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Home My WebLink AboutBuilding Permit #783 - 58 LINDEN AVENUE 6/4/2010BUILDING PERMIT TOWN OF NORTH ANDOVER c? btt,, -A 96 F L .,� APPLICATION FOR PLAN EXAMINATION ?o Permit NO: Date Received 4q `°`"""`""" CRATED "SSgcHus�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION i t den A u me 4;tom A n do v - Print PROPERTY OWNER Print MAP 210 PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village ves 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 UtSUKIPTION OF WORK TO BE PREFORMED: 09 (C Identification Please Type or Print Clearly) OWNER: Name: _'by'�d gr\ Phone: 9W (o 4o 530-3 Address: 5b b Y\ C--\ \\J o �r+t— A nj-os A O Q Y j CONTRACTOR Name: l.0 L"LQY — 100' m, Phone: A 0'3., LO Address: &-o� Z z(. 0,oAt, Ar iove,- W U is Supervisor's Construction License:3 Exp. Date: A (10 -)10 Home Improvement' License: Exp.. Dater 1 �1 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 Co • % � 0 0 • �' FEE: $ �— a7Check No.: Receipt NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contract C 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: Building Permit Revised 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS t HEALTH COMMENTS DATE REJECTED DATE APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT -Temp Dumpster on site yes_ Located at 124 --'Main Street Fire Department signature/date- COMMENTS Locatea 664 Usgooa Street no 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 No NOTES and DATA — For department use) ❑ Notified for pickup Date ............_................................................... __._...__............. ................................. _.......................................... __._................................... _............... _............................ _........................ _.... _.......................... _............................. _............................. _..__... _........ _. ................................................................... Doc.Building Permit Revised 2010 Location f j J C/- /h u ell No. Date MORTh TOWN OF NORTH ANDOVER C'p • 1 • pe b 9 ' ; ; Certificate of Occupancy $ Building/Frame Permit Fee $ -- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # -4�( 23266 Building Inspector 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 Haverhill 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, constru and place the improvements according to the following specifications, terms and conditions, on p�'ses below de 'bed: Jam+ 'r/l / Owner's Name.... ...G%::... / .E �,t< ..(�1` Tel one #. �.��r..�....7. Job Address...., ! - r /. - .s✓ r..c ... l �.{t .(' ................... City. .......G.r.../..0..V..-c a............ State ....111:..... Specifications: s*i'.;r................................................................................:............................. ��............................................................................... .... trp existing shingles.( -Apply new drip edge to all edges. k��;�� .................................................................................................................................................................................................. . A(fply _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. ................................................................................................................................................................................................................... vApply felt paper underlayment. rns tall ridge vent to 3 �' / .................................... ✓Reroof using shingles with a J0 year ..warranty... ...................................................................................................................................................................................................................... "Counterflash chimney. z -]W v vent pipe flashing. - 150al disposal of all debris. ....................................................... ..... ............................. _ ... Area(s) to be worked on: s 6••l.•.. r.. ....17� ....N .zz.c t .S.Q ,........................................... l� • L eJ..V, C......................................................................................................................... ..........� r7xt..l............�.......... .. R.................................................................................................................... .................................................................... �......................................................................................................................................... Roof board replacement if necessary @ C/V /sheet c r '/ —'/foot. ..................................................................................................................................................................................... Two Year Workmanship Warranty (Not Transferable) Manufacturer's Warranty as sped y manufacturers The contractor agree to rform the work p finish the materials specified above for the S of $........ .L?.Z?....... :. Payable.... b.v....... on ..5� ........... 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 wails, 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 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 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 cancellation) IN WITNESS WHEREOF, the parties have hereunto signed their names thisA210.. day of....ALL .......... Accepted: n Signed........ ...... .......................... Owner Signed 4.........�. .. ! . David Castricone, President n Owner I 60 7 O z Ti 0 p o u. v cn 0 5 ca o 4.1uz C o w o c� :11, :� U a w o a o a a w" o w o w cii coG w o rz � w" a w v cA o cn Q cn �o o C2 :a c c ; o c Cm.3 v C7 •ate CL A �v m m O �c o m W E a C� m O 0 :tea E= z c �1m O E Go v L m 11 CA o :;3 = CO y y..r CD m H l m O C/) CD E 'c U � 1 h m VJ cm 0 C Fes+•/ •� W dCt � m O m 1 ^ � �yZcc o c ~ a Q m y m C •O t- o y m4- cu $~ m cr r W C �""•cy=.. � E cj cm o LU COD CL F- s 0 =cc O ,CAN CD O O• 0 s Z o o. O y Q C O cm o•— ca Q 'C 0 y O O •E0 CD m m CL ~� CD O � �3 CD L � O � CL CMa o �� cc c ■� 0 D C V y O C C •_ C CO) D LU 0 N U) 19 W 19 W 0 -�"-�+=�'-�-moi' CERTIFICATE OF LIABILITY IIVSI�t�ANC*E ,�,� DATE (M8/2009 09/zs/zoo9 PRODUCER (506)651-7700 FAX 508-653-8D89 Eastern Insurancle Croup LLC - Commercial 233 West Central Street Natick, MA 01760 Select Ext -53389 :THIS CERTIFICATE IS 1S.5UED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS GERTIFiCATC DOCS NOT AMEND. FKTEND OR ALTER THE COVERAGI_ AFFORDED BY THE POLICIES uELOW, INSURERS AFFORDING COVERAGE NAIL # IN13uRED David Castricone Roq Ing & Siding Inc 200 Sutton St Suite 226 North Andover, MA 01845 INSURER A: The Inwar,ce Co of State PA POLICY EXPIRATION DAVM=')D INSURER B: INSURER G; GENERAL INSURER D: INSURER E. rnlicDArl.ce THE POLIGIE5 OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THI! POLICY PERIOD INDICATED, NOTWITHSTANDING ANY Q9QUIREMENT, 'r0M OR CONDITION OK ANY CONTRACT Ori OTHEP b©CUMEN'r WITH RESPECT TO WHICH THIS CERTIFICATE: MAY BE ISSUED 013 MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CON()IT10NS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRDD' 1715 ljtTYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DAVM=')D LIMITS GENERAL LIABILITY EACH UCCURRENCr $ COMMERCIAL GENERAL LIABILITY DAMAGE TO IdL-NTEU $ CLAIMS MADG ❑ OCCUR JJI one MCD EXP (Any one ornun) pnr g PCRSONAL 5 ADV INJURY $ rj L;NbFiAI A4ZCa('rQAr1 $ OWL AGGREGATE LIMIT APPLIES PER. r'NUUUC I b - COMMOP AGG $ POLICY PRO LOC JEGT AUTOMOBILE LIAMLIYY ANY AUTO C0AeBINED5INCLEI-IMIT (I -a pt:odenl) $ ALL OWNEn Aui DS SCHEDULUD AUTOS BODILY INJURY (Per person) HIRED AUT09 NON -OWNED AUTOS 13001LY INJURY (Por ac(:idenl) $ PROI'r lY I)AMACP (Pet wfdent) S GARAGE LIABILITY AUTO ONLY, EA ACCIDENT $ OTHERTHAN 12E $ ANY AUTO $ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY CACI I OCCURRENCE $ OCCUR CLAIMS MADE AGGRL"GATE $ 2 V 5 I�tVV01'IIiL4 $ RETENTION E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC9752746 09/23/2009 09/23/2010 )( WC STATU- DTH U E.L. EACH ACCIDENT S 1001000 A ANY PROPRIFTORIPARTNEIVEKECUfIVE OFFICERIMEMEER EXCLUDED') IIya5,dascnwdCr bo E.L. DISEASE - FJ1 EMPLOYEE $ 100,000 E.(., DISFA$F - PUI ICY LIMIT $ 500 000 SPEGIAt. PROVISIONS below OTHER OESCRIPYION OF OPERATIONS I LOCATION'S I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS David Castricone 200 Sutton Street Suite 226 North Andover, MA SHOULD ANY OK YM9 A90VE DESCRIBED POLICIES 9E CANCCLI.0 9EPORC THE Roofing & Siding 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 LIAe10" 01845 OF ANY KINb UPON YHP IN5Ut1rR, ITS AGENTS OR REPRCSENYATIVES. AUTHORIZED REPRESENTATIVE Stace Brice PKG ACORD 26 (2001108) (s1ACORD CORPORATION 1988 Construction Supervisor Specialty License License: CS SL 99358 Restricted to: RF,WSi ly DAVID CASTRICONE ul'. 31 COURT ST13EET i :- ::.'•'':,! NORTH ANDOVER, MA 0'1845 Expiration: 121,1612.011 Clunn,i .iuu''' Trn: 99358 ,..._" w�.,r.,a u, uuuumg Kr:gulalinrtis and Sl:uul:u•ds HOME_ IMPROVEMENT CONI'RACTOR try Registration; 104569 ;i Expiration: 7/14/2010 TO 270265 Type: Privale Corporation DAVID CASTRICONE ROOFING, SIDING & David Castdcone 200 SUTTON ST SUITE 226 NORTH ANDOVER, MA 018,15 ;�dwiuisU•aU�r Town. of North Andover BuIldlllg Depill-I:Ment 27 Chiules Street North Andover, Massachusetts 018d 5 (978) 688-9545 Fax (978) 699-954.2 �AcwJ5 DEDIUS DISPOSAL F01W In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit. # the debris I ting from the work sluill be disposed of in a properly licensed solid waste disposal facilft.) as defined by MGL c.l 1, sl 50a. The debris will be disposed of in /at- raGility liot� -- Signature of AppliCunt Date NOTE A demolition permit from the Town of North .And.over must be obtained for this project tluough the 012.1:1ce of the Building Inapector, 11 The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations 600 Washington Street Boston, MA 02111 www. mass.gov/dia pensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): _DWI I e M-rR I C 0 NE Q 06 E 1 NCS `' S lA 1 N (z- J N L Address: 2 C> Ca S u-1; -t f3 S'r R t' SO V-�-E-_ Z2tA City/State/Zip. h. Mbo vU NA 0 I g uS Phone #: °I-) 9 20 Are you an employer? Check the appropriate box: 1. ® I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- 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 listed on the attached sheet. 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. ❑ Plumbing repairs or additions 12oof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. .r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors 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. Cor Insurance Company Name: �1n P Y;S c 1 _a4 c e, CCAI) 6.11 y G Policy # or Self -ins. Lic. #: W C 9 q 5 a `1 y (p Expiration Date: 11 Job Site Address: b Li rx ] e_n Neliuc_ City/State/Zip: ivy 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; ('n $ Date: I / 6 #: (11 3 34t0 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 #: