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Home My WebLink AboutBuilding Permit #109 - 58 GREEN HILL AVENUE 8/10/2009 tkORTH BUILDING PERMIT 00 qti TOWN OF NORTH ANDOVER o� APPLICATION FOR PLAN EXAMINATION 70 Permit N0: to / Date Received 7a 4DR.t7ED 'PP�,�GJ us� Date Issued: Zl SSACH IMPORTANT:Applicant must complete all items on this page LOCATIONkir - s _T E P PROPERTY,OWNER s J r��e t1 �t( •�� MAPNO; PAROL:• D, ZOi4lNG`DISTRICT Historic District yes :no Machine'Shop Village . yes no M� _ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial VRepair, replacement Assessory Bldg Others: Demolition Other Septic ; Well Floodplain :`,Wetlands Watershed Districfi WF aterf Sewer _ DESCRIPTION OF WORK TO BE PREFORMED: S i (n (Q rho Identification Please Type or Print Clearly) Q OWNER: Name: Sktr-ke u Ryvttrto t<< Phone: 'I Address:_5� G'c�P h- � � II Pel!e. f1od-t4. proj a ve` _ II . _ Phone: r civ CONTRACTOR-Name E JAS Cr(� C Address. dtYi'� ,3 �. Su:pet 'isor's Constructjon1icense 3 S r Exp te: -� -Home Im rovementI' ense (v v r Ex I U 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: $ I 0 0 FEE: $ // ,e Check No.: 12o �5� Receipt No.: 0/ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund _. - �c Signature'of Agent/Owner of contractor _ . 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 ❑ 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 ❑ 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 2.2008 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 - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 9 O r 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 ,'FIRE-'DEPARTMENT. -°Temp Durnpster on,si#e1 .fyes �� _ no Located at 124M1v177 ain Street Fire Department srgnatu i/date _ e COMMENTS i 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) I ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Location -lam �- • G �- ^1� -- No. 1419 Date MORTM TOWN OF NORTH ANDOVER .3? • O0 * i • , Certificate of Occupancy $ �SSACMUsE<�' Building/Frame Permit Fee $ - y Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 1 7 Check # 12n 2250 Building Inspector NORTH T091 I L over No. �.ZO LA Edover, Mass., COC HOC HE WICK AORATED POf. �C7 H BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .... .....::::�'...:................................ Foundation has permission to erect.........:...............:.............. buildings on .�........ - �� .��--, � .. .................... .......... .... ......... ......... Rough to be occupied as.... _M .. ' ......... . ......-.. ' - u� - .9 �i;� ( .:.. `°`. .... ............................. Chimney provided that the person accepting this permit shall in a res ect to the t s of t a lication on file inP P P P �� @�Af� PP 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 CONSTRUCTION STARTS Rough Z11!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 J1 Smoke Det. " w} The Commonwealth of Massachusetts { t Department of Industrial Accidents Office Investigations .�.r of 600 Washington Street Boston MA 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): �J�V I n cAS T R l C.0 U E ROOF 19(r 4• SJ h 1 u G WC Address: ADD S u-t7a N SC ra l.e.-T So i-r r,- Z 2.b City/State/Zip: N•AN NVEK. NA 6 ( $'f Y' Phone#: 911 413 ,34� o Are you an employer?Check the appropriate box: Type of project(required): 1.2 I am a employer with_ q 4. ❑ 1 am a general contractor and 1 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 g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P h'- $ 9. ❑Building addition [No workers'comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ lumbing repairs or additions self. Y m ' right of exemption per MGL �o workerscomp. 12. Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑ 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 employee& Below is thepolicy and job site information. Insurance Company Name: \ft 5QC0JXC(. COVAP&-A ca G f Policy#or Self-ins.Lic.#: WC 6J' 0 177 . Expiration Date: 93 Job Site Address: is (f ee^ )V,--// A U e- City/State/Zip: /' 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 coveraize verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct: Signature: "„ �J- C Date: Phone#: q7I ( 93 3`l oL.O 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 o� �a, a p s.., L * .. Building Department 27 Charles StreetV. x North Andover,Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 SSNCHU5 DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s e54, and condition �diti cork shall be disposed Building permit# the debris g ' a:oro erl licensed solid waste disposal faeilit}' as defined by MGL ell 1, sl 50a. of in ,. P Y The debris will be disposed of in/at: Facility ]creation Signature of Applicant Date Permit from the Town of N6rth Andover must be obtained for this NOTE: A demolitionp project through the Office of the Building Inspector- PRODUCER 10/3/2008 Phone: SDO—G51-7700 Fax: 508-653-8009 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION. Eastern Insurance Group LLC -Commercial Lines ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 West Central Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Natick MA D1760 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURED INSURERS AFFORDING COVERAGE NAIC# David Castricone Roofing & Siding Inc INSURER A:Cj t su - e --4.0274 200 Sutton St INSURERB:' ie nsu -ance Co of State PA Suite 2Z6 INSURER C: North Andover_ MA 01845 INSURER D: COVERAGES INSURER E: 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 DE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERIRSIrMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. T POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION G EN E RA L LIABI LITY LIMITS EACHOCCURRENCE I; COMMERCIAL GENERAL LIABILITY AMC I'071rPTL PREMISES Enamiuna 'U CLAIMS MADE OCCUR MEDEXP(Anyono parson) !k PERSONALAADVINJURY GISNEIIAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER: PPRO- PRODUCTS-COMP/OPAGG $ OLICY LOC A AUTOMOBILE LIABILITY 08MMBBTNKT 8/1/2008 8/1/2009 ANYAUTO COMBINED SINGLE LIMIT $ (Ea ocGdonl) ALL OWNEDAUTOS XBODILY INJURY scIIEDInEDaur°s (Parporson) 250,000 X HIREDAUTOS NON,OWNEDAUTOS BODILY INJURY (Paraccldonl) $500,000 PROPERTYDAMAGE (Poraocldarl) $100,000 GARAGE LIABILITY AUTO ONLY-EAACCIDEIdf $ ANYAUTO — OTHER THAN EA ACC AUTOONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION AND WC587775G9/23/2008 9/23/2009 X WC ST Tu• oTH- EMPLOYERS'LIA BILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $" (IO OO OFFICERIMEN DER EXCLUDED? — Ilyyos desedbaundor E.LDISEASE-EAEMPLOYEE $100,000 SPECIIAL PROVISIOI IB bokyw OTHER E.L.DISEASE-POLICY LIMIT 9. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION ' i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOT'ICIS TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY Y,IND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001!08) m ACORD CORPORATION 1988 Nlassaefill setls - llcparfinent ul' Public S10*0A �,- ✓tie of.,:t1�aa�cutiiieplld Board of Building' lle!'nlaflUlls ;Intl Cant1;U'tls �� Board ofBuildingReaaro-moruuNgulatiottSSsandStandards Construction Supervisor Specialty License HOME IMPROVEMENT CONTRACTOR License: CS SL 99358 _ = Registration: 104569 Restricted to: RF,WS Expiration: 7/14/2010 Tr/r 270265 DAVID CASTRICONE r Type:'Private Corporation 31 COURT STREET C DAVID CASTRICONE ROOFING,SIDING& NORTH ANDOVER, MA 01845 David Castricone ° 200 SUTTON ST SUITE 226 �- - Expiration: 12/16/2011 NORTH ANDOVER, MA 01845 Administrator l' nuui"inncr Tr—,: 99358 41lUnZlo7 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 HoverbLU 978-374-7314 Uwe the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to fumish 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: I T e hone#....�.�. !.q.. �l....... a.rn tE .l ............................... p Owner's Name..... !•!`�E�........., ......... ......... Job Address...v.... �1 ... .t..� ..././.i�. r.........City....[.XA.�..l.t. .t7..11.eel..................State.... ...... Specifications: ......................... ...................... ..............................................................:.......... .................................................................... •'Strip existing shingles PPIy new drip edge to all edges. e. .......................................................... .. . . .... ...... ................................................................................. �{p . , ply _ 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 .............. ................................................. ..... ✓Apply felt paper -n-d' yment 'Install ridge vent to ..... ....................... ................................................................... .. : .............. . .................. g�� shingles with a O year warranty. R'eroaf usin r a nt ............................................. ........................... v1egal disposal of all debris. ounterilash chimney. ew vent pe flashing. ............................. ............................................. } , rea(S)to be worked on: Al „�,,,••.................. \ ......... �.l......1^.tz o. ......a �a�'.... �..t�.r- .�•• •�� d .?., . ... ..... . �......� .............................................................................. .... O 680 goo �rl� .... ...................... .... (T�l . ...................... ............... Root board replacement if necessary* 4/D /sheet or /foot ............................................................................................................................................................... Two Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as spec ed by menu ac The rotor ogees to perform the work and ish the materials specified above for the S of$..... .. . . ............. ayable.d 'D-04?...........on..5. ............ Payable.......... .................. alance a able on completion of job on............... t� P ay able or Owners are not responsible for Property Damage or Liability whilee jo is in operation. or Contractor is not responsible for any damage to the interior of property,including pre-existing conditions(i.e.water stains,crumbling plasia,exposed nails) .objects coming loose from walls,crumbling plaster,exposed nails,dust in attic or other living conditions resulting from application of materials specified above(i.e spaces).hens in attic may need to be covered by homeowner.All materials ace 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)��i�labove obligation an�u��rs contractor. Upon refusal to do so,contractor may at its option declare the entire contract price or so much as then remains unpaid,i Y PeY� that agreed that,if permitted by law,contractor shall be paid by the owner(s)all reasonable costs,a numey fees and expenses.in 9"tion on this contract may be unpaid, by shall be incurred in enforcing the terms and conditions of the contract and/or any lien in connection herewith It is further agreed contractor,and also that the obligations hereof shall bind and apply to their heirs,successors or estates of the parties.The undersigned omt(s h or �) the owners(s)of the above mentioned premises and that legal title thereto stands of record in his(their)names(s).There are d trepresarer subject to any conditit>m warranties,except such as may be herein incorporated,if any,nor any agreements collateral hereto,nor is the contract dependent Pon 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 Tel:617-727- 8On8e Ashburton Place, Room 1301,Boston,MA 02108 secures his own construction- Any and all necessary construction-related permits shall be obtained by the Contractor. Any Owner who related permit or deals with unregistered contractors is excluded from the Guaranty Fund provisions of MGL c.142A. Approximate starting date of work.. '.`..�....!1:....... `'. Completion date......................................................... Receipt of a copy of this contact is hereHy 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). f q da of1 .f...`......,20...4..1 IN WITNESS WHEREOF,the parties have hereunto signed their names this... . Y Accepted: Signed.»:: !»».. ». .... ».»....».»»»».....».. Owner Signed......».....»......................................».........».......... Owner David Castricone,President