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HomeMy WebLinkAboutBuilding Permit #754 - 407 WOOD LANE 6/18/2008Permit NO: Date Issued: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received I IMPORTANT: Applicant must complete all items on this Daize I LOCATION q61 Wood {gine. Print L PROPERTY OWNER ne. 4e. �1U I VC11eAf 4 Print MAP NO.: PARCEL: TYPE AND USE OF BUILDING ZONING DISTRICT: HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ❑ Addition ❑ Alteration : e One family ❑ Two or more family No. of units: ❑ Industrial Repair, replacement Demolition ❑ Assessory Bldg ❑ Commercial Moving (relocation) ❑ Other ❑ Others: i Foundation only DESCRIPTION OF WORK TO BE PREFORMED and � rou F Identification Please Type or Print Clearly) OWNER: Name: AF nh ne,Ae_ 'P&w 1Veeu\4 Phone: 919 (o $ 2 d 0 3.0 Address: %to CONTRACTOR Name: Y1ort-h (►n � Q( -M l� Address: ,Zoo Suiten Strcr.-v 14or'i. Aill&uyv- NA- Ol u r J 3X Z6 Supervisor's Construction License: C.S SL 9936% Exp. Date: 12.1 It. I Z°K I-Iome Improvement License: 10,45(01 Exp. Date:'I I l v 1� ARCHITECT/ENGINEER Name: Phone: lddress: Reg. No. FEE SCHEDULE. BULDING PERMIT. • $12.00 PER $1000.00 OF THE TOT,4L EST/MSI TED COST BASED ON 5125.00 PER S.F. Total Project Cost S iv ZSU d ci FEES_ Check No.: (t>� ( C) Page IoF4 TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools C Public Sewer Well Tobacco Sales FJ Food Packaging/Sales L Permanent Dumpster on Site 17 Private (septic tank, etc. _ i Electric Meter location to project ivy l E: Persons contracting with unregistered contractors do not have access to tine guarantyrnd Signature of Agent/Owner �,► 4 t� fI ;,signature of celttractor ' Plans Submitted ❑ Plans- Waived C. Certified Plot Plan { ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION COMMENTS DATE REJECTED 0 DATE APPROVED DATE REJECTED DATE APPROVED ❑ ❑ DATE REJECTED DATE APPROVED Alk 6 P• COMMENTS— FIRE DEPARTNIENT - Temp-Dumpste' ori site yes no Fire Departldl�6nt signature/date 1 ! ; COMMEic1TS' a Zoning Board of appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments 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) I'agc 3 of l Doc: INSPECTIONAL SERVICES DEPARTMENT:1313Fi)RM05 CrealedAIC 1,1,12006 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) ❑ 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: INSPE(TIO.NAL SERVICES DEPAR'r:',tEN'r:BPFORN'105 Page 4 of 4 Location No. �Date [ ' �oR,M TOWN OF NORTH ANDOVFR o�o•,,•.o ,��tio� i N A Certificate of Occupancy $ Building/Frame Permit Fee $1 s+cNus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # t U 2,,256 Buildir�spector 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 furnish all necessary materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and conditions, on prem• a elow described- Owner escribed: . . Owner's Name......... .. .1Z.i ..... .:l��.l.`t? ...f ......................... Tel p one ....... . Job Address ......�.1o..��. �t....�,—�,a�4,./.......... Ci . .� ty...... p.,..... ..�, .ttct.4 ............ State.............. Specifications: .....3......ca/ .....i.�.r.............`....j`'.. e ....... .t ............... ............................f. ......................................... .......�.. .... ........ ......0-1............... � ......r...........�. . . loc .................................................................... ....c.�....... ... ............. e..........��,1....�.,.......c.,s �.......... .........n1�.......................................................................... � h _ r r i1 .............(.....:........1..,; ........ .......w ..% 9 .........3...... ........ ,..t,, .........V., ...................� .......u.. I ................... .�t .. r ...- .... r. Two Year Workmanship Warranty (Not Tralzv If ............. W...r•,..!.........Q!.t.�Q.1" . ............... 1,.,.('.J.--...' ..fib..... Warranty as _ The c ctor agrees to perform the work 'sh th ateri s specified above for the SUM o($........a.. �ayable .., LT.�7.U........ on ... - r , 444-1 sain.............................. on ... ....... ..—...... ..... ... alance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability whys 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 parties are contained herein. _ .�Sb 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 f cancellation). / .1- /� IN WITNESS WHEREOF, the parries have hereunto signed their names this ... day of .... ..L�.rn.,e�l...., 20...t.l...� Accepted: Signed...../....................................................................... Owner I Signedx:/.�J .11141.4... Owner David Castricone, President O z x w A � u aG ;. ° w N � a cn o Uw GO z W � or. •� w m w v Uw" w a co p a Z w caw ir, a a U V rx cn w a p H u ,a � w co w z w w A a w v CU ° z cn Q cn mm N CA 3 cm m� m M .o N W N g oID . N m ; t M o o�oa imp0 O M '� Z CL CD i m c mCOD H IBJ C Co CD O +„ uim V m ._ 01 COD a' m O"o W h O !�- t .- CLO. m E v OLD t s N C CD m om m cri 0 c 'c N CD t O Z O J O II CD O E co • L O Z °D d O y D C IO cm Oca 'C h m m ow 3.0 C L env o a cm< ca aS C C cc •V J 'fl go d O ♦0.. C z Q :..� COD O C C C. C C CD r- 0 O o � O N C vV O ea m C CD O CD N � Q c ts `c\ 0 a T N ems.: C J Q: O O y r �':?• u cm cmc mm N CA 3 cm m� m M .o N W N g oID . N m ; t M o o�oa imp0 O M '� Z CL CD i m c mCOD H IBJ C Co CD O +„ uim V m ._ 01 COD a' m O"o W h O !�- t .- CLO. m E v OLD t s N C CD m om m cri 0 c 'c N CD t O Z O J O II CD O E co • L O Z °D d O y D C IO cm Oca 'C h m m ow 3.0 C L env o a cm< ca aS C C cc •V J 'fl go d O ♦0.. C z Q :..� COD O C C C. Massachusetts - Department of Public SafetN Board of Building- Re-julations .int] Standards Construction Supervisor Specialty License License: CS SL 99358 Restricted to: RF,WS rt DAVID CASTRICONE 31 COURT STREET NORTH ANDOVER, MA 01845 -�- �-� Expiration: 12/16/2011 (' uuwissi aicr Tr#: 99358 �1ie �anrinzareiaea�L o�✓��,aoaac/zuaelta Bonrd of Buildiug Regulations and,Standards.. HOME IMPROVEMENT CONTRACTOR x Registration: 104569 Expi ratio: i:. 7/ 14/2008 Type: Private Corporation DWO CASTRICONE ROOFING; SIDING & David Castricone: 200 SUTTON ST SUITE 226U� u -- NORTH ,ANDOVER, MA 01845 Deputy Administrat:n- 6 t The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia pensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):—IAVG_CAS-r &COME R00 F1 N&- S 1 D ug(, 6 T 1J C, Address: app &jm&d s-CY4u-,.-t` So tn_ 1Z,.l, City/State/Zip: R. ISN a p & n t -t A 4 i zq S Phone #:_ 9? ? 6 U 3 Y -�-Q Are you an employer? Check the appropriate box: 1. RC I am a employer with 8 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors !. ❑ I ant a sole proprietor or partner- listed on the attached sheet. ship and have no employees working for me ui any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have employees and have workers' comp. insurance.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 Type of project (required): 6.-E] New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition:.: ,. 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. [✓J of re air 13. ❑ Other *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. $Contractors 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: T14 E I NSU fAN } Co o f S -1 -pi -p. —?A Policy # or Self -ins. Lic. #: VV C. I aa), al B Expiration Date: q'aa I o i Job Site Address:11 A,"1_„ "0 C. City/State/Zip: NOA AAao orf , qA 01 opur 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 herebynder pais an penalties of perjury that. the information provided aboly ve is true and correct uAo Phone #: 7 0 �� 3 3 qa 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 #: Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM 04 '9 O y � V. T p LAMS 1e Cnc n�L���Mlt 11 A�R•lreo hpµ`y.t� .. . �S 5AC1U5�� 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: 4Z,* 5 //V(f, s 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.