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Home My WebLink AboutBuilding Permit #672 - 51 JOHNSON CIRCLE 5/4/2010BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: 0 IMPORTANT: Applicant must complete all items on this page LOCATIONS 4N�'t �(► l�t`C`, A rl Print Print MAP 210 RJ PARCEL:_ ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Exp. L b Print MAP 210 RJ PARCEL:_ ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Exp. Date: l azx- <l Residential Non- Residential New Building One family Date: 11�tLHome 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: Name: Address: -51 CONTRACTOR Address: DESCRIPTION OF WUMM I U tit rKtrutcnntU: i17 4 - Please Type or Print Clearly) �M S m Ct d10 �' X10 J W "1-1- �adaL,� Phone:(q7f e3 �v Supervisor's Construction License: CS' SL q15 q Exp. Date: l azx- <l Improvement License:_ 10 5-a 9 Exp. Date: 11�tLHome ARCHITECT/ENGINEER. Address: Phone: 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: $—&3D6 FEE: $_ "-)h- Check No.: / 3- �O Receipt No.: A� � 5 NOTE: Persons contracting with unregistered contractors do not have access to the 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/MassageBody 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 c6MMENTS 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 Usgood Street FIRE DEPARTMENT - Temp Durnpster on site yes no Located at 124Main Street Fire Department signature/date COMMENTS m.M:�• 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 2010 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) No Plans Submitted I 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION DATE REJECTED DATE APPROVED Reviewed on Signature HEALTH Reviewed on Signature C6MMENTS 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: Locatea X364 Usgooa Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124' MainStreet Fire Department signature/date COMMENTS. . ,:.. 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 o' Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o . 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) Li 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 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO. Date Received '�iq A°R�TEI SSACH Date Issued:. 0 IMPORTANT: Applicant must complete all items on this page r �M,St LOCATION Ie ((}} Print PROPERTY OWNER t-C+tab t11 Print MAP 210 PARCEL: _:ZONING DISTRICT: Historic District ayes no Machine Shop Village ' yes no TYPE OF IMPROVEMENT PROPOSED USE 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: i P + /Q- - S Sc Identification Please Type or Print Clearly) OWNER: Name: ( (A(La 2c)we Phone:�g7�� Address: 1 UwISUv� ��i`�e- Ak Apj�� xA a CONTRACTOR Name- ,t y�Phone: Address: Supervisor's Construction 'License: �` Exp. Date: !/ Home Improvement License: Exp. Date: 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: $ OD b FEE: $ Check No.: ReceiptNo.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund signature of Agent/Owner _Signature of contractor (1 Location-5C4"&y No.Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ is Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #V 22991 —Building Inspector rg4 1*3 76 z • W M s•. o A cz' /O W a u o w° U a cit 0 w z z° ..� �q 'L x ro w° x m v U ita w p w a°' w O W U W �° v v V) m w x O a x � w w ¢� W w a q o z cn Q o cn c� _ o '�m c :amO. l0 O O C ' � L p Ea 0 C 00. O CO)L. tj E E u C i/� �; to • O m O O . O � �• y t �►; '> > � M, cc y y C c ' O O ♦ca E.00 �ev .` CO CL -C.2 05 LA O m Z0 cm r-. : Aco` O w CD j c no c Q :cmc 'c = m c* -o ~ H- $ vi o � � o y R L m L LJJ C �. � t w OCm y G tai .Ecj.o 0 � ® 5 2 mcy'm O -:5 m z 0 w w a Oil co 0 E L Z CL A CO) ICDcm � O■� C 0 . m ff C%3 CD O CD CL �- COCD i2lo, C13 Q Lm o m ® d CL CO C 0� C Cc CO) C CD CL C.± CO) cc C _c �. 0 Construction Supervisor Specialty y e License: CS SL 99358 Restricted to: RFAS 01 Pr�4Pi9�, DAVID CAS'fRICONE 31 COURT STREET NORTH ANDOVER MA 018451" Expiration: 1211612011 i unuui..i ni'' Tr; : 99358 t! JL I he Commonwealth of Massachusetts Department of Industrial Accidents Off ice of Investigations 600 Washington Street Boston, MA 02111 - wwu. mass.gov/dia orkers'�Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(BusiiiessiOrganizatiotVlndividtai): 1� AV I C ASTR I o tuL R U F I LSC- I I N S Address: Zcoo u71-rnt3 S-'c2s_i_E_-r Sy City/State/Zip: NDO 46IC "A 0 I Phone #: 3q Are you an employer? Check the appropriate box: ® I am a employer with $ 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors ?. ❑ I am a sole proprietor or partner- listed on the attached sheet. 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 These sub -contractors have employees and have workers' comp. insurance.t 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. ❑ Electrical repairs or additions 11. ❑ Plumbnig repairs or additions 12. ❑ Roof repairs 13.LN Ocher S (tkI4 AJPdAA_--' *:dry 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 afi'idavit indicating such. 1Contracters 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 ant an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 71\1) Policy # or Self -ins. Lie. #: 9 9,S A 7 y b Expiration Date: q a 3 20 t p Job Site � �ASM C tPdC city/State/zip:-Alt) I L MA 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 cruninal penalties of a fine up to $1,500.00 and/or one-year imprisomuent, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify�epains andpenalties ofpetjury that the information provided above is true and correct. Signature: C—J-- , :, a.e. Date:g tEq I 10 _ nne #: G_D_ ([t _ -31-Lo Official use only. Do notwrite in this area, to City or Town: city or town official Permit/License # Issuing Authority (circle one). - 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other " Contact Person: Phone #: ... 1, 2 ^� Town of North Andover • � p�(]Ir7fy OE�t��,o Building Dcpal-tMenl ia�iy0 27 Chaules Street North Audover, Massachusetts 01845 * '� (978) 688-9545 Fax (978) 688-9542 V 3AcfW541 � DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of. Building perinit . the debris re,%.:Iting from the work slulll be disposed of in a properly liccnsed solid waste disposal facilil., as defined by MGL cl1, s150a. The debris will be disposed of in /at: Signature of Applicant Date IIzgho NOTE- A demolition permit from the Town of North .And.over must be obtainod Cor Chis project tlaough the Of:[ice of the Building Inspector. �4CORD,I CERTIFICATE OF LIABILITY INSURANCE 09/28/200 ' PRODUCER (508)651-7700 FAX 508-653-8089 Eastern Insurance Croup LLC - Commercial 233 west Centra; Street Natick, MA 01760 Select Ext. 53389 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIL # I111;URED David Castricone Roofing & Siding Inc 200 5utton St Suite 226 North Andover, MA 0184$ INSURERA: The Insurance Co of State PA INSURER B. INSUReR G; INSURER D: INSURER E. CnVFRAGFS THE POLICIES OF IN5URANGE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY 911-QU1REMgNT, 79RM OR CONDITION 05 ANY CONTRACT OR OTHGA DOCumr N i 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 DY PAID CLAIMS. INSR DD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY V..ACH OCCURRFNCU COMMERCIAL GENERAL LIABILITY OCCUR CLAIMS MADE F]OCCURCXP DAMAGE 10 12L•NTEU IAP.cPRW e pa�cl (Annyy one perean) $ PERSONAL & ADV INJURY $ r31:NFItA1 nC�H�GafE $ 6rN'L AGGREGATE LIMIT APPUE3 PER. F'RODUC I: - COMVtOl' AOG L POLICY J fECT LOC AUTOMOBILE LIABILITY ANY AUTO C:OAdBINEOSINGLE LIMIT S (I ? p[ndenQ ALL OWNEF) AUTOS SCHEDULED AUTOS BODILY INJURY 4 (Pei person) HIRED AUTOS NON•OWNED AUTOS BODILY INJURY S (Per uctidmd) PROPV.R'IY DAMACP $ mer eccIdent) GARAGE LIABILITY AUTO ONLY, EA ACCIDENT $ EA ACG $ 07HERTHAN ANY AUTO AUTO ONLY: AGO $ EXCESSA)MBRELLA LIABILITY CACI I OCCURRENCE_ S OCCUR F-1 CLAIMS MADE AGGREGATE $ $ ^�^- y IitVVCI'IBLk $ RETENTION S WORKERS COMPENSATION AND WC9752746 09/23/2009 09/23/2010 X I WCSTATU•sj OTH ER EMPLOYERS' LIABILITY E.L EACH ACCIDENT $ 100,000 A ANY PROPRIPTORIPARTNENEXECU(IVE OFFICER/MEMBER EXCLUDED? If, doscnbe under E.L. DISEASE - EA EMPLOYEE S 100,000 F -L, DISFASF - POLICY LIMIT $ S00,00 S qr,IAl. PROVISIONS beIDW OTHER DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS I IF IUAI h "ULULK CANCELLUION SHOULD ANY 0r THE ABOVE 0E5CRI9E0 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 OF ANY KIND UPON THE INSUReR, ITS AGENTS OR RUPRESENTATTIV0. AUTHORIZED REPRESENTATIVE Stace Brice PICC I( 1�('�V•`,�•— ACORD 26 (2001108) CEACORD CORPORATION 1988 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 HaverhIM 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 belgw desc ' ed: Owner's Name.... A—A-k AII- , ........p.yJ.e........................................................ Tel one #....SO.. Sr..........� .ti.... Job Address .....t�?...�...: ohr Secy. ...�./�.�,r............ city ..... �.et...... 4. .V.,:Z:............ State....1:...4%..1....... Specifications: ..................................................................................... ............................................................................................................ ....... ..... ,t.t� ¢, ...... (�.. 5:1 6........lib.ts.►.t S_ ca ....... :. x ................................... .............t �..t.J`t ......... 5:..L. Z..1.lri ...........cR .n t ......�./.. 5./�. Ct. S.", ......6 T ..... � .. t` hS s .................................... ............Ao.-p..IV ....... .� �t ....-.....�.v..�..� u?.1.� . �...................,............\.......................#1......... ............. Two Year Workmanship Warranty Not Transferable Manufacturer's Warranty as sp ted by manufacturer The�nlractor agrees to perform the work and h the materials specified above for the S of $ ....�,..c�,t. d.nZ......... �p _ l ayable -3.0.0.0...... on ..5.. .............. Payable ............................. on.................................Balance payable on completion of job _ Owner or Owners are not responsible for Property Damage or Liability whilejob 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 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 warrants) that he is (they arc) 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 9 cancellation). IN WITNESS WHEREOF, the parties have hereunto signed their names this . ....... day of ... A.kd-J..1..... 20..10.. Accepted: / Signed .11l!l 1 ..)-h....... ................. Owner -- _ Signed............................................................................. Owner David Castricone, President`