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Home My WebLink AboutBuilding Permit #627 - 40 COVENTRY LANE 4/16/2010TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 011_�' Date Issued: t IMPORTANT: App LOCATION ` ven f Date Received it must complete all items on this page Pri�}t PROPERTY OWNER M C1 Print . MAP NO:_PARCEL: ZONING DISTRICT: Historic District Machina Machina yes TYPE OF IMPROVEMENT PROPOSED USE v Residential Non- Residential New Building "One family Addition Two or more family Industrial Alteration No. of units: Commercial Others: � Repair, replacement Assessory Bldg Demolition Other Septic Well Floodplain Wetlands-- Watershed District Water/Sewer OWNER: Nam Address: 140 COV UtsUrur i 1UN I wvR ( To BE PERFQRMED: res h i (3 >�f sle fi c 00f- &�oq Gf OWNER: vf- )n Please Type or Print Clearly) 1 \Oo Nd P 06. ftyv U e., f -1A WK CONTRACTOR Name avtri CAS" 6�n&- Kdt� Y15 . Phone:'q") 3 3 Y2.) Address: 'c 0th_ Supervisor's Construction License: ct 5 Exp. Date: ci Home Improvement License,' Exp. Date: (. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ �j �, o d FEE: $ Check No.: _L -,L 5 O Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ignature of Agent/Owner_ Signature of contractorV� � • C Location CaV4*1 11'7 /14-5-1— V— Id No. &d Date TOWN OF NORTH ANDOVER 0 40 Certificate of Occupancy us' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22941 Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales 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 H4 HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition Planning Board Decision: Comments Conservation Decision: Comments Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signa FIRE DEPARTMENT - Temp Dumpster on site Located at 124 Main Street Eire Department signature/date COMMENTS l_ocatea jts4 usgooa Street yes no 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 Doc:.Building Permit Revised 2008 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 o 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 ❑ 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 ❑ 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: Doc.Building Permit Revised 2008 V. .0 F=4 � 5 0 �m c t••i �o= O C �vO Q V 'O ;•C A CDCD C Q L S H = �r4,: i•r Y,d y � 3 :CD o o. Juo E5 *# A Oimc t V O z Q Rio -' I .br O E CDL O v Z °D CL O y D � CO c - caCD C '� y m m co Cl - co l -Z R � CD O � i Cc O CC C � rQ (A o cc v c% J= C CD V y C cc C _c Q H 0 uj ul U) W W 19 W c� ° z a o x W U w w O w � U O z C7 aw, a O z � A A o v o v a w o zo v ono �0D v o f w 0 8 w° cn w° w2' U w w°' w vi w w CE cn cn � 5 0 �m c t••i �o= O C �vO Q V 'O ;•C A CDCD C Q L S H = �r4,: i•r Y,d y � 3 :CD o o. Juo E5 *# A Oimc t V O z Q Rio -' I .br O E CDL O v Z °D CL O y D � CO c - caCD C '� y m m co Cl - co l -Z R � CD O � i Cc O CC C � rQ (A o cc v c% J= C CD V y C cc C _c Q H 0 uj ul U) W W 19 W Town. of North Andover 131ilding Department 27 Charles Street North Andover, Massachusetts D1845 (978) 688-9515 Fax (978) E88-9542 DEBRIS :DISI-DISI1~OIW �r�►�71y In accordance with the provisions of MCrL c 40 s 54, and a condition of. Buildiag permit. # the debris rel .,i.rItinb from the work slulll be disposed of in a properly licensed solid waste disposal faeilit.y as defined by MGL c.l 1, sl 50a. The debris will be disposed of in /at: t Nd Signatt,►re of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project tluougli the 017:7ice of the Building Inspector, Construction Supervisor Specialty License License: CS SL 99350 Restricted to: RF)WS DAVID �A8TR|C0NE 31COURT STREET NORTH ANDOVER, MA 0-1845 sxp/.n/mn: 121'16)2D11 Tr -P: 99358 HOME IMPROVEMENT CONTRACTOR Regi m,abon: 104569 Expiration: 711412010 TO 270255 Type phvaleCnqmratiom DAVID CxSTn|CDNEROOFING, SIDING & David Caotrioune 2OOSUTTON SrSUITE ozn NORTH ANDOVER. wm01O45 m ^ ACORD..r CERTIFICATE OF LIABILITY INSURANCE 19/28/20 9 PRODUCER (508)651-7700 FAX 508-653-8089 Eastern Insurance Group LLC - Corr•rlercial 233 West Central Street Natick, MA 01760 Select Ext.53389 :THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, INSURERS AFFORDING COVERAGE MAIC # muvREv David Castricone Roq Tng & Siding Inc 200 Sutton St Suite 226 North Andover, MA 01845 INSURERA: The Insurance Co of State PA INSURER B: INSURER C; INSURER D: INSURER E. CnVFRAG59 THE POLICIES OF INSURANCE. LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY P90UIREM9MT, T01V! OR CONDITION 05 ANY CONYRACY OIC OTHGR bocum r WIYH 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. INSRI TO DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS Stacey Brice PKG GENERAL LIABILITY M-.ACH OCCURRFNCQ $ COMMERCIAL GENERAL LIABILITY DAMAGF TO RL-NTEU $ pprMISCIR IrA�cCu[cnC CLAIMS MADE ❑ OCCUR MCD EXP (Any one parson) $ PERSONAL R ADV INJURY $ QL-.NI.HAI AOCRL"GArc $ Ctril AGGREGATE LIMIT APPLIES PER. F'NODUC 1,5 - COMr(OP AOG $ POLICYPRO LOC JECT AUTOMOBILE LIAfI1UYY GOA491NE0 SINGLE LIMIT ANY AUTO (I-? Pcndem) $ ALL OWNEF) AUTOS BOOILY INJURY SCHEDULFOAUTOS (119e Parson) $ nonu.v INJURY HIRED AUTOS NON -OWNED AUTOS (Pur mc(:idenl) � PROPKI11Y DAMACP (Pee eceldent) GARAGE LIABILITY AUTO ONLY, EA ACCIDENT $ OTHERTHAN FA ACG $ ANY AUTO AUTO ONLY: AGO S EXCESS/UMBRELLA LIABILITY EACI I OCCURRENCE $ OCCUR CLAIM$ MADE AGGREGATE $ $ T $ litl)vc l'IBLI: $ RETENTION S WORKERS COMPENSATION AND WC9752746 09/23/2009 09/23/2010 x WC STATU- OTH- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 100,000 A ANY PROPRIF,T0R1PARTNERLEXECUFIVE E.L. DISEASE • EA EMPLOYEd $ 100,000 OFFICERIMEMBER EXCLUDED? U Ws-dascnbc Vndcr E.I.. DISFASE - POI ICY I,IMIT$ 500 000 SPECIAL PROVISIONS below OTHER OCCCRIFY10N OF OPERATIONS I LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS CERTIFICATE "OLDER CAMrr-1 I ATInN David Castricone Roofing & Siding SHOULD ANY Or THE ABOVE OESCRIBED POLICIES 8E CANCELLED SOORC TME EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 200 SUtton Street 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Suite 226 BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGAYION OR LIABILITY North Andover, MA 01845 OF ANY KING UPON YHE IN$URnk, IYS AGENTS OR RCPRESENYA'rIVCS. AUTHORIZED REPRESENTATIVE Stacey Brice PKG ACORD 25 (2001108) CEACORD CORPORATION 1988 Copy DAVID CASTRICONE t/3`ia CASTRICONE ROOFING & SIDING INC. SIDING & REMODELING REPLACEMENT WINDO �-t� u ` ROOFING, �� (ea ��,, HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 200 SUTTON STREET, SUITE 226, NO. ANDOVER, MA 01845A n i 3 ZQ I Q In North Andover 978-683-3420 In Boxford 978-887-6147 In Heverh1U 978-374-731 Uwe the owner(s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish F6lYtecessary ........... materials, labor and workmanship, to install, cons and place the improvements according to the following specifications, terms and conditions, on premises below described: Owner's Name ......... ,.p..,l.......................................................... Tele one #..&.x9:7 Job Address ......lib..... I �l a.;/ ..l.. ................ city ...... N'C i..J!.! . .. -66a,ii .......... State...... . d.... y/ Specifications: ............................................................................................I.................................................................................................................... -Strip existing shingles. --Apply new drip edge to all edges t,,//CyG g ........................................................................................................................................................................................................... Apply Meet 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. ............................................................ 7 ........................................ !Apply felt paper underlayment stall rid event to ............................ .....� ............!..................................... ..... ............................................................................................. -Reroof using shingles with a -?6 year warranty. ...................................................................................................................................................................................................................... Cownterflasli-chin 4:iegal disposal of all debris. - sac ........................................................... ......... ...... Areas) to be worked on: �.�/ ................................................... ......R ..r..a.................................................................. ...................It.......,:...................................................................... r 'ytE_....I11 ems. >n ........................,t LX....... �ltc 1 .....,.c�.....G� '...................f?....... ....... ... Q� . ............ ............. :.................................................... ................................................................................................................................ Roof board replacement if necessary @ GD /sheet orr�w`= /foot. �d.,,r ..................................................................................................:.............................................................................. Two Year Workmanship Warranty (Not Transferable) Manufacturer's Warranty as s by mnThe cof,►Qractor agrees to perform the work y�td sh the materials specified above for the S M of $. t, �. payable ... J.O..Q.Q......... on..S:.4............. ........ ........ on .................................. . OBalance payable on completion of iob 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 nags) 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 du mpster placed by contractor is for his use only. Upon completion of above 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. 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 names this .................. day of ............................ 20........... Accepted: Signed----- .... Owner Signed David Castncone President Owner Ike Commonwealth of Massachusetts 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 1 Please Print Leeibly Name(Busuiess/Organizatiot>/Individual): y NV I D C M7R j LO pL q o) FJNL-,- `I S 1D 1 N Lr 1 P L Address: 2(>o Su::t-Ve t3 SryCZv---E--r S0 E_ Z2.e City/State/Zip: N - A 0 J8IC NA 0 t & 4S Phone 4: 9-) 9 (P � 3 3 41-0 Are you an employer? Check the appropriate box: t. ® I am a employer with 4 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors ?. ❑ 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' INo workers' comp. insurance comp. insurance.$ required.] 3. [:11 am a homeowner doing all work myself. [No workers' comp. insurance required.] t ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no 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. Z Roof repairs 13.❑ Other *Any applicant that checks box #1 must also till out the section below showing their workers' compensation policy information. fi Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractcrs 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 tate 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 andjob site information. nn Insurance Company Name: 7� e Cil C64-(_ e, (20 mi) 6-1 V a f- S+jo7b Policy # or Self -ins. Lic. #: y�q 7 5 a, IS G Expiration Date: Cl - A 3. 20 t o Job Site Address: ` 6 6vtl- � �tsl City/State/Zip: lilff a *d6e/ PA - 61m," 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 imprisonttuent, 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: -� )2 �1_ C,..e � Date: 10 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 e Contact Person: Phone #: