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HomeMy WebLinkAboutBuilding Permit #442-11 - 555 SALEM STREET 11/23/2010 tdORTfi BUILDING-PERMiT of 6 TOWN OF NORTH ANDOVER pr APPLICATION FOR PLAN EXAMINATION '' Permit N0: Date Received 11f 02� .�wo o �t R,7rEn��F Date Issued: RSsgcHUS�� IMPORTANT:Applicant must complete all items on this page �•'7=kf>',5�•n - ' �r=•,;r..,-t3d':4:_.�s.y�. ..1:'s5->;%r{=- -e.-;�.:, 'I'.;, _" _ _:ii:!: :;::+,:�'^ tti:- '•�.: - - _ - r.T; ..t_-,_:per.••,= e w�a .3 ._,.e...•y,. ���:. :._...-.,..`�1._ .f!iE.� ..,fie„ -- - ids ..�-._d:�:=:xt=`it:n- .::.�•1!' i"t rwi•i:e - =^i=. ^i'=..12:.3_ _ .T:._.u.f',J�..4.� - _.1 ..f•S, - e.. +-.aP:. _ - tea`: ,..yae•:�e�.��>.-' - •..s:.. .M1 - �`!' 9:S a-�. .,%.-: ti- -`:'.�. 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C•�=.r-�[�:� :13j+::I�w_ieTt _ ['7"�. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ne family Addition Two or more family Industrial Alteration No. of units: Commercial . Repair, replacement- Assessory Bldg Others: Demolition Other 1J1r'".•"i4'C-`��:,'w;��'1 • - i:E-'"'ioz'c"y�'y.•'_']•.' _ -_ _ '::r=�T... _ - P.".''?I<'Lr�,J!-`'.'.'c:_"r' ��.Js.__, 4ri''': "^v r,tTi*ar�t.. a a:';pgl:s.:�'•'..sr'n-u� y.�_• >:-_ _ MEMO , ^',�,,�. ..��.-. ?��a �7^ - ,-y..<.1��� _,�- "aa. _,Y�. -.�,d .i,.:-i:G72c}%•=y�.��.;.-.••,•• r-�`�-s-•. -•�: '12�'"ry-S:F� F .,`•.''^?.�A.;.c `,..`L..^ifi:_.a_;,lr,..r:'"e.ru".S _._:�r":�-a. .{.yam• ,� _'�F�+-- .S+u,"•.:..;-var -- :i^a.- .'.. _ 1•� �d r �-�r�:.d�.",?'::_->ir..l r:t� � ;�s:x _ . A. E 1a• r m � D, � _r.. s=u-•,?.ice,-�r.•c '!:r._s,;g� ,. _fir !k'-t �,;�y; *rrr.?Y''E`� _,Jx-,.k'-,.", _ .',e.-,�.�:a�� >x, .� ..{'.`:'' ill!���/'' �.._•n,''_ r ; .ux,._ ?ami,\.-: r'",+.:. - -TS'(.cts .4,J"..'..�r'nz._h^..••�rx'*7'*r•..-s' ,.�; ri '-' -_�h,_ --'�-'._ :z,31' 'rZ .*`__S 2' ,�,.7:_?'-a?: �s3� 9d, ::;:,�•L i'J},.:n.;,:"U.a`.. ¢-'�=�":1:_.:�"-` x ry, '% g�•��-'�r�`_�''fyc?�^'--;=iy'-,z z• =s,t,,tk..;-_ :,�_:.r._r, iRFi�:.JF _.b?Ne��rr..t..-.. ..L, „s� � T���'17��tr.� .�*,r•' _.r=. _,�r�.��. �': �M_�• �:;-stz '�-=_ �-,�..zr ...�:,9m ��h•.,. - J ..h,:^.�c. --.-z�...ii.��..,__•_-,,.�,._,._...,_...._._.-�_.,�c..r::�:_><-,=•_..::�:-,:_._.J.r_e`-7eT':----.,.=.t�-....c�=a!FY-5.'=__J1o••-,al•:cNr�}�-c.� _ ._,y,:,;�"1`�4:,r: --- --��'a:��n�an'�`. -3��J�::•_�>,•si DESCRIPTION OF WORK TO BE PREFORMED: oL1 Identification PIease Type or Print Clearly) OWNER: Name:_ P X Phone: 97 76-r 5k7, Address: 2TY J466 S7110di-TI! 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Total Project Cost: FEE: $ /"067' eQ Check No.: / Receipt No.: NOTE: Persons contracting with unregister'ed contractors do not have accesVth ran nd :�• end;aar.�:�,er'�- •��_ F=-�.,.�y=:-• -- .�� � � >; ' �. i Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. i Roofing, Siding, interior Rehabilitation Permits ❑ Building Permit Application i o 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 i ❑ Building Permit Application. ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossecti-on/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 e' Propr-ised "lo' ❑ 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-bailding application Doc:Building Permit Revised 2008 Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPTTobacco Public Sewer ssage/BodyArt Swimming Pools Well esFood Packaging/Sales Private(septic tank,etc. umpster 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 �,ONii '!Eiv i HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:`variance, Petition No: Zoning Decision/receipt submitted yes Planning- aoard Decision: Comments Conservation Decision: Comments Wafer & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Sig-nature: . : "�:, i' i:::;�ii.s_F'•.i.'sLocated doy:c4aE-tief„'d^�.r•mr.3.,-.,8+;.:.4A<�Osgood s ood Street treet � r-g:: _�:4•..a.:-a•.;:.. cT�'j`� EP`J:ti;.:;rsn: - _i:K.r v;•��_Sti:[1'_j^.• =_.�-.;t.�• _ _ ate` - _T —•tip __ ''- a6:'- .:•>:s�aL-y-gat, iRt _ ::.'ss-. _ �ot — - ''•:,:JSP — --_c..Y...h... 4.l" -- -4.-._-' _ ••.T?fi•. - _ __- __ -+�•�' - .ate �1� - -?`]� rwi+i7:- - +Y''^2 - '•-.i;.. .t:pt.?.. - +:{'w;. - air:�:�.. __-.?1i51:';r.,.::.?-rv.4'-„•:=�...,:c'��,�,2. _r - - - - - ter'='-= '%�.•� — ��.t� - - - "1• 'r - p - �i7 c - i 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 pp 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 . I Doc.Building Pernut Revised 2010 Location S7— No. Date U NORTq TOWN OF NORTH ANDOVER 3? • O 9 �a Certificate of Occupancy $ MUS t< Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #{ 0-2, 2 ` " Building Inspector ORTH i T0VM of 6Andover LAK V dover, Mass., ia • - COCMICMEWICK y�. 7�ADRA7ED P' 5 `S V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System 1 BUILDING INSPECTOR THIS CERTIFIES THAT................. -6,,<........J ... ?.�5 .......................... ........................................................... Foundation has permission to erect........................................ buildings on .rte-� ..... s. ...........�......................... Rough 9�grn. 3 r Chimney to be occupied as........... ...... . .........-t........ �.... . ... zi.or�.W.!�........... Egi:_4_ . ....-........rovided that the arson acce in this ermit shall in eve. res act corm to the terms the aationon file inP P P 9 P PFinal 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 lo6 _ PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUC ON TS ELECTRICAL INSPECTOR Rough Service BUILD 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. i Town of North Andover01 tAnkrH Building Department o� ,- � oe; 27 Charles Street ` North Andover, Massachusetts 01845 v , (978) 688-9545 Fax (978) 688-9542 40 �ss�c►au5e 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 MGTL cl 1, sl 50a. The debris will be disposed of in/at,- A)/-/ 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, i 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 �1a In North Andover 978-683-3420 In Boxford 978-887-6147 In HaverhX 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 blow described: Owner's Name........C e v cam.... ..T phone#..Q ..................................................... Job Address.....`- -S S'... -t� ...... ....................city.. . tut.... .a . . `' ... '' .tt-1;,f..:.. ..State.. .. Specifications: .................................................................................... lt..�...�...r....111.l i:....� .............. ✓Strip existing shingles.(1) '�hPI new drip edge to all edges. W�,�e :.`,.... ......................... .................. .......................................... .............................................. . ............... -Apply feet ice and water shield membrane to bottom edges of house. 3 feet....rc..e and wafei.shield'meoibrande- in valleys and bottom edges of any unheated areas of house. -Apply fel,paper underlayment. wbstall ridge vent to S e !�� i g........:...... ar warranty. Reroof using 7i� 3shin les with a; ye .......................................................................................................................................... -Eounterflash chimney. -New ventPe �i flashing. P g• aI dis sal of all debris. [o� ................................................. �.... ... -Area(s)to be worked on: ............. ....................................... ...........................................Al1.....G- r:...S.e ........IQ.., ter....... .�.,. .....i. . ......... .... . s� �......rd . . �r.r.,...1 ..7`. ......v....... .... rA.... r rxrt.4.........Er—c .....IA'-, t . � t- ' ."'('/Y' '''- A.S.., Roof board replacement if necessary /sheet o ��- /foot. ......................................................................................................................................................................... Two Year Workmanship Warranty(Not Transferable .......................... A)anufacturer's Warranty as specifi y nuf eture The contractor agrees to perform the work and furnish the materials specified above for the SUM f S.....a.on 7.. Payable on _ ... .......... 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 albs 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 is 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 Weed 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 c incurred and 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 end 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 title thereto stands of record in his(their)mu s).There aro no representations,guaranties or warranties,except such as may be herein incorporated,if any,nor any agreements collateral hecto,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 ofwork...........s�!��. ....................... . Completion date.......: k 4< Receipt of a copy of this contact is hereby acknowledged,and it is further acknowledged the undersigned that the foregoing provisions have been read and the contents thereof understood and that no representation or bindingupon the P agreement not herein contained shall.be p 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 notic of cancellation). IN WITNESS WHEREOF,the parties have hereunto signed their names th' ....... day of...A4.9 20.J.Q. .Q. Accepted: Signed......... ..................... ! ...»......... Owner Signed............................................................................. Owner David Castricone,President/� The Commonwealth of Massachusetts 6 �; ► Department of Industrial Accidents 1. 1 Office of Investigations 600 Washington Street Boston, MA 02111 t 15.4 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Informationss Please Print Legibly Name (Business/Organization/Individual): .DAV f D l,qSTRf(t7Nt ROO F i Nls y SI /1%I(r INC Address:__,)U b Sv SsR Sv ;rz 2 Z� City/State/Zip: N o. A N by4i_f— MA d lets Phone #: I)$ 16%33'f Z Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 4. ❑ I am a general contractor and I 6. ❑Newconstruction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition ' S [No workers comp. . ❑ We are a corporation and its p 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12,Rj Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#l 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. n Insurance Company Name: 1. A tZ�S Policy#or Self-ins. Lic.#: W C©Q 5L?LIga3 Expiration Date: q Job Site Address: i,§sJ V I`rC- In fmte`- I City/State/Zip: ljd` A/1,b&4^ Moil,- 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 fonn 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 thains and_p;eenna-lttiiess o'fpeijury that the information provided above is true and correct. Si nature: Ely Date• Phone#: q 7% U3 J i a® 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#: I