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Home My WebLink AboutBuilding Permit #424 - 481 REA STREET 11/27/2006 1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Of NORT1�kOR qti t O Permit NO: Date Received 'e2 4IWI '+4 Date Issued: "� 0 �9SSACHUS�� IMPORTANT: Applicant must complete all items on this page LOCATION g � / � PROPERTY OWNER !`7tC 1�C./ Print Print MAP NO.:S!t--PARCF.Q4- ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial C Alteration No. of units: ❑ Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED AO Identification Please Type or Print Clearly) ,� l I Cowlt/ /q OWNER: Name: !tel I L'Aa e—1 Phone: / 9�-J 6 d 7 11 Address: �ea J� reet y r4-� &A CONTRACTOR Name: / ` 1 fie PVA()Ci J(� �( Phone: C f3 3 V2 O Address: Ste,v) S f rte� 1 b j�OV�►� . 6 Supervisor's Construction License: `I Exp. Date: Home Improvement License: T�w� Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$10.00 PER$1200.00 OF THE TOTAL ESTIMATED COST BASED ON$115.00 PER S.F. Total Project Cost :$ i 3 H 0- A x12.00=FEE:$ &03— Check G3— Check No.: / �� Receipt No.: 401 _ 11:age i of 4 i i TYPE OF SEWERAGE DISPOSAL Swimming Pools El Art ❑ Public Sewer ❑ Well Tobacco Sales ❑ Food Packaging/Sales 11❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor C Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SICK OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit I ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer connection/Si nature& Date Driveway Permit Temp Dumpster on site yes n Fire Department signature/date 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) r Page 3 of�! Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Cremed AT.Lm._000 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 o 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:INSPEC'r1ONA1,SERVICES DEPARTNIENT:11PFOR:1105 pnoN 4 4)CA r-- Location �� f �y e s I-- No. 7 Date "ORT1y TOWN OF NORTH ANDOVER O?O•'•`•D '•,hOow • ; ; Certificate of Occupancy $ sACMUS t� Building/Frame Permit Fee $ �. Foundation Permit Fee $ y Other Permit Fee $ TOTAL $ Check #/ q�4 19829 Building Inspector NORTH Town of Andover No. 6 over, Mass.,/hAl2 CPG 1� coc..C.6".'.C. '- \ 40ATED I" BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT.....t...........*. C.A.... ... ............ BUILDING INSPECTOR Foundation has permission to erect................ t........ buildings on.. to..........AWA1010........................................... Rough tobe occupied as......A... ... .... .0 .....Sk. . .............................................................................................................. Chimney provided that the person ac ting i irmit s6ill in every respect conform to the terms of the application on file in*'c W 44 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 TS Rough Service aTI.........i........... INSPECTOR Final Occupancy Permit Required to Owipy 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. 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 978-683-3450 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: p Owner's Name.......Mt.. . .......c0�1/.................................I...........T ephone#.....rll.. ..- r...... Job Address.....W.1.... .....................I...........City.. Ct.... v.ir<-�`.............State......M...... Specifications: .. rip. ..e..x...ist...i... .hin......g..les.. . ..................................................................................,�r............................................................................................. tng...s ( ply new drip edge to all edges. 4, ............................................................................................................................................................................................................. Apply G feet ice and water shield membrane to bottom ed es of house. 3 feet ice and water shield membrane in valleys and bottom edges of any unheated areas of house. ................ 1.... pply felt paper under) rent 'install ridge vent to /. .. ..A.a ...............�.. ............................. .... goof using shingles with a year.warran - ................................ ty" i P160unterflash chimney. LXM vent pipe flashing. I'Legal disposal of all debris. ................................................. 1..t................................. Area(s)to be worked on: //, .J- .......................................... tl.... i.:rr�.J ....... ........ri ....... . .n1.cS.� ............................................... ......................................W.- .......lN...:... ......................................................................................................... ..................................................................... ....................... Roof board replacement if necessary @ ep /sheet or y t" /foot. ...................................................................................................................................................................................................................... Two Year Workmanship Warranty(Not Transferable) Wanufacturer's Warranty as s ' y manufac u The c for agrees to perform the work h the materials specified above for the M of$....1-3..$.2L).............. ayable....l. a...........on... ...... Payable..........:=............on...........;FF ............... alance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability whItirl5b is in operation. Contractor is not responsible for any damage to the interior of property,including preexisting 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. 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 119-qt'.day of../)Cy.1 „ r 20...G,(; Accepted: Signed .. .. ...........�. ................................. Owner D,- ) Signed............................................................................. Owner David Castricone,President Town of North Andover F J,ORT�, o Building Department o� �� - �Q o 27 Charles Street North Andover, Massachusetts 01845 (978)688-9545 Fax(978) 688-9542 � 0�,ro CH 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, s150a. The debris will be disposed of in/at: 91 c M N# 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. Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumlbers Applicant Information Please Print Le 'blv Name (Business/Organization/Individual):�Dj CA t ' Cone— RacAi A, Address: ,.UO &At r ' -+Y ec_+ - Sri 22(0 City/State/Zip: N 6. WUef M A d I%qS Phone #: 9� (o 3 3 YZ o Are you an employer? Check the appropriate box: Type of project(required): l.)C I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employee's(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. [] Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' camp. c. 152, §1(4),and we have no 12, Of7repa s insurance required.] t employees. [No workers' comp. insurance required.] 13. Other *Any applicant that checks box#I 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 tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. rn Insurance Company Name: rr ..L• �./ ' r• Policy#or Self-ins. Lic. #: Y VV l.. OO / 0 OQ l 24D Expiration Date:_ 9,a3–0" Job Site Address: City/State/Zip: he t¢dDQ 6/0 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 tine up to$1,500.00 and/or one-year unprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains andpenalties of perjury t: that the information provided above is true and correct. Signature: p c / Date: Phone#: "l 7 0 � E 55 7�- Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: . CERTIFICATE OF LIABILITY INSURANCE DATE(MM/� DDIYYYY PRovuCER 08/2o/20G6 THIO CERTIFICATE I$ISSUED AS A MATTER OF INFORMATION Internet Insurance Agency ONLY AND CONFERS NO RIGHT13 UPON THE CERTIFICATE 522 ChIDkering Road HOLDER,!Hla CERTIFICATE DOES NOT AMEND,EXTEND OR North Andover, MA 018:15 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, . INauReo INSURER$AFFORDING COVERAGE I NAIC.$ DAVID CASTRICONE INSURER A; NORFOLK&DDEDHAM ROOFING AND SIDING INC, INSURER B: NORPOLK$DEDHAM 200 SUTTON STREET,STE,228 weUr,ERC; AIM NORTH ANDOVER, MA 01845 f 1'JaURERD: INE RER:, • COVERAGES THE POLICIES OF INSJRANOE L;BT80 9ELOW HAVE SEEN ISSUED TO TIE INSURED NAvED ABOVE FOR THF POLICY PERIOD INDICATED.N.TWITHBTANDING ANY RFOUIREINT.TERMOR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WiTH RESPECT TO WHICH THIS CGR T IFIOATE MAYBE ISSUED OR MAY EE•V PHRTAIN,THE INSURANCE AFFORDED 8Y THE POLIGiES DESCRIBED HEREIN 19 SUBJECT TO ALL TME T2RMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIE8.AGGREGATE LIMITS SHOVNN MAY HAVE BEEN REDUCCU BY PAID CLAIMS. L R I45R0 TYPO OF INSUPAIlGra POLICY NUN15CR !U / UMITS A GSNRRALUAEILITY �;p.p.Opggg7 8112/2005 8/12/2007 eACrlaccuaRENCE a �.000.000.00 COMMERCIAL GENERAL LIABILITY PA4 E ec fi nn 59.000.00 CLAIMS MADE 7 OCCUR MED 60(Any one person) g e,000.00 I PERSONAL&ADV INJURY 3 'AC0,000.00 6 G'NERAL AGOREGATE = I,D00,000.00 EN'L AGGREGATE LIMIT APF7 PER: PRCDUCTS-OOMPIOP ASP A 1,000,000,00 POLICY pF;OJBCT LOO B AUTOMOBILE LIABILITY 445015400001 OBi01/2006 08/01/2007 ANY AUTC $PjMcc eM)eI.Vle SINGLE LIMIT $ A A:L OWNED AUTOS V/ acHE0'ULEOAUTOS A ILYINJURY S 250,000.00 (Per person} hIRZD AUTOG NON-OWNED AUTOa ILY i JJUIjRV =600,000,00 PROPER7Y DAMAGE $100,000.00 (Per ecclden:) GARAGE LWNLIIY ANY AUT? AUTO ONLY-CAACCIOENT 6 ' OTHER Tr 1 ..E_A ACC 6 A O OjltON A G EXOEsa/UMBRELLA UABILITY ( EACH OCCURRENCE 5 OCCUR CLAIMS MADE AGGREGATE S • I 6 DEDUCTIBLE RETE�7IUN E C *p 00.5MI XMANDVWC 6009480012004 09/23/2008 0912312007 TORY MITs ANY P RY��EppRIFTOR/PARTNeAr6XECUTIVP EL.EACH ACCIDENT s 100,000.00 OFFICER/M44MAER 6,'ICLUDEW IIrr ye.,daecribe undsr !l.DISEASE-EA EMD.OYEE 5 tiU0 ODO,QO BPCCIAL PROVIBIbNB below E.L.bISEASE-POLICY LIMI j "00,00040 OTNER CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE OEBCRI@GD AOIJ01E6 At CANCELLED BEFORQ THE SMIDATION DATE THCREOP,THE 156UING INSURER WILL ENbEAVOR 70-MAIL 030 DAY$YYRIIT@N NOTICE TO THE CERTIFICATE HOLOCA NAMED TO THE LEFT,BUT FAILURC TO 00 80 SHALL IMP06E NO ODUQATION OR LU181LITY QF ANY KIND UPON THS INSURER,ITS A4jNT8 011 REPRESGNTATIVE8, AUTMORI2ED RGPRESENTATIVC ACORD 25(260110$) A A RD CORPORATION 1966 I II I