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Home My WebLink AboutBuilding Permit #343-11 - 59 MILK STREET 10/25/2010 TOWN OF NORTH ANDOVER �.►ORTli APPLICATION FOR PLAN EXAMINATION 0 -(U%o 61tio �6 o Permit NO: Date Received Date Issued: � c►+us��y IMPORTANT: Applicant must complete all items on this page LOCATION H t y-Ce_y Print PROPERTY OWNER <<- Print MAP NO.: PARCEL: 3 ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building eepone family ❑ Addition ❑Two or more family ❑Industrial ❑ Alteration No. of units: Repair, replacement ❑Assessory Bldg ❑ Commercial ❑Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED -,ship onres i op i QJ (Z o ( ofCcW o ou a�- / Identification``Please Type or Print Clearly) OWNER: Name: I M ho C 0 I Lt Phone: q9 C, g 5 g q b Address: 59 M k N, sof u-N W o v- � ��U Jel- MYk d ( F3 S CONTRACTOR Name: &Ancunc �( Phone: 11� (A 3 3Y?-(j Address: ZUU SU-4W ZZ(- P>v)6 O/ Supervisor's Construction License: Exp. Date: Home Improvement License: I Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED OST ASED ON$125.00 PER S.F. Total Project Cost S 40 U D FEES Check No.: J / Receipt No.: Page I of 4 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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:BPFORM05 Page 4 of 4 TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ .COMMENTS FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date 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 Building Setback(ft. Front Yard Side Yard Rear Yard Required Provided Re uired Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA—(For department use) Page 3 of4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created IMC.Jan.2006 Location 6- �r No. Date MORTM TOWN OF NORTH ANDOVER f w } Certificate of Occupancy $ ��s''^•'�t�' Building/Frame/Frame Permit Fee $ �� f s,k,H,se 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # qq� Building Inspector NORTH TO" of . . Andover A-- No. .33 LAKE o dove , Mass., tL- COCHICMEWICK �1. oRATED �l BOARD OF HEALTH Food/Kitchen Septic System .PERM IT T D BUILDING INSPECTOR THIS CERTIFIES THAT........ .(.l!h.............`� ..�..�. .. ................................................................................... Foundation has permission to erect........................................ buildings on .....s.... ....... .!. .. ......5 ................................. Rough to be occupied as.... T �Q Chimney ............... ... ... .......................................................... . .......................................................................... provided that the person accepting this permit shall in every respect c form to the terms of the application on file in 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 j�`� ' UNLESS CONSTRUC STARTS Rough ..... ......... .................................................................. 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. Smoke Det. SEE REVERSE SIDE . DAVID CASTRICONE 10`91!0 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 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 below described J � Owner's Name........f!.�.1.>':Y1..... �Ctr._..1. . ......................................................Tele hone#.....�2 1 .......c>..F..Yz/ �{ Job Address....... .L..../....../...:�1../.. ..... t.............................City.., 0,.., to ..a.(,hg ..............State....d.•: . ...... Specifications: ................................................................................................................. .. ............................................................................................. ^Strip existing shingles�� 4kpply new drip edge to all edges. �tJLt��, Q`r ...................................................................................................................................................................................................................... vl(pply__feet ice and water shield membrane to bottom edges of house. 3 eet ice and waters eld membrane in valleys and bottom edges of any unheated areas of house. F7 � �e r � ...................................................................................................................�. ............................................................................................ ✓1�pply felt pa derlayment nstall ridge vent to / .n (.. ..................... ............ . ........ .. ....... ..................................... .................................................... Reroof using shingles with a_,3Q_year warranty. ...................................................................................................................................................................................................................... Lounterflash chimney. Nely vent pipe flashing. .--egal disposal of all debris. Areas)to be worked on: � ......................................... ,1�©.�i ........ a.Lta.................................................. e.1-.trz.t. .... .e............1...,. ..................... ..................................... ........ ... .............. ................ -PC. .........Z......X. 4-11 ..................................................................... ............................. Roof board replacement if necessary @ 60/sheet of /foot. .............................................................................................................................................................. .................................... .............. Two Year Workmanship Warranty(Not Transferable) Wanufacturer's Warranty ass .ted by ma acturer The ctor agr a to perform the work the materials specified above for the SU of 5......� d.�..... ...... l Payable..... b.x�........on.. ." Payable............-`.............on........ Balance payable on completion of job Owner or Owners arc not responsible for Property Damage or Liability whr job i m operetron. 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 covered by homeowner.All materials arc 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 be 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 hereio,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 of cancellation). �K IN WITNESS WHEREOF,the parties have hereunto signed their names this... 0�........day of..0(70.�'s..6XC 20./,a..... Accepted: Signed.. ..... ... �1� .............. Owner Signed............................................................................. Owner P David Castricone,President 1 /� / ; N The Commonwealth of Massachusetts Department of Industrial Accidents j„ Office of Investigations ;u 600 Washington Street : "" , Boston, MA 02111 Ulf. !� www.mass:gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business!Organization/Ir•.ividuaI): DAV i b C A S T P I C o w t, Roo r= i N tT a S 11,3/tic, IN C. Address: -2,J rL i-- -t- City/State/zip: City/State/Zip:N o . A ii o v A D r 8 IPhone #: 9 rl 8 (D�3 3,3 Y"z u 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. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or p.-Aver- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9_ ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their I0.❑ Electrical repairs or additions 3.❑ I am a homeowner doing 0..1work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comr'. c. 152, §1(4),and we have no hoof repairs insurance required.]t employees. [No workers' comp.insurance required.] 1311 Other *Any applicant that checks box#I must a' )fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit i.`�iicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must atta:•,hed an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providh Z workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: C., 14 Prg T IS Policy#or Self-ins. Lic.#:_ \, 0— o U ;q Expiration Date: q Job Site Address: S q mt I t s � City/State/Zip:N- ltYlC1 d\r_,, N1+ 0 4 vT Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as regt.'red 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-ycar 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 pair.s and penalties of perjury that the information provided above is true and correct. Signature: Z)z c:7- c. Date: Date: Phone#: q 9 , U 3 g Z a 7 k.i Official use only. Do not writ^ n this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one;: 1. Board of Health 2. Buildii.g Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Town of North Andover a� NAkTfy - i�,�4 ti Building Department o 27 Charles Street North Andover, Massachusetts 01845 o^ V , (978) 688-9545 Fax (978) 688-9542 °° 4WK 7 40""re 'st" 15 SAC US 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 MGL cl t, s150a. The debris will be disposed of in/at: 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.