HomeMy WebLinkAboutBuilding Permit #739 - 45 BRIDGES LANE 5/21/2010BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: -7)31
�^
Date Issued: !�.-V 'Lv
Date Received
TYPE OF IMPROVEMENT
PROPOSED USE
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 V1/ell
FloodplainUNeflarids `'
Watershed District
;.Water/Sewer
ur-Owo Ir i 1Un Ur VVUMK I U tit PKEFURMED:
/ 4 w// spa iv Ofe"'I of
Identification Please Type or Print Clearly)
OWNER: Name: M, -I, / Tk
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: $ 1% i'��. �� FEE: $ R (�•��
Check No.: 1 ?j �Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guarantj7 fund
Signature of Agent/Owner Signature..1 contractor -._C
Location -""t
No. 3 Date
1 �U
.—so Th 1 TOWN OF NORTH ANDOVER
[ + r s
F : I0 Certificate of Occupancy $
IMUS Building/Frame Permit Fee $ .
Foundation Permit Fee $ "
Other Permit Fee $
r TOTAL $
Check #Il 5
23: b6
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
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/Slignature & Date Driveway Permit
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
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
NOTES and DATA — (For department use
❑ Notified for pickup - Date
i
--- ----..-_.- ......... - ... ...... .......... ----
Doc.Building Permit Revised 2010
No
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
❑ 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: Building Permit Revised 2008
DAVID CASTRICONE �! / p ljb g
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 978-683-3410 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 des ribed:
Owner's Name .....�l.,l.......E.4.............................................................. Te hone #...� l••..- .. .✓. ..
jj
��/
r
Job Address ..... 7i.t11...........City....d»......rz.jG-.............. State...(./........
Specifications:
.................................................................
......... ...
Areas to be covered: 11 `
............,�.1........... .. ......'.!.'.........
......... .
.Apply vinyl siding and corners. Type: Ji f r_r ... f
:......................................................................5-!.....s%<...........�.........`r'J (� ree:/�..•y� t,Jo-ter y.
...
fiver fascia boards and rake boards.-dastall vinyl soffit -solid rtorated WcJ� ra-d i /�
......................................................................................................................................................................................................................
�o*ver wood giisings arouu wipdows. -Replace any gable vents and dryer vents with vinyl.
..{.7C ,tr gyp.: uax J...s.�. I•'.c�/x...l........................................................................................................................................................
;�iply a'derlayment Type:
............................. .... ...................`...`.................................................................................................................
.-Existing siding ... stripped go -over --Legal disposal of all debris.
............................................. ........
Rotted wood replaced @CO /sheet or....................................................................... �......
. ° ` .foot. ...........................
n.�"> ...... ,� ...... �F; .... ......... ..�................................................
........................0 .L( ...........S.l•y�/.r..7—
............................
...�g......�..................................................................
.rzi.1.�->^x xuzl........Wh.L.............................................................................
L ......
.................................................................................................................................................................. ....................... .....
................
One Year Workmanship Warranty (Not Transferable) Manufacturer's Warranty as sp by manufacturer
The contractor agrees to perform the work anish the materials specified above for the M of s....,12.ga.o..... ....
/ ayable on ..�$ ........
Payable......... ............ on..................................payable on completion of job
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 pro -misting 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). 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 finther 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 wanant(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) nemes(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 staled. 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, Horne 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 nonal
pe ty (see notice �gf cancellation).
IN WITNESS WHEREOF, the parties have hereunto signed their names this ......1. ...... day of ...... ....., 20... .......
Accepted:
Signed ............ ........ . ........... Owner
Signed .. .. - ......
.f........... ....................... Owner
1 Q2,
David Castricone, President ��
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
74d' www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lep-ibly
Name (Business/Organization/Individual): -DAy 11 C ASTR I C O N&. R o6 F I N(, a 5 IA 1 N LT I N L
Address: 2ocb Su--lspl3 S-v(?-�_E-"r Sy V -V -e- Z`L1.
City/State/Zip: N - M bQ JE IC MA 0 19 4S- Phone #: )-)� (p t 3 341-0
Are you an employer? Check the appropriate box:
1. ® 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.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
[No workers' comp. insurance
comp. msurance.t
required.]
5. ❑ We are a corporation and its
3. ❑ I am a homeowner doing all work
officers have exercised their
myself. [No workers' comp.
right of exemption per MGL
insurance required.] t
c. 152, §1(4), and we have no
employees. [No workers'
msurance
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. ❑ Roof repairs
13. ® Other y,rn s J,
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
I 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: _fl
y,-P
Policy # or Self -ins. Lic. #: W C.9 q S a I y b Expiration Date:3`201 °
Job Site Address: `JAS /�� d�eJ ^CCity/State/Zip: %% AI&V l
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: L� ..:/ CJ- C Date:
use
City or Town:
area, to be completed by city or'town official
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 #:
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Town. of North Andover
Building DCPartment
27 Charles Street
North Audove:r, Massachusetts 01845
(978) 688-9545 Fax (978) 688-9542
DEBRIS :DISPOSAL FORM
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,�.
-9
S�ACFlUS�'t
In accordance with elle provisions of Iv1GL c 40 s 54, and a condition of.
Building permit: W the debris r& -i.:1 ting from the work shill be disposed
of in a properly licensed solid waste disposal facilit.7 ;Is defined by MGL cl. 1, s150a.
The debris will be disposed of in /at:
Facility lc>�:.410tl
Signature of Applicant
Date
NOTE: A demolition permit from the Town of North Andover must be obtained. for this
project thiougli the Office of the Building Inspector,
License: CS SL 99358
Restricted to: RF,WS
DAVID CASTRICONL
4..
31 COURT STREET
NORTH ANDOVER MA 0-1845
l'" nuni.+ii a •r Tr-.:
99358
I I iFil�`' FIOMI.: IMPROVEMENT CONTRACTOR
Registration: 104569
Expiration: 7/14/2010 TO 270265
Type: I- rivalr.,. Corporation
DAVID CASTRICONL ROOFING, SIDING &
David CnslriconB
200 SUTTON ST SIJITE 226
NORTH ANDOVER, MA 0I8<65
�idminirfrator
m
L}SLY_/_1Yf.1 %_#L_ f% I I I j %0'r-% 1 L_ W f , I A 1-_09/2 8/21)09
PRODUCER 15487651-7744 FAx 508-653-8089
Eastern Insurance Group LLC -- Commercial
233 West Central Street
Natick, MA 01.760
Select Ext -51369
:THIS CERTIFICATE IS 1551IFD AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THk CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGr AFFORDED NY THF POLICIES BELOW.
---_�_
INSURERS AFFOROING COVERAGE NAIL #
INOURE0 David Castr4cone Roo Yng gr aiding Inc'IINSURER&:
200 Sutton St
su.; to 226
North Andover, MA 01645
-The Insurance Co of- State, PA
INSURER 6:
INSURER C.
INSURER D:
INSURER E.
rnwrvAnrc
THE POLIGIE5 OF IN5URANGE LISTED BELOW HAVE BEEN 155UEO TO THE INSURED NAMED ABOVE FOR TI !I' POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY Q{ OUIpEMENT, 71v4jM ()R I.nNDiTION nr ANY CONTRACT OR OTHER b0CUMIrNr WITH PESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED 013
MAY PERTAIN, THE INSURANCE AF=FORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF $UCH
POLICIES. AGGRfrATE LIMITS SHOWN MAY HAVE BLEN REDUCED 13Y PAID CLAIMS.
INSRDD'
I To
200 SUttOn Street
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
DAYS( tllAQ/XY
LIMITS
EACH QCGURRrNCr
AUTHORIZED REPRESENTATIVE
Stace Brice(PKG [j+Q'31L
GENERAL
LIAOILITY
�COMMERCIAL GENERAL LIABILITY
I CLAIMS MADG - DCCUR
—J LLL���
5AMACF_ TO ITL-NTF1
_
EiuCXr
MCD CXr' (Any one pornnn)
(Anyone In nion)
S
PCRSONAL P AOV INJURY
$
OL.NI-EAI AGC�PUGAR
$
CtN'L A0011rGAT1_ LIMIT APPLIES PCR.
11H000C15 -COMP1011 AGO
POLICY rRCI LOC
JECT
AUTOMODILF
LIAMUYY
ANY AUTO
COAnBIhIKD SINGLE LIMIT
11-a aerldr_m)
$
ALL OWNED AUTOS
SCHEDULED AUT05
BODILY INJURY
(PAI peronl
$
HIRED AUTOS
NON -OWNED AUTOS
RODIL.Y IMJI.IRV
(po'raa'den,)
$
PROI'I'.HYY OAMA(-1r
(Per Accldenl)
$
-�
GARAGE LIABILITY
AUTO ONLY, EA ACCIDENT
$
OTHER THAN PA ACG
$ _._..
ANY AUTO
AUTO ONLY: AGO
$
EXCE331VMBRFLL.A LIABILITY
CACI I OCCUPR^NCC
:F
OCCUR CLAIM$ FAACIE
AGGNLGATG
$
�^
$
T
Ott'VOTlliu.
R_
_L
RETENTION 5
WORNER9 COMPF-NSATIDN AND
EMPLOYERS• LIABILITY
WC9752746
09/23/2009
09/23/20,10
x WC STATU- OTH
nY UMLT"
E.L. EACH ACCIDENT
—
3 1001000
A
ANY aRQPRIE'rQRIPnR'iNFNEkFCl1'flvE
OFFICFRIM[MRF-R tXCLUDr_D9
If d.nnbc moor
E.L. DISEASE -1"Jl EMPLOYEE
g 100,000
F.L, DISFA$F - PQI ICY LIMIT
$ 5IQ QDQ
qyroe6
SPECIAI. PROVI&IONS below
OTHER
---
OCtr RIPYION OF OPERAYION3 I LOrATION9 I Vr HICLE9 I EXCLU91ON3 AODEn BY ENDORSEMENT I SPECIAL PROVISIONS
CFRTIFICATF nni nr-P rAGIrr-I I nTIn1,1
David C a S t r i c on e Roofing & Siding
SHOULD ANY OK YFIE ABOVE ,)I_; CRIDED POLICIES M: CANCELLED 9EI'ORE YHE
EXPIRATION DATE THEREOF. ThIE 1STIUING INSURER WILL ENDEAVOR TO MAIL
200 SUttOn Street
_ 10 DAYS WRITTEN NOT MP TO THF CERTIFICATE HOLDER NAMED TO THE LEFT,
Suite 226
BUT FAILUP..F TO MAIL SUCH h't.YIOE SHALL IMPOST NO OIILIGATION OR LIABILITY
North. Andover, MA 01845
OF ANY KIND IJPLIN YHE INSI, ;GR, IYS AGENTS OR 1epPRESL'NYAYIVES.
AUTHORIZED REPRESENTATIVE
Stace Brice(PKG [j+Q'31L
ACORD 25 (2001108) (T.1ACORD CORPORATION 1988