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Home My WebLink AboutBuilding Permit #1014 - 74 MEADOW LANE 6/8/2015 : 4L1,14- - BUILDING PERMIT o`'I, F. .6, TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION �O Permit No#: r� Date Received ° �gSSAC H�1`�� Date Issued: & IMPORTANT: Applicant must complete all items on this page LOCATION 4 C��Ccs 4-(J�1 e— n �� T J8 Print PROPERTY OWNER t'� k Sc Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 9POne 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: ,gf l r2 and rc--s I b e- 0,11 s► `n� 61f6i h66 J Identification- Please Type or Print Clearly OWNER: Name: 'R a -Ty; iJ« Phone: 9A Address: � ME(�6 L�, h&V)e IAC C 'h \,ey MA Contractor Name: et,� tine Pho e 4 3 l�1 � the cf�� 8 y )- Address: , 1 E ...+)br, S+Ylee- U A 3 Pr0 0 . . I�7i1J lel�YT Supervisor's Construction License: �I. J Exp. Date: Home Improvement License: , ) ` Roi Exp. Date: r7 - ) Y .olGi M 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. 03 Total Project Cost: $ o FEE: $ ^ '- Check No.: sp- Receipt No.: O d 2 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund - -. - . Signature of Agent/Owner Signature of contractor. .L Plans Submitted ❑ Plans Waived D 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS P 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: g g 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 Call Email 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 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/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) ❑ 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:Building Permit Revised 2014 Location) No./ Date O • - TOWN OF NORTH ANDOVER . Certificate of Occupancy $ g Building/Frame Permit Fee n Foundation Permit Fee $ Other Permit Fee $ ok D TOTAL $ Check# Building Inspector NORTH Town of ? E �. ndover O - ;�. 0 No. IL L111 KI h ," ver, Mass, COC NIC NE W�CN �� AERATE O aT V BOARD OF HEALTH PERMIT LD Food/Kitchen Septic System THIS CERTIFIES THAT ....... QI.. �..Q.....: BUILDING INSPECTOR has permission to erect .......................... uildin s on ...1_4......... � J ..........�rFoundation Rough to be occupied as ......................... .................. ....................r .. . ! .. ......................... Chimney provided that the person accepting this permit shall in every respeto the termsf the application Final on file in this office, and to the provisions of the Codes and By-Lawto 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 CONSTRUCTI . Rough Service ............... ................................. Fina 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 CASTRICONE ROOFING&SIDING INC. "f ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 R31 P. 2enuTTON STREET,$sb b,NO.ANDOVER,MA 01845 In NorA Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314 Itwe 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 preens below descri / p/ /��y Owner's Name...... .. 4t:�1......... �. .L' ..................................................... Telepho #...� 4• •••L•{,r•1.A........ /M �I Job Address......f .k......1...�4L ..P..4f1.... YtYY ................City. L?.I 1�. .Yl '.D.1f I'd ....State..M ........ Specifications: ?4 A r ...... ...... Areas to be covered: :..S.l. ....rte >7.�� v .......................... . I'�pply vinyl siding and corners. Type. pp� i j/ / G� .............. .6.5..(.1..4 z.. t l rl .. ........ . ....l.alL Y................... I/Cover fascia boards and rake boards. bTnstall vinyl soffit - solid perforated ...............o.........as...in... ....n..d...win...... ... ......................................................................................................... ................................................ Cover w**o' cgs.....a..rou.. do.. 'w-*s*.* Replace any gablf,�'v�nts and dryer vents with vinyl. ,,.41�� LiSl....................................... ................................................... p-ly underlayment Type: /�/ — ' ) 1. Fl.t7.1!15.VYt1...........1 .rS4?11.V11. t.... ....... ;)E'zisting siding stripped / go-over —Legal disposal 6f all debris. }� i .......................... ...............p .............................J•• SxJ 1.a.... F:X,,..�.jZ .. .. ..�.... ....... .,.A............. ......... Rotted wood repsheet OT vb /foot. V e-1- .. ........ .....��. -... . . , A..... ....... ...p ...., �. `1� ....� _...................... ..f . ...:..f z.�t'... .dr..Si .. .!l1. ........................................................................................................................ Ont Year Workmanshi�Warranty(Not Transferable) Manufacturer's Warranty as specified by manufacturer The�rn to prrformthe work aq4 the materials specified above for the SUM of$..�..r��-52D........... b . ..l:t.(Q.......on....S. .hcSJ.4�..4............ Payable........-'...............on........."....................„� lance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability whir 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 Spam).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 waremt(s) that he is(they arc)the owners(s)of the above mentioned premises and that legal title thereto stands of record in his(their)names(s).Tbcre 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 ppnotice of cancellation). IN WITNESS WHEREOF,the parties have hereunto signed their frames this...p.t�.......day of.....fn. ...........20.l.5.... Accepted: r—f Signed... .......L.....:�.....