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HomeMy WebLinkAboutBuilding Permit #215 - 61 LANCASTER ROAD 9/18/2007 NOec N BUILDING PERMIT TOWN OF NORTH ANDOVER 0 - • . p APPLICATION FOR PLAN EXAMINATION Permit NO: is Date Received ��SSAc►+us���� Date Issued: IMPORTANT Applicant must complete all items on this page 41 s. t V. - WNE - Nth IITOT� lstotcdesa PAS r7 e �s 01, MAl? N© a TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building vOne family ❑ Addition [I Two or more family ❑ Industrial [I Alteration No. of units: p Commercial f?Repair, replacement ElAssessory Bldg 5 Others: ❑ Demolition ❑ Other ., 1t1/ anrs Warmed Lltstrc � ' e o:Septile, i V1(eII Floalaia : gyp 0.Water/ W ;r ,e. ... DESCRIPTION . n. _ .. OF WORK TO BE PREFORMED: reshrnG Identification Please Type or Print Clearly) OWNER: Name: ��y I I ac.iano Phone: 97 �(o �Ou O Address "QCCU le4l�-C� �0�� A' 16 Y 'c 4 Q �T ,CT �', L r � POW ; 4 reM a s ' , ` S.uperUlsflr s ofistru fic�a � a ,Jp �© t�"ipt-i7�YPYT'1Et7t.L't��'1'154, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTf BASED ON$125.00 PER S.F. Total Project Cost: $ 9 ( 60 � ' FEE: $ Check No.: �� � Receipt No.: �0��`C NOTE: Persons contracting with unregistered contractors do not have access to the gugranty fund i Sig ure of Ag :rat/Owner Sagnature o contractor 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 f DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Located at 384 Osgood Street Driveway Permit Fitt flEPA#� 'tll1t�T Temp Du�pster�n sit yes �o Luca#e al 14 Mair►Sfr et .Ftre Depar rnerf7 77 s� q gnature/date 3 777 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.s100-s1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date ..................................................................................._............................._............................__..............._................_...._..._............... Doc.Building Permit Revised 2007 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 2.2007 Location/ No. CDate �� d TOWN OF NORTH ANDOVER f 9 Certificate of Occupancy $ �sswcHusEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 206C, `. - Building Inspector NORTH Town of 0 No. y 0 , dower, Mass., T Q - LAKE I� COCMICMEWICK V 7�ADRATED � S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.............lalwi.......... .L.�./Irk.. / ...................................................................... Foundation has permission to erect....................................... buildings on ..... ...........`fjll�(./q j.�!�!f nr. AW... Rough to be occupied as................... �. .... �*the .. Chimney ..... .... .... .................................................................. provided that the person accepting this rmit shall in every respect to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating tspection, 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 000,00 i 1S PERMIT EXPIRES IN 6 MONS ELECTRICAL INSPECTOR. UNLESS CONSTRUCTI S 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. SEE REVERSE SIDE Smoke Det. • 1 �/ eaii `',,,ff/.wac,`ivaetta Board of Building Regulations and standards Residential contractors and service HOME IMPROVEMENT CONTRACTOR j providers doing business in Massachusetts Registration: 104569 Expiration: 7/14/2008 must be registered. If the contractor or Type: Private Corporation subcontractor is not registered, you will not be entitled to compensation from the state DAVID CASTRICONE ROOFING,SIDING& if something goes wrong with your job. David Castricone200 SUTTON ST SUITE 2.26 �G � NORTH.ANDOVER, MA 01845 Deputy Administrator This firm has met RPI's qualification criteria rr L�ASTI:2D[�E :tt.gQB�t �.' '' S '1?T11G'"�. •` ,(]F Sll���if }' l�>:F�"Q frs7injra�aalr!1nA�An .411tr?r.' :, •� for experience, reputation and dedication to nabiji?�+��1K�'ta, �4erS"A; o�a �rA,tHo ,�pT,R� professionalism. '` ' ? !`Pt:�V?P3f?� !I�}. �?R�f•' 'I '.•::: Ihorisq• JurvGn Tidy ��; u. t t r�:+{ A.