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HomeMy WebLinkAboutBuilding Permit #247 - 483 JOHNSON STREET 9/28/2009 BUILDING PERMIT o�"u t) ";�tio TOWN OF NORTH ANDOVER 32 b._..`` ° o APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received pZ447ED �SSACHus�� Date Issued: IMP RTANT:Applicant must complete all items on this page LOCATION 03 Jd h rtj t,,-) Sre e-k Print PROPERTY OWNER 5a`byl le, lch Print MAP NO: PARCEL: ZONING DISTRICT: HistoricDistrict yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building VOne 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: re's hI/V� (P w if Identification Please Type or Print Clearly) Y) OWNER: Name: 6b&ro n L t d Phone: f G E 5 D i 4 Let �, 97 Address: 3 Jd htodn 9JHe1 4rfk 1%daves, M14 CONTRACTOR Name: -baj Id T" tbrne., Poob At Phone: Address: Zoy S-4on StM - nc(rJ x Hp1 , a , ( Supervisor's Construction License: q q 3 S Exp. Date:__ Home Improvement License: f D+�;to Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ o�J ` FEE: $ aJ / Check No.: �1S Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to th guaranty fund 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/SaTes - 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS I 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/Signature$Date Driveway Permit Located at 384 Osgood 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 NOTES and DATA— For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 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 o Floor Plan Or Proposed Interior Work o 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 o 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 L3 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 2.2007 Location No. Date Na�Th TOWN OF NORTH ANDOVER 3 � F R • _,::_. Certificate of Occupancy $ AI sArM�SE<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #_0_ r •� ,�Cf O 2 / 4:UJ Building Inspector NORTH o Of o a - No. 7 ,. �'o A K E dover, Mass., COCHICHEwICK %p ADRATED S BOARD OF HEALTH PE .RM IT T D Food/Kitchen Septic System C­I / BUILDING INSPECTOR THISCERTIFIES THAT..... rave............... ... ....................................................................................................... "' C Foundation has permission to erect........................................ buildings on ...... a. .............0h_/kSdn........' --..................... Rough g Chimney to be occupied as........... ........ .......-4-........ ......... ......... y provided that the person accept! this permit shall in ev 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 CONSTRUST TS Rough 7................................. ........................ 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. DAVID CASTRICONE glAf o 9 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 978-374-731 4 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...... ......... .SrI. ... ............................................Tele elf....9 �.�9 C1. Job Address...... ..... r -....... ..............Ci ty......� .,.�.f. . ..........State......y^ ........ Specifications: ...................................................................................................................................................................................................................... rlp existing shingles.( Apply new drip edge to all edges. l0'_'" ...................................................................................................................................................................................................................... Apply _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. .......................................................................&..........................::..::............................................................................j.. -pply felt paper underlayment. :.Ifistall rid event to ...""""" ........................I-r. . ................. ......... �, ................................ .. ........................................................... 'Reroof using shingles with a&_year warranty. ..................................................... ............................................................................................................................................................... .Counterflash chimney. •filew vent pipe flashing. legal disposal of all debris. �r r .................................................. .............. .......... .................................................................. Area(s)to be worked on: j� l ��••��-- ......... ................... ...............� rS.......A.l.......... . z .6tcl a°..r.................................................................. � r ..............x..:nn.it~�.....�..... .....�. ......Ne-e.W...... . ...... ±­--C'�1-.'.f ................................................................................................... .. .r..-.... ........................... ....................................................................;*......I......I....... _ ... .......................................................................................................... Roof board replacement if necessary @ //p /sheet or'3 z¢ /foot. ....................................................................................................................................................................... .� .. . ............... ...... Two Year Workmanship Warranty(Not Transferable) Nranufacturer's Warranty as spec' y manufacturer Jj The co ctor agrees to perform the work d is the materials specified above for the SU of S......Q .�.t� '� = � � payable `f.1,la a........on...� ... . .. ..... .............. Payable............— ...........on........7=................. alance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability while1job 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 refusal to do so,contractor may at its option declare the entire contract price or so much as then remains unpaid,immediately due and payables 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 warrants)that he is(they aro) the owners(s)of the above mentioned premises and that legal tide 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.A211.day of... e ....,20....�.� Accepted: hSigned. ................«....... Owner Signed............................................................................. Owner David Castricone,President >1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): DAV 1 D CAEhi M1W NE 'R00 F fN y ! S (DING /,I(- Address: HCAddress: U 6 SUZ*D STt2f-e.z Ecu 1Tt Z2�o City/State/Zip: N. A N DOVF A MA 61W Phone#: 9 78 (o$3 3 y 40 Are you an employer? Check the appropriate box: Type of project(required): 1.X I am a employer with It 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. E]Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.insurance. 9. E]Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself o work ' right of exemption per MGL y � workers' comp. . 12.K Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ��^^ Insurance Company Name: X VIS V(LP%N(.L h-l'l1h&]l 6F S'T! T$ PA Policy#or Self-ins. Lic.#: w C.5 l I r11% Expiration Date: q.a 3 .0 9 Job Site Address: H �3 JO It n�a n S1 rt°e a City/State/Zip: NA A JO Je/. HA &d Yr 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: Cop'�.`..,.Qi Date: _ Phone#: aO 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 �1511'11-1�1 T 1p., 'yo Building Department m 27 Charles Street � u North Andover, Massachusetts 01845V., K (978) 688-9545 Fax (978) 688-9542 `6-p- �R�ran �NHy�� �SSACFIUS�� DEBRIS DISPOSAL,FORM In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit # the debris re:,.dting from the work sl 11 be disposed of in a properly licensed solid waste disposal faeilit., as defined by MGL c11, sl 50a. The debris will be disposed of in/at: Facility n Signaeure 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, `Ile 'Cna�rirnorerue:rz�� o//: uuac�iceellJ Board of Bliildinl- Re'-ulations and Stlutllnrtls Board of Building RegnlatiodsandStanlards Construction Supervisor Specialty License mLoumu toc i 1 IPIVH I C VI' LIADILI I T IIVJURHIVVC 09/17/2009 PRODUCER (508)651-7700 FAX (508)653-8089 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC - Commercial ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 233 West Central Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Natick, MA 01760 Select Dept ext 53389 INSURERS AFFORDING COVERAGE NAIC# INSURED David Castricone Roofing & Siding Inc. INSURERA: Citation Insurance 40274 200 Sutton Street INSURER B: The Insurance Co of State PA Shite 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. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONDATE(MM1DDNY1 LIMBS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE F]OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY n PRO- JECT LOC AUTOMOBILE LIABILITY 09MMBCNGCV 08/01/2009 08/01/2010 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) A X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ _1q ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUM13RELLA LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC5877756 09/23/2008 09/23/2009 X WCSTnRY TATU- OTH- T.11 ER EMPLOYERS'LIABILITY RENEWAL OF WC5877756 09/23/2009 09/23/2010 E.L.EACH ACCIDENT $ 100,00 B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000 Ityes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY David Castricone Roofing & Siding Inc. OF ANY KIND UPON THE INSURER,ITS AGENTS OR;�R��EEP�RESE��EJ�NNTT�ATIVES. **** FOR FILE PURPOSES ONLY **** AUTHORIZED REPRESENTATIVE %/ U Stace Brice/CMH2 __Cl ACORD 25(2001/08) ©ACORD CORPORATION 1988