HomeMy WebLinkAboutBuilding Permit #323-11 - 777 JOHNSON STREET 10/19/2010 BUILDING PERMIT of NORTH
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION y
Permit NO: 2 — �
Date Received
Date Issued:
IMPORTANT Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
Addition Two or more family Industrial
Alteration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
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DESCRIPTION OF WORK TO BE PREFORMED.
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Identification Please T e or Print Clearly)
OWNER: Name:—TA AA t (� h ric t1r) 1 .P . V1 . , Phone: ���( �F17 70
Address -7- JA'1S1(Jh Shea 4%'IdQwl M/T 04yj-
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 P,
Total Project Cost: $ 0 3rJ '1� FEE: $ 2Z.— J o"
Check No.: �`�� Receipt No.: Qs74. 1
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty.fund
ignatur�]of Agent/Owner gnatu er nflcOn ractor Y ; t
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
i
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
1RE DEQ i2TMEl T lernp`Durnpst .r mn srte des no
vacated at'I� /lam S#reef {1
F
kA s�gnaure/da#e`-
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 2010
Building Department
The following is a 1.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
❑ Certified Proposed Piot 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 2008
Location r� Yoh(1 S�n S
No•.3 — Date v
NpRTM TOWN OF NORTH ANDOVER
0 R
A
Certificate of Occupancy $
Building/Frame/Frame Permit Fee $
J�cwust 9
Foundation Permit Fee $
Other Permit Fee $
i
TOTAL $
Check #
235 `% 1
Building Inspector
NORTly
olm 0 6 over
No. �3
..3 - ao �� K
* _ - - -
o over, Mass. b ' i
COC MIC HE WICK
'Ll,9S°RATE° P 'CCl
U BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
I
THIS CERTIFIES THAT...........�....d..0 .j...........� ...Q..h.!1.t•.5........................................................................................ Foundation
has permission to erect.................:...................... buildings on .. ......s ................... Rough
to be occupied as .......... ............t' 12Q..4.
Chimney
................. .......................... . ...............................................................
provided that the person accepting th per shall in eve respect co m to the terms of the lication on file in
P P P 9 P every P PP 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
UNLESS CONSTRUCTI T TS ELECTRICAL INSPECTOR
Rough
........... ......... . .................................................................................... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Ocmpy 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.
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 978-374-7314
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
ld
conditions,on premises scribed bSe.tdY
.n.. xIS...................Te hone#.....Owner's Name........ F: t1S .............City.... '....�.......�e.l...t..St:.a.t.e...1...".1�11./ .�J............Job Address...�fL .... .� .
Specificalions:
) .............................................................................................
/ strip existing shingles.) -Xpply new drip edge to all edges. ,
......................................................................................................................................................................................................................
-vApply _feet ice and water shield membrane to bottom edgesspof house. 3 feet ice and water shield membrane
in valleys and bottom edges of any unheated areas of house. 3 1 f. drt,. /,.P_,�r
.................................................................................................................................................................../.........I.............................
Apply felt p r nderlayment stall ridge vent to r,,
s� .,,� ........................................... ........................
✓Reroof using MA� shingles with aQ year warranty.
........................................................I........�..................... po
...................................................P.........�.�............� .............
-Counterflash chimney. '`F'1Qew vent i tlashi Ll
al disposal of all debris.
K, ................... an
.......................`''`'.........` .. ................e`.............
Area(s)to be worked on:
1..�..... ...� ..... .... �. . ....
R.fs. o-'sRA.4n.Y�.t/[Esu S... Gi df:dR..r
..AG (/r.,� ..�.Lc�.r''t.t7:t:�..�rr.-t...G�.f..j?.(.��..1.'1.�tsl....i✓..1.rt..l�¢.l.'ir..cS.A....,(4........................ ....tr..�.............
Roof board replacement if necessrry @ /sheet oF'Vp°/foot. Ct.Go F
................................................................................................ ....................................................... �.... ............
...... ..... .....
Two Year Workmanship Warranty(Not Transferable) M`anufacturer's Warranty as specifi by ma ufacturer
The contractor agrees I�tp9 perform the work d m ish the als specified above for the SUM o .........40..�.:.0..........
Payable.....21A.,...............on.� b.�J
Payable.............................on.................................. Balance payable on completion of job
Owner or Owners arenot 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 hgree 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 owners)all reasonable costs,attorney fees and expenses,in addition to the amount due and unpaid,that
shall be incurred in enforcing the terns 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 hervif shall bind and apply to their heirs,successors or estates of the parties.The undersigned warrant(s)that be is(they arc)
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.zferencc hereto shall be binding only if in writing and signed by all patties.
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 rend and the contents thereof understood and that no representation or agreement not herein contained shall.be
binding upon the parties and that al of the agreements and understandings of said parries 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 noti a of cancellation).
IN WITNESS WHEREOF,the parties have hereunto signed their es this... ..
...da of..(1.�d:�7.(�..,20......4.1.
Accepted:
/`CSig ......................................... ........... 'aOwner
Signed............................................................................. Owner
David Castricone;President
Imo' \ The Commonwealth of Massachusetts
f Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston'MA 02111'
,2.
www.mass:gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): AV i 'b A ST I:I c o N E= o U F t N 6-- a S 1,3 G c.
Address: 20 to So—i.-ro rz �C_ 2 z.%.J
City/State/Zip:Jy o A ii -o ov A 6 1 8- Phone#: 9 7 b V33-3�a 1,
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 6. ❑Newconstruction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
thyself. [No workers' comp. c. 152,§1(4),and we have no 12.m Roof repairs
insurance required.]t 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 new affidavit indicating such.
TContractors that check this box must attached an additional sheet showing the name of the sub-contractors acid their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: C f-f A-g T is
Policy#or Self-ins. Lie. a 0 r-;q ,3 °7oA 3 Expiration Date: 9 /f/ L
Job Site Address: 'I I� V Q h nS� A i1 f f City/State/Zip: N 0 YI t11/�r kq al r 11
�%
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 tnay be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certifyundder t(h�epains andpenalties ofpeijury that the information provided above is true and correct.'
Signature: J / �J Date:
Phone#: q 8 U 3 3q Z o
Official use only. Do not write in this area,to be completed by s Ity or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2. Buildirg Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
Town of North Andover �o�v
O
Building Department a �•
27 Charles Street (�
North Andover, Massachusetts 01845
(978) 688-954S Fax (978) 688-9542
ocwl[,IwaN 1
04ATED
SHCNuS��
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 cl 1, s150a.
The debris will be disposed of in/at:
Es'c'
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,