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Home My WebLink AboutBuilding Permit #466 - 30 WENTWORTH AVENUE 1/23/2008Permit NO: Date Issued: 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received I IMPORTANT: Applicant must complete all items on this page I LOCATION �2 6 e r 4z o o'r+ig ri e -n o -c— PROPERTY OWNER ��—kA' K CvJ P �CU Print MAP NO.: PARCEL: TYPE AND USE OF BUILDING ZONING DISTRICT: HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE (-(,, � , Phone: 9 7 � 913 " y-J� Residential Non- Residential ❑ New Building ❑ Addition ❑ Alteration kOne family ❑ Two or more family No. of units: ❑ Industrial 0 Repair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Commercial ❑ Moving (relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED i r\ Identification Please Type or Print Clearly) OWNER: Name: kA S;kA \V c is (-(,, � , Phone: 9 7 � 913 " y-J� Address: 3 d LUQ-�- W 6 Y' iU �O%J e -K,. I d OQ2,— hA,^ CONTRACTOR Name:,-), c4j +i C -00y- Phone: 3 3 Y Address: ZcAU Sv+�bv\- S ret no m d.,Ci (1\-A-- 0 (" V Supervisor's Construction License: Exp. Date: Home Improvement License: I � 4 5,,49 Exp. Date: 1 U ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost :$ 1 �. 6O- 6U FEE:$ Check No.:y 3 y Receipt No.: Page W4 TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools ❑ Public Sewer ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales El ❑ Permanent Dumpster on Site ❑ Private (septic tank, etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT ❑ COMMENTS DATE REJECTED CONSERVATION COMMENTS DATE REJECTED HEALTH COMMENTS Stamped Plans ❑ DATE APPROVED DATE APPROVED 11 DATE APPROVED 11 FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date 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 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: iN v i -:N and VA I A — (v or department use Page ot'4 DEPA RTM ENT: BPFO RM05 Created.)MC. Jan.2006 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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:BPFORM05 Page 4 of 4 Location '20 No. Date NORTM TOWN OF NORTH ANDOVER Of No ,ti0 i • OL S Certificate of Occupancy $ c usE`� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # O0 O 20908 �' Building Inspector 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 HaverhN 978-374-7314 Uwe 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 belo described: Owner's Name ..... N...6Me- tl..... t1.11..1..t1,.................................................. ephone #... y..L.. .................. Job Address ...... .0 ..... 0,0 iJ'a.a ...../•/..V..4r..c....... city....1..VtO.a....... .mow rz./.................. State........... Specifications. r..................................................................................................................... L Leas to be covered: . - ` A-1 s-, ................................................................................................................................................................................................................ tApply vinyl siding and corners. Type: Mst� Qt' ...................................................................................................................................... ... over fascia boards and rake boards.tall vinyl soffit - solid I orated ..�........................................................................................................................................................................................................... Cover wood casings around windows.P&.t_s Replace any gable vents and dryer vents with vinyl. ............................................................................. ..................................................................................................... ply underlayment. Type: G ......................S 1. .............: d ....................................... .- tin tal disposal of debris.striPPd o over P. . �.�. ..........::..... ....................................................................................... ............................................................. pr��3.......... IZtted wood replaced ®. o /sheet or 3 ..— /foot. / .......�j..ca ........C{J... ........in[.....1M 1..4.J.L..J... ........ ............ ..............`.................................. r(�.:....... 1. ...l.,y.:.4.Fc.+G..l......IA-L......t-P..t�f..1.....r...C'.�.rc _...._�__S.XR-/a-.d ........................................................................................................................................................................... :.__.......................... One Year Workmanship Warranty (Not Transferable) Manufacturer's Warranty as specify m nut ct�yrer The for agrees to perform the work ish the materials specified above for the SUM f $.... /.� X.�.......... 71 ayable ....G,�..V-Z) ....... on ..X�f ............. Payable.....:- .................. on....... 77- .................. alance payable on completion of job Owner or (Tuners are not responsible for Property Damage c2sinoperation. 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). 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 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: 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. 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 name s .. day of.Z". r. }rk ...... 20.0.f. Accepted: Signed ...... ..... ............»........................::............... Owner Signed............................................................................ Owner ................................................................... 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C2 a �Q C y C C C.3 J 'p C� C Z CD 0 CL V co cc C C CL is LLI. 11llll��l ACOB� CERTIFICATE OF LIABILITY INSUKANUM THIS CERTIFICATE 5133 ISSUED AS rokoor `" FAX ONLY AND CONFERS NO RIGHTS Wi] lows .zn6urance' Agcy HOLDER.THISCEKTIFICATEPol 43 Je.twood St N.Indover MA 01845 INSURERS AFFORDING COVERAGE David-'Castric6n4 Roofing & Siding Inc WaLftR 5; r e, *aURER 0. 2.00 button gt SRitg,#226 wsURERe 1 R INFORMATION CERTJF:ICATE _ND. MEND OR . MAIC R ' yK ANY REGu REMENT TERM O GONOtT10N OAF BEEN OR 07HER DOED TO M CUME T WITH SPECT 0 YVHICH 1ii1S CER11FtCATE MAY BE ISSUED ICY 00 IND"TF0. NQT"IM ~rR MAY PERTAJN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE 7t RMS, EXCLUS�Fls ANO CONOff 10 SUCH POU=S. A*WAOATE LIMN$ ShOMVN MAY HANE BEEN REOUCED BY PNC CLAIMS. ryRAT10N LIMITS I rM OF WSUMNOE ►atm NUM�� pOUC /EFFECTIVE a F�1CH OCCURWEHCE i GBMFIW.Lwalif �- • ' TCD s so 0 COMWAALGENEMLNuffff L001319-01 9/6/07 /6/08 B . (kw m" i 0r� cLNLMc wMoe 0 OCdUIi LIEo oo� Wry � 0�1 PoksoMAL.sADvwURY t•1000000 A $ pp_ODh1P10PN:O 81 00 OM AOORWATE LlMrT ANnZS PCR AO0RE � '----' ' rotx.�r p�r Loo OCCUR AVTn1I0BLl!L!"U" WGLELfAtT i ANY AUTO ALL&M90AUM OmyY i so"S 1A m Autos HGiHDALRDs it i NDNCY"D A" WORKERS CONPIZAKILON AND OIMAGE : EYPL,OY61 "Aaam �PRopeRIY i AUfO01MY-EAA LWALaT IEAA CiiANVAU F La 3 NS -•---,. EACH000URRE"E CLAWLMADE AO0RE � '----' i OCCUR i I DEOUGFKE'— RETEIITLON i - ---- . -]-- - - YdC 6TATU- 0 WORKERS CONPIZAKILON AND EYPL,OY61 "Aaam E.L EACH ACCMIENf i L musFwsf-9AbW'L s F La rwLdwa&eunder vi m=-AtE.POI0YL9ff i OPERAMM I LOCAflONS I VE1vem l ACORD 25 (2001108) 1 SPECIAL CANCELLATION slwul.o AIIY OP TNe ADOYE Drscwece roLI0tE8 >� cANc�.I.w eEFOR& THE EXprArM OAYE TNEREOF. UJE ISSUING WSURER WILL ENOVAKA'ro MNL 10 DAYS WTUTTEN NOTICE TO THE CE yrnkTE NoLoM NAMED TO THE LEFT. BUT FAILURE TO MNL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LMUMUTY OF ANY IGNO LWON THE WSURM; rr$ AGENTS OR gpPRFSENTATIVES. OACORD CORPORATION V 01/23/2008 10:09 9786833097 DATE(MMIDD)YYYY) ACORQ. CERTIFICATE OF LIABILITY INSURANCE 9/25/200'7 PFtoOuceq pngTly: 508-651-700 rax: 309 -663 -BOSS THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Eastern Insurance Group LLC -Commercial Lines HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 233 West Central Street ALTER THE COVERAQE AFFORDED BY THE POLICIES BELOW. Natick MA 01760 NAIC# INSURERS AFFORDING COVERAGE paVld Caatricone Roofing s Siding Inc INSURER B:TbP, _tP,=aIRC 200 Sutton St • • INSVFIER0: Suite 226 INBUREPD: North Andover MA 01845 INOIwFAr COV G POLICY PERIOD P. BELOW OTHERDOCVMENTOWITHERESPECT TO WHICHNTHIS D CONTRACTUORDD POT,T('.TT.q OF INSURANCE NJ;jr, OTWITHSTANDING ANY REQUIREMENT, A TERM OR CONDITIONS OPE ANY BY THE POLICIES DESCRIBED HLRLIIN IS SU$JECT TO ALL THE C£RTIFICATS MAY HE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED LIMITS SHOW MAY RAVE BEEN REDUCED by PAID CLAIMS. TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES- AGGREGATE RATIONFun POUCYNUMBEW Y6ff YE POUCYEX UMKS EACHOCCURAENCE S _ ... ............. '.•__ ......... GENENALLIA8IUTY GE1i3TaETdET3"�""- • OOML*XIALGENERALLIABILITY PREMIBEB ESOCCUIOnw CLAIMS MADE 7OCCIAI MEDE7(PWMonegetnon) f PERSONAL & ADV I W URY $ _w GENERAL AGGREGATE S pRODUCT6-OOMPODPAGG S 0 NLAGGREGATEUMnAPPLIES PER: POLICY MIPA LOC AVTOMOBREUABIUTY 07MMBBTNXT 8/1/2007 8/1/2008 C0MBINNEE0S1WLBLIMI'r y ,A ANYAUIID ALLOYINEOAVTOS BODILYMJURY S 250000 (Pof Parson) SCHECUtEDAUT09 HIREDAUTOS �ealINnFPY 9500000 X NON-OWNEDAUT08 FMOFERTYDAMAGE = 100000 (AW& M IX) AUTOONLY_EAACCIDENT Y GARAGHUABIU7Y 0THER THAN EA ACC 7 ANY AUTO AUTO ONLY: A00 t MosstUM PALUIUABILrtY EAOHOCCUPRENCE 9 AGGREGATE S OCCUR ❑ CLAIMBMADE E i DEDUCTIBLE B RETENTIONS WORKERS COMPENSArON AND WC7222278 9/23/2007 9/23/2008 X wcs EMPLOYERS'LIABILITY E.L. EACHACCIDENT 1100000 E,L,pSEASE•EAEMPLOYEE $100000 NY1.0111 ETOR/PAR1NERiFMECUTIVG oPRCERMEMBCRExcLUDE01 =1.011122x, p CYLI T It �s4al0eYun0eIN3 07HER DESC( M014OPOPERATIONSILOCATIONS IVEHICLES rEXCLUSIONSADDED BYENDORSEMENTiSPECIAL.PROVI&ONS CERTIFICATE HOL.DEH "^•`��" '- 8HOULD ANY OF THE ABOVE DE=CRISBD POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DRYS WRITTEN NOTICE TO TRE CERTIFYCATL nOLDER NAMED TO ;NL L&FT, AVI FAXLVRE SO DO SO BHA.LL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON TRS INSURER, ITS AGENTB OR R);11pE6ENTATIVE8, AUTMORmeo Rep vasENtAn x _w %J,�rnn11 l�AO}fA0/1TIf1N 10YA AGOFTU lb I2V Vl )UG) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02m www mass.gov/dia pensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 2)AV 1 „/' '1 21 -0 N C I N 1, `� 5 L'i,1 A tV C. Address: ;�o 0 6 u?'rON S "T ZU-- T — 5u ITE, ;L ',L. (.o have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet, City/State/zip: � , A -ND oyerR H A 01 NS Phone #: CO F 6 9 3X3 4 ag Are you an employer? Check the appropriate box: 1. ® I atn 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. employees and have workers' (No workers' comp. insurance comp. insurance.$ required.) 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comp. insurance Type of project (required): 6. ❑ New construction 7. Q Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbutg repairs or additions 12. ❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I 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 -contactors and state whether or not those entities have employees. If the sub -contactors 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:71e„ 1 r150M.0cc- Co of .5+bA . VA Policy # or Self -ins. Lie. #: W c, 7 A A A� 7 0 Expiration Date: 9 l a 3 We Job Site Address: 36 UJ Cn }z,1-' 0r +i" lav due- City/State/Zip: N 0- TSI J oy e % ` H14 d / FYr 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. Signature: Date' Phone #: q 7 314 IN -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 #•