The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #241-11 - 33 ELM STREET 9/21/2010 tAORTH ' ETH__N BUILDING-PERMIT 0* TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: � Date Received AC Date Issued: IMPORTANT:Applicant must complete all items on this page _5 ME 5 Z N Mot" Pre"& gli LZggp . _55 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building -One family Addition Two or morejamily Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other 611 lf-= _'JP DESCRIPTION OF WORK TO BE PREFORMED. m a' z e,f1c Ae gea,c A x4 a/ V V V Identification Please Type or Print Clearly) OWNER: Name: t"'7/7,0 d W e- Ph-one: Address d ............. ,011 Re gl V —4. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED CO TBASED ON 25.00PER S.F. Total Project Cost: $ - - J FEE: Check No.: *1 Y (e L/ Receipt.No.: NOTE: Persons contracAng with unregistered contractors do not have ac-cess to the gguarantyfund en, ;:S 52 Location. �2 & /l'YI No. Date MORT1y TOWN OF NORTH ANDOVER � _ R 9 + s ia ; , Certificate of Occupancy $ CMUs t�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # r � 2J << , v Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Swimmiri Pools r T7baccgo/MSa nassageBody Art g -Well Tles Food Packag" Safes . 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 CONSERVATION Reviewed on Signature HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comrients Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located c ted 384Os ood Street ,l 3 '1,1�u•''�"FI- J.4 N: _i,}�-.,..._.�.t11•r`,^.:I' ..Ctt.,�w-:.':'-:'•.. "',.TYS`s'.— �. .. _— x ��; -f:-'��:r?-:rte•-*w::ru-:.,3,.-+_c:tr;v's-c±>.�F..'p- _ _ _ _ _ - _ _ ___ •t:i•w�,�3a: :�: _ =::r-a..— r%'rl�: ':.__ss�r.;,:'-.'a lr•. _- .�re..:.ti.Z.> ' f — - - .�r-. "--:f7'�. ll� — — d., �l:-_:.•.:i.::t��rur _ — _ �=k�..._. :?t.t.:—.I- :..1 -.'F,7'•trw H-,'��i� �.{.c ::Y:: 3 •w�- .a4F _ ;t. r�nen� - - - tys c r .Y yA __ - `Ci` 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.s100-$1000 fine NOTES and DATA—(For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 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 n 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 ❑ -Ceified 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 2008 NORTH Town of Andover 41 P� W 4 -= K E v dover, Mass., "I O GOC ICNEWICK y1 7dSD�ATED PPa�� 7 BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D . THIS CERTIFIES THAT........ / BUILDING INSPECTOR �.�..�1,.��5 ......... ..........:10�:��............................................................................................. Foundation has permission to erect........................................ build' son ...�J' .��..... G .... .....'....................................... Rough tobe occupied as .... :........ .............. .. ................................................... ........................... Chimney provided that the person accepting t s permit shall m every respe conform to the terms of the application on file in Final 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 CONSTRUC ARTS Rough ............. ....... ................................................... .............. ....... Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocatpy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. DAVID CASTRICONE,PRES. CASTRICONE ROOFING&SIDING INC. ROOFING,SIDING&REMODELING REPLACEMENT WINDO)YS ; 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 978-374-7314t3y� 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 elow described: Owner's Name.......t ,r../l=(r5....... ..W..:e............................................... ............T honeIRA #...I1 I�—.Sys S��i............... Job Address...... ....... ....................................City... t?....L../.a+4.i1..✓.. .................State............ Specifications: .......................................................� ..... ...................................................................... /L�...f1JT7. ... I:C ........../ U.p. ........... • r - ...kr• ......., �� ls. ..as ......ct. c ....... ... .......� � -:. ...... *::.........:::.:..:::.::::::::::::::::::.:: ................ ..c, . .,......�.e.a.r...............1a.. p t � ./ ... .. 1..... �� ...... ��. ............ -... ...................................................................................................................................................................................................................... ...................................................................................................................................................................................................................... ..................................................................................................................................................................................................................... ...................................................................................................................................................................... ......... ............. Two Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as spa ' y manpufactur The contractor agrees to perform the work and furnish the materials specified above for the SU .�J. .G\ .... ............ Payable...:.........................on................................. Payable.............................on.................................. Balance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability whilejob 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 ofabove work,all undersigned agree to execute and deliver to contractor,theirjoint 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) m naes(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 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 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,200 Sutton St.,No.Andover,MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their namXthis .........d .. .. ..................20.:......... Accepted: Signed............ ........................................... ner Signed............................................................................. Owner D4J-cj�- -.... David Castricone,President Licen;e: CS SL 99:1fitl /Ie C24��c�ieaircr.rccll� ! /(�cf�tu udelGi i;!!SI�'IC:IQ(i IO: NJ-.Vvc; Office of Consumer Affairs& Business Regulation a HOME IMPROVEMENT CONTRACTOR DAVID GARegistration: .104569 Type: -fRICONE 31 COU a 1 Expiration: 7/19/2012 Private Corporatio RT Sl ILL--"I I1 ;r/ �: NORTH ANDOVER, MA 0DAt/ID CASTRICONE ROOFING,SIDING& it David Castricone 1?/111''p11 200 SUTTON ST SUITE 226 NORTH ANDOVER, MA 01845 99',150taUudcrsccrcry y 1 b I The Commonwealth of Massachusetts d` Department of Industrial Accidents 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): _D AV I e M-ra I C O N P_ R m F i Nc, r S 1D I N, 1 N L Address: 20C) Su-t-mt3 S-c(Z-t-E-t- Su V-t->`- -n_k. City/State/Zip: h-Mbo 46 K MA 01&46 Phone#: 01 ) 3 3 4 20 Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 9 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 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 me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.F1 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 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 whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. COInsurance Company Names e— O C��Le (YID fi./1 k1 af- S' ' 3 tf Policy #or Self-ins. Lic. #: W C 91 a 14 G Expiration Date: Job Site Address: 1,x,3 fb'n S76tct- City/State/Zip: No WAW(ivei Ay6f d/t6'1 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: i J C Date: q� /!a _ Phone#: 10 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#: • Information and Instructions d a Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permitilicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. 4 617-727-4900 ext 406 or 1-877-MASSAFE Fax 9 617-727-7749 Revised 11-22-06 www.mass.gov/dia