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Home My WebLink AboutBuilding Permit #586 - 8 WOOD AVENUE 4/1/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:✓� Date Received Date Issued: (D IMPORTANT:Applicant must complete all items on this page LOCATION 0iQOct /g/c 7 Lpe /Yc hC�vvC'd Print PROPERTY OWNER �e( i�JA Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes (/n0 _J 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 Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: � ff Identification Please Type or Print Clearly) OWNER: Name: gnn TO[L)/)e Phone: �?0/ Address: CA)04c( tgOeAuL CONTRACTOR Name:1- 4-,�Loiy 34 o 6 nc Phone: q 7ff b,-B3 q)L C Address: Z06 �U i n st �u t ZZ(� 3 Nva ore' Supervisor's Construction License: Csq q',3 S w Exp. Date: Home Improvement'License: 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: $ �{�5(� , v'v FEE: $ Check No.: d 331 Receipt No.: �rZ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 15ignattare of Agent/Owner '� �� Signature of contrac C a 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 l Private(septic tank,etc. Permanent Dumpster on Site I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS i HEALTH Reviewed on Signature M 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 DPW Town Engineer: Signature: • A 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 - 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 ❑ 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: Doc.Building Permit Revised 2008 Location � � N �--- No. 6 (O Date r (,o NOR, TOWN OF NORTH ANDOVER 3? ' 0 Certificate of Occupancy $ • i ��?'^-°•;.�' Building/Frame Permit Fee $ AGMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # a 33 22692 _ Building Inspector 4 The Commonwealth of Massachusetts Department of Industrial Accidents Ic Office of Investigations 600 Washington Street } Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /� Please Print Legibly Name (Business/Orgarrizationdndividual): AV I Zl 1.ASTIt 1 C Q N� R�Q F I N�, `! S ID J N 6 IJ Address: ZOC> SQ-` r t3 S-r2v---F-T' Su Z2 k. City/State/Zip: h.MDO VE IC MA 0 1&NS _ Phone 4:3-)6 (p 3 3'4 20 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(full atnd/orport-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. F-1 Demolition working for me in any capacity. employees and have workers' 9 E] 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 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.N Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp, insurance required.] *.Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy inforniation. 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 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. Insurance Company Name:-Th P \ OA U G lee en CAI) Policy#or Self-ins. Lie.#:\L(q q S 9,1 y (O Expiration Date: 9-a 3 201 0 Job Site Address: 7 U)60J.. fboNe_ City/State/Zip: I ld.Bnr)d re-. MA d 1 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 m the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification 1 do hereby certify under tains and penalties of perjury that the information provided above is true and correct. Signature: J C Date: ////O _ Phone#: 10 Offccial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other ' Contact Person: Phone#: Town. of North Andover � pyi]WYIy .- A O t01u �nl-1ding Department - �a, 27 Chiules Street North Andover, Massachusett Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 ry �A�io a SACT0 5tt DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit # the debris re%.slting from the work sluill be disposed of in a properly licensed solid waste disposal faciliC-, as defined by MGL cl 1, sl 50a. The debris will be disposed of in/at: Facility 5igDature of Applicant Date NOTE: A deolition permit from the Town of North An mdover must be obtainedfor this project through the Office of the Building Inspector. r I ACM,, CERTIFICATE OF LIA 131LITY INSURANCEATEI jaoD ) . 7 PRODUCER (500651-77DO FAX 508-653-5099 THIS CERTIFICATE I$ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC - Commercial ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 west Central Street HOLDER,TH15 GERTIFICAT�DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Natick, MA 01760 v Select Ext.53389 INSURERS AFFORDING COVERAGE MAIC# INOVRED David Castricone Roo Tng & Siding Inc INSURER& The Insurance Co of State PA 200 Sutton St INSURER B: Suite 2261 INSURER C, North Andover, MA 01845 INSURER D; INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 1I1E POLICY PERIOD INDICATED.NOTWITHSTANDING ANY 99QUIRGMENT,T1911M OR CONDITION OK ANY CONTRACT 011 OTHER DOCUMEN r 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 BLL-N REDUCED BY PAID CLAIMS. INSR tlO' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY F.nC1+G000RRFNG7. $ COMMERCIAL GENERAL LIABILITY DAMAGE TO IILNTEU $ CLAIMS MADE ❑OCCUR MCO CXP(Any one parson) $ PERSONAL 6 ADV INJURY $ r3L:Nf.RAI AGGREGArC $ GtN'L AGGHEGATE LIMIT APPUES PER. I'HUUUC IS-COMPIOY AOO S POLICY PRO LOC JEG7 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (I-a Pcadem) ALL OWNED AU1 OS 9UUILY INJURY ¢ SCHEDULED AUTOS fedi p915tl01 HIRED AUTOS BODILY INJURY $ NON-O WNEO AUTOS (Par-6den1) (Per Weldon) GARAGE LIABILITY AUTO ONLY,CA ACCIDENT $ ANY AUTO FA A(;Q $ OTHERTHAN AUTO ONLY. 'AGG $ EXCESSIUMBRELLA LIABILITY CACI I OCCURRENCE S OCCUR CLAIMS MADE AGGHL-GAIE $ $ 1)tVVC1'IBLL T $ RETENTION E WORKERS COMPENSATION AND WC9752746 09/23/2009 09/23/2010 X TORY wG siaruIhAIT• oR EMPLOTERS'LIADILITY A ANY PFGPRIPTORIPARTNEWEXECUTIvE E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? E.L.DISEASE.EA EMPLOYE S 100,000 It yas.dascnbc under SPECIAL PROVISIONS below IF-L,DISEASE-P01 ICY I,IMIT $ 500,000 OTHER OCSCRIPYION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDERN EL N SHOULD ANY OF YHE ADOVE OESCRI@ED POLICIES 0E CANCELLEb 600RE THE i David Castricone Roofing & Siding EXPIRATION DATE THEREOF,THE 159UINGINSURER WILL ENDEAVORTOMAIL 200 Sutton Street 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Suite 226 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGAYION OR LIABILITY North Andover, MA 01845 OF ANY KINbUPONYHEINSURFR,IYSAGrNTSORRVPRGSENYATIYES. AUTHORiZEO REPRESENTATIVE {�� —4.,+•y StaceyBrice PKC l� ACORD 25(2001109) ©ACORD CORPORATION 1988 1 af �Otrt11• )nillill' Rl1II; IlUtti ;Intl titllnit 'l5 ✓ir r: fear/brnOdelu[:rbCUo- p/.,;/(cr.IJcrrfic�de�ll �� hoard of Building Rc9ul:lliolYs;ind SLrndards Construction Supervisor Specialty License �_ License; C5 5L 99358 __-_ HOME IMPROVEMENT CONTRACTOR - Restricted to: RF,WS Registration: 104569 f= Expiration: 7/1412010 TO 270265 DAVID CASTRICONE a ' ^t:' Type: Private Corporation 31 COURT STREET f ...a DAVID CASTRICONE ROOFING,SIDING& NORTH ANDOVER, MA 01845 a _- David Castricone 200 SUTTON ST SUITE 226 Expiration: 1 2/1 61201 1 NORTH ANDOVER,MA 01845 -_-._—• P Administrator C unn....iuncr Tr.".: 99358 a i I j i - j DAVID CASTRICONE V/6 kc) 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 AaverhU1978-374-7314 Uwe the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to famish 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: Owner's Name......4h414k......... .......................................................... lephone# Job Address.......21......Wx.. .....p. ✓,P_ y.........................City..� .....�.�a5...�..`�t� ... State......,!'l.t�..... Specifications: -,Strip existing shingles rt;pply new drip edge to all edges. Wk f,—Y" ...................................................................................................................................................................................................I.................. ,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 bouse. ............................................................................................................ . ...... ..................................... ply felt paper and r . layment. ..Install ridge vent to u� rfl� x . .�.,� ( .. . .................i... .r. ................... .. .................................. Reroof using shingles with a J0 year warranty. ........................................................................................................................................................................--......................................... -Cbunterflash chimney. —NEw vent UUy11ipe flashing. ..Legal disposal of all debris. ..............----.......I.............af•...S.ery,Y........�i............................................................................................................................................. Area(s)to be worked on: \ f./. o ..... .rr..ut S.f .................................................................. ..................................................... ................................................... . r r .................................................................e............................................................................................................................................. Roof board replacement if necessary @ GO /sheet t>foly=!foot ....................................................................................................................................................................... ttturcr� .......Two Year Workmanship Warranty(Not Transferable) M'anufacturer's Warranty as sped y mryThe co for agrees to perform the work and sh the materials specified above for the SU of$.....` ....... j ayable..y Q lJ.......on...�. ........... AmpoiSie..........z.r. ...........on............77...............�alance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability while,lo n 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). 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,aaomey 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 warrants)that he is(they aro) the owners(s)of the above mentioned premises and that legal title 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- j related permit or deals with unregistered contrac rs is excluded from the Guaranty Fund provisions of MGL c.142A. fzo-, Approximate starting date ofwork�. . .1 t. Completion date......................................................... Receipt of a copy of this contactis hereby aledged,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...1. ,day of.. o,( ....,20.11. Accepted: jCJSigne ............ .. ......... Signed ............... Owner ..... ....... ...... ....... ...... .... David Castricone,President NORTH Town of 4 over . So v..... :A.. No. 860 * =� idover, Mass., T O - LA E COC KICKEWICK V �d A00ATED PPVL `r � BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ll BUILDING INSPECTOR THISCERTIFIES THAT............................ .......(,�,,�sti OC`...... ............................:...................................................... Foundation has permission to erect..:......y............................. dings w� ......T '...................... Rough t0 be occupiedK 0 Chimney as .............. P................................. provided that the perso accepti g this permit shall in every respepl� form to the terms of the application o 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 STARTS Rough .. ... ............................................ Service .. . .. ................................................ BUILDING INSPECTOR 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.