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Home My WebLink AboutBuilding Permit #260 - 36 HAWKINS LANE 10/14/2008 BUILDING PERMIT NORTFf TOWN OF NORTH ANDOVER -b-'.". 4.�..5 o APPLICATION FOR PLAN EXAMINATION " , Permit NO: v ,� Date Received Date Issued: 0d / - SS'gCHUSE� IMPORTANT;A plicant must complete all items on this age 3� H AW K.1 N3 C.A ti� iVd(z i�-t �INDO� IL i�/I- [P7ROPERT'Y OWNER Print nl R C a l l✓c Print pARCEL:6/2 2 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 y Industrial nits:u of Repair, replacement No.o. of ory Bldg Commercial Demolition Other Others: Septic Well Floodplain Wetlands Water/Sewer Watershed District DESCRIPTION OF WORK TO BE PREFORMED: OWNER: Name: Identification Please Type or Print Clearly) Address: '3 co0 Phone: r:O S- -17gq� !�-�yJ�<I L c LHe TRACTOR Name: � C �Tl;i�o � o Iu� `S/phone: 2 ess: 20U S uT7�� STS h-/ d 5 r rvisor's Construction License: S t_`��<3 r3 Exp. Date: �, ao y / Improvement License: Exp. Date: IL—) 4E— Address: ) d-e I r7 ARCHITECT/ENGINEER Phone: Address: FEE SCHEDULE.BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST Total Project Cost: $ BJASED ON$125.00 PER S.F. 1 O FEE: $ / �o`�' Check No.: 4pl NOTE— Persons contracting with unregistered contractors do nol phave access he u a Signature of Agent/Owner g n LV Sinnati iro -f -— E. Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools II Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site i' Il THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM ° DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS I I CONSERVATION Reviewed on Signature COMMENTS ` HEALTH Reviewed on Signature COMMENTS I Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes f Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 MainStreet Fire Department signature/date 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 21 A—F and G min.$100-$1000 fine NOTES and DATA— (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriatee p rmit 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 Engineeredro NOTE: All dumpster permits require sign off from Fire ducts e Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo OCf py Of H.I.C. And C.S.L. Licenses [3 COPY Contract ❑ Floor/Crossection/Elevation Plan Of Propose Hydraulic Calculations (If Applicable) d Work With Sprinkler Plan And ❑ Mass check Energy Compliance Report (If Applicable ❑ Engineering Affidavits for Engineered rod ) Products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 9 New Construction (Single and Two Family) ❑ Building Permit Application M ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be6 Returned) to Include Sprinkler Plan A Hydraulic Calculations (If Applicable) nd I ❑ 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 Bld P In all cases if a variance or special permit was required the Town Clerks officeamp g ermlt that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds.the lAppeals One co m the Board of A must be submitted with the building application py and proof of recording Doc:INSPECTIONAL SERVICES DEPARTMIENT:BPFORM07 Revised 2.2008 Location a; No. ,;26/0 Date Id A/d NaR*M TOWN OF NORTH ANDOVER Certificate of Occupancy $ ��s'•^e•,�� Building/Frame Permit Fee $ _sr +cwus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 , 553 V Building Inspector xAORTH '9 TO" of No. T F � T o dover, Mass., � � e q. COC N.C..".C. V ADRATED PPp` '9S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............... ..1b....:r1o......�.1-111I.M..i1 .......:......::':: ......................�........................ """"'" Foundation has permission to erect........................................ buildings on .... `........� 11JILI.A...t..............lomm! Rough to be occupied as..............5... .....I. .. *................. ...�.�. Chimney ......................................................................... provided that the person acceptins permit shall in every respect nform 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 CONSTR O, STARTS Rough .... ... ........................................................... Service BUILDING Final Occupancy Permit Required t0 Occupy .Puildi g GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFina, No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Town of North Andover t%ORTH a��t �o Building Department : ' o� 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 7 �R^rpo �Pp`y �SSACHU5 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 cl 1, sl 50a. The debris will be disposed of in/at: Facility location Signature of Applicant 16 by/v g Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector, �. •� The Commonwealth o Massachusetts M Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.isnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): _Dw t d C OLs tr [-p 11 r4 'n c- 13 Address: a2.oU City/State/Zip: N. AJe1 6 l 8 4 S Phone #: 7% 183 d 4 d o Are you an employer? Check the appropriate box: Type of project(required): 1.R I am a employer with Y 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 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. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp.insurance. 1 required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 PIUMM'bing repairs or additions o myself k ' right of exemption per MGL y � workers' corn p• 12.[✓]' ofre a� insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ 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. tContractors 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. 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. \nest/ra.AL�. �� SAm&iL �-T�j A Policy#or Self-ins.Lic.#:_ W C.. ►,8 q 11 S (p Expiration Date: Job Site Address: "2 (0 A tN K l M S �A 1J L City/State/Zip: Q _T,,- Ao Qei 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. Ido hereby certi undera pains a d penalties of perjury that the information provided above is true and correct. t9 Si nature: Date: Phone#: C06 (c u 3 4c)-o 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#: ACORD,. CERTIFICATE OF LIABILITY INSURANCE PRODUCER110/3/2008 DATE(MM/DD/YYYY) Phone: 508-651-7700 Fax: 508-653-8089 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC -Commercial Lines ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 West Central Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Natick MA 01760 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURED INSURERS AFFORDING COVERAGE NAIC# . David Castricone Roofing & Siding Inc INsuRERA:Ci t' nsu a c 0 7 200 Sutton St INSURERB:The Insurance Co of State PA Suite 226 INSURER C: North Andover MA 01845 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POUCYNUMBER POLICYE FFECTIVE POLICYEXPIRATION GENERAL LIABI LITY LIMITS EACHOCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Eaoocurerloe $ CLAIMSMADE D OCCUR MEDEXP(Anyone rson) $ PERSONAL&ADV INJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: p PRODUCTS-COMP/OPAGG $ POLICY LOC A AUTOMOBILE LIABILITY 08MMBBTNKT 8/1/2008 8/1/2009 ANYAUTO COMBINED SINGLE LIMIT $ (Eaacadan) ALLOWNEDAUTOS X SCHEDULEDAUTOS BODILYINJURY (Per person) $250,000 X HIREDAUTOS BODILY INJURY NONO WNED AUTOS (Per acGdsrn) $500,000 PROPERTY DAMAGE (Peraccldern) $100,000 GARAGE LIABILITY ANYAUTO AUTOONLY-EAACCIDENT $ OTHERTHAN EAACC $ AUTOONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACHOCCURRENCE $ OCCUR FICLAIMSMADE AGGREGATE $ DEDUCTIBLE RETENTION $ B. WORKERS COMPENSATION AND WC58777569/23/.2008 9/23/2009 X WCSTATU- OTH- $ EMPLOYERS'LIABILITYTOR ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.LEACHACCIDENT .-$1001000 OFRCER/MEMBEREXCLUDED? Sgqes dssc'be undar E.L.DISEASE-EA EMPLOYEE $10 0 0 0 0 SPECIAL PROVISIONS below OTHER EL DISEASE-POUCY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED David Castricone Roofing & Siding Inc BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER 200 Sutton St WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE Suite 226 CERTIFICATE HOLDER NAMED TO THE LEFTr BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON North Andover MA 01845 THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108) p ACORD CORPORATION 1988 `l:tssachusctts - Departntcnt of Public Sated 4 Board bl'Buildin,, Regulations and Standards `� ✓/2P. '�UII!•Y/ZU!'N.UF,'ILLG/L U�'✓�[.I29J1�(,yG[!d� '. Construction Supervisor Specialty License _ \ Board or Building Regulations and Standards License: CS SL 99358 __ HOME IMPROVEMENT CONTRACTOR Restricted to: RF,WS Registration: 104569 DAVID CASTRICONE = Expiration: 7/14/2010 Tr# 270265 31 COURT STREET � -.�;' Type: Private Corporation NORTH ANDOVER, MA 01845 t.f:> �, W" DAVID CASTRICONE ROOFING,SIDING 8 David Castricone Expiration: 12/16/2011 200 SUTTON ST SUITE 226 ��~•'�""� Tr,-: 99358 NORTH ANDOVER,MA 01845 Administrator (1uun�issiuncr 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 Bazjord 978-887-6447 In AaverhIU 978-374-7311 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 remises low described: p , W' Cl 7- 7302- -,?J-'?V Owner's Name........'V 0 ... ..f..eL..4e—Ic— ..............................................Te ephone#......�o...g`�.. ?I/Ile........ Job Address.....3.6 Lt.<a7. Yi.�.......�,.Q,•►a e, .......City..../...Y.A.�. a.11.¢/................State...l.:l/1......... Specifrcations: ,r... ..................... ,+, (p. ........ �. ,/Strip existing shingles(/) Apply new drip edge to all edges .................................:............................................................................I.......................... ................................................................. [/Apply _feet ice and water shield membrane to bottom edges of house.nn3 feet ice and waters eld mbrane in valleys and bottom edges of any unheated areas of house. F� mcg t aim o-n S!�� ........................................................................................................................................ .....I................ ............................................. /Apply felt paper erode went ;ilnstall ridge ve t to , ..... ... d� n. ... .. �-`. ........................... ................................................ .G......... .. .. ... .. . . . ....... .... ... . „Reroof using ' shingles with a year warranty. ..............................................�..-................................................................................................................................................................... `Counterflash chimney. r/iVew vent pip flashing. vI egal disposal of all debris .................................................. ........ ............................................... ..... ................................................................................ Area(s)to be worked on: .......................................... l`aa.... ................................... ld . ' ...e. ................................... ...................... 2 t r ltd/...... `'I.tl e NW. . ............................................................................................................ .................................................................... ...................... ..e^............................................................................................................... Roof board replacement itnecessary��0 /sheet or /foot. .................................................................................................................................................................. ...... ........................... Two Year Workmanship Warranty(Not Transferable) Wanufacturer's Warranty as sped t by g!anufa��f urer The co fora ps to perform the work anfern'h e materials specified above for the S of$....,1 ...7.`..0.. ........ ayable.... .�?Q.�.........on..�,$ ...... -Rayable.....:7=..............on............'-.............. ,q, alance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability whr ejob is in operation. Contractor is not are 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 otherliving 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 wort,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 foes and expenses,in addition to the arnount due and unpaid,[fust 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 m estates of the parties.The undersigned wanant(s)that be is(they rat) the ownem(s)of the above mentioned premises and that legal title thereto stands of record in his(their)names(s).There aro no representations,guaranties or warranties,except such as may be herein incorporated,if any,nor any agreements collateral herdo,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 patties 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 cancellatio . IN WITNESS WHEREOF,the parties have hereunto signed their names this.... day of ...20..0iZ. Accepted: Sign .... ...... . _._ . Owner Sign David Castricone,President