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.] t have hired the sub -contractors 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' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I L ❑ P1wnbing repairs or additions 12.❑ Roof repairs 13.2 Other 9 i p l)y & Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy infomiaiion. 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 whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: --M G , n5 u'f> occ. Co O f 5�' 'PAt r� a� Policy # or Self -ins. Lic. #: WC, l aA � q 0 c Expiration Date; 9a3 We Job Site Address: e;� 7� /7� i� Ci /State/Zi � �/ �/l LM ry p: %7i� ! 1/[ r 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 civilenalties ui the form of p a STOP WORK ORDER and a fine of up to $250.00 a da against the violator. Be g advised that a copy py of this statement may be forwarded to the Office of Inve Y shaattons of the DIA for Insurance coverage verification. I do hereby certi under theTms andpenalties ofperjury that the information provided above is true and correct. Due #: �� (O U cJ (✓ — Official use only. Do not write in this area, to City or Town: or town official Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3 Cit /To Cl k 4 EI 6. Other Contact Person: 3 /j,/ a Q y wn er . ev-0 cal Inspector 5. Plumbing Inspector Phone #: