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HomeMy WebLinkAboutBuilding Permit #839-14 - 293 MASSACHUSETTS AVENUE 5/19/2014TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO. Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page WATION! -_ PR0PERTYp QWNER L/ Z/ � _ `A /- - - � lY Print 10.0 Year•OId Structure yes no- MAP NO:04�PARCEL.ZONING'D.IST�RICT Historic�Distncf yes no: - - Machine Shop Village. ye no. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic• E1Well! ❑.Floodplain ❑ Wetland's. ❑ Wbtershed4Dist(icP . D Water/S,ewer . DESCRIPTION OF WORK TO BE PERFORMED: Identification Plep�se Type or Print Clearly) OWNER: Name: ;0i/J J,? Phone: 9�� V/ ou Address: %'lGc✓✓Ale, C, ON TRACTOR Name• /. ci _G � _ �� /t .Phone:__Qf, Ad diress� ;. Su ervisor s Construction. License,- . ExDate: p _ Home,Im_provemenf License /U,S Exp Date: 7 / c 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: $ % e0d . 0' FEE: $ 7; _ Check No.: � q41- F Receipt No.: 92,fi12 NOTE Persons contracting with unregistered contractors do not have access -to. the guarantyfund Signature�of Agent/Ovvner !...: F, _ Signature of contractor; ._ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Building Department The fol awing 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 o 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 app: al 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.Bui?ding permit Revised 2012 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 PLANNING & DEVELOPMENT ❑ DATE APPROVED 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: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Towo Engineer: Signature: Located 384 Osgood Street FIRE DEPARTME=NT - Temp Dumpster on site yes no Located at 'U4.Main` Street Fire Depakine t�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 fleeter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes leo MGL Chapter 166 Section 21A -F and G min.$100-$1000 fine NOTES and DATA — For department use El Notified for pickup - Date E E Doe.Building Permit Revised 2010 Location2A�— "Jyk�A7e— /�L No.— Date !;I I I TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL Check# 2 7'S 5'2 -Buil6ing Inspector U) a CD CD O Cr 2) m , � Q �. > O CL cr CD O CD O C• CD U) CD O n N 0 F 0 CD CD CD N� N O O �D CD R WZ3 Z m U) O cn C: Z cn ;o cn C Z. z I O m cn Z Z /'2^ V+ n 0O-0 Ort a O O " LU O -, < O OA CL O' CD C CD COy 0rt Q. .Z7 O 0, n c s .a v, Z7 O OCG C Z V1 n 0 O O —0- O H W O 0 CD CD CL O R i; O� O O CL rt (Q O y O O rt n 3 F C � OD O � � O -h��.�, C r Cnas:�� 0Q <mS'=� o �0)<R CL r CD iN a� -a 0 I�s cp_ (D _ CD � O CD �D CD �+ CD cn O �+ P � DCD 91) m @� su o CL . 00 1 y 0 3 OT. + (D Z W C T o n y Z -i TW 7 O OA O z y T > N rD .Z7 O 0, m m nO a n 0 T >' Z7 O OCG C Z V1 n 0 T j _S m O 000 O 7 d = C v z H m 0 (D �. N 3 O Q =' 3 W ° O S D _ 1 v's 0 c 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 :des /.` ..d: ..... ..........Owner's Name.... /l`.15.DY........21ephone 4..... "1 —t ...... Job Address.—v.. d..3......ty..41l��................. . �•••6<•. .� State...,.... ............ ......... ............. A......... ..h ................ :r.../..�?...,.IS.I n.....�...., ..............� 6' ......1.. :.... , e4 -431.I.... '...eJ.....` YI GrI.GS Specifications: ............... ..�7�......V.L ..er.................. .............................. .................... (I ....$........r..j..., Z***.,.................................................................... ......................... _..... .�.....i......?..........r........................... .....,................. .. ............. ....Pic. mac::............ (.................................... ................. ;.....................,:.. ...................... ... X-- .......... 2.03 .................................................. ................................................................................................................................................................................................................... Five Year Workmanship Warranty (Not Transferable) Manufacturer's Warranty as spec' mapufacturer. The ggtractor awes to perform the work d ' h the materials specified above for the SU of $..lp.....(�...."..� I/� Payable ..D............ on .& G•f.................. ���rr Payable ....... .=.................. on...........:-:................... Balance payable on completion of jo r' �� ��� Owner or Owners are not responsible for Property Damage or Liability whwj,, b is in operation. 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 dumpster placed by contractor is for his use only. Upon completion of above 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 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 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 Improvement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to the Office of ConstYtner Affairs and Business Regulations, Tel. (617) 973-8700. Any and all necetssary'consiruction-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 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 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, 23 •/ Sutton St., No. Andover, MA 01845. IN WITNESS WHEREOF, the parties have hereunto signed their names this .... day of ..f ' d° `............ 20..,(.-?. Accepted: David Castricone, President i Signed..::....,, tCf��VG4�✓ li/l:S�wner Signed ........ .... :.............................................................. Owner The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): _T)A\/) (,ASS T2 I lIN (- 1 \C)l)�,1 hl lT i I N it I Address: &U T-Tati ST(ur i UP t,r 3 A Crty/,tate/Zip: u, A mty w HA 61 �qf Phone k Ql'� � (� � 3 -3 These sub -contractors have working for me in any capacity. Are you an employer? Check the appropriate box: 1. RT 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- listed on the attached sheet ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp, insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 11.❑ umbmg repairs or additions Poof repairs 13.❑ Other *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 ace 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. A Insurance Company Name; Policy # or Self -ins. Lie. k q 70)u Expiration Date: Job Site Address: oC C%� / "/�t(f -Ni (/ le- City/State/Zip: , AMI'liked / `7%9 01fAr, 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 r70 hereby certto underthepains andpenalties ofperjury that the information provided above is true and correct. Simature: - J.,�.,/ C Date: Phone #: 979 0 3 3U-0 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 #: Town of North Andover Building Department 27 Charles Street Nonh Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM 0�4S�no O L c ---s .OX 6 'Q coc rii uc war p�R�reo ♦P�y.(h AC U5 In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # the debris resulting from the work slia.11 be, disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S1 50a., The debris will be disposed of in /at.- � Z' t E SIC, )10 A - / VN Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project tluough the Ogee of the Building Inspector, AC I CERTIFICATE OF LIABILITY INSURANCE DAT 2 IMM.'DD'YYYY) _ 10.7:2013 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 POLICIE! BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE[ REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 thr certificate holder in lieu of such endorsement(s). PRO_UCER NAME:___ I-asiern nSUrance [-.roup LLC - Main PHONE FAX C No r 0 1-7700 Lc.No).781 586 62 t4_._ _ 233 b1/est Central Street E-MAIL Natick MA 01760 "OCR ESS:' I c rk erninsur nce.com �rJR'0 31969 DaviD Caslriccne Roofing & Siding Inc Casu scone ;roofing inc K", Rear Sui;on Street, Unit 3A Nor'h Andover MA 0184S I INSURERS) AFFORDING COVERAGE ! NAI[ X INSURER A: INSURER B INSURER C : INSURER D INSURER E : COVERAGES CERTIFICATE NUMRFR• i-7nini ince QFA/IQI(1AI NLI I6nGc0 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIO[ NDICATED. NOTYfITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CEPTIPICAT2 Mj• ',Y BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TF,RMS tXCLU51ON5 AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INs4 j LSP TYPE OF INSURANCE AODLISURRI— INSR WVO POLICY NUMBER MM/DD!YYVVLIMITS POLICY EF.'RF��� C_•�'_=_L LIA31LiTY NPP1350515i 16/2013 (Sti,000,000 COHIMERC:IAL GENERAL LIAB41TY -7 CL ..Io -:IS +aoDE OCCUR I T E' - PR MIS E occurrence 550.000 ME D EXP (Any one person) S1.000 _ PERSONAL a ADV INJURY S 1,000,000 = i I GENERAL AGGREGAT= S2,000.000 _E� rL �GGRcGATE Ur: IT APPLIES PEP. icy F 1 PPt�. P �: LJC' I -- — I PRODUCTS - CUMP.aoP AGG S2,000A00 , $ ` aUTOM0311L= LIABILITY 9C:NGC /11'2013 i ;1i201u Ea aalderu 1 000,0Co In .UT.' -- Ct'`Nr0 XSCHEDULED AUTOS r'IRLFjaUTOS b1OtJ-0IVNED I AUTOS I I &DDIL •J INJURY ;PeiuerSOn1 e BODILY INJURY (Pe, acetum) S PROPEr1T'1D4Nd4G ------ U:'SRcIJ_L LIAR _xceSSLIAS — I OCCUR CLAIKIS•Ma.DE j I E.SCHal000PREraCE � 5 AGGREGATE S — I DED I . I RETGtITICIHQ --- "'Or1.<ER5^O:.YERS' rdPEN5ATION LIABI LITV Y(N -d: •r PROPPIE TOR,?.4.9TNER;EXECUTIvE ❑ C:=FiCER4: _P.dSER EXCLUDED? N1 A WC003989?23 123'2013 Q,29/201[ i N/(.YT:MU 15 I QTH 5 ' i E L. EACH ACCIDENT S10U,000 jF,1s�vciJnin N;-;)------- n as essai uNer JL.(RtPTi;ll•dilF llPc RA.TCIRIS below I i i FE L DISEASE EA EMPLOYEEI 5100,000 E . DISEASE POLICY L(M(T I S50-0- ()()D CESCSIP TIONOF OPFRATIONG: i nr ATntic.:re --- --- „v„m 1c"'d a ocneome, n more Spa Ce R required) l --M 111"ILA I t HULOtH Castricone Roofing & Siding Unit 3A 231 R Sutton Street North Andover, MA 01845 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF; NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. wu 1UNLtU nt NHESEWATIVE n .•T © 1988.2010 ACORD CORPORATION. All rights reserve ACORD 25 (2010;05) The ACORD name and logo are registered marks of ACORD Massachusetts - Department of Public Safety Board of BuildingRegulations and Standards Construction Super%isur Speci;ilt% License: CSSL-099358 _� 1 1, }. DAVID T CASTRWONE. _ . .. 31 COURT STREET { NORTH ANDOVER MAY0445 ixplration Commissioner 12/16/2015 SCA t <i 2OM-05/11 .a ^ane rnr.iAifairs s. Office of Consumer:4ffairs & Business Regulation fq, OME IMPROVEMENT CONTRACTOR egistration: 104569 Type: x xpiration: 7/14/2014 Private Corporatic i DAVIt CASTRICONE ROOFING, SIDING & David Castricone 231 R SUTTON ST SUITE 3A _ NORTH ANDOVER, MA 01845 —rte Undersecretary