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HomeMy WebLinkAboutBuilding Permit #343-2016 - 615 BOXFORD STREET 9/17/2015 BUILDING PERMIT 16 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 70 o . > Permit No#: I� Date Received �'�s q,TED�e���y G � ` SACHUS Date Issued: I �� I IMPORTANT:Applicant must complete all items on this page LOCATION koI� Gb1 & 1 �+ Print PROPERTY OWNER St Ci0 Print 100 Year Structure yesno MAP PARCEL: 0677 ZONING DISTRICT: Historic District ye no Machine Shop Village ye 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 El Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: S At e-, J Ab 4 a)WLS Identif ation- Please Type or Print Clearly OWNER: Name: SR A, 6 tptp- Phone: Address: Contractor Name: , s r��SrdieM ALPhone: Email: uii a� o M Address: 131 S o ✓t Supervisor's Construction License: CSS , b 13 5 Exp. Date: Home Improvement License: 0 �.Ss (O Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED CO ST BASED ON$125.00 PER S.F. Total Project Cost: $ 9��o FEE: $ 1 Check No.: bQ`4 Receipt No.: 201��5 NOTE: Persons contracting with unregistered contractors do not have access to the guar ty fund E-ahiffiie-of-Aclent/Owner Q* I � . Location No. 3Date I �� . - TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ ., Building/Frame Permit Fee $ �7 Foundation Permit Fee $ r: Other Permit Fee $tet TOTAL $ Check# "f e) , ,; Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans F PE OF SEWERAGE DISPOSALlic Sewer Tanning/MassageBody ArtSwimming Pools ll 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 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 D;EPARTM.ENT �T:emp Dempster on i ste yes = no '. Locatedat 124 Main Street Fire Dp -rtrrferit.Sinnature�daxe = `'` 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 ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pen-nit Revised 2014 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 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 Doe:Building Permit Revised 2014 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 o 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o 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 2014 NORTty Town of 2 E F. Andover 0 No. zol * ,� h ver, Mass A- r COCKICKl WICK 7,95 RATED 0'1? S U BOARD OF HEALTH Food/Kitchen PERM L D Septic System THIS CERTIFIES THAT ................... BUILDING INSPECTOR .. ...................... .................. .......... ...... .. ..... . . has permission to erect ........... .............. buildings on ... . ..... ....... ................. ...t................. Foundation Rough to be occupied as ............... V...�... ......................................................................... 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 j UNLESS CONSTRUCTIO ?toe Rough Service .................. .......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. g, ,,fig,iS` CASTRICONE ROOFING & SIDING INC. ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 2318 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 be des ribed: ] Owner's Name... tr'..... �t.C.1..�..1. 11.x,-....I...,�CiO.U`.t ............T phone k...1v1�6 � . Job Address............ . ......... ...CIX. .t✓ .b.............. . .........City... ... 1;......tl ..l?.k.'.�J..................State.........,............. Specificalions: ........... .......9...C...�............................................................................................. Strip existing shingle V pply new drip edge to all edges. .............................................................................................................................................................................................................. -/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 unhcated arras of house. Apply ft?#t pa Icr dcrlaynteu Install ridge vent to �3 s : � �.. .......�.. r. - .. croof using) /�+.uMv r f lx shingleswith a _10 year warranty. .................................................. �...........,.. :JCounternash chinmcy. �New vent pipe clashing.-cgal disposal of all debris. n ... ...... . ............. ..�n..y......................................................................... :�:,lM.�..... i�.�Y1G.�a .44� 1......... Area(s)to be worked on: .............. ...........I............... .................................. ......................... fICt2,....z .......................... ................................................................... �... ... ................................................................... ...... .............. .................................................................................................................. Roof board replacement if necessary @ (6 /sheet m•.� 97 foot. ..................................................................................................................................................... Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as sped cit y nufalclturer The contractor agrees t perform the work yand fylnis the materials specified above for the SUM E..... .. .{/................. Payable...:. J..................on.cy/tti f' ................ 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-cxisting conditions(i.c.water stains,crumbling plaster,exposed nails)or conditions resulting from application ofmatcrials 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 woik,all undersigned agree to execute and deliver to contractor,theirjoint 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.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 hind and apply to their heirs,successors or estates ofthe parties.The 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. .✓ All Home Impro4ement Ctmtractors 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.neccssary 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 e,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 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[fie,2)31 R Sutton St.,No.Andover,MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their names this....... .......day of..............P.�....,20.d.. . Accepted: i Signed... ..... 61Crrr........ Owner Signed .................. Owner ........................................................... ................................................................... David Castricone,President Deparrinerli of Industrial Accide&s Qf[Ce of Invesd atdons '�,T T.ef t_t 600 I-Mashin ton Street { L Boston, AM 021.11 y' 'rte IVFV1V.n1aSS.g0I,1dia Workers' Compensation Insurance Affidavit: Builde>i-s/Conte•acto8's[EEecti-icians/Plutubei-s kpPlicant Information Tease Print Legibly Tame(Business/Organization/Individual): �@,t)l `, l�t1s Cl 1 CbYJ,,, �p&^Af f� n� ',ddress: 112 CCG S� u► i f �� T� ity/State/Zip: . 6(Y 4S� Phone #:_ Oln 6 M 1"r1a-L1 re you an employer? Check the appropriate box: Type of project (required): I am a employer with _ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6- ❑New constntction I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Buildino addition No workers' comp_ insurance comp. inst.trance.l required.] 5. We area corporation and its 10.❑ Electrical repairs or additions officers I am a homeowner doing all work ohave exercised their 11.0 Plumbing repairs or additions m self. o workers' com right of exemption per MGL y , p c ar15?, l(4); and we have no 12.(Vf Roof repairs insurance required-] ' 13.❑ Other employees. [No workers' COMP. insurance required.] r applicant that checks box ill must also fill out the section below showing their workers'compensation policy information_ meotvners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. itraaors that check this box must attached an additional sheet shoxvine the name of the sub-contractors'and state whether or not those entities have oyees. If the sub-contractors have employees,they must provide their xvorkers'comp.policy number. it an employer that is providing workers'compensation hisurance for mY emploUees- Below is the policp acrd job site ,rination. trance Company Name: cy# or Self-ins.Lic. f1:_W_L 609 `!a '7 , 3 Expiration Date: Site Address: i 1 b I[AQA0 I'-[. LS+ City/State/Zip:A0 Jam/t&A'M'4 P lee ach 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 !p to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of !stigations of the DIA for insurance coverage verification. t hereby terrify t r 6/ p is d penalties of perjury that the information provided above is true acrd correct. nature: �y Date: me Official uYe only. Do not write in this area, to be completed by cit.v or 1011,11 ofciaL City or Town: Permit/Lici:ttse # issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Cityffown Clerk 4. Elecirica€ Inspector 5. Plumbing Inspector �7RTH o�� n o No Andover �o� ,6gti01 TT North o 1. � � � �• �• .s�7�P1 p Building )7epartwcnt Ch: les Street 45 o , Massachusens 01R c) oRS.c,,aS Fax (978) 6Rt� 95' �NusE�. DEBRIS DISPOSAL FO-%'L c c ,Ce ;,h rjle provisions of N,1GL c 40 s S4, and a condition of the debris resulting from the wort: slll Le d spo$ d �. l,censed solid waste disuosal iacil!ty as defined by \40L L:i 1 , sl�Oa GL', . ',VIII e Ul$POsea Of !n J. h Facility iocat.on n I Sianat'ure of Apph,:art D atc III i I � 4 iUt 5cim dic Town of Nor.h. And0V2r must DC !01 11115 the OrTce of the Build ng Inspector fx r ,a►C40R O CERTIFICATE OF LIABILITY INSURANCE r 9DATE /9/ °5 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(les)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 Select Dept. Eastern Insurance Group LLC PHONE (800)333-7234 x66807 I .(781)586-8244 233 West Central St EMAIL .selectwork@easterninsurance.com ADDRESS )NSU S AFFORDING COVERAGE MAIC# Natick MA 01760 INSURERA.Western World Insurance Co INSURED INSURER B-Commerce Insurance Company 4754 David Castricone Roofing & Siding Inc. INSURER C�ranite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER D. INSURERE. North Andover MA 01845 1 INSURER F: COVERAGES CERTIFICATE NUMBER-.CL159964794 REVISION NUMBER: j 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. )LTR TYPE OF INSURANCE POLICY NUMBER MWDD EFF EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY R DAMAGEES Ea NTecGlirenne $ 50,000 A CLAIMS-MADE OCCUR GL 2015 /6/2015 /6/2016 MED EXP(Any one parson) $ 1,0-00 PERSONAL&ADV INJURY $ 1,000,000 ! GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY Co anent IN LIMIT 11000,000 BANY AUTO BODILY INJURY(Per person) $ AUTOS AUTOS X AUTOS ED G(`p /1/2015 /1/2016 BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOSdenf $ 8 UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION 1 $ C WORKERS COMPENSATION X I WC MUMf 0TH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNEPJEXECUTIVEE.L EACH ACCIDENT $ 100 Q00 OFFICERIMEMBER EXCLUDED? ® NIA (Mandatory In NH) 003989723 /23/2014 /23/2015 E.LDISEASE-EAEMPLOYE $ 100,000 If yes,descnbe under DESCRIPTION OF OPERATIONS below 003989723 /23/2015 /23/2016 E.L DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks ScheduM,it more apace 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/KH3 ACORD 25(2010105) ©1988.2010 ACORD CORPORATION. All rights reserved. INS025r;-mnns m Tho Annan nsma onrl Innn om mn)cfamA mmAre of Arnpn Massachusetts - Department of Public Safety Board of Building Regulations and Stan dards C,mn ucii,ui Sulirn isnr Sl1ccia11\ c_cense CSSL-099358 , tt DAVID T CASTRICONE 31 COURT STRE.ET NORTH ANDOVER MAk°pol8 g , Expiration Commissioner 12/16/2015 Office of Consumer Affairs& Business Regulation' ifi` k}OME IMPROVEMENT CONTRACTOR F - egistration: 104569 Type: z ;;Expiration: 7/14/2016 Private Corporatic DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER. MA 01845 — Undersecretary