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HomeMy WebLinkAboutBuilding Permit #329-2017 - 561 PLEASANT STREET 9/27/2016 ■ NORT, BUILDING PERMIT of ctyeD q�0 . TOWN OF NORTH ANDOVER J0 - APPLICATION FOR PLAN EXAMINATION 10 ey Permit No#: J��/ —�� / Date Received - el °RATED c5 gSSACHV`'�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION ( 1 -PL- 6- d�SA1JT 2CG 1 Print PROPERTY OWNER D SIJ t E(_ -B(Z4 s PA N Print 100 Year Structure yes no MAP b 3 PARCEL: O U ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building liipOne family ❑Addition ❑Two or more family 11 Industrial ❑ Alteration No. of units: [I Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well Q Floodplain Q Wetlands 0 Watershed District ❑Water/Sewer - - DESCRIPTION OF WORK TO BE PERFORMED: �1 ate AOb Ft-S"1`0GL�-- Identification- Please Type or Print Clearly OWNER: Name: 2)AQ1 C L $rLo-S��A� Phone: q 7 Z 720s' Address: r, 1 `1 L AS ST - �)0 h ( AoD aObh- 56 q y' Contractor Name: QuoF Jl Phone: G•7� 6 3 Email: c�� r-P'"' Address: 23� �� ,.: sT , y� ►t 3 A� tiar�-�-� ltwD�� �. Supervisor's Construction License: 3 Exp. Date: l�Tb�l-7 Home Improvement License: `t SIC 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: $ G FEE: $ Check No.: 3 5-3 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fund 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i Addition Or Decks 4, Building Permit Application 4 Certified Surveyed Plot Plan Workers Comp Affidavit � Ph y Photo Co of H.I.C. And C.S.L. Licenses Copy Copy Of Contract Floor/Cross Section/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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit I 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 2012 I ECC Energy code Engineering Affidavits for Engineered products OTE: 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 2014 ■ 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 m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ 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 Osgood Street �FIREtDEPA,=R�TMENTTernpDmpster�o4ntsiteyesu �;��: r '�o ,: '' ii ocate at¢124 MainiStreet ;rp `Cc a ; `,� +•- r-' 1`E, aI fir_v a{- �r ,L.+ff. {,,.,£ ,1,4 e*.� "+ C ,..-.'* .:- • ,' ? F F,ire4Department;signature/date : � ..��' €� =f;,J -,i a t.�> y -a,e- rA.sr.�_.s � gepw. �- A.�.. �. a«..•.....SXt�,._.....r. ..a...:..�..-�.`�,.,. V s7 i 7, COIVIMEfVTS r - ,. . 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 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 Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 r Location s(' �I� P1 No. 3,x c7 Date • - TOWN OF NORTH ANDOVER r,« Y• Certificate of Occupancy $ Building/Frame Permit Fee $ T Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 1 f • -• Building Inspector 01 ve- 0 . - No. _ o K h ver, Mass, coc"ICNlWK.t y1. % �.95 RAreo U BOARD OF HEALTH Food/Kitchen PERMIT __ T LD Septic System THIS CERTIFIES THAT C�$ �..C.� 1.19............ ...zoo 0„ , ,,,, ,, BUILDING INSPECTOR ............�..... .................. it A s'M has permission to erect .......................... buildings on ... ........../...... ... . ..............N......r........... r.... Foundation . ........ Rough to be occupied as y ................... rot %..�...:................A.�.......`.a....................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR-_. UNLESS CONSTRUCTION STARTS Rough Service ............ .. .... .............. ..................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. \ The Commonwealth of Massachusetts z Department of Industrial Accidents d 1 Congress Street, Suite 100 Boston,MA 02114-2017 ow �' www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organizatiort/Individual): ,AV I n G/S1f R1 Ct7 NC Z-)o f I N 6 t 1> I KJ C, i me Address: 31 5 v !� c- -z T 0(\\T- &A City/State/Zip: SAO• PON W 4&A. NA 01 6 q:� Phone#: q 79 -4:)93-3 Yao-O Are yo an employer?Check the appropriate box: Type of project(required): ;.am a employer with employees(full and/or part-time).* 7. New construction I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] 9. D Remodeling 9. ❑Demolition 3.o I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.7 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 1313oOf repairs These sub-contractors have employees and have workers'comp.insurance.t p 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'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. C Insurance Company Name: IZA N 1 T-t ST P•-c t; Policy#or Self-ins.Lic.#: CU Q 3 q S el 7A 3 Expiration Date: _dZC j !c Job Site Address: (o l T Lf ASA 07- 1�1_ City/State/Zip: WO- Ak%bUta 1`7/+ v/�aflj Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certift under the pains and penalties of perjury that the information provided above is true and correct Signature: C Date: Phone#: S .3 ..3q au 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#: DAVID CASTRICONE, FRES. CASTRICONE ROOFING & SIDING INC. ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 231 R SUTTON STREET UNIT 3A, NO.ANDOVER, MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314 1/we 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, m re. .... h11. described:rtr.. .} . .............................................T Iephone tt/...7p.:.i. .1... �.`.//.... Owner's Names �' " , Job Ai3dress..': _(F:..'.... .1 5( 94 ......> .............City... .C.I ..Gtx.:�:'..............State.../M....... Spec•ijrca(ioru: ...................................................................................................................................................................................................................... 'Strip existing shingles,14 4pply new drip edge.to all edges. lbflt;(ci .......... ................... .. ............................................ ......................................................................................................... ,/Apply feet _�.� 1. _ membrane to bottom ed..es of house.3 feet in valleys and bottom edges of any unheated areas of house. ....................................................................................................................................................J............................................................... apply tPap r underlay `Install ridge vent to 5.. .I�C .... ..................................................................... Rel [sing t z 4 - .� vx -v l ryl r /L` iC` shingles wtth a year 1\'ar't'allty. ......................................................................................................................... ...... ` vent pipe flashing. (eg t disposal of all debris. n l �omttcrflash chimney..... eco..,......x ..........................._.................... ............ ......!—b.l.i7r.... D..1. ....�..... •.. ..... �'ea(s)to be worked ou: / �- ..........................r i.LhJ. rsr.............................. ................................ .. ...i.. hr Imo ....... � �?(a-.. �......... �e......1.5...... .1.� e ........................................ ............................................. pp .............: ,..s..� .: ...... �?tt ...l.i ..}1. ct :.... .T�.... ��Z3(. :..5 .i:r:r.0.................. ........... 7.t°.i1.G3.�fE .:'....�y �1t�Gl -�..... �1•S.I.a✓yl..G +e !9.4�. ......eC.I�...�...lo.. ... ?.�ra�, Roof board renlacernent,ifi cessdlY..(gn /sheet,or.... - ."........................................� . --: .::::, ............................... Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty ass fred by_manufacture The c u�actor agrg_es to perform the work and Turn' h the materials specified above for the M of$..�1� D•.....••• ••••••••• �ayable"...:�.7:. a..b.........on.S:�it/� ..........� Payable.............................on................................. Glance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability w ob 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 cover cd by homeowner.All materials are property of contractor. Any dumpster placed by contractor is for his use only.Upon completion ofabove work,all undersigned agree to execute and deliver to contractor,lheirjoint 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 incumcd in enforcing the terms and conditions of the contract and/or any lien in connection herewith.Property may he subject to mechanic's lien if unpaid.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 tic is([hey 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 lmprovemvnt Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to tht-Office of Consumer Affairs and Business Regulations,Tel.(617)973-8700. 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 This contract may be cancelled,without penalty or obligation,within three business days of the below-referenced date.Mail or deliver a signed and dated notice or send a telegram to Castricone Roofing&Siding Inc,2311 tfun St.,No. ver,MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their names this . . ...1k1 day of... .p.....,20.., . Accepted: "`�"'. t.Signed. ...... .A.a.. ................. Owner r Signed............................................................................. Owner David Castricone,President'2n',2 I ACOORL311CERTIFICATE OF LIADATE BILITY INSURANCE 9/28/2015 ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Select Dept. NAME: P Eastern Insurance Group LLC PHONE (800)333-7234 x66807 FAX (781)586-8204 A1C No 233 West Central St E-MAIL DRESS:selectwork@easterninsurance.com D INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER A:Western World Insurance Co INSURED INSURERB:Commerce Insurance Company 4754 David Castricone Roofing & Siding Inc. INSURERC:Granite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER D: INSURER E: North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER:CL159964794 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR POLICY NUMBER MWDDIYYYYI (MMIDONYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 }{ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence S 50,000 A CLAIMS-MADE a OCCUR NPP1404373 9/6/2015 9/6/2016 MED EXP(Any one person) $ 1,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 }( POLICY PRO- LOC S AUTOMOBILE LIABILITY EO aoBlGNdeDt SINGLE LIMIT S 1,000,000 B ANY AUTO BODILY INJURY(Perperson) $ ALL OWNED X SCHEDULED CNGCV AUTOS AUTOS /1/2015 /1/2016 BODILY INJURY(Per accident) $ }{ }{ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident S S UMBRELLALIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS S C j WORKERS COMPENSATIONX WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNE.R/EXECUTIVE E.L.EACH ACCIDENT S 100,000 OFFICER/MEMBER EXCLUDED? F N I A (Mandatory in If er E.L.DISEASE-EA EMPLOYE S 100,000 DESOF OPERATIONS describe and C003989723 9/23/2015 9/23/2016 DESCRIPTION Or O.ORATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,H more space is required) ROOFING & SIDING INSTALLATION CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING INSPECTOR 1600 OSGOOD STREET AUTHORIZED REPRESENTATIVE NORTH ANDOVER, MA 01845 John Koegel/KH3 ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(qnlnn.5lni Tho arrwn nnma nnri Innn ara rani¢farari m2rka of Arr)Pn "_t. r��P (Nit nrriimrri1/X(/e-1(rr,,;rrr7tnir//. : License or registration valid for individual use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: =1 HOME IMPROVEMENT CONTRACTOR Registration: 104569 Type: Office of Consumer Affairs•and Business Regulation f 10 Park Plaza-Suite 5170 r Expiration: 7/14/2018 Private Corporation Boston,MA 02116 1 DAVID CASTRICONE ROOFING,SIDING& David Castdcone 231 R SUTTON ST SUITE 3A _ NORTH ANDOVER,MA 01845 Undersecretary Not valid without signature Massachusetts Department of Public Safety Board of Building Regulations and Standards License: GSSL-099358 Construction Supervisor Specialty DAVID T CASTRICONE 31 COURT STREET NORTH ANDOVER MA 01845 CA-- Expiration: Commissioner 12/16/2017 Answer Service 508.270.1042 Sent 8126/2016 5:04:42 PM Page 1 of 1 PPID:4 There were no messages to deliver as of 08126/2016 17:00:08 Thank you, Pro-Call Answering Service