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Home My WebLink AboutBuilding Permit #842 - 77 BRUIN HILL ROAD 6/28/2010TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Py -- Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATIONLea 1/7 l�ti fIl ,c% /Ud tCGfiL°i /�./fi 11 i Rrin ..- PROPERTY OWNER AtW 1—C LL L Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building —One family -/ 6 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 utsc:rur 1 FUN OI- WORK TO BE PERFORMED: 6#1',o and rei h,ng k /W f cvCc-s OWNER: Name: Address: CONTRACTOR r/d,4 I �A 11 Type or Print Clearly) & //Crf�_ ,4 Q )6,0 6,,- �OL� Address: 24 4) cft n Supervisor's Construction License: Exp. Date--/, -/ 6 Home Improvement License: /d 46G � Date: 7 '/ �17oke)/' 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: $ X006 , FEE: Check No.: -_�_-5 �F` Receipt No.: 2 5,0 3 % NOTE: Persons contracting with unregistered contractors do not have access to the aranty fund Signature of Agent/Owner Signature of contractor Location No. ef-I'V-4e Date I a Check # Ik 2 3 0 vo BdIldiAg inspector TOWN OF NORTH ANDOVER Certificate of Occupancy $ CHU Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Ik 2 3 0 vo BdIldiAg inspector 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 Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 1 Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Locateo M4 FIRE DEPARTMENT - Temp Dumpster on site -yes_ no Located at 124 Maim Street Fire Department signature/date COMMENTS Street 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 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/Crossection/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 o Certified Proposed Plot Plan o 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) a Copy of Contract ❑ Mass check Energy Compliance Report Li 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 cd w O A O a o w v CO O0 U z O o w o c� , U r w O0 U O o n: G x OF W u V a W o w � cn G u: a a C7 x w�' w W O�,, A rx w v z cn o v o cn 1 0, 171 co Cl co O v Z CO Q. O CO) � C co cm CIO O O— y O O �E m m 0 CD CL ~ ♦�.+ � O � Q O O d o � � vC J .0 •C. O iCD COD C Z � C.3 v) C � C c o a� c c O i :.ch O_ C O VCc C3 Q O co N = E¢ 43 CF .�: m r = CCD L N 5 _ :5 m C.3 O cE �� m L- CA m a O�y Al CA 3 t .. m N O CID � v. O -a Ca C s Em a� s Q: C42 m o cn m CID o� y O V ' � Z C d C CD N m C O _ D ~ CD rt=+ CD ra • •N om O C2 CO, p ® C y d m� O x � a_ mo H t +0+ Rajm 1 0, 171 co Cl co O v Z CO Q. O CO) � C co cm CIO O O— y O O �E m m 0 CD CL ~ ♦�.+ � O � Q O O d o � � vC J .0 •C. O iCD COD C Z � C.3 v) C � C .t•_v w.rw_.>,�rr,, V L.I % I 1I I1s/i I L- W I L-as-%LJI I1L„1 J I I I m t..4 %a xNIA 6'%Z—* ISS I 09/28/21709 ` PRODUCER (508)652-7700 FAX 508-653-8D89 Eastern Insurance Group LLC - Commercial 233 West Central Street Natick, MA 01.760 Select Ext.53389 :THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE= DOES NOT AMEND, r.XTEND OR ALTER THE CaVERAGE AFFORDED HY THF POLIC:IE` UFLOW. — — - INSURERS AFFORDING COVERAGE NAIL # INUURED Pavid Castrllcone Roq -Ing & Siding Inc 200 Sutton St Suite 226 North ,AnOover, MA 01845 INSURER A: The In5uranc_e Co Dl' State PA INSURrR a'. INSURF11 C; INSURER D: INSURER E. 1I01TAII.lL'Iti- 1i THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TI1C POLICY PERIOD INDICATED. NOTWITHSTANDING ANY R90UIP1mFm7, T0M OR CONDITION O� ANY CONTRACT CTR OTHGR 00CUMFENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED 0I3 MAY PERTAIN, TI IF INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONOITIONS OF ,SUCH POLICIES. AGGREGATD LIMITS SHOWN MAY HAVE DF -LN REDUCED BY PAID CLAIMS. INSRDD' TYPE OF INSURANCE POLICY NUMBER POLICY F_FFECTIVF_ ll POLICY EXPIRATION DAYI= (MWIUYRfY1' LIMITS HACH UCGURRFNC(: L GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADG 11 OCCURMLD OAMACF TO RENTED EXP (Any onene pnropvaonf S PCRSONALP ADV INJURY _ 'St:WPAI A(,GRLQArC $ GtN'L AGO iEGATi" LIMIT APPLIES PEO. r'RUUVC I S - CUMYfOP' RC1lT POLICY PRQ LOC .IECT AUTONOBILF LIAMLIYY ANY AUTO COMBINED SIN(.'E[ LIMIT (1-a mcidom) $ ALL OWNFq AoOS SCHEOULED AUTOS LIUDILY INJURY (P9i p9159n) $ HIRED ALITOB NON -OWNED AUTOS BODILY INJURY (Pur :aa:4Jvr,I) $ PRf7�F q'1V OAMA(11` Milt ArVld9n1) -- GARAGE LIABILITY AUTO ONLY, EA ACCIDENT $ ANY AUTO OTHER THAN PA A" $ AUTO ONLY: AGO $ EXCESSAIMBRELLA LIABILITY OCCUR CLAIMS PAADE - CACI I OCCURR=NCE A AGGRL- GATE $ $ ^^ T y 1)LVVC1'IDLLN RETENTIO5 _ __ __ $ WORKER9 C.OMPEN5ATION AND EMPLOYERS' LIABILITY WC9752746 09/23/2009 09/23/2010 '( WC STATU- OTH Rv LIMLT"I ER E.L. EACH ACCIDENT $ 100 , coo A ANY PROPRIFTORIPAR'fNPFVC%4FCUfIVE 0FFICl7R/mEM9ER EY,CLl1DrD^ 11 yyooa, doicnbc Vndcr SPECIAL. PROV16IONS billow E.L. DISEASE - FA EMPLOYE $ 100, ()00 F.I., DI$FA$F - PQI ICY I,IMIT $ 500,000 OTHER — — — OCCCRIPYION OF OPERA'f10N9 I LOCATION'S 1 VEHICLE9 I EXCLUSIONS ADDEO 8Y ENDORSEMENT 1 SPECIAL PROVISIONS David Castricone Roofing & Siding 200 Sutton Street Suite 226 North Andover, MA 01845 SHOULD AMY OK YHE ABOVE IN -SCRIBED r'OLICIC$ 3E CANCELLED OrWORE YHC EXPIRATION DATE THEREOF THE 199UING IN9URER WILL ENDEAVOR TO MAIL -10 DAYS WRITTEN NO1.Ie;E TO THE CERTIFICATE HOLDER NAMED TO THF LEFT, BUT rAILUR.F TO MAIL SUCH b'OYICE SHALL IMPOSP NO OBLIGAYION OR LIAalt fTY OF ANY KIND UPON YHE IN$L.iLa IYS AGVNYS O2 RErRC!Q:WA) IVt:S. AUTHORIZED REPRESENTATIVE Stacey_ 6rice/PKG ACORD 29 (2001108) C)ACORD CORPORATION 1998 "Pul"u' -'PeCIL11ty License o1'-'A62&-J(zc1uz(w,& less Regulation License: CS SL 993-50 Office of Consumer Affairs Restricted to: RF'ws HOME IMPROVEMENT CONTRACTOR .104569 Type: L; Registration: Expiration: 7 Private Corporatio DAVID CASIRICONF /14/2012 31 COURT STREET D CASTRICONE-ROOFING, SIDING & NORTH ANDOVER, MA 01 Bij David Castricone 200 SUTTON ST SUITE 2.26 x1:111,11 ]ow 12/1 6)2DI I NORTH ANDOVER, MA 01845 Undersecretary 99358 0 DAVID CASTRICONE ` CASTRICONE ROOFING & SIDING INC. �l GL �� 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: 9 Owner's Name........: &..... � 4 ........................... Telone #...�....��`�c.J l Job Address...... .....&-14,1.r1...#/.,//....... K ................ City.... AetL4.V..eX .............. State........... Specifications: /StriI. existing shingle.t610- ....�pply new drip edge to all edges. W� r"�v."?".""*.................................................................................. ...................................................................................................................................................................................................................... ---'Apply 6. 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. ,' orn J�� z,>`tt�rr ................................................................................................................................................................................................................. /AppyIt �nderlayment.... �tal1 ridge vent to ... r ............................�.......................................................... rt i. Gr.,.... ..... ,.... goof Lsing s , shingles with a Year warranty. ................................................................................................................................................. ,................................................................... . Counterflash chimney. —New vent pipe flashing. -4;6gal disposal of all debris. ......................................................................................................................... ... ..................... �...................................... Areas) to be worked on: S,.... / ..................................................................,s..... �,I...........r.. ........ f (�, ..........I.......... ........ L .., i.....t`.c .... Cx 1` .... :. .. �� `.�� ... .?sdD s " t;.. ............... -L"r.+ii............... k......�,...... �.c�.e.f }..... .. .ls..... x.........................� ... ....... f;� ..................... : Roof board replacement if necessary @ 60 /sheet o'I?=`� /foot. .............................................................................................................................................................. Two Year Workmanship Warranty (Not Transferable) M'anufacturer's Warranty as specifi y manufacturer The cactor agreeso perform the work and 'sh th materials specified above for the SUM o $..... �Z 2aTJ ..........:✓. ayable .......V„ 7 . ............... on -0 .......... Payable.......'.." .............. on................................ alance payable on completion of job__ 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 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 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 warrant(s) that he is (they are) the owners(s) of the above mentioned premises and that legal tide 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 Find provisions of MGL c. 142A. Approximate starting date of work.......674!:.44-2--.0. )Gam....... Completion date ......................................................... Receipt of a copy of this contact is hereby acknoledged, 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street 3 Boston, MA 02111 `r www mass.gov/dia _J Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): -DAV I l C AM -r 1 C O N E R 06 F I NCT `! S 1D 1 N (r 1 N L Address: 2oeo Su--r-rnl3 ST 2 t - E -t- Sy e- Z2tA City/State/Zip: h- IkNbO 46I( MA 0 19 LAS- Phone #: °I-) 9 (o 8 3 3 41-0 Are you an employer? Check the appropriate box: 1. ® I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- ship and have no employees working for mein any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.$ 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. [Roof repairs 13. ❑ Other *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. 1 am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. nnf Insurance Company Name: 7h e— \ OA t) E"- e (20 MD 6.l1 Policy # or Self -ins. Lic. #: W,, C q qt a'� jJ y i(o Expiration Dateq - a, 3 Job Site Address: �% `� 1L%i2!//� CI7 I ` City/State/Zip: /)0, Q- &LK /� (� 11/0 V1 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: E)2 � C Date: 10 use only. Do not write in .this area, to City or Town: or town official 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