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Home My WebLink AboutBuilding Permit #598 - 63 CROSSBOW LANE 4/8/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:- Date Received Date Issued: /D IMPORTANT: Applicant must complete all items on this page LOCATION (,o , CR04fbda /1 Print PROPERTY OWNER _ ��/(�! S 6)1��K Print MAP NO: _166 PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes 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 DESCRIPTION OF WORK TO BE PERFORMED: 5TRI F) AJD 'Re ?oot7 Al A 6p Ajj Identification Please Type or Print Clearly) OWNER: Name: �i /UIS CEy Phone: 99� („R3 D U/ Address:_ ( ,5 cmzj &J / )dn.T 1 44bgL ot, MA odyr CONTRACTOR Name: .C' 77100 ooraj6- Phone- �� &U Va 0 ,v- Address: ( b �S07R/� i �S�Jt7 2 Z(O ,Cs I to 6LI�,C QriY Supervisor's Construction License: 993-5-S Exp. Date:A-2 -/6 -d O I ( Home Improvement License: /0L S-6 Exp. Date: 7- 0 /o 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. Total Project Cost: $ Ov FEE: $ �1� . oa Check Noy: /� �� Receipt No.: �� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature r—of Agent/Owne-r Signature of contractor TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: /D IMPORTANT: Applicant must complete all items on this page LOCATION (p ,5 Cryo C!e d36 L //I Print PROPERTY OWNER Jeer A)lul S 5(-) G Print MAP NO: _&6PARCEL:_,�pf ZONING DISTRICT: Historic District yes no Machine Shop Village yes 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 DESCRIPTION OF WORK TO BE PERFORMED: AA)D �ooF 4jj Identification Please Type or Print Clearly) OWNER: Name: le-4)/UIS ,1)(J E Ey Phone: !278 60M 0 U` Address: ( 5 CxCW&W LHIO�-- /ydr�-7l Iq1wLt--k. /YA OdYi— CONTRACTOR Name:1.C''&MCO.t I?U()f l k(r Phone: 971 (o U3 9�0 Address:_ D d 'UT7b S7i �StJ/7 Z Zra ttaU,( 1 /�}V) 6 )�,( � U11Ii' Supervisor's Construction License: 993ss Exp. Date:/d, -1(o dO It Home Improvement License: l0 L . -6 Exp. Date: 7-I dt 0 /c ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTT BASED ON$125.00 PER S.F. Total Project Cost: $ 7 f�, 00 FEE: $ Check No.: /3 �/�� Receipt No.: X790,4 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund �� . � cam. Signature of Agent/Owner Signature of contra'ct'or Location No. Date NORTH TOWN OF NORTH ANDOVER � 9 • ; ; Certificate of Occupancy $ ��s''^°•E<�' Building/Frame Permit Fee $ 96 - HU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # � q • 22 : 0U 41" Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public SewerSwimming Pools Tanning/MassageBody Art 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 i CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature i f' COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning r Decision: Comments a g Boa d Conservation Decision: Comments E Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 - Date Doc:.Building Permit Revised 2008 Building Department artment 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 j o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 p p nkler Plan And r 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 ConstructionSin le and Two Family) � g Y) ❑ Building Permit Application ❑ Certified Proposed Plot Plan e ❑ 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: Doc.Building Permit Revised 2008 i NORTH own of 0 4 over No. dover, Mass., T O - LAKE COC HI MEWICK V 7�AoRATE0 `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT t ^�/�lr..S...... U ................................. Foundation has permission to erect........................................ buildings on .... ..C�.I- 55� ..C1. ....�. �,.4/15i..................... 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 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. UNLESS CONSTRUCTION STARTS Rough ................_! / ry .... ,............................................... Service BUILDING INSPECTOR Final OccupancyPermit 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. 414 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ,r 600 Washington Street a, Boston, MA 02111 WWW.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Informationnn Please Print Legibly Name(Business/Organization/Individual): 'DAV 11 `Am{C O N E R O� F I NCT ! S ID I N�- 1 N L Address: 20c) Su-tSpIJ SrvR-E-&-t- S0 \^C-e_ Z2to City/State/Zip:h.tkNDO 46(_ NA O 19 4S Phone it: 9-)9 6 3 3 41-0 Are you an employer?Check the appropriate box: I am a general contractor and I Type of project(required): 4. 1.® I am a employer with ❑ g 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. E] Building addition [No workers' comp. insurance comp. insurance.$ required] 5. We are a corporation and its 10.E] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑ Plumbing repairs or additions myself o workers' right of exemption per MGL Y � comp. 12�Roof repairs insurance required.] t C. 152, §1(4),and we have no employees. [No workers' 13.❑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. $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. Insurance Company Name:�e_ \ 17 Cc014-cc (.o(Y 1641-V Cf— S -{� 3 ft Policy #or Self-ins. Lic. #: W_t;9 TS a,14 (o Expiration Date: q a 3- 201 Job Site Address: 66 CESS X36 G) L4/_C City/State/Zip:No. MADOU&. W 6410, 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: ; �J C � Date• �sfi.0 _ Phone#: U, 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#: i Town. of forth Andover �ot�rty Buildixxg Dep,lrtMent �'� h 27 Charles Street ° u .. 1 North Andover 1Vlassuc - 1+a husetts 01845 , (978) 688-9545 Fax (978) 688-9542 CpG plc pWic N S�-4CFtU5�'� DEDRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of. Building perinil: - the debris re%.!1[ing from the work sluill be disposed of in a properly lice»sed solid waste disposal facilit.l, as defined by MGL c11, s15Oa. The debris will be disposed of in/at: Facility l wation1E) -- , S;g lature of Applicault /10Date NOTE: A,demolition permit from the Town of North.Andover >nust be obtained for this project tluotigh the Office of the Building lnspector, i ORDDATE(MMIDDIYYYI) „, CERTIFICATE OF LIABILITY INSURANCE 09/28/2009 PRODUCER (505)651-7700 FAX 508-653-8089 .THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC - Co"wircial ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 West Central Street HOLDER,TH15 CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Natick, MA 01760 Select Ext.53389 INSURERS AFFORDING COVERAGE MAIC# INUYRED DaVid CBstricone Roo Ing $r Siding Inc INSURERA: The Insurance Co of State PA 200 Sutton St INSURER B: Suite 226 INSUR�RG North Andover, MA 0184$ 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 99QUIREM611VT,'TE11M OR CONDITION OK ANY CONTRACT OR OTHER Documew WITH RESPECT TO WHICH THIS CERTIFICATE MAY 13E 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. INSR D 2 IL WSWE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCGURRFNC(; $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RLNTEU $ PRpmls r.c rr"."�GYLGO CLAIMS MADE OCCUR MED EXP(Any one person) S PERSONAL&ADV INJURY $ r3L:NI-RAI AGGRL'GAiE $ GtN'L AGCKLGATt LIMIT APPLIES PER, r'HODUC 15-COMVIOF AGG $ POLICY f7l PRO f7 LOC JECT AUTOMOBILE LIABILITY ANY ALIf0 (C-1 Acrident )INGLE LIMIT $ ALL OWNEQ AV706 BODILY INJURY $ SCHEOULEDAUTOS (Ilei person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per auidenl) rmt)Rt'.RYY DAMAL.>F (Par Ardden[) ; GARAGE LIABILITY AUTO ONLY,EA ACCIDENT s ANY AUTO OTHER THAN EA ACG $ AUTO ONLY: AGO S EXCESSAIMBRELL:A LIABILITY CACI I OCCURRENCE S OCCUR CLAIM$MADE AGGREGATE $ b UtUUC YIDLt 5 RETENTION S WORKERS COMPENSATIt7NAND WC9752746 09/23/2009 09/23/2010 )( ITORYLIMITS Fn WCSTATU• OTH- EMPLOYERS'LIABILITY A ANY PROPRIUORlPARTNENEXECU'flvE E.L.EACH ACCIDENT S 100,000 OFFICERWEMBER EXCLUDED? II 5,dascnbc undCr E.L.DISEASE.EA EMPLOYE $ 100,000 SPECIAL.PROVISIONS below E.L.DISEASE-POLICY I,IMR $ __500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATEHOLDER CANCELLISTION SHOULD ANY OF YHE A0OVE OESCRI@EO POLICIES 9E CANCELLED BEFORE THE 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 OBLIGAYION OR LIABILITY OF ANY KINb IJPON YHE IN$URER,IY$AOENYS OR REPRESENTATIYE5. AUTHORIZED REPRESENTATIVE IStacey Brice PKG ACORD 26(2001/08) C=�ACORD CORPORATION 1988 VV J art ,rla UI u1111U1i1 f(l" lllilllllll.ti i1111i .titillllliU llti r'1� i iaiur,:r.7.ILit• L/, Fi:C7JilCGC,/G[Ial(CLJ tea... VV Construction Supervisor Specialty License .•-. �.,... Board of Buillli,lg Ret;ulaiunis:111,1 Sl:uulnrds License: CS SL 99358 HOME IMPROVEMENT CONTRACTOR Restricted to: RF,WS , airy Registration: 104J, 1 u� %% Expiration: DAVID CASTRICONE 7/14/2010 TO 270265 Type: Privale Corporation 31 COURT STREET NORTH ANDOVER, MA 018/45 i� :.��y+ DAVID CASfRICONE ROOFING, SIDING& David Castricone 200 SUTTON ST SUITE 226 Expiration: 1211612011 NORTH ANDOVER, MA 01845 - � Adminisfratol' ('llnuuk. il$III-v Tri: 99358 y 1 N I � I 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,construct and place the improvements according to the following specifications,terms and conditions,on premises below described; Owner's Name........ ..t?rx1!✓t..lS........ ....it...x�..y...................................................Tel hone#...(.a.9r ....... .(.�. /......... / 2 1 / Job Address.......4!.:1..... �fry. . ..u.Gt1.....h 4kq v ............city.... a«.. u.11 h 1 ...............State....M,4..... Specifications: ................................................................................................................................................................................................................ 1 .........&.E....... may. .. t ('f. f1'�l1-4.'. 1. .......c'. !.. l..r' L.✓.o Lr t.,�. A. ....C1 ......! Glc:-.. / ,Sa............ 1L,.;- .... bit t/`.... 641/1.` .� .4 c[L 1w................ ............A [y...... ......�e. ..............4 .......rA< lt li;`��.....�......... F1. ....... ft�z/:.................................................................................................. ............... . (.�� ,�.� ................ . .. ...... . ..,.q..,............. .... lX ..�... 'qq VV —11 / � rJ.� ..L .S.! . ..�e ......... C+.. �.. a.�ral�Ct.h . ' .... .�.�..�.....�Ss�.........................../.. ... .. .. .... n .. -.� .................. �.Pe.r 4.1.......I..e-0-5 .. .4............... .-: a.. ............. w .� . =i?..Q .J.�:n✓..i'.::.l..e.r�. .1Z.:;�....... t.:y/�.p. Tw Year Workmanship WarrantNot Transferable) Manuf>;cturer's Warranty as specifiedr-77.7. me of c��J�!!rer The ctor agrees perform the work and h he materials specified above for the SUM of ...... ......((�?.p......... 1 Payable.....l �. ...............on..�: �f ........ Payable.........—:............on..............—'............. �Balance Payable on completion of job Owner or Owners are not responsible for Property Damage or Liability wh 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(ix,objects coming hose 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 dmnpster 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 wartanks)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 of canceilatio ). II <� k:. . IN WITNESS WHEREOF,the parties have hereunto signed their names this.. .....day of...lit 20... Accepted: Signed ....................... Owner Signed........................................................ ..................... Owner David Castricone,President MA4t� �F LAOSQ-•tr R I