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Home My WebLink AboutBuilding Permit #389 - 428 WINTER STREET 11/19/2007 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 0 No pT 6 quo 0` 0 x � Permit NO: Date Received Date Issued: �9SSAGHU`�� IMPORTANT: Applicant must complete all items on this page LOCATION q01 ? W;r1' v Sim -r P ' PROPERTY OWNER /'Can -td J Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building W-One family ❑Addition ❑Two or more family ❑Industrial 0 Alteration No. of units: M repair, replacement ❑Assessory Bldg ❑ Commercial ❑Demolition ❑Moving(relocation) ❑Other ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED C fn*,Q and It4hInQ k, JU die- 4gd!AJ L Identification Please Type or Print Clearly) OWNER: Name: 'A,10FOrd Phone: 37" Address: 7 02 B wjb yei--J)f t f fa rw-,� A116(o vel &E-FJ' CONTRACTOR Name: J Phone: 91� (o&? y� VYt �U � t1� (J/ Address: Supervisor's Construction License: Exp. Date: Home Improvement License: ! UJ Exp. Date: os ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMAT D CO T BASED ON$125.00 PER S.F. Total Project Cost :$ (n FEE:$ o, 40—�— Check No.: D6 Receipt No.: Page I of 4 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 o Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building PP Permit Application o Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo CoPY of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) ❑ Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o 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 e TYPE OF SEWERAGE DISPOSAL Swimming Pools 11F1Tanning/Massage/Body Art ❑ Public Sewer Well Tobacco Sales ❑ Food Packaging/Sales [I❑ Permanent Dumpster on Site LlPrivate(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty4und r., Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING& DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS 4 s DATE REJECTED DATE APPROVED HEALTH ❑ ❑ "` COMMENTS r FIRE DEPARTMENT -Temp Dumpster on'site :yes .'no Fire Department signature/date 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 Drivewav Permit i i 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 f Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 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 i ❑ 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 E 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 No. Date N0RT1y TOWN OF NORTH ANDOVER Certificate of Occupancy $ ��s'••° �� Building/Frame Permit Fee $ ncwusE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # (� 20809 � Building Inspeci®i NORTH Town of Andover No. 3 ~ dover, Mass., l q' a C% HIA 0 0 L COC CHEWICK RATED S BOARD OF HEALTH Food/Kitchen PER IT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT......... . ...... ............................................................................................................... 0 buildings a Foundation has permission to erect....................................... n ..... ...... .......a .. ...... Rough tobe occupied as .....q.............................................................................I........I........................ Chimney. provided that the person acceptin his permit shall in every 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 CONSTRU Rough .................... ...................................................................................... Service. BUILDING INSPECTOR Final Occupancy Permit Required to Occupy 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. �j 'ACORQT,, CERTIFICATE OF LIABILITY INSURANCE DATE(MMI°°"YYY, 9/25/2007 PRODUCER 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:cltatlOn Insurance 40274 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. WS-TTAUM LTR INSRD TYPE OFINSURANCE POLICYNUMBER DATE( MIDO .I ) POLICYEXPIRATION DATE fMMIDr)/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGETORIN PREMISES Eaoocurenco $ CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ POLICY F1JE LOC A AUTOMOBILE LIABILITY 07MM13BTNKT 8/1/2007 8/1/2008 COMBINED SINGLE LIMIT ANYAUTO (Eaacciderd) $ ALL OWNEDAUTOS X SCHEDULEDAUTOS BODILYINJURY $250000 (Per pe(son) L 5 0 0 0 0 X HIREDAUTOS BODILY INJURY X, NON-OWNEDAUTOS (Peracciderd) $500000 PROPERTY DAMAGE (Peracciderd) $100000 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO EAACC $ OTHER THAN AUTOONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACHOCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ B WORKERS COMPENSATION AND WC7222278 9/23/2007 9/23/2008 XT CYT'TU- OTH- EMPLOYERS'UABWTY ANY PROPRIETOR/PARTNER/EXECUTIVE E.LEACHACCIDENT $100000 OFFICER/MEMBEREXCLUDED? IIvee,describe under E.L DISEASE-EA EMPLOYEE $1 Q Q Q Q Q SPEC IAL PROVISIONS below OTHER E.LDISEASE-POUCYLIMIT $ 5 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SP ECIALPROVISIONS I i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, .BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. 1 AUTHORD'ED REPRESENTATI ACORD 25(2001/08) `f p ACORD CORPORATION 1988 The Commonwealth of Massachusetts —_v Department of Industrial Accidents t F rj s; Office of Investigations 600 Washington Street Y k; Boston, MA 02111 } www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): :DhV I h LN,TR l Co N C Q i N 6 `' L tJ i Nt a L Address: -o 06 5 u 7TOQ S TIZU-T - Su ITE ;Z.')-(a City/State/Zip: . 4N b o vLce, IMA 01 F49 Phone#: Q 19 & S 3 <3 4 a o Are you an employer? Check the appropriate box: Type of project(required): 1.2 I am a employer with $ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. F1 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 g. ❑ Demolition working for the in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.2' oof repair 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. #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: C. ,h5 V IlaflCCt CO O 5�`o#L Ypt Policy #or Self-ins. Lic. #: W Expiration Date: Job Site Address: I City/State/Zip:np• dues RA 0 �� 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 cer ' under t pains an enalties ofperjury that the information provided above is true and correct. Signature Date: / Phone#: 3 3�� 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 VAORTfy � Building Department a .. 16 27 Charles Street North Andover Massachusetts tt s01 1845 h O �o V. �AHi (978} 688-9545 Fax 9781 688-9542 pp COLHICryC yKH ( J � 0R�treo �P�` •(y ��SACNUS�'� 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: � Z' ` e, ' eA Facility location 4 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. 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 premises below described: Owner's Name......... J•••••T,i•L` ............Tele hone#...t��.4..�.S.r ...f....- <..� ...... .. .................................................. JA�r Job Address..... ;, VV.L.F 1/1.L' 1......tis.�................city....AL....A. a..►l.a Z...........State...../."F... ....... ... ............ Specifications: ..................................................... .................................................................—............................................................................................. ✓Strip existing shingles.0i tApply new drip edge to all edges. ll� i 7,_ go> .. ...................................................................................................... ....................................................................................... ✓e�pply _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. ..................................y..................................................................... ........................................................................1,.................... ... �( 1 felt p7cr u rla ment. -Install ridge vent to a .S•gji� PP.y..e'i�...I.ra. .................. . .............. .............................................................. ....... VIteroof using-77_. �'L� �KV f yr shingles with a -year warranty. z n�� .......................�'G ............,......................... .. IY6)......................................................................................... unterilash chimney. —New vent pipe flashing. --Ykgal disposal of all debris. ........................................................:Y..j....................................................................................................................................................... Area(s)to be worked on: J.....r .......S..L:il. 5......JF1LaS.c.ru....a -u� r> .,...a.., �- ................................. ................................................... ............................ ...............................�,..... . ...... / a.. 7 ! ... �.. ..........`J ..... 4.0 . ... ..... t,...A-11... ......� 3. . . V . . ................................................. ....................................................... ........... ................... ...................................................................... Roof board replacement if necessary @ 40 /sheet ora° /foot. r---.--: .................... Two Year Workmanship Warranty(Not Transferable) 11'M'anufacturer's Warranty; sped bymanufacturer L The cp�ractor agrees to perform the work ish the materials specified above for the SU of$... f•iL l�J........•• Payable.....YL.................on....5 ............... Payable........—...............on........... ................. ,2 alance payable on completion of ob Owner or Owners are not responsible for Property Damage or Liability whi e�s i.0 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 owners)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 ate) the owners(s)ofthe above mentioned premises and that legal title thereto stands of record in his(their)names(s).There are no representations,guaranties or wan antics,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 ac.. .......................... pknowledged,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 es this....?.4'4*'.day of........... �• •••••,20..0.7. Accepted: Signed.... .. .. .... .......... Owner Signed............................................................................. Owner aii 22rc-U \ David Castricone,President �u S 11