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HomeMy WebLinkAboutBuilding Permit #88-16 - 460 STEVENS STREET 7/22/2015BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: 91 Date Issued: IMPORTANT: Date Received must complete all items on this LOCATION L4(D D 51e -V 4rce-A \ PROPERTY OWNER -b r e n C 0–n Print �v 5e -y- Print 100 Year Structure yes MAPPARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes or ■ SLED /6� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 00ne family [I 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 OWNER: 1Name: Address: 'f � o Contractor Name: DESCRIPTION OF WORK I U tit rtKrUKivitu: Identification - Please Type or Print Clearly Y\ AA n TIS c �P r Phone: I Supervisor's Construction License: 99 Exp. Date: 1 ,�, - I L - ZO 15- Home Improvement License: Date: 'I - 14-1 Z01 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERM] IT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ `7 . �L) FEE: $ t Check No.: t�9SReceipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund n r— Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature, CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 4 9 COMMENTS 0 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Com Conservation Decision: Comments Water & Sewer Connection/signature Date Drivewav Permit DPW Town Engineer: Signature: F; IRE�DEPAR�TMEN�T, �-`Temn�n COMMENTS_ Located 384 Osgood Street n "Mr.' onIsite 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 lies No ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine Doc.Building Pennit Revised 2014 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 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) :rF Engineering Affidavits for Engineered products All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two. Family) � Building Permit Application 4 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 2012 IECC Energy code Engineering Affidavits for Engineered products TOTE: 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 Doe: Building Permit Revised 2014 O JQ Z 0 C r +u+ Y O U. +a) N .Q V) 0 W N Z z D m c 2 m LLL K U � LL 0 W N Z Z m d K LL 0 W N Z (� d• W to K v i (n LL oc 0 V W a Z Q to C LL z W a. a CL W W i CO p z N V) +� v O {n w F Q U a cnZ Z 0 m i z G Z O Lu I.L Q. z W O U W J E o o z ^� V/ W CL � 0 0 O CL a CL co Q O _ V J ca • -0 ,CA Ot'wy'yw+, W O U cU c U) DAVID CASTRICONE, PRES. CASTRICONE ROOFING & SIDING INC. fir.• ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 231 R SUTTON STREET UNIT 3A, NO. ANDOVER, MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314 I/we 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: ,s Owner's Name... 1.I"%dr..F7••r+l ....�. f�.S..'.:...................................... Telephone tl......�:., 7:...... -017 i Job Address....:.l..G� ( ::... '.:� ✓..iwi f �....�. ]...;. / ... City.....�...,�, .,..f..�: til{. �.I1..L. ;`............ State... Specificalions: ..................................................................................................................................................... :/Strip existing shingles.(d ✓/Apply new drip edge to all edges. Wk -PI -e- y �/ ... ................................ I.,............................. .... ........................................................... ....................................................... I................. l,r{pply _feet ice and water shield membrane to hit ttom edges of house. 3 feet ice and water shield membrane in valleys and bottom edges of any unheatedareas yeas of house. ........................................................... rXpply LW t'tpy't' a nderlayment. Install ridgtewent to at 1-02silliz C, J, .......r}..... )...... ............................. ,......,............................................................... _shingles with a-warranty. ........................................................................................ . .......................................................................................................................... vCounterllash chimney. ►'New vent pipe flashing. egal disposal of all debris. .......................................................... ....................... r: .Arca(s) to be woi'6et1 on•................................................................... ........ ................... J kv .. .... 4, . - ....................... ............................................ ............................................................. .r ...a.,....-:.:......................................................................... ....................repl...............:............, ry..................../Ar........i'roor Roof board replacement if necessary /sheet or VV ................................................................................................................................ Five Year Workmanship Warranty (Not Transferable) Manufacturer's Warranty as specified by manufacturer The contractor a ees to perform the work d ish the materials specified above for the SUM of $.... .... PayabI . . .......... on .. ,: i�f ................ M' ` 'fr Payable ............................. on .................................. Balance 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 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 ofabove woik, 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, attomey 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. Property may be subject to mechanic's lien if unpaid. It is further agreed that this contract may be assigned by contractor, and also that the obligations horcof 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). Therc 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 lmprovement.Contractors shall'be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to the Office of Consumer Affairs and Business Regulations, Tel. (617) 973-8700. 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�.UAP ..%..�°- 'r . ............... Completion date ......................................................... Receipt of a copy of this contact is here* 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 This contract may be cancelled, without penalty or obligation, within three business days of the below -referenced date. Mail or deliver a signed and dated notice or send a telegram to Castricone Roofing & Siding Iric, 231 R Sutton St., No, Andover, MA 018 45. IN WITNESS WHEREOF, the parties have hereunto signed their this .,a 5�.:.:... day of ..'.r.t�t d t r -,,.,,., 20../?,.. Accepted: - JJ ;y1 Signed ,... N•��.............. ..Z...............Owner Ii Signed............................................................................. Owner David Castricone, President The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of .Investigations I , _ J` 600 Washin fon Street - Boston, MA 02111 - - fvww. rnass.go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information SiPlease Print Legibly Name (Business/Organization/ladividual): /��{ 1 D �J S ('� 1 �V t 'RO b F 1 N6 " J D( N O 1W L Address: �,3 i S, jre N S` i (Re- e-7 U N t 'i 3A City/Statc/Zip: No, A N oor f�r,, W 61M M Phone #: 9%103 & �) o Are you an employer? Check the appropriate box: . M I am a employer with J 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.4 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 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.X Roof repairs 13.❑ Other *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 Thether or not those entities have employees. Lf 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 Com an Name: 0 p Y �I�ANrT� iATr; NSU UNCI Co Policy # or Self -ins. Lic. #: WO -0 O 39 i 9 q o 3 Expiration Date. --'f Job Site Address: 4(0 0 Je ie V 11 Mox-c-A City/S-ta&Zip: I `r0- AnA o" o iu s - 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: Phone #: �� ' fo� OAC) Official use only. Do not write in this area, to be completed by city or town offzciaL 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 #: A� O® CERTIFICATE OF LIABILITY INSURANCE 9/10/ 014 ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Eastern Insurance Group LLC 233 West Central St Natick MA 01760 CONTACT SUSan Donnell NAME: PHONE (800)333-7234 ac No: E-MAIL ADDRESS: sdonnell@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC # INSURER A Western World Insurance Co INSURED David Castricone Roofing & Siding Inc, DBA: 231 Rear Sutton Street, Unit 3A North Andover MA 01845 INSURERB:Commerce Insurance Company 4754 INSURER C:Granite State Insurance Co. INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBERMaster 14-15 REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I LTR TYPE OF INSURANCE INSR WVD SUER POLICY NUMBER EFF MMIDDY/YYYY POLICY EXP MMI D/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGEPREMISESS ( RENTED 50,000 Ea occurcence$ A CLAIMS -MADE Fx1 OCCUR NPP1388404 /6/2014 /6/2015 MED EXP (Any one person) $ 1,000 PERSONAL& ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaccdent $ 1,000,000 BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS CNGCV 8/1/2014 /1/2015 BODILY INJURY(Per accident) $ X NON -OWNED FX HIRED AUTOS AUTOS PROPERTY DAMAGE$ Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ C WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y I N E.L. EACH ACCIDENT $ 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A WC003989723 9/23/2014 9/23/2015 E.L. DISEASE - EA EMPLOYEE $ 100,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Roofing & siding contractor CERTIFICATE HOLDER r.ANrr-I I ATION AL,UKLJ ZO tZVIU/UD) I NS025 nn nns n i ©1988-2010 ACORD CORPORATION. All rights reserved. Tho Ar'nPn n,m nn ,l lnnn -- runic♦ororl m jr ^4 Amon SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE John Koegel /MET----�� AL,UKLJ ZO tZVIU/UD) I NS025 nn nns n i ©1988-2010 ACORD CORPORATION. All rights reserved. Tho Ar'nPn n,m nn ,l lnnn -- runic♦ororl m jr ^4 Amon Massachusetts - Department of Public Safety Board of Building Regulations and Standards C ,mtruL HIM SuiurN 1.1,j Shrri;:11� -cense CSSL-099358 DAVID T CASTRICONE� 31 COURT STREET NORTH ANDOVER MA: 4'018 5 r J..G... �+=XpiratiOn Commissioner 12/16/2015 ur..riu..... Office of Consumer Affairs & Business Regula DUlatiOn T!=OME IMPROVEMENT CONTRACTOR .1.6 Oegistration: 104569 tom„ Type: Expiration: 7/14/2016 Private Corporatic DAVID CASTRICONE ROOFING, SIDING & David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undcrsccretary Town ot' North Andover F 4(')k7 0 9� 0 Building Department 27 Charles Street A Nonh Andover, Massachusetts 01845 (x'78) 68 8 -9 54 5 Fax (978) 688-9542 �ro 4 p cSACHU5E� DEBRIS DISPOSAL FORM ,'n accordance with the provisions of MGL c 40 s 54, and a condition of Bui!ung Permit 9 the debris resulting from the worl; sltall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 1 sl 50a The debris will be disposed of in /at v r , Facility location Signature of Applicant Date NOTA A demolition permit from the Town of North Andover must be obtained for this project tluough the Office of the Building Inspector. Locatio" *Pc) 41fQ0,5 S�Ul+ No. 15r-� I g5 Date Check # 42--70 " - 122. e- U TOWN OF NORTH ANDOVER Ceftificate of Occupancy duilding/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL $ Building Inspector