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HomeMy WebLinkAboutBuilding Permit #1018-15 - 74 MEADOW LANE 6/8/2015 tfNORTH q BUILDING PERMIT •61ao TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: O I Date Received �gSSAC Date Issued: V.� IMPORTANT: Applicant must complete all items on this page LOCATION 1 `7 __ Print PROPERTY OWNER k.S C-0 Print 100 Year Structure yes no MAP PARCEL: , ZONING DISTRICT: Historic District ye no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building y�One family ❑Addition ❑ Two or more family ❑ Industrial 0 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: SEr oW rn h/'/13 L rz)0 b 0 J�t �UJ e- Identification- Please Type or Print Clearly OWNER: Name: W i -1-U IS C t Phone: CIA 49(.0 q0 F Address: J Ll fY)eabw 4�_ne. t`t&r ` k Ay-)A6\fei, NA Contractor Name: OOJ fn&Ae- `� J t Cl J3 3Y a L) Address: 1 �U >'1 k . Un No , A rv)6 V`ev tl,+ 64 ` ) Supervisor's Construction License: �C�3,� Exp. Date: I - 1 ( 0 I J` Home Improvement License: 1 D - % _Exp. Date.- 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: $ FEE: $ Check No.: Receipt No.: � 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 ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody 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 Signature COMMENTS HEALTH Reviewed on Signature COMMENTS e 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 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 Doe:Building Permit Revised 2014 Location-- q � L� No. 3 Date . - TOWN OF NORTH ANDOVER • 5.�q"fLb 1�' • • t Certificate of Occupancy $ r Building/Frame Permit Fee 's Foundation Permit Fee $ Other Permit Fee ' x TOTAL $ Check#V1 V LL�, Building Inspector � NORTF•� Town of 2 E ., ndover o . o. 6/S_ /4T h ver Mass VW olk� COCNICNl WIC.[ *_ A�RATEv /+Pa�,�S S U BOARD OF HEALTH PERM T LD Food/Kitchen Septic System THIS CERTIFIES THAT ....... Q. � � 0 BUILDING INSPECTOR ........................ ......................... .......... .......................................... 14Foundation has permission to erect .......................... buildings on ... ......... ........ ... .r.............•••• Rough to be occupied as sksm ...cc .... 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 I66M01# HS ELECTRICAL INSPECTOR UNLESS CONSTRUC R Rough Service ........... ..... .................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wali To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. DAVID CASTRICONE, PRES. g� CASTRICONE ROOFING & SIDING INC. ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 231R 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,herebycontract with and authorize you as contractor,to fiuiish all necessary materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on premises below desc ' ed: i I'I Owner's Name..... 11.�GI�J.j.�../.�. .' s.1✓a..............................................................T phone#...lof�•G..�..1.W.L.t?........... Job Add ress........ ..f...../....1.. .. ...P.4J1.../... _...C�.f.............Ci {�� • ry /•Y•k�.. YL .O V.:C'..r...............State...... . .... Specifications: ......................................................................................................... ................................................................................................... t/Strip existing shinglef.,* LApply new drip edge to all edges. it", 44��'' 1 b b ...............................................I............... g 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 unheated areas of house. / / 4� �u�G ova.!^fir-- bre.�,zrw-.y �a� ,, ................... ............................................ ................................................... pply felt ape nd rylayment. nstall ridge vent to r r.� Qt=L:E yk1. Y.f fes.... ............. yS �lr .lJt–...lite. .... g —Y warranty. �eroof usi g s r � shingles with a year warran i .................................�....................................................................................... ....... nterflash chimney. k'ew vVit pipe flashing. �al disposal of all debris. _ o `.............. .................. ............................I...........�.i�.��. .4.. .... ..... . ... Xrea(s)to be worked on: �� h ........................................I...... . . ...., .YLd.Vt. ..��.:.G sh.G?FxS...�I D..t .Pte.. ... . ..... g.X_e� ................. i Tn `... tt4 .:�...rLtlj. .tcS.....,p ....r' '..5....r�.t.fS.JQ.1 .�:............ �• 1. .-.r, , ............ J ..................... ............... ... ................................................................................................................... Roof b and replacement if necessary@ 40 /shZ� foot. ............................................................................................................................................................ ................................ Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as spe " In manutac u The c ntractor agrees to perform the work ano t rni�h the materials specified above for the SU of$..... 8 b............. .... Payable.. Q.Cl j7......on... a!.: ............. Payable.............................on.................................,� ,alance payable on completion of job (Tuner or Owners are not responsible for Property Damage or Liability o 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 dumpster placed by contractor is for his use only.Upon completion ofabove woik,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 title thereto stands of record in his(thein) names(s).There arc 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 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 the 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 Inc,231R Sutton St.,No.Andover,MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their names this..4.M ...day of.... ........20........... Accepted: Signed 1 .