�....r....................... Owner ' Signed. ....1.1.�.....r/ .. Owner David Castricone,President �` / Z\ The Commomvealth of Massachusetts " Department of Industrial Accidents Office of.Investigations 600 Washin ton Street Boston . . ..,, , AIA 02111 www.tnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pltimbers Applicant Information Please Print Legibly Name (Business/Orgatuzatioa7ndividual): DAV 1 b C AJ S R I CONI ROOF( Irl(s h Si D 1 NO IW(- Address: N(- Address: �3I R SUTTc N S i REL 7 UN i t JA CJty/Sf.mC/l,P� No, A NDovet: �IA U ( t f Jr —q --G b 3 _ Phone #t: Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 4. ❑ I am a general contractor and I employees Gull and/or 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 g. ❑ Demolition working for me in any capacity. employees and have workers' 4. ❑Building addition [No workers' comp. insurance comp. insurance. 1 required.] 5. We are a corporation and its 10.0 Electrical repairs or additions ❑ P 3.❑ I am a homeowner doing all work officers have exercised their 1 I.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, and have no 13�Other S employeees.es. [[No workers' — 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 artacbed an additional sheet showing the name of the sub-contractors and state T;hether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. .l ani an employer that is providing}vorkers'compensation insurance for my enrployees. Below is the policy and job site information. Insurance Company Name: GRAN i T i A`I e- I N co _ Policy #or Self-ins. Lic. #: W C(.) 0 3 9 &9 7 c 3 Expiration Date: Job Site Address: McQjO(� IAI)e . City/S-tafetZip: 6 Ewe A 64`t f 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 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be for-warded to the Office of Investigations of the DLA for insurance coverage verification. I do hereby certif under the pains and penalties of perjury that the information provided above is true and correct. Sicmature: .� [�,- Co Date• Phone#: 9�D � 370�6 Official use only. Do not write in this area, to be completed by city or town official Cite or T oN n: Pcrmit/Liccnse Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone#: ACC?R 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 FAXX No: 233 West Central St EAD-MAID EL .sdonnell@easterninsurance.com INSURERS AFFORDING COVERAGE NAIL p Natick MA 01760 INSURER A:Western World Insurance Co INSURED INSURERB:Commerce Insurance Company 4754 David Castricone Roofing S Siding Inc, DHA: INSURER CGranite State Insurance Co. 231 Rear Sutton Street, Unit 3A I INSURER 0: INSURER E: North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBERMaster 1d-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 NOICATED. 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POUCY NUMBER IMWDOrfYYYI IMMJODtYYYYiLIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE T RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea o=rrencei b 50,000 CLAIMS-MADE OCCUR P1398404 /6/2014 /6/2015 IVIED EXP(Any one person) S 1,000 PERSONAL d ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 �N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 X I EOLICY I PECT F7 RO LOC I I S I(AUTOMOBILE LIABILITY (Ea BIOMBINdeDISINGLE LIMIT S 1,000,000 y3 I NY AUTO BODILY INJURY(Per person) S II.ALL OWNED XSCHEDULED CNGCv ALrl OS AUTOS /1/2014 8/1/2015 BODILY INJURY(Per accident) S XX NON-OWNED PROPERTY DAMAGE ! -1RE0 AUTOS AUTOS Per accident S �I � � 5 UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LiA8 CLAIMS-MADE AGGREGATE $ I D'c0 1 IRETENTIONS S C WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'UABILrTY Y/N FIR ANY PR0PRIc70R/PARTNER/EXECUTIVE 05-ICEAd REMSER EXCLUDED? O NIA E.L.EACH ACCIDENT $ IDDODD (MancatorYin NH) 14CO03989723 /23/2014 /23/2015 If yes,oescnJe under E.L.DISEASE-EA EMPLOYEE S 100,000 Oc SCRIFTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 I I i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,A more space is required) Rcc`i�g siding contractor I CERTIFICATE HOLDER CANCELLATION p SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE Castriconeftofing & Siding THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Unit 3A ACCORDANCE WITH THE POLICY PROVISIONS. 231 R Sutton Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 John Koegel/MET ACORD 25(2010/05) (D1988-2010 ACORD CORPORATION. All rights reserved. I N.&O28,7 ; im The A"r)Pr)nnma�nrl Innn oro roniglerori masiro of er^non Town of North Andover o� "oroTN e ti0 Building Department 27 Charles Street n * 7 � Nonh Andover, Massachusetts 01845 (978) 68 8-954 5 Fax (978) 688-9542 t O M 7 R�rto �P 5 CHU5e DEBRIS DISPOSAL FORM i In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit 9 the debris resulting from the work sliall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, 91502. The debris//will be disposed of in /at: e s A)/-) Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project tluough the Office of the Building Inspector. Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction SuhCII iwr SpeCi:1lth License: CSSL-099358 DAVID T CASTRLtONE� . 31 COURT STREET r VAR' NORTH ANDOVER MAktq1845 l Expiration Commissioner 12/16/2015 'xxr' urrirrcrrrnen�/� , =. Office of Consumer Affairs& Business Regulation qi'i ,ROME IMPROVEMENT CONTRACTOR 1� registration: 104569 -_ .fix Type: piration: 7/14/2016 Private Corporatic DAVID CASTRICONE ROOFING, SIDING& i David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 — Undersecretary