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HomeMy WebLinkAboutBuilding Permit #183-2016 - 712 GREAT POND ROAD 8/10/2015 i NORTH q 4 -4 4LF BUILDING PERMIT o <��Eo '64 do a"2 �" b TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION _ p Permit No#: \Jy\/ ,L/ Date Received SSgAT ED cHUS�,�c5 Date Issued: I� IMPORTANT: Applicant must complete all items on this page LOCATION to LAT t , Print PROPERTY OWNERtc S Print 100 Year Structure yes . no MAP PARCEL: ZONING DISTRICT: Historic Distract yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ne famil ❑ New Building � Y ❑Addition ❑Two or more family ❑ Industrial El Alteration No. of units: ❑ Commercial I repair, replacement ❑Assessory Bldg ❑ Others: ❑ DemolitionElOther -- . Se tic ❑.Well ro ❑_ Floodplain. D Wetland$ V, q! Distract - - - DESCRIPTION OF WORK TO BE PERFORMED: I' �► � a.n � Ire °�1�1ti � �1ov a-e- Identification- Please Type or Print Clearly q OWNER: Name: vrk rs k-a u1 j Phone: Q� 11 Address: d GIr'e end �� ` A i , Contractor Name:-b • CM-J n)c av h Phone: Email: Address: 3 t R �S dfi�,n 4:- 141, Supervisor's Construction License: Q Exp. Date: Im rovement License: O �o Exp: Date: -� i Home p u ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �j ` -")O-FEE: eFEE: $ ' �� Check No.: b�1 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to th guaranty fund Kinriatum- , _ 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 Dinupster 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 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: ' FIRE DEP �� _ =� ��" Located 384 Osgood Street AR�TIVIEIVT Temp.Durnpster on sitew)yes; iw. �.; no ocatecl at 124 Main Streets ,, � - } +± Sti4{F{ 4c a:d`-3 t '''#Y�"^° ,'`a ,JirR� 5 -''.: t} ,x` ; fire Dartment mature/dateA. 4 is .fie•- �.v • ` r .+. 8 '. 3 �ITX` Y+t �_..� .� { r , ,�`7ti`""!'.'�.4 �, �� .# Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Dieter 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 r I N®TES and DATA— (For department ease) i i i i I ® Notified for pickup Call Email , I Date Time Contact Name Doc.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 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) 16 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 j 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to is of Bldg. Permit In all cases if a variance orspecial permit was required the Town Clerks office must stamp the decision from the Board of Appeals j t then get this recorded at the Registry of Deeds. One copy and proof of recording that the appeal period is over. The applicant mus ,) must be submitted with the building application Doc:Building Permit Revised 2014 i 1 Location �(P �✓�'�cr � ' No. ,V Date J . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee '7 Foundation Permit Fee $ ti Other Permit Fee $ TOTAL $ v Check# 8 Building Inspector NORTH Town of . � E ndove' r 0 No. ' ,� 4 i „ o . : �A�t h , ver, Mass, � 2619 coc«Ic«ewaK y1. A°RATED P'P�,�'(y S ll BOARD OF HEALTH Food/Kitchen PER' MIT T LD Septic System w THIS CERTIFIES THAT „ ,� OQ ,,1!�, „ ,,�,�............... BUILDING INSPECTOR �•............ ....... Foundation has permission to erect .................:.::..... buildings on ...,..Q. ...... . .. - .................. . Rough tobe occupied as ............ .:. ..... .... ....................................................................... Chimney provided that the person accepting t is permi4t 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 CONSTRUCTIO ARTSRough Service ............. ...... .. .. .. .. ........................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired 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. 0- 7o 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: p/�Q !FA / Owner's Name... Ll.kl/.. 'L'S..IA..W/ ... ...........................:............. lephone#....... ( q17 Job Address.. J. r.. �'D /...l ,t..........City.. D...A .c?..t!R+ ./�..................State.. ........ Specifications: f...............................................✓ .. ..................................................................... ......... .................. ............... Strip existing shingI Apply new drip edge to all edges. W�rT......g. ......................... ......... ......... 'r ........................................................................................................... ......................................................................................................... /Apply feet ice and water shield membrane to bottom ed..es of house.3 feet ice and water shield membrane in valleys and bottom edges of any unheated areas of house. /j ] n re, ............,. ..............................(.,J. ` �1 1 P� f........................................................... Apply` paper underlayment. 'install ridge vent to z y cam.. ...... t/tteroot�using �� ( ��i4 l i/P__J shingles with a 3j�year warranty.` rta� 11 . .... ................................... .... .. ... ........ v(ounterflas.....h chimney.✓I\ew vent.. pipe.. .. flas....hing......�egal disposal of all debris. ' .......,.3..`.............. .................................................... . 2l'r ./,�....1.* ...dt. uyn....... ,/Area(s)to be worked o' fJ s .. .................. .. '.��...s�•X),j•/tt 1...Gf 1"L'tRaS....fJ .. .LT. !� rt. .............................................. pl ..5..1. ..1.Pt ... .41.-- ,$......6L�. r...Z�.ytJ .'[7A......... C-f— j'14 S.......Q r.....�.l3 �I................... k J•1• .. I JJ�_ - /1 //l// i ........ 1�, �. I. .....]~ .... .... .ALL .Ga-{. .L.l,�i..... ...n'l. .t2Z.... .. .... P.�. /sheet a�-.. ....... ....... Roof board replacement if essary /sheet 1J/foot. / _(' 1 ......... X�tec, 1.xx...... .zn. d. - Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as spec' y manufacturer The contractor a t�oyperform the work and fu 'sh the materials specified above for the S of$...� .P............ Payabl 6)& ......on. .. . Payable............ .on. �� Balance payable on completion of Jo 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 prc-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.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.The undersigned warrant(s).that he is(they are)the owners(s)of the above mentioned premises and that legal tine thereto stands of record in his(their) names(s).There arc no ripresentaions,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 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 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 ntained 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 o the below-referenced date.Mail or deliver a signed and dated notice or send a telegram to Castricone Roofing&Siding Inc,23 S tton St.,No.Andover, A 01845. IN WITNESS WHEREOF,the parties have hereunto signed th ' es thi .... . .. ..day of. ... ....,20.. Accepted: Siged...... . . . ..................................................... Owner Signed............................................................................. Owner L �Laj .fi`f�S David Castricone,President The CounnonwealJoh oj'ft assrchu-,eta's N Departmeni of hzdzistriat Accidents Office o-Investib atdons v :.:_e r t+.,,til -;rY: 600 Ulash ina tort Street L ,w Boston, AL4 02111 iviviv.mass.govIdia Workers' Compensation Insurance Affidavit: Builders/Conte-actoi-s/Electi-icians/Plur>tlibers kpplicant Information .Tease Print Legibly ,Tame (Business/Organization/Individual):� � e 6V S)� r C. address: C) 3 e\ S U+fbh s,-V V I 6 A- ity/State/Zip: . Auld\ed A Oft 0-0Phone #: �7 8 3 2 � 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 6. E] New constriction employees(full and/or pari-time).* have hired the sub-contractors I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling These sttb-contractors have ship and have no employees 8. ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. inst.trance.t C required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions I am a homeownerofficers have exercised their doing all work l l.❑ Plumbing repairs or additions myself. o workers' com right of exemption per MGI_ y , p c 152, 1(4), and we have no 12. Roof repairs insurance required.) ' 13F] Other employees. [1'4o workers' comp. insurance required.] i applicant that checks box#t must also fill out tlne section belo,•.,showing their%vorkers'compensation policy information_ meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. itractors that check this box must attached an additional sheet shoving the name of the sub-cornractors'and state whether or not those entities have oyees. If the sub-contractors have employees,they must provide their workers'comp.policv number. rt an employer that is providing workers'compensation ursnrrnce for mY emplovees- Below is the policv and job site wffrntion. trance Company Name: e 1t-"%'b_, I I�1SyYzlrt�LZ cz cy it or Self-ins. Lic. M. 1�('Q(} ej h�d3 Expiration Date: I a3 h r Site Address: -�i A- G 1'e-a-i P-0 Y\c, Ron() City/State/Zip: Qo, Ando vn, ",f���1�� aeh a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). ire to secure coverage as required under Section 25A of l\4GL 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 tp 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 DLA for insurance coverage verification. hereby certify under the pains and penalties of perjury tlrrri the htfornration provided above is true and eorrect. nature: Dater toe 9: &� t?fficial use only. Do not write-in this at-err, to be completed by cite.or town offzeh L City or Town:— Permit/LtcetISC 9 issuing Authority (circle one): t 1. Board of Health 2. Building Depariment 3. City/Town Curl; 4. Elecirical Inspector S. Plr�mbing Inspector A�® 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 . (800)333-7234 FAAX No: 233 West Central St ADDRESS:sdonnell@easterninsurance.com 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 INSURER F: COVERAGES CERTIFICATE NUMBER3taster 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. IPOLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO}� COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ 50,000 A CLAIMS-MADE Fx_]OCCUR UPP1388404 /6/2014 9/6/2015 MED EXP(Any one person) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 XI POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED F---.r-I SCHEDULED CNGCV /1/2014 /1/2015 BODILY INJURY(Per accident) $ AUTOS I AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTO iX AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ C WORKERS COMPENSATIONWC ATU- IMITS 10TH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) 0003989723 9/23/2014 /23/2015 E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Roofing & siding contractor i 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 I ' John Koegel/MET ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 nm nn5i m Thr ArtflRn namo­4 Innn ern rAniNororl mar4c of Ar npiri Massachusetts - Department of Public Safety Board of Building Regulations and Sta 9 ndards C',nctructi'rn Sulur1 k ,r - cense: CSSL-099358 DAVID T CASTRICONE 31 COURT STREET NORTH ANDOVER `e0 I MA 18� J..G.. ��• =xp;rat3on Comrnissroner 12/16/2015 Ofiii _._ Office of Consumer Affairs& Business Regulation ROME IMPROVEMENT CONTRACTOR 6 {"egistration: 104569 Type: � t ;. ;Expiration: 7/14/2016 Private Corporatie DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 — Undersecretary Town ot' North Andover 0F .t"x 0 0 b 0 Building Department 0 Ch ales Street N 0 n 1 i A-,-:,d-C)v e f Massachusetts 01845 689-9345 Fax (978) 688-9542 T I. C E1 A C'4 U DEBRIS DISPOSAL FORIM core ce with the provisions of MGL c 40 s 54, and a condition of permit :V the debris resulting from the wor.: shall be disposed p-operly licensed solid waste disposal facility as defined by MOL cl 1 , slSOR I he 2" b i i s i be disposed of in /at ZW I s 3e-� 0'Inn Fac)hTy locat)on Signature of Applicant Daie NOT= PUrrul from the Town of Not-Th. Andover must ce obtained for this project thicuoh the office of the Building Inspector,