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HomeMy WebLinkAboutBuilding Permit #309-2016 - 58 PINE RIDGE ROAD 9/9/2015 NoRTh BUILDINC PERMIT of.""E bgtio 2 5� ?n,•a TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 7° O �^-� ArED Date Received ` o� ,��.�KP" Permit No#: gSSACHV`'���� DateIssued: MPORTANT: Applicant must complete all items on this page LOCATION /?/,a C PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL:_ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building FrOne family [I Addition [I Two or more family 11 Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 4 <`Septic "UVglIq k ❑{Flo1 .otlpla na O�Wetl dos �� �0 W she Di nct a ater d st p- a ®`Water/S`ewer - - - - DESCRIPTION OF WORK TO BE PERFORMED: ori J Identification- Please Type or Print Clearly 9�+ OWNER Name: Phone: 7 9•c3/41-65 Address: JT ;D//,36 /'c/D6,5- AA® Contractor Name: Phone: 9-n Email' dwv�b c2 CjLs EriLb) moArv,- conn Address: Qat e'Z S�,t-E-�v. S�j Urs d 2A Ada cf�, /aus�L ly( A d SC. �(' �3S _Exp. Supervisor's Construction License: ,, Date: Home Improvement License: Exp. Date: 7 f a ARCHITECT/ENGINEER Phone: -, Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT;$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. i. Total Project Cost: $ /ol iF6 • e0 FEE: $ /5!5- 2-9 Check No.: :3 . p . U� Receit No : �?7 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty 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 46 Floor Plan Or Proposed Interior Work 4. Engineering Affidavits for Engineered products OTE: 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/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 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 IECC 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 ❑ f 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 WEALTH Reviewed on Signature i COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature� ®ate Driveway Permit ]DPW Town Engineer: Signature: FIRED ' "� � < r.. Located 384 Osgood Street RTME Tem D ter oris 'y.. ,n , � `urngps ite �yes «�yw : yr ono �r R 4 4 �fI 1�- ) .'4.' ' R * *I..'.. },vat y_�5 Y:l $Located at' 124 Main Street.',,*-. y� `,tfiT , <, ; f , Y d Fire Depamegnature/date ► .. . . :- „'� + Z t�v�}�,�t^'t zfL '�°' "`�`,g' '+':,p�t� ?_,Y3""�, q'1�'-p'�.'c""t.,y'�,�''"""i'w` ra9.-�3�{p�•�� l��w...��'ae' r♦�)aS.l,t' � ��' is 3 i T-i h"' #<' r {s ��y3''*q�' "9° 1 't� 'Ol y<�'� •t fi P , * y- � f P t - �"i a v`�� i .. �` ,,.. t ►.:.fit : ,s`., 'f.; t '��#{,. i�=,4'�*}e3< {. -`ri -[-''rS�+ -x� '� �, Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Defer 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 Permit Revised 2014 Location e— I No. Date • - TOWN OF NORTH ANDOVER ' • Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ �`'�tx ,►� TOTAL $ Check 30 Building Inspector k. t%O R Try own of E , ndover No. - � Z n h , ver, Mass, COC NIC HtwICH y1' Z1,4 A°R�re° ►�P�,��(5 S U , - BOARD OF HEALTH Food/Kitchen PER T 1 LD Septic System THIS CERTIFIES THAT ....... • I�� BUILDING INSPECTOR ....... ...... .. . ..... ............ .................. . ... .... .. ........ ... . . ..... .... ` has permission to erect .......................... buildings on ........�,�.�.... ...k!!!� r. Foundation.... • �..'. Rough to be occupied as ........... .... ........ . ........................................................................ 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT I S TS Rough Service .................. ......................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy.Buildin 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. DAVID CASTRICONE, PRES. 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 I/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,on premises below described: ! Owner's Name...,..... .v.•kl..v6<......M .............................G...........T. ele. ..on.e N....... J ..,�.�..�Lf�4......... � . .........State lob Address.... .... Specificalions: ....I....�..,.........p..................................................................................... Ship existing shinglcs,G> Apply new drip cllgc to all edges. tR_. p / ................................................................................................................................................................................................................... t,/Applytp 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 fdYp{al cr}u�nllcrlayment. nstall ridge vent io � .. ... ........................................... e ...... VReroof using shingles I ..................... with a y - -, wat•rant / �. ......-............................. t'lleourtterFlash chinutey. New vent pipe lPshing."Legal disposal of all debris. .................................................A..........2 ........ ................................... ..... .. ................................... �Area(s)to be worked on: .............................................. 4 ............. ...../ti ALt .. ........... 1•tee ....................................................... ............. 1 �:t t1. ....... ....J:.H:<" 1.. �--� .L�1` �.:.......... ....... ... ....... ................................... ........... .... 'f ..fa�rr. .....{rf.Q.1.......Gz:V..E'.l.`...... ..tr....cel.'r.............................. .................. ,�'. , r.... �. .z�I'"... .. ..a.. .I! .. ...� ..................... Roof board replacement if necessary @ Cb /sheet orfoot. ............ ....................................................................................................................................... ................ Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as spedfi y arn�a�l�turer The ctor a%%�s to pe orm the work a d ish the materials specified above for the SUM $.... off d•�( ........... �ayable''..•� � (�......on...A.tw)'* ........... Payable........:•:7r..............on...........-................... alance payable on completion ofjob Owner or Owners are not responsible for Property Damage or Liability wh b 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 matcrals 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 ofabove work,all undersigned agree to execute and deliver to contractor,their joint note in accordance with his(their)above obligation as requested by contractor.to. U n refusal to do so contractor me Upon t y at its option declare the entire contract prig 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 enforcingthe terms and conditions of the contract and/or any lien in connection herewith.y n hen th.Property may be 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.'Ile undersigned warrant(s)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. w All Home Impr®vemetit Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to the 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 unr 'stered c a ors is excluded om the Guaranty Fund pr •s'ons of MGL c.14 15 �r Approximate starting date f .....� ...1..........r.V. PP g /...........'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 the 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,231 R Sutton St.,No.Andover,MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their names this.m.4/19l1*7 day of4t. .S.l f l!/�..,20.1..( Accepted: J Signed..... 1I '4..�...... ........ Owner e Signed............................................................................ Owner ....... ... .......... .... ... David Cas tricone,President x 7 ti, . N(�k711 o� ,�r° ,b � -11ONvn of North Andover �o�, o r� C) ti? Pl n Buiidin�. PepartuielIt ti Chj-, es Streetdo " MassachuseRs ° Fax (978) 698-9542 9\Ss1C Nl)SE� DEBRIS DISPOSAL FOS%'I �k,,th TJle provIs,ons of viGL c .0 ., 54 and a co edition of the debris resulting from the word: sii--11 Le disposed g ''DeI-MIt acIl ea solid waste disposal _f itv as defined by MGL. cl 1 s] 50a ocer!v !;cens -,> 1. he ulsposed Oi in .at Faci!it}' IOC�iIOn Signature of Apphcan D.o;e per rut from lite Town Of North Ardover must 'oe oLtaineu for -this r ec; til l,. the OrTlc` of the Buitding inspector �w The Lon-anonwealth of Tfassirchul-,eas Depar onew of Industrial Accideiz6 Of ice Df 2t2stl C,tfofrS 600 I-Mashinaton Street Boston ALA 02111 (��� 1vivu).ntass.fgov1dia Workers' Compeosstiori Insurance Affidavit: Builders/Cotte-actor-s/Electi-icians/Plumbet•s Ipplican, Information Please Print Legibly NTame (Business/organization/Individual):MA\j.i IJAST-2( c.piu �L (7K6(J t:/A)G d s iz tic �/JG address: a2 1 So tl-D>3 S-F U QI T 3A :ity/State/Zip: IV. "t)YLi NA 0 1�� �� Phone #: °( ? � C4 � 3 3 q re you an employer? Check the appropriate box: 4. I am a general contractor and I Type of project (required): I am a employer with �i ❑ g 6. ❑ New construction employees(full and/or part-time).*- have hired the sub-contractors 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ guildino addition (No workers' comp. insurance comp. inst.trance.t C. required.) 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their I am a homeowner doing all work officers Plumbing repairs or additions myself. o workers' com right of exemption per MGL y � P• 12_� Roof repairs insurance required.] 1 c. 151, .1(4), and we have no i employees. (No workers' 13F1 Other comp. insurance required.] applicant that checks box ill must also fill out the section below showing their tvorkers'compensation policy information. meowners who submit this affidavit indicating they are doing all,:pork and then hire outside contractors must submit a new affidavit indicating such. itractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have oyees. If the sub-contractors have employees,they must pro,-ide their lvorkers'comp.policv number. it an eniployer that is providing workers'compensation insurrrrrce fir mi, employees. Below is the policv and job site wination. mance Company Name: Q lA K�t-rf_- S T 7a T-F- I cy 4 or Self-ins. Lic. ll: W CDC)3,5- g �j7:)-3 Expiration Date: 9• d,3 - 15 Site Address: d �`'"/A e /C l b 6k- i�_ 7� City/State/Zip: �Yb- ku�y✓Ex- Af 6-���J� ac>h a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Lire to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 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 ip to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of �stigations of the DIA for insurance coverage verification. hereby certify under the pains and penalties of peijury that the information provided above is tare and eorrect. nature: C Date: the il: TY6 3 3`f Lz) Oficial us-e only. Do not write in this area, to be completed by city ar town offrciaL City or Town:_ f er mit/License 9 issuing Authority (circle one): 1. Board of HeaBth 2. BuMing Deparimeni a. City/Tow n Clerk 4. Electrical inspector- +. Humbing Inspector i l ® DATE(MM/DDIYYYY) ACOOR o CERTIFICATE OF LIABILITY INSURANCE 9/10/2014 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 Susan Donnell NAME: Eastern Insurance Group LLC PHONE IAIC. . (800)333-7234 FAX No: 233 West Central St E-MAIL sdonnell@easterninsurance.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER A:Western World Insurance Co INSURED INSURERB:Commerce Insurance Company 4754 David Castricone Roofing & Siding Inc, DBA: INSURERC-Granite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER D: INSURER E: North Andover MA 01845 1 INSURER F: COVERAGES CERTIFICATE NUMBER3faster 14-15 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 ADDLTYPE OF INSURANCE INSR SUBRIWVD POLICY NUMBER MWDDY� MWDD� LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 TO X COMMERCIAL GENERAL LIABILITY DAMAGEPREMISESS( RENTED 50 000 Ea occurrence $ A CLAIMS-MADE FxI OCCUR NPP1388404 /6/2014 9/6/2015 MED EXP(Any one person) $ 1,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY F PRO- LOC $ AUTOMOBILE LIABILITY EOa aBINEDt S INGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ BIx ALL OWNED X SCHEDULED CNGCV 8/1/2014 /1/2015 BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ C WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $ 100,000 OFFICEWMEMBER EXCLUDED? N I A (Mandatory In NH) 0003989723 9/23/2014 9/23/2015 E.L.DISEASE-EA EMPLOYE $ 100,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Roofing & siding contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE John Koegel/MET ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSn25l9mnnsl n1 Tha ACnr7r)names and 1—ares ranicFaroil marLc of Ar A1�r) Massachusetts - Department of Public Safety Board of Building Regulations and Standards Cn.trurtirn Sulur�i.ur �licri::lt. i —cense: CSSL-099358 DAVID T CASTRICONE, 31 COURT STREET r NORTH ANDOVER M4:PU18 5 - '1 w ' =x prat 10`1 ::omrnissioner 12/16/2015 1p- Office of Consumer Affairs& Business Rebulation ROME IMPROVEMENT C ONTRACTOR Oegistration: 104569 Type: a, , Expiration: 7/14/2016 Private Corporatic DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA -- 01845 Undersecretary