�'��5 ;1 " � ��U � 3t ^�`ta�,i� ��,�s����i4r,�� � ;IJ�a�'`• r� � . Through special training programs available ,;,�, •� � I, . rr � f.: � �;�;, exclusively to Alcoa Master Contractors they learn how to be experts on quality installation and how to build and conduct business in a highly professional manner. t 4 DAVID CASTRICONE D CASTRICONE ROOFING&SIDING I.D.No.: A01921D-A N' °Member S ince 41,,02/1996 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE M � Y 0�tfi7/2b07 -;• PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Internet Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIftATE 522 Chickering Road HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR North Andover,MA 01845 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC 4 INSURED INSURERA! NORFOLK&DEDHAM DAVID CASTRICONE INSURER w AIM ROOFING AND SIDING INC. INSURER C: 200 SUTTON STREET, STE,228 NORTH ANDOVER, MA 01845 INSURER D•, INSURER E COveRAGES 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,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INUR Awn LTR INSSO TYPE OF INSURANCE POLICY NUMBER MM IYT A ( /D LIMITS A GENERAL LIABILITY ND-P-009867 8/12/2007 8112/200$ EACH OCCURRENCE $ 1,000,000.00 �/ COMMERCIAL GENERAL LIABILITY PREMISE Ep $50.000.00 CLAIMS MADE L:J OCCUR 5,000.00 MED EXP An one eraan) $ PERSONAL A ADV INJURY $1,Da0.Doo.00 GENERAL AGGREGATE $ 1,DOD,Dp0,00 GEN'L AGOREGAT$LIMIT APPLIES PER; PRODUCTS-COMP/OP AGr, $ 1,000,000,00 POLICY PROJECT LOC AUTOMORILE LIABILITY ANYAUTO CO*=Went) SINGLE LIMIT $ ALL OWNED AUTOS (Ea SCHEDULED AUTO& BODILY INJURY $ (Per person) HIRED AUTOS NON•OWNEDAUTO$ S eDBL d J CRY g oaee r OPER Y DAMAGE $ sr accirl) GARA439 LIABILITY AUTO ONLY•EA ACCIDENT S ANY AUTO OTHER THgN EA ACO $ AUTO ONLY: AGO $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE 6 RETENTION S $ WORKERS COMPBILITY NAND EMPLOYERS'LIABILITY VwC 6009480012004 09/2$/2008 09/23/2007 7 TORY LIMITS MUr ANY PROPRIETOR/PARTNER/EXECUTIVE E,LEACH ACCIDENT $ 100,000,00 OFFICER/MEMBER EXCLUDED? Ifyyes dueriha under E,L DISEASE•EA EMPLOYEE $600,000.00 SPEGILAL PROVISIONS 6*1*w E.L.DISEASE-POLICY LIMITB 100,000,00 OTHER CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE V E DESCRIS POLICIES BE CANCELLED BEFQRE THE E><PUiATIDN DATE THEREOF, ISSUING INSUR WILL ENDEAVOR TO MAIL 030 DAYS WRITTEN N E T CERTIP4GATE HQ R NAMED TO THB LEFT,BUT FA IkURE TO DOW SHALL POSE N 9000IATION OR UA ILITY OF ANY KIND UPON THE INSURER,ITS AGENT$OR REPRE TATIV53. THD D REPRESENTATI ACORD 25(2001/08) 0 ACORD CORPORATION 1088 I Town of North Andover t%ORTf F Oa0 Building Department o o 27 Charles Street North Andover, Massachusetts 01845 if.-'i h V (978) 688-9545 Fax (978) 688-9542 �y�°� I "60 rEo ��SACHl15E� 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 1, s15Oa. 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" _ The Commonwealth of Massachusetts �` Ya Department of Industrial Accidents Office of Investigations 600 Washington Street aj Boston, MA 02111 ,E: www mass.gov/dia Workers' Compensation Insurance Affidavit:• B it ers/Contractors/Electricians/Plumbers Analicant Information Please Print Legibly Name (Business/Organization/Individual): _�D Aw b C A STK I CO)4 e '-RUO F 1 hl(r S $D I N& �K�- Address: cgn O SL—M&) S-Frz k-ej: — Sy ITT-- ZL(o City/State/Zip: NO ANDOVZ12. kA 0 )44S Phone#: Are ou an employer?Check the appropriate box: Type of project(required): 1. atm a employer with g 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. [] We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I atm a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. oo re insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13,0 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 employees. Below is the policy and job site information. nn Insurance Company Name: Policy#or Self-ins. Lic. #: V W C.• to OU 9 If%UO (A0 Expiration Date::� Job Site Address: CD ! ky ! (w 46, 4&Z City/State/Zip:Y l J . 6gdla diaj- 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 c under a pains and penalties ofperjury that the information provided above is true and correct. Si nature: p� Date: 4 Phone#: 0 co $ 4a)-� 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 U CASTRICONE ROOFING&SIDING INC. D ROOFING,SIDING&REMODELING REPLACEMENT WIN V9P, 1,1 2007 HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 200 SUTTON STREET,SUITE 226,NO.ANDOVER,MA 01845 B Y----------------------- In _____ ___________In North Andover 978-683-3420 In Boxford 978-887-6147 In HaverhUI 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. r .�''d I t? _ Owner's Name........Z_.G..t QS. ....A��I C i.a rritc...................................../................Tele hone#... �1 .' . . ... Job Address.......W./.....�..4i .�a t2 r`.......RD................City...../.X.a?:....f.l.rna�it.:1�,t..............State...M....... Specifications: ...................................................................................................................................................................................................................... .,Strip existing shingles.(( LVpply new drip edge to all edges. w4; -, $" ...................................................................................................................................................................................................................... -Apply feet ice and water shield membrane to bottom edges of house. 3 feet ice and water shield membrane in valleys and bottom edges of any unheated areas of house. ............................................................................................................. . .... apply felt paper underlayment. -Ifnstall ridge vent to /-e�,,, G o a X Yl�,� r�-Iv„ V,` ....................Au.. �iAAID. —T�..........................-�.-r..... ............................................... ,R2roof using f .�,�/r, �/ /;, �r�(� shingles with aSj>_year warranty. kl- IT .. r.... -IC-ounterflash chimney. 4KEe vent pipe flashing. legal disposal of all debris. . .. ................................... ... .... ...... �.. .. Areas)to be worked on: � t /� ...........�.. , .... ._5........a.l.(.� ... �t.�LA...S.*.........../t._.............f,) /� '�y� ..,.....ti_J.�:xr.a..,....�::. �.p . ...�.....�J\b.cr,r. t � .. 1 / a P ..................................................................... .................................................................................................. .......... 'V ............................ Roof board replacement if necessary @ L d /sheet or Y be/foot. �o . l G(2 0 .. ................................................................................................. ................................................................... .................. Two Year Workmanship Warranty(Not Transferable) NCanufacturer's Warranty as specify manufactu The con actor agrees to perform the work h the materials specified above for the SUM f$.�_ . ..�)Q..... .... ayable.... .g ,.Q........on....5th ............ PAyabiw............................on................................. alance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability whifLTob is in operation. Contractor is not responsible for any damage to the interior of property,including pro-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 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 rho obligations hereof shall bind and apply to their heirs,successors or estates of the parties.The undersigned warrents)that he is(they tare) the owners(s)of the above mentioned premises and that legal title thereto stands of record in his(their)names(s).There rue no roprescntations,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 ��c/ontracto is a luded from the Guaranty Fund provisions of MGL c.142A. Approximate starting date of work.....W.1Y: �.. 1'Q. Completion date... WLc-...l.l.l.!!✓ S Z: 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). IN WITNESS WHEREOF,the parties have hereunto signed their run this...:.7. rl.day of..� �T�..•...,20...�i5./ Accepted: Signed..... .. . ........�4i.1.L:L jj._aA.,u................ Owner _ Signed............................................................................. Owner David Castricone,President