HomeMy WebLinkAboutBuilding Permit #685 - 471 JOHNSON STREET 6/10/2009Permit N06
Date Issued: O 1
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
41
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IMPORTANT: Applicant must complete all items on this Daize I
LOCATION -71 ,�nsoa Strre-r
l Print
PROPERTY OWNER�e
MAP NO:q_PARCEL:� ZONING DISTRICT: Historic District yes no
Machine Shop Villaae ves no
TYPE OF IMPROVEMENT
PROPOSED USE
Phone:
9 �8 0 3 -3 4 D-0
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 PREFORMED:
�-S�'nc� �
Identification , Please Type or Print Clearly)
OWNER: Name: )o- - � \.s F='-f"l Phone: 9)& 6 & j-621 y
Address: Li-) �
M
JT' -
CONTRACTOR Name: C1a0b
u) w e( ah Cb
Phone:
9 �8 0 3 -3 4 D-0
Address: (! 0 U
y
Supervisor's Construction License: Exp. Date: 1 ba
Home Improvement License: 104 �l Exp. Date: ` H -- U 1 Q
ARCHITECT/ENGINEER Phone:
Address: Reg. No
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST ASED ON $125.00 PER S.F.
Total Project Cost: $ LI % • d v FEE: $
Check No.: Receipt No.: 22 ( o
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
-®-- -- - ----- _ - -- -'- - - _ �--�--- - --- - --___- lj - -
Signature of Agent/Owner Signature of 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 Osaood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
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 No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTE5 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
❑ 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
Location .0
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No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
'Its ^O ��<�' Building/Frame /Frame Permit Fee $
�ss.�....tE 9
Foundation Permit Fee
Other Permit Fee
TOTAL
Check #
22,LJ
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www massgov/dia
Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Name (Business/Organization/Individual):
Address: ZAU St -i-er SA SL.:, �-)a -Z ?-(p
City/State/Zip: lei, P4)A0Vp! W M Phone #: 916 6 �3 3q -Lo
Are you an employer? Check the appropriate box:
INI 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. insurance.1
required.]
5. ❑ We are a corporation and its
3. ❑ 1 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'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. E] Electrical repairs or additions
I L ❑ Plumbing repairs or additions
12.❑ Roof repairs
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:7) \jy�,e„ 0_o. Qc� S p, >rr
Policy # or Self -ins. Lic. #:_ I I C. '!�(6 —771 : tD Expiration Date: I of 3 U9
Job Site Address: y Jbhnsbil STM- City/State/Zip: d e, 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 $256.00 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 #: 1 (a ((� 2-c)
use only. Do not write in this area, to
City or Town:
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 #:
rtl v'a a I A I 1 v /'1 I IL V I- L, LH a I
PRODUCER Phone; 500-651-7700 Fax: 509-653-0009
Eastern Insurance Group LLC -Commercial Lines
233 West Central Street
Natick MA 01760
---IMPUNANUt 10/3/2008
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
ACORD 25 (2001/OB)
AUTHORIZED REPRESENTATIVE
p ACORD CORPORATION 1988
INSURED INSURERS AFFORDING COVERAGE NAIC #
David Castricone Roofing & Siding Inc INSURE RA:Ci' t Insurance 02 4
200 Sutton St INSURERB:The Insurance Co of State PA
Suite 226 INSURER C:
North Andover MA 01845 INSURER D:
INSURER F:
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.
MR
T I TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY AEACI-(OCCURRENCE
UnrPTL'D-
1:1PREMISES Eaoccwence_j_ 'U
CLAIMS MADE OCCUR
MEDEXP(Anyone parson)
PERSONALAADVINJURY $
GENERALAGGREGATE $
GEM1 AGGREGATE LIMIT APPLIES PER;
POLICY PRO- PRODUCTS-COMP/OP AGO $
LOC
A AUTOMOBILE LIABILITY 08MMBBTNKT 8/1/2008 8/1/2009
ANYAUTO COMBINED SINGLE LIMIT
(Ea accidarl)
ALL OWNED AUTOS
X SCHEDIILEDAUTOS BODILYINJURY
(Per person) $ 250, 000
X HIREDAUTOS
}( NON-OWNEDAUTOS BODILY INJURY
(Par aCCICION) $500,000
PROPERTYDAMAGE
(Peracrldonl) $100,000
GARAGE LIABILITY
AUTO ONLY -EAACCI DENT $
ANYAUTO
OTHER THAN EA ACC $
AUTOONLY: AGG $
EXCESSIUMBRELLA LIABILITY
EACHOCCURRENCE $
OCCUR CLAIMS MADE
AGGREGATE $
DEDUCTIBLE
RETENTION $
$
B WORKERS COMPENSATION AND WC 58 7 7 7 5 G q WC ST TU- OTH-
EMPLOYERS'LIABIUTY `3/23/2008 9/23/2009 X -
ANY PROPRIEIORIPARINOW-XEC1TIVE E.L EACH ACCIDENT $100,000
OFF] CER/MEMBEREXCLUDEp7
Ilyyosdasalbaunclar "• E-.LDISEASE - EA EMPLOYEE $100 000
SPECIAL PROVISIONS bokyw e
OTHER E.L DISEASE- POUCY LIMIT $ soo. 000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
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 Y,IND UPON
THE INSURER, ITS AGENTS OR REPRESENTATIVES.
ACORD 25 (2001/OB)
AUTHORIZED REPRESENTATIVE
p ACORD CORPORATION 1988
Massachusetts - Department of Public Safetj
Board of Building, Re�-ulations and Standards
Construction Supervisor Specialty License
License: CS SL 99358
Restricted to: RFAS
DAVID CASTRICONE�_"
31 COURT STREET
NORTH ANDOVER, MA 01845 `
Expiration: 12/1612011
( nuuL..i ncr Tr;{: 99358
,p� ✓�ze T�ayxyno�uuP,al� a��//Ca��ivaeiia
n\ Board of Building Regulatio s and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 104569
Expiration: 7/14/2010 Tr# 270265
Type:- Private Corporation
DAVID CASTRICONE ROOFING, SIDING &
David Castricone
200 SUTTON ST SUITE 226,1,`
NORTH ANDOVER, MA 01845 Administrator
i.
Town of North Andover
Building Department
27 Charles Street
North Andover, Massachusetts 01845
(978) 688-9545 Fax (978) 688-9542
DEBRIS DISPOSAL FORM
tAO R Tly
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O�is��o �6rt 41o . 1
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V.
<O<KI[ry� W K h
pORATEO nP�`y.ty
ITACHOt
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, s150a.
The debris will be disposed of in /at. -
Z'
Facility location
` a
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.
61-�It f
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 HaverkiU 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 irlow de cribed: , c� M1•
�b—. �.t �........ ...�.c.. �E. a .................................. T ephone #.....�S1..:.....C..�,.,.%.Li.
Owner's Name......��.d :....�.... �1' .......
Job Address .... q.t�..:.l . l....rt �.t tet.:..... ............................... City...1.Jv.C:.......... l:u..v-c.. .............. State .... /yW..T.........
Specifications:
.................................................................................................................S............................
.......................................
.................................
.Strip existing „tingles w 'Apply new drip edge to all edges. Vit, k'r.
vlpply G 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 ugderlayment, —Install ridge vent to
tRi roof using
.....................1.........................
rd..
shingles with a 2 year warranty.
......................................................................................................................................................................................................................
-Counterflash chimney. -- New vent pipe tlas�ing. Legal disposal of all debris.
')
8� .. ,. .....................................q 4--C_,,Areas to be worked on: 11 / j ...................................... L.1.1.....LTz:a........G w':.r . ........ ............... .l.. .... d.............................................................
........ ,.. ...Lq........ .� .....�..a .... � �Y....................... ..............................................................
..............
� .... t:.......zJ..........................................................................................................................
.......................................................................................
05 .. ...........
Roof board replacement if necessary @ 6,0 /sheet L ` /foot.
........ ........................................................................................... ......................................................... I ....... .. ........ .. ..
....................
Two Year Workmanship Warranty (Not Transferable) hTanufacturer's Warranty as specirper6y ma of cturer
The c clot agrees to perform the yvork 2 g i_sh the materials specified above for the SU of $....71.1' .z�!...............
�ayable .....`:.C7........ ...........
Payable....... .......... on .................................. 0Balance payable on completion of job
Owner or Owners are not responsible for Property Damage or Liability while boli 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 refinsal 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 ad
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.
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 ...�J. %l .... day of .:� _r .... ......... 20.01..
Accepted:
)'Signed ... r% : . » : » ».......... Owner
�} Signe............................................................................. Owner
David Castricone, President