The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #390 - 73 FOREST STREET 11/19/2007 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION o�No oT 6 6 C� / > 0 A Permit NO: �`j Date Received 4` 1.ED Date Issued: SSACHU`�� IMPORTANT:Applicant must complete all items on this page LOCATION 73 rrr4 fu t S17-c L Print PROPERTY OWNER �QlI/�/C IND/J /)?�' Print MAP NO.: b PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building Z-One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: 4-l`epair,replacement ❑ Assessory Bldg ❑Commercial ❑Demolition ❑Moving(relocation) ❑Other ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED c�uoo/u arrcd ��ct�7t,// i doyh!e Xd.Lj� a Identification Please Type or Py—L4,1h rintClearly) 1 OWNER: Name: (/3�yiJic AJal�Shome1 - 14✓ Phone: cr//3 Address: 113 A eu "'Yrlc(dve� CONTRACTOR Name: 6J14 Us-it /rd J/iiL. Phone: f 7F,� 10ayato Address: Supervisor's Construction License: Exp. Date: Home Improvement License: /1041)-70 9 Exp. Date: e ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATEC T SED ON$125.00 PER S.F. Total Project Cost :$ a Jet), a FEE:$ n Check No.: C9 Receipt No.: 0 Page I of 4 r r� Location 3 �� ! •J No. Date// NORTH TOWN OF NORTH ANDOVER F 9 Certificate of Occupancy $ _,__. .' • ;�a"•^° '��' Building/Frame Permit Fee $ swcNust Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20 Building Inspector TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools ❑ Public Sewer ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Well ❑ 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 t FIRE DEPARTMENT - Temp Dumpster on site yes J 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 Required 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 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 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 o Floor Plan Or Proposed Interior Work Addition Or Decks o Building Permit Application ❑ Surveyed Plot Plan o 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) . o 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 NORTH If ToVM Of Andover No. a ?o C% " LAdover, Mass., C I HICHEWICK y�. Ids RATED P'PS 7 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... Q.f11�.. ! !..........4;�ko.. ..5. 0..1 � �......................................................... Foundation has permission to erect........................................ buildings on ...13....... .dr.44.'f-.......s.T Rough .. t0 be occupied as4-* �`�►r �.1.�..Q....�..s... .............................I...... Chimney provided that the person accepting thi 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 CONSTRU S' Rough r.................................................. Service BUILDING INSP TOR 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. ACORD,. CERTIFICATE OF LIABILITY INSURANCE9/25/20`07 DATE(MM/DD/YYYY) PRODUCER Phone: 508-651-7700 Fax: 508-653-8089 THIS CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION Eastern Insurance Group LLC -Commercial Lines ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 West Central Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Natick MA 01760 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURED INSURERS AFFORDING COVERAGE NAIC# David Castricone Roofing & Siding Inc INSURERA:Citation Insurance 40274 200 Sutton St INSURERB:The Insurance Co of State PA Suite 226 INSURER C: North Andover MA 01845 INSURER D: COVERAGES INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOP. 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. LT, X"I TYPE OF INSURANCE POLICYNUMBER POLICY EFFECTIVE PO ffEXPIRATION LIMBS GENERALLIABILITY C EAHOCCURRENCE $ COMMERCIAL GENERAL LIABILITY A PREMISES Eaoccurerroa $ CLAIMS MADE F]OCCUR MEDEXP(Anyoneperson) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATE LIMIT APPLIES PER* PRODUCTS-COMP/OPAGG $ RO POLICY j LOC A AUTOMOBILE LIABI LITY 07MMBBTNKT 8/1/2007 8/1/2008 COMBINED SINGLE LIMIT ANYAUTO (Eaacciderq) $ ALLOWNEDAUTOS X SCHEDULEDAUTOS B $250000 rpersonn))pers (Peer X HIREDAUTOS NON-OWNEDAUTOS Beraoci era) $ (Per acciderrc) 500000 PROPERTY DAMAGE (Per aoclderrt) $100000 GAR AGE LIABILITY AUTOONLY-EAACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTOONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACHOCCURRENCE $ OCCUR El CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND WC7222278 9/23/2007 9/23/2008 X T CYTATT- OTH- EMPLOYERS'LIABILITY ANY PROPRIEfOR/PARTNER/EXECLMVE E.LEACHACCIDENT $100000 OFFICER/MEMBEREXCLUDED? Il Ves,tlascribe undar EL DISEASE-EA EMPLOYEE $1 Q 0000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT1$ 500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICETO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REP RESENTATIVA ACORD 25(2001/08) p ACORD CORPORATION 1988 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 978-37/-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 premis s below describedr: Owner's Name...... k`w_.tt� ........ . .. ............ ephone#..... Job Address.....13 et. .. i.......................City. YD.. la.�,.7....^.>-?..L. .... q.. .................State........... Specifications: ........................... ...................... ......... .... .................. ........ ...... ..... .......... .... .. ....... . .. ......... j......../..�. e.('s. /�.......tlJ/n. ialC .........n.ear11................... u.1 s?. ...�........./..Y...£..4d......�?Q�C�d.c?.L ............1`1 ........................... ,`.11.t: .. ....1/..r ........ ...... .'.Gt.G�.r............d..i , 21.. yr ........................... t.......... .V1.I..l..e ......e!....e t t.ter.r....... ..r..t.Gl. ........I•..t..r r....t.. 1.R.r........ .t�.r.. ..,............................................. ................................ ---- .............. ...... a. .. .. .......w.a a..> s.......W)..... / ...�.ir-�r..F. ..... ..^x . s.�... ....................................................................................................................................................................................................................... ...................................................................................................................................................................................................................... ...................................................................................................................................................................................................................... Two Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specified by ma�qufacturer Thec9atyaoragree to rform the work d furnish a°�rt specified above for the SUM of S.....r YAC f.�..A............ 1 ayable... .0......on.�j ctJ o paywhle............................on........... ............. Balance payable on comnletitmf i oob re Owner or Owners anot responsible for Property Damage or Liability wh ob 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(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 dampster 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 temrs 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 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 arc no represartations,guaranties or wan-antics,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 f cancellation)'' IN WITNESS WHEREOF,the parties have hereunto signed their names this... day of.. f .,20..Q.. Accepted: r' Signed �. .... . » ... . N.4.lGl..!�. Owner L)JC-4,2� Signed............................................................................. Owner David Castricone,President�/h Town of North Andover tAORTly °�,tt Building Department o °�, 27 Charles Street North Andover, Massachusetts 01845 e„ (978) 688-9545 Fax (978) 688-9542 oo SACHUs�� 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 c,l 1, sl 50a, 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 i Department of Industrial Accidents I Office of Investigations 600 Washington Street Boston, MA 02111 _ www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information T r Please Print Legibly Name (Busuiess/Organization/Individual): :DhV I h L&&t fR l C n N E �0 f•1 N L l'I,i N C. \lV L Address: ;�o 0 S u 7'TQQ 5 VZU—T — Su ITE A�-(o City/State/Zip:l, AND ovL-R MA OiNg Phone#: Q Z F 6 Z 3 3 4 a o Are you an employer? Check the appropriate box: Type of project(required): 1.® I am a employer with f 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6• ❑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 8. E] 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.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑ Plumb mg repairs or additions myself [No workers' comp. right of exemption per MGL 12 insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.Vother 14 0111_� 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: G n,n,5J✓n0.11C ct CO O S+-a#c. VA Policy#or Self-ins. Lie. #:_ W C Expiration Date: qlz 3 oz Job Site Address: City/State/Zip: 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 certifv under t epains andpenalties ofperjury that the information provided above is true and correct. � r Si nature: f:�ADate: 3 — Phone 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#: