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Home My WebLink AboutBuilding Permit #73 - 34 EDMANDS ROAD 7/30/2007Permit NO: 3 Date Issued: D TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received L ,3O 6 I IMPORTANT: Annlicant must complete all items on this page I LOCATION 3 4 EJ ill 60 dS R0 O -C1 Pri PROPERTY OWNER O n �-- 21 YY1. 4;0, Print MAP NO.: AO PARCEL: TYPE AND USE OF BUILDING ZONING DISTRICT: HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Addition .'Alteration One family ❑ Two or more family No. of units: ❑ Industrial ❑ Repair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Commercial ❑ Moving (relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED �4r i.n aA d /fit h AQ le- n 0 f - Identification Please Type or Print Clearly) OWNER: Name: �:Z)6 nn C- LziM 6-tj Phone: q 7 9 FS S% lam'/3J Address: 3� E dfraAC(J Raa.d Nor -A AndoVeIVA 0/ �Y} CONTRACTOR Name:, afft o&c- ?UG&M -I' Sl L�� tiq '11(• Phone: q%f Address: S0*n Sty Supervisor's Construction License: Exp. Date: Home Improvement License: / y S(9 % Exp. Date: �% S 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 S �o /e DO. °J FEES Check No.: Receipt No.: O �� Page I of 4 Location No. Date " 0-0 "%.. aoRTM TOWN OF NORTH ANDOVER 3?� SOL Certificate of Occupancy $ t i Building/Frame Permit Fee $ wcMus Foundation Permit Fee $ Other Permit Fee $ t TOTAL $ Check # / J 2044 2 �----� Building Inspector TYPE OF SEWERAGE DISPOSAL Art E]Public Swimming Pools ❑ Sewer L1 ❑ ❑ Tobacco Sales Tobacco Food Packaging/Sales ❑ Well Dumpster on Site El Private (septic tank, etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guarantylund � C Signature of Agent/Owner Signature of contra., Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 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 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 Re uired Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: N V l EJ and DAl'A — (k or department use Page 3 of 4 DEPARTM Created JMC. 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 o 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 E Q� w v cn a Ci 'orr--6� 8 . a. O cs: U w G a j,.,� p w G w a ►vi p aG �w' G � p aG G w Yom/ p m c) Q O cn rA CD Cc .. �' o O y C p d� CL C Co CL, C o �'la M Y d c •r C W I C2 QvWca Z f � *-UIr y k v E c p :D o ES I , `AGO -L5 � •v :4 a y � � O J O C C _m '= C '44w H m mo � fpm cm o it O a c r UL, y O C.2 Z a C-2 F- h 4D Lai Ion LNU LLO •mm Ca+ I.-•t�/1 dt C�C _, E C2 = • v m Ogco z g c a O -- Z = A 0 i N 7 - a$12 E I� N .0 h a N C O CD oa m `O cm C QC N t w 0 2 0 a w MP /0 f R, U O O i..l h •� • ca cim CL Cp CD CD L Cc o � c ev C .0 a� CD CD CL CO3 !O C Ck Y/ LU C4 W W W N Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978)688-9545 Fax(978)688-9542 DEBRIS DISPOSAL FORM O O � m V. y O TE T 4 4AN� ,t 'f CO[HI[NI WHM ACN05�� 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.l 1, s150a. The debris will be disposed of in /at: Facility location e Signature of Applicant /50 o? Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector, 101-1-0166 DAVID CASTRICONE ROOFING, SIDING & REMODELING REPLACEMENT WINDO4v� HOME 200 SUTTON STREET, SUITE 2226,NT CONTRACTOR ,NNO, ANDOVER, MA GISTRATION 01845104569 JUL zi]Q 7 HILLSIDE ROAD, BOXFORD, MA 01921 $ i 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 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: Owner's Name ......DLL .4> ... J ........................... T llephone #.... r.-. .A)�,Job Address...�..T.... 17v.9�...S.a.. ........... Specifications: ................................................................................................................ . ............................................................................................ . a�trip etdsting shingles(l� r�fpply new drip edge to all edges. col 1�_g u ...................................................................................................................................................................................................................... ✓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 and layment. ✓Install ridge vent to o r :23�. �3 a X:spa �.. n� I..,............................................................ ✓Reroof using ��„�� a Lam! G ' l 2 shingles with a 3e year warranty. rr...........................................�......................................................................................................................................................... ZO"u'ntertlash chimney. v ew vent pl-e flashing. ✓legal disposal of all debris. Area(s) to be worked on... /) { . f...5'. .......................::...........::. 1........................................................................................ f...ct t .a.. ..AF....f2.o.ths e.... _ a...� . d. ...ti2� �&......................................... .�G(.4...0� .................................. ............................................................................................................................................ J. . ,-...... ,... ,, . .. ... r ,v......... ................................................ Q...6.6.. 0................................................................................................... One Year Workmanshi r-anty ( Transferable) Manufacturer's W anty a.. spa/Q1fle�by m u eturer �� " Materials and Labo o cost $.......1YIp..fJC?....... ... Payable .... e':4?.......... on .../ ............... Payable........— ................-un .... ............ ...--:........ Balance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability while job 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, water stains when roofing shingles have not had adequate time to cure). 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. 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 shall be excluded from access to the Guarantee Fund. Approximate starting date of work..................................................................... Completion date .............................................................. Receipt of a copy of this contract 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. IN WITNESS WHEREOF, the parties have hereunto signed their names this ............ V.......... day of ...9*1............ 20'%7.... Accepted: Signed...' ................:/.... .................................. Owner s Signed .. ................. ....... CCC../..........:. ..............................Owner Per n r Representative /� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 °'� •�� www mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Letzibly Name (Business/Organization/Individual): —010)- / i 6 C&S-( Lone— ` Cp 56 Address: 2.00 &4& r S rp-c-+ 4. ❑ I am a general contractor and I Sikt- 22(_ City/State/Zip: N 6. AMOW M A O t % qS Phone #: TU 6 S3 3Y10 These sub -contractors have working for me in any capacity. Are you an employer? Check the appropriate box: 1.)6 I am a employer with % 4. ❑ I am a general contractor and I employee's (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t 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.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. oo aus 13.n Other {Any applicant that checks box #I must also till 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. lContractors 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. Q �^ Insurance Company Name: ! t ' -L .�• Policy # or Self -ins. Lic. #: Y V V 4 Q OO I ALJ T Expiration Date: Job Site Address:__) 7 tQ M/LW 906.2 City/State/Zip: M , J'Y')UdVC./- &A 0dyJ 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 C Phone #: Oficial use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # 30/6 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 #: