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Home My WebLink AboutBuilding Permit #379-11 - 358 BEAR HILL ROAD 11/3/2010 BUILDING PERMIT Of 00RTN q `st`ec °+ ti0 TOWN OF NORTH ANDOVER o� o� APPLICATION FOR PLAN EXAMINATION 7° Permit NO:ri Date Received �4w�Rwreo'°"y(`� �SSACHU`�� Date Issued: E IMPORTANT: Applicant must complete all items on this page LOCATION t.. .5�� oew 01 8"d Print PROPERTY OWNER LW J a r fi7'e- Print MAP 210 , ^{ PARCEL: ZONING DISTRICT: Historic District yes no !Machine Shop Village yes no 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: all Identification 41lease Type or Print Clearly) OWNER: Name: (-t Phone: 6� 717 " Address: �3,0 Qe_2Y Hilt p&d Nd(+L- omr- CONTRACTOR Name: i n �ualln% Phone: Address: � � Supervisor's Construction License: Exp. Date: a-U Home Improvement License: �` x_(09 Exp. Date: -7-4 "Zo CL ARCHITECT/ENGINEER 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: $ o;Za �60 DO FEE: $ 1• Check No.: % Receipt No.: it W IW NOTE: Persons contra ing with unregistered contractors do not have access to the guaranty fund Signature of Agent/OwnerC Signature of contractor om, Location //— No. ocation//No. Date NORTh TOWN OF NORTH ANDOVER F w 41 Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s,+cwuse 9 Foundation Permit Fee $ i Other Permit Fee $ c TOTAL $ Check # / 2 3 6 Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools cs Well Tobacco Sales Food Packagin #e.<0i 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 COMMENTS HEALTH Reviewed on Signature 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 DPW Town Engineer: attire: i % Located 384 Osgood Street FIRE DEPAR N� - T p Dumpster on site yes Located at 124t1peir Fire De artment si natu a/date P 9 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 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 o 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 L3 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 o 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 DAVID CASTRICONE,FRES. 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 Ln Boxford 978-887-6147 In Haverh111978-374-7314 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 described: Owner's Name....../..'� .•.u..t5.�j':...,�..,tr..:+v.....��.,t',,...$'c:......_ ��...:...........................Tele one#.....G�.3'..2........J�'..(.1...�... •`"rte ...... / a Job Address.....t �....A.......,C.t.c.� �............city.....�V& .../...1.;c ..a;/.r«t�...............state....,JM:...... Specifications: ......................:.................... 91 � 1.... .. , / ...�•.. 4 1 .. t ............. 4 .............�. '. d ��rr ....................................................................... •........•.•.•.•'•i••Y!+: '!•..•..lw��•'/'•lYt.......4/ .Uc:✓�•u1.. ...Yii�).....•t'•'a.T.•1....<6.J•�r.�.G ..6J.+ /..S,r...........•....•............................. `�..x�i ..................................................1................... .................. . ...... ..........r X71—, ..w..:e�:v.'crr. .....J•.. :.-........J.14. :.i. ...a :....... t.............................................................................................................. . - y 8a o 1 ......t �•�a ..........�1`— ....... cr.............. �.r. .................................�� ....................................... �.... .1.t .5..::.�`k�...../...!'.� ....(.. » r:......`" ,�.r.t .. ' ..:.......`-.....� PO O ..................... Two Year Workmanship Warranty(Not Transferable) Manufactur 's Warranty as specifte y manufacturer The contactor agrees t perform the work an furl•sh die materials specified above for the SUM o $.. �.........,.,. [.Payable....... .t................un.... %: a r Z _ A ayable...... 3. �..:A................on...l3 .c., ,�.,y�:•balance payable on completionfjob S z J� Owner( ners are not responsible for Property Damage or L' ility while job is in operation. L1-) d fTr ,� Contractor is not responsible for any damage to the interior of property,including pre-existing conditions.(i.e.watci sta' s,crumb!' g plaster,s ails or ' conditions resulting from application of materials specified above (i.e.objects coming loose from walls,crumbling plaster,exposed nails,dust in attic Oro[ living spaces). Items in attic may need to be covered by homeowner.All materials are property of contractor. Any dumpsler placed by contractor is for his use only.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.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 warrantiesexcept such as may he 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 Consurner 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. l 01l✓lam Approximate starting date ofwotk..�'... /.1±�..1�.. ....... Q Completion date.... ....*................. . . .. ....... ate.................. ....... . . .. ....... 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 names this.. L.}(.t.._SLI day of.. ...............20. .6.... Accepted: Signed ��. /iy ,1 .............. Owner Signed ( ............................. Owner David Castricone,President r ORTH And over TONM Of LAKE O dover, Mass., AP C OCHICHEWICK 7�A0A?ATEO S BOARD OF HEALTH Food/Kitchen Septic System �PERM IT T D � BUILDING INSPECTOR THIS CERTIFIES THAT IJ. ��'� ...... � ....... .. ..................... .................. .' r ......... Foundation �� IN.J.r............ has permission to erec ...........:......................... build in s on .. .... ......... IN.W .:..... Rough .................. ............... i�0... ........................................................ to be occupled.as.......... Chimney .. . ............. 'provided that the perso accepting this permit shall in every respect confor o 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 MO THS ELECTRICAL INSPECTOR NLESS CONSTRU ST URough . Service .................. ......................................................................................... BUILDING INSPECTOR Final Occupancy Permit Required t0 Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final I No Lathing or Dry wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner. Street No. L SEE REVERSE SIDE smoke Det. The Commonwealth of Massachusetts . Department of Industrial Accidents W. �= Office of Investigations u 600 Washington Street . �.�. Boston, MA 02111 M€,� www.mass:g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legib Name (Business/Organization/Individual): D AV i D HST P i c o N 1✓ r'�0 6 h i N G- � S In/t9 U N C. Address: U co S 0 V-RD N S R t- 'r- -I- 'T Z 2- City/State/Zip:iy o . A k) t)c v�- ti HA 0 i 0 q Phone #: 9 7� V3331-2u Are you an employer?Check the appropriate box: Type of project(required): 1.91 I am a employer with 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 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.NX Roof repairs insurance required.]t 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. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors acid 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. Insurance Company Name: C 1-f ft2 Tvs _ Policy#or Self-ins. Lic.#: Vy 1. 6 U -;q ,3 EA 3 Expiration Date: 9 Job Site Address: �J!$ ear' 4),/1 NOW City/State/Zip:NQr4k Attd oyey kA 0/1 Yr Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requited 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 andpenalties of perjury that the information provided above is true and correct. Signature: �:� (�.aZL Date: Phone#: q q 8 (A3 3 g Z a Official use only. Do not write in this area,to be completed by pity or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Buildina Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Town of North Andover F SOk7M O' t �a .qA• Building Department o - 27 Charles Street '' A No.rtli Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM 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 c11, s150a. The debris//will be disposed of in/at: Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector,