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HomeMy WebLinkAboutBuilding Permit #769 - 40 MOODY STREET 5/23/2007Permit NO: Date Issued: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received 16'~00 0 i A � o a �0 Arm I IMPORTANT: Applicant must complete all items on this Daize I LOCATION 76 M0 ob Y 67X,�_L Print C - PROPERTY OWNER 0 l0 /q 7HI9N W �k6 E 1_ {� / / MAP NO.: /i / PARCEL: / CG PrintZONING DISTRICT: TYPE, AND USE OF BUH,DING MSTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Addition ❑ Alteration 19q)ne 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 /a Identification Please Type or Print Clearly) OWNER: Name: Jo na_4� ��'U(lG�% Phone: -71)n-) a ` Address: CONTRACTOR N S i ) � YNc �w Phone: Supervisor's Construction License: Exp. Date: Home Improvement License: I Oak 0-n "I Exp. Date: U _ ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. • $12.00 PER $1000.00 OF THE TOTAL ESTIMA TEQ COST BASED ON $125.00 PER S.F. Total Project Cost S ,,) op bb FEE:$ Check No.:__zReceipt No.: vU' �O Page 1 of 4 eJ r TYPE OF SEWERAGE DISPOSAL Art r]Public Swimming Pools El Public Sewer ❑ ❑ Tobacco Sales Food Packaging/Sales ❑ Well Permanent Dumpster on Site ❑ Private (septic tank, etc. ❑ Electric Meter location to proj ect NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans El THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE APPROVED 0 DATE REJECTED DATE APPROVED ❑ ❑ DATE REJECTED DATE APPROVED ❑ ❑ �i FIRE DEPARTMENT - Temp Dumpster on site Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Water & Sewer Connection/Signature & Date Driveway Permit Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA — (For department use) Page 3 of 4 Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC. Jan.2006 -- — r 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) o Copy of Contract ❑ 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 Location goo No, 2A Date &CRT" TOWN OF NORTH ANDOVER f � ° • CL .. D ..�-._.. Certificate of Occupancy $ Building/Frame Permit Fee $ AC MUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20260 - Building Inspector � a 0 a � a o ` a C y O C O J x w cn a w° a°G v U C w a°4 w w a°G °�%i w a c7 o�4 w w a� ca o z U) � 0 V) w O CD cm CIO O co y O O g m m 0 CD .CD O.rD 3.0 CD CL as � � L omQ CIO o =� c v CD co Z IS C CD CL C.3 y O •C cc C _. US o ` C y O C O J CJ Gi �a� :cum c O L O ' m .12 C c w O CD cm CIO O co y O O g m m 0 CD .CD O.rD 3.0 CD CL as � � L omQ CIO o =� c v CD co Z IS C CD CL C.3 y O •C cc C _. US 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 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 famish all necessary materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and conditions, on premises below es 'bed: // nn• � Owner's Name.... �l.l2.3!t tP,✓L.......................................... Telephone #.....2.� �j �{ n Job Address ......%. .....Mme ..........r�1a ............................ city.... Li,... a.V 4 . .............. State ..... J.: kCT..... Y Specfficarions: lri......................................................................................................... .............. 'Sttrip existing shingles(') �Cpply new drip edge to all edges. ................................................................................................................................................................................................................ ✓ripply _feet ice and water shield membrane to bottom edges of house. 3 feet ice and water shield mem ne in valleys and bottom edges of any unheated areas of house. r hh rs� .................................... vApply felt paper ur di ................................... eroof using ......................... I.................................. -Counterflash chimney. 4.,txw ven ...................................................... Area(s) to be worked on: A i ...............................................................................�..............V .................. ... �-Yeg. ........ .. e flashing. al disposal of all debris. ........................................... _ .........I .......... I ... �.......... . .r .........f1.1...............................................j.�`.../............. ......................................... .....................�................................. ... �). e. fl....... .e..4S.....t-6... . o..�t?kL 5�.1+ ...5... li°x .... — �8 �D.. 6! ..1�`1'.¢..%!� ............. . . Roof board replaceme t if necessary @ 60 /shat ore3 . /foot ....................................................................................................................................................................Y- .._+........... Two Year Workmanship Warranty (Not Transferable) 14)"anufacturer's Warranty as specify y m nufacturer The co tractor agrees to perform the work an ish the materials specified above for the SUM o $......�� Q. v ............... Payable ........ ................ on....S� ........... Payable........... �-.............. on............................ Palance payable on completion of job Owner or (Tunas are not responsible for Property Damage or Liability while fob 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 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 than remains unpaid, immediately due and payable. It is agreed that, if permitted by law, contractor shall be paid by the owncr(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 warnings) that he is (they an) the owners(s) of the above mentioned premises and that legal title thereto stands of record in his (their) names(s). There are no represartations, 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 tim business days to cancel this contract and incur no penalty (see notice of cancellation). - IN WITNESS WHEREOF, the parties have hereunto signed their names !.....,. day of ...�.".!.� yy 20...../..... Accepted: Signed......... .»............. .._........... ............... ......... Owner Signed.....................».................................................... Owner L-11.... David Castricone, President , t e 41"I y f Department of Industrial Accidents j Office of Investigations 600 Washington Street Boston, MA 02111 V www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): RQ©A-i n, , S i Address: __ UU &411 r\ S&m+ - Sick -p- ZZCo v City/State/Zip: N 6. A(KIOVe M A O t B ifs Phone #: 9'7 � G$ 3 3` 1 o Are you an employer? Check the appropriate box: 1.)c I am a employer with __%— 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have workers' comp. insurance. 5. ❑ 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. El Electrical repairs or additions 1 I - El Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other �.r arY....a,...,o. VIIG�" wn ,r, ,uusi aisu L111 Out (Be sectlon 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 subcontractors 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. Insurance Company Name: ! t • -f- _` ' Policy # or Self -ins. Lic. #:.0V W C.. 60 00 � 4 0 OO I �1J � T Expiration Date: q o�,3.. Q 8 — Job Site Attach a copy of the workers' compen �A ���s�,' city/state/zip .� � - t'1 r eyP/ H 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 thepains andpenalties ofperjury that the information provided above is true and correct Simature: E).2C - n�+P r_/I ? /n 17 Phone #: Ojf1eial 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 #• Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM �"V�ig4iE0 1 �ly� SAC 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, s15Oa. The debris will be disposed of in /at: s Facility location Signature of Applicant ldT Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector.