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Home My WebLink AboutBuilding Permit #561 - 40 WENTWORTH AVENUE 5/1/2018 TOWN OF NORTH ANDOVER ,* APPLICATION FOR PLAN EXAMINATION Permit NO: �(o Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 7 d is n /Nd. !, /1(A✓�' JJ-- '� /� Print PROPERTY OWNER i M be,-& VD,i a, Print- MAP'NO:.�'a t oPARCEL:b�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 PERFORMED: sfrl� and I&AIA1 // lb d l alzui o"d a)-e Identification Please Type or Print Clearly) OWNER: Name: Phone: Jo?4J ,-?O 76 Address d drA Al 0 C., AIA 6W K) CONTRACTOR Name:,�? 24,6 Am .` r jinty Phone: 9 7 G 3 3 y Z d Address: ZO 6 &J*6 S e:/ Sul 2-U. �o. X1ntlJ re- /yR d/�Yr s Supervisor's Construction License:, CS ggJJ-13 Exp. Date: Home Improvement License: l 11 (,o Exp. Date: 9" /;j'aW u 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: $ 73 FO 00 FEE: $ f Check No.: _ Z2 4-10 Receipt No.: ,(2 NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner Signature -f contractor 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 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: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. i .Total land area, sq. ft.: I 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 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 ❑ 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 LiWorkers 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 Location -//e�) 1-v 1 No. �� Date -3 y NORTH TOWN OF NORTH ANDOVER � 9 + Certificate of Occupancy $ s °'E<� Building/Frame Permit Fee $ wGNUs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22b66 Building Inspector tAORTH own of Over . No. 0 LAKE dover, Mass. 31-7ZZ COCHICI 0RATED BOARD OF HEALTH Food/Kitchen "t PERMIT T. D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT................. ......xFoundation has permission to erect........................................ buildings on ...... ................................................ Rough tobe occupied as............................................ ..................................................... C everyhimney provided that the person accepting this permit shall respect conform 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 CONSTRUCTION STARTS Rough . .... Service ' BUNG INSPECTOR Final Occupancy Permit Required to Omtpy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE- Smoke Det. DAVID CASTRICONE aA2, v 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 HoverhiU 978-374-7314 i 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 descrid: �y/ Owner's Name....... '. .1..n .c. ..... .......,/...i<?.Y.6) [ Job Address........./.: .....4!Il.. .......a1�.CL.L...... :..... ��.....City..... G.r.... k..�!.R� .........State.....):.k. Specifications: ......................................................................................... Strip existing shingles(O oApply new drip edge to all edges. !,)lr, � ......................... ... ................................................................................................................................................................................. i/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 u er yment. ....Install ridge vent to �7 � .b................. g. . ................. ..................................... .................. —Reroof using 3 shin les with a y.ear warranty. .............................................................. ............................................................................................................................. —Cbunterflash chimney. New-vent pipe flashing. ---t;egal disposal of all debris. �A .................................................................................................................................. /! >...:...:............ YI �f Area(s)to be worked on: — ......f..4a... Na f`ea� ti 'V �t^e.�t•s�ic�, /`�.a. .....Q . - I..............lZ.u.u. .�.............-. .3.. ......... .................... .......c ...... .t ...l� � t 5..1...Yl......YYk ....... :... CLG.'< .....A ...L.... .....:................ .. .. ................................. Yrs►' .�r7 ..e .......Rb t .....! .L i.................................................................................. ....W....... Roof board replacement if necessary @ 16geel�'}.C- [foot. ................................................................................................................................................................... .)................................. Two Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as spee}ficd by manufacturer The c tractor agrees to erform the work d i h the materials specified above for the SU f S........73...zQ........,._._i l Pa able... .7e )........on., .14_4.... y F•• Payable........`—................on.........—:................. ,l alance a able n co i Owner or Owners are not responsible for Property Damage or Liability whi e,lo 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 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 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 cancellation). IN WITNESS WHEREOF,the parties have hereunto signed their names this..r .!!�.,day of...��1'/1.:>•u.(:,!!..,20.,66L Accepted: I Signed ... ........ ........ ......... ....... ...................... Owner Signed............................................................................. Owner David Castricone,President t The Commonwealth of Massachusetts P_ Y 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 Please Print Legibly Name(Business/Organization/Individual): C AMR I c0 Nc_- R 00 F I NCS- d S ID f N(,- 1 N L Address: 20 CO S urtT-t1J So V-, -E_ Z2.b City/State/Zip: /kNDo 46 K NA 0 18 LAS Phone#: (P Are you an employer? Check the appropriate box: Type of project(required): 1.® I am a employer with � 4. ❑ I am a general contractor and I construction employees(full and/or part-tune).* have hired the sub_contractors 6. ❑New 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. 9. Building addition required.] 5. ❑ We are a corporation and its 10,❑Electrical repairs or additions 3.❑ I ani a homeowner doing all work officers have exercised their I L❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.K Roof repairs 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. CoInsurance Company Name: e S� cc, Co Mp o-AL( Policy #or Self-ins. Lic. #: W C_9 9 s 9,1 y b Expiration Date: 9-A Job Site Address: IC) 6()eA*1J oif�- S� City/State/Zip: fi,#,'1/6�i 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. Signature: C Date: a l l?b o _ Phone#: 20 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#: Town. of North Andover41 Building Depai lment 27 Charles Street o �a J` � P& u North Audover, Massachusetts O1 688-9545 l� ,. 845 V (978) Fax (978) 688-9542 .Y °Rnre��.(h CHLJ5� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL e 40 s 54, and a condition of. Building permit; # the debris m i.rILin&; from the work shill be disposed of in a properly licensed solid waste disposal faeilit.; as defined by MGL cI1, s150a. The debris will be disposed of in/at: Facility 4:kation Signature of Applicant 3 //?//4 Date NOTE: A demolition permit from the Town of North Andover must be obtainedfor this project through the Office of the Building Inspector, P ] g . ACORR, CERTIFICATE OF LIABILITY INSURANCE DATE,MMIDDITYYY,09/28/2009 PRODUCER (508)651-7700 FAX 508-653-8D89 . CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC - CoDmerci al ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 West Central Street HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER Natick, MA 01760 THE COVERAGE AFFORDED BY THE POLICIES BELOW, Select Ext.53389 INSURERS AFFORDING COVERAGE NAIG# INBUREv David Castrocone Roo Ing $c Siding Inc INSURER A: The Insurance Co of State PA 200 Sutton St INSURER B: suite 226 INSURGR C; North Andover, MA 0184$ INSURER O: INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY R9QUIkFMEN7,TERM OR CONDITION OF ANY CONYRACY OR OTHER DOCUMIENf 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. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY FACH GCCURRFNC(; $ COMMERCIAL GENERAL LIABILITY DAMACC TO IdL•NTEU $ G�anccl CLAIMS MADE ❑OCCUR MCO CXP(Any one Person) S PERSONAL&ADV INJURY $ QL:Nl•ItAI AGGRL'GATC $ GLN'L AOGHEGATE LIMIT APPLIES PER. F'HODUC 1:-COMPIOP A00 $ POLICY PRO- AUTOMOBILE )ECT AUTOMOBILE LIABILITY ANY AUTO (COMBINED1'INGLE LIMIT $ ALL OWNED AV70S BODILY INJURY 4 SCHEOULEDAUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Peer accident) Pri0 Fnry()AMACP $ (Per Accident) GARAGE LIABILITY AUTO ONLY,EA ACCIDENT $ ANY AUTO —'- 07HERTHAN EA ACI; $ AUTO ONLY: AGO S EXCESSIUMBRELLA LIABILITY EACI I OCCURRENCE $ OCCUR CLAIMS MADE AGGRrGATE $ $ OLVVCTIBLk T $ RETENTION S WORKERS COMPENSATION AND WC9752746 09/23/2009 09/23/2010 X WCSTAru- OTH. EMPLOYERS'LIABILITY TORY LIMITS I ER A ANY PROPRIF,TOR/PARTNEWEXECU'flvE E.L.EACH ACCIDENT S 100,000 OFFICERWEMBER EXCLUDED? If ms da5GnbC undCr _LL DISEASE-EA EMPLOYE S ]QQ QQQ SPEGIAl.PROVISIONS below E.L,DISFASF-POLICY LIMIT OTHER $ 500,00 OESCRIPYION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED By ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE N EL N SHOULD ANY 00 YHE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WELL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIN13 UPON YHE INSUREIR,ITS AOCNTS OR REPRESENTATIVES. IAUTHORIZED REPRESENTATIVE StaceyBrice PKG AGORd 25(2001 108) OACORD CORPORATION 1988 lre 'Cborr�a�rnruuerrll/. o.,//.'„%(cr��ecftirveClJ Boat-if of l3uilllinl Kc!-ulaliuns and tit;tnll;trtls Board of Building RegulatioiSs and Standards Construction Supervisor Specialty License r �- HOME IMPROVEMENT CONTRACTOR License: CS SL 99358 Restricted to: RF,WS ib4 � _ Registration: 104569 Expiration: 7/14/2010 TO 270265 e: Private DAVID CASTRICONE ,;.; ;. wT Yp Corporation 31 COURT STREET t, DAVID CASTRICONE ROOFING, SIDING& NORTH ANDOVER, MA 01845 David Castricone �:. .., . 200 SUTTON ST SUITE 226 � - Expiration: 12/16/2D11 NORTH ANDOVER, MA 01845 Administrator nnnii"inot•lTri: 99358 n