•-r�...n..�.Y...:..... ........................ Owner Signed ..... ................. Owner ........ ..... ....... . . . .. David Cas tricone,President The Commonwealth of Massachusetts - ' Department oflndustrialAccidents Office of.Investigations 600 Washington Street �.,._- Boston, 41A 02111 MOV.rrtass.go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plurubers Applicant Information ( Please Print Legibly Name (Business/Organizatioti/Individual): D A\J 1 D C I\J i r 1 coNm Ro G� ix 6 " J i D f N 0 IW (-- Address: NLAddress: -�31 R Su-FT-0 N S RE e-7 UN i i JA Ci ,/Stittc/z V No. A NDo\'e_(, r)A U 1 NJ Phone tt: 9 -71 0 3 & NO Are you an employer?Check the appropriate box: Type of project(required): 1.M I am a employer with 1 4. ❑ I am a general contractor and I employees (fuand/or part-time).* have hired the sub-contractors 6. New construct ll ton 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors bave g_ ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. corporation We are a oration and its 10.0 Electrical repairs or additions ❑ P 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12�- oof 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 nea,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:hose entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. > Ian:an employer that is providcnga workers'compensation insurance for my employees. Below is the policy and job site information. �^ ' Insurance Company Name: G J t A T e N J e C co P 5 f � U hN Policy #or Self-ins. Lic. #: W 0_0 6 3 ej 9 q tU Expiration Date: Job Site Address: J ('��OLu, L&r,.Q— City/Sta&zip: no. OVAA6� `VA OR r Attach a copy of the workers' compensation policy declaration page (shorting 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 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Off ce of Investigations of the DLA for insurance coverage verification. I do hereh certi under thepains andpenaItzes ofperjur} that the information provided above is true and correct: Siznature: �2 J. C Date: Phone#: 6 Official use only. Do not write in this area, to be completed by city or town officiaL Cit}- or Town: Perna t/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#: ,oil. F ® 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 No: 233 West Central St EAODIL .sdonnell@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC a Natick MA 01760 INSURERA;Western World Insurance Co INSURED - INSURERB:Commerce Insurance Company 4754 David Castricone Roofing b Siding Inc, DHA: INSURER CGranite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER D: INSURER E North Andover MA 01845 1 INSURER F: COVERAGES CERTIFICATE NUMBERMaster 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. IN SR TYPE OF INSURANCE ADDL SLAR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDM'YY MWDO/YYYY LIMITS GENERAL UA3fUTY EACH OCCURRENCE S 1,000,000 �I COMMERCIAL GENERAL LIABILITY PREMISES(EaDAMAGF TO occurrence) S 50,000 A I � f CL:.tMS-MADE ❑X OCCUR P3386404 /6/2014 /6/2015 MED EXP(Any one person) S 1,000 L✓ PERSONAL d ADV INJURY $ 11000,000 .I GENERAL AGGREGATE $ 2,000,000 LG—EllAGGREGATELIMIT APPLIES PER'. PRODUCTS-COMP/OP AGG S 2,000,000 I X I POLICY I I PRO LOC S AUTOMOBILE UABILITY COMBINED SINGLE LIMIT I ANY AUTO Ea accidentS 1'000,000 :LL O B WNE WNED SCHEDULED BODILY INJURY(Per person) S ' �ALTOS X AUTOS CNC�V /1/2014 8/1/2015 BODILY INJURY(Per accident) S j X l HL2=0 AUTOS AUTOX "ON-OWNEDPROPERTY DAMAGE S r—I Per accident L—�UMBRELLA UAB OCCUR ��LIAB I EACH OCCURRENCEF_X S CLAIMS-MADE AGGREGATE y I Dc0 I I RETENTIONS C WORKERS COMPENSATION WC STATU- 0TH. S AND EMPLOYERS'LIABILITY Y/N :7IQBy LIMITS FR ANY PROP R!ETOR)PA,RTNER/EXECUTWE OFFICER)UE.MSER EXCLUDED? ❑ NIA E.L.EACH ACCIDENT 5 100 000 (Mandatory rn NH) WC003989723 /23/2014 /23/2015 E.L.DISEASE-EA EMPLOYE If yes.desS 100 000 nix under D'c SCRI?TION OF OPERATIONS oelow E.L.DISEASE-POLICY LIMIT S 500 000 I DESCRIPTION Of OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,A more space is required) Roo=Ing 6 siding contractor I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Castricone,Roofing Bt Siding SHOULD 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/ MT — � ,. 5�= ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. I NSD 25 nn:rvx,n, Th<Arr Qn nnmo�nH Innn oro ronigfnrorl_"J"of Ar non Town of North Andover N�k7 0 4t�ro Building Department o 27 Charles Street ti n Noah Andover, Massachusetts 01845 (978) 68 8-954 5 Fax (978) 688-9542 7 R.,reo ♦P vcHuse� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit 9 the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl50a. 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 tluough the Office of the Building Inspector. Massachusetts - Department of Public Safety Board of Building Regulations and Standards C11n%tructiun SuhcrN isill'Shcci:jlth License: CSSL-099358 = DAVID T CASTRICONE 31 COURT STREET NORTH ANDOVER MA�i018 5 Expiration Commissioner 12/16/2015 SO =. Office of Consumer Affairs& Busine s Regulation' ip glOME IMPROVEMENT CONTRACTOR 1egistration: 104569 Type: � b�M1i expiration: 7/14/2016 Private Corporatic DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undersecretary