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Building Permit #618 - 80 OLD FARM ROAD 5/14/2009
Permit NO: (y Date Issued: J7 - I q" D BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received I IMPORTANT: Applicant must complete all items on this paize LOCATION io old 1` G�/tj'J UGc ci Print PROPERTY OWNER_ �9l) 6ej M Jet/he i Print MAP NO: _ 5' PARCEL: ZONING DISTRICT: Historic District yes Machine Shoo Villaae ves m TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building vOne family Y12 ��o-� IJo✓ fG.r1U(�V� Addition Two or more family Industrial Alteration No. of units: Commercial ' Repair, replacement Assessory Bldg Others: Demolition Other Exp. Date: 1-1 t) -(J 1 Septic Well Floodplain Wetlands Watershed District Water/Sewer Reg. No. DESCRIPTION OF WORK TO BE PREFORMED: nn le VD0F Identification Please Type or Print Clearly) OWNER: Name: Phone: q -)k 96 `f - Address: $ 6 W I—a. r Y12 ��o-� IJo✓ fG.r1U(�V� ` irnV� 6l S^ CONTRACTOR Name 3AA0 Q10 Phone: �)d tct 3 . 1' -() Address: Zoo 30A�un St SuZ�u `ZZi, yr © PA o,6'1f Supervisor's Construction License: Exp. Date: 1 a. -1 to d-4 it Home Improvement License: Exp. Date: 1-1 t) -(J 1 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: $ 6 o FEE: $ / d 4 Check No.: ( X- ° \ Receipt No.:�)L3 `i NOTE: Persons contracting with unregistered contractors do not have access to the ranty nd Signature of Agent/Owner Signature of contracto 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS /HEALTH COMMENTS DATE REJECTED DATE APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site Located at 124 Main Street Fire Department signature/date COMMENTS Locateo 364 Usgooa Street yes no 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location go No. &19-- Date 40RTN TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ S^Cmus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Id �o �— Building Inspector CA m m m m X CAm VI F, m _2 C � CD � O n Z Co) CL r Q d =� y C C C2 CD CD O CLQ CD CD O CD w E3 C O co) CD CZ O y O CO I = CD S v CO) O 'O Z CD O CD O CCD W Oq. cn cn \ / O cn cn ."Mow cn V 7� cn C O Wg=g. d -4 Q y = EL- o S 0 ,o t/! g'm C09 � C-) CE m .. c R. Ss � ,y :: COL y T CD S_dT �00y O ti -1 0 2 �CID' O n faO O y� 0 S aCO ye: CL -w E O SS. CD N 71 0 CD CD H a? cr W S.a O y y CD O . �C w O O CD CD O CA C) 0 ,.. =CD o a� y CD cz 0 0 dm: a � n CA C/) ti cn z p bn Oil ►r M M Ir] w opGa Z w cn GO. M O 7d w IV M O � x ` r- �* C r z Cn oil pCD O M F z O H 0 0 c YJ 9 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, c/o� tru,� and place the i�rt Rrovements according to the following specifications, terms and conditions, on premises below ascribed: /7'/kL/csi/ ��� �/` Owner's Name....p.. (.�..y......C[. �...f.............. T lephone#..... �........... ,C%�..ler....... .. Job Address....... o.....oI.GJ.... r a ...................... city .... 11/ aY ei ................... State..... D r.......... Specifications: ...................................................................................................................................................................................................................... ✓Strip existing shingles.(/) v4(pply new drip edge to all edges. akl; - S P1*y G 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. ...................... f....A................................................................................................ ........ a.1 ... ....... ............................. ........ ... ............... pply felt paper underlay ant I5sta11 ridge vent to r� v Lo„� 6 g > ... . .... ...... ... ................................................... ...../.}................................. ..... . -Reroof using � s 'a j� � 1/ - shingles with a,? year warranty. ............ ............................................................:................................................................................................. ............................................ �ounterflash chimney. -New vent pipe flashing. r. -Legal disposal of all debris. .................................................. Area(s) to be worked on: ad % `...... b.a.l....... Ct5........ Li.. ..... ..A..t t�Rro......................................... �...... r _ /p .................................................................................................�...r3.0....Y.f...... s11.I . ............ ....eb............... .. J. a ....y,"...1. .. ..............�2. 2-0 .................... ...................................................................16 ...................... Roof board replacement if necessary @ � /sheet or . /foot. .......................................................................................................................................I.............................. , .t ....................................... Two Year Workmanship Warranty (Not Transferable) 1VCanufacturer's Warranty as specifi y u a erre The co�ntractor agrees to rform the work and furnish the materials specified above for the SUM $....1}..fP................ . tractor ........� ............ on ....... ............ e ..... ..-.-............... on.................................. tBalance 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 penaitted 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 swiped 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 (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 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 notice of cancellation). IN WITNESS WHEREOF, the parties have hereunto signed their names this .......I.. day of ... ........, 20.x?..... Accepted: Signed .............. .............. .............. ..._.»..... Owner ✓ ' Signed........................................................................... Owner David Castricone, President J.Ct n1e-5,pleech C6M C" b- �� I" The Commonwealth of Massachusetts Department of Industrial Accidents 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/Organization/Individual): :D AV lb (2ASTkic,0 Niff IRd d F/N(T � Si h j u& / N L Address:A00_ S(j ITD &) 3T(2 &1, T c5y t TF.. 2.1(,y City/State/Zip:_ N . A t4b hVeg 01849 Phone #: qZ W (Q I3 (9f 1;i-0 Are you an employer? Check the appropriate box: 1.0 I am a employer with a 4. I am a general contractor and I employees (frill and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for tue in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. required.] 5. We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. F] Demolition 9. E] Building addition 10.0 Electrical repairs or additions I LM Plumbing repairs or additions I oof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy infonnation. t Homeowners who submit this affidavit indicating they arc 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. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company (Name: T�Ne_ p R1�y � QAV_ Co o l Pb.11.t..1 O f SA -A xo__ --plot Policy # or Self-ins..Lic. #: wc,$ U l �� �`j &V D Expiration Date: C1 • a 3 • 09 Job Site Address: � 0 a Id t a / M RD C{ City/State/Zip: NU• At „duye, Ni Old �I 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 $25Q..00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of I do hereby certify under thepainsandpenalties ofperjury that the information provided above is true and correct. Signature: J C Date: �/f /0 q Phone #: !g qs . %5 ,,3g a0 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 tkORTHNi Building Department 27 Charles Street 70 North Andover, Massachusetts 01845 � ti a (978) 688-9545 Fax (978) 688-9542]i ° T C,LMS CHI[Ary� 11^.W... A�R^re0 JJ*"y �SSACHUS�� 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 - 4 Z-, at: 4Z-, -�- S zwc-, Facility location Signature of Applicant //meq Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector, ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE (MM 10/3/2008 PRODUCER Phone; 508-651-7700 Fax: 508-653-8089 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC -Commercial Lines ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 West Central Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Natick MA 01760 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURED David Castricone Roofing & Siding Inc 200 Sutton St Suite 226 North Andover MA 01845 CnVFRAn9q INSURERS AFFORDING COVERAGE NAIC # INSURER A: Cit at JQJD Insurance 40274 INSURERB:The -Insurance Co of State PA INSURER C: 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 TH CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES pESCRIDED HEREIN IS SUBJECT TO ALL THE IS TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICYNUMBER POLICY EFFECTIVE POLICYEXPIRATION GENERAL LIABILITY LIMITS $ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS MADE OCCUR PREMISES Ea occur.". $ MED EXP (Any onsperson) $ PERSONALBADVINJURY $ GENERALAGGREGATE $ GENIAGGREGATELIMIT APPLIES PER: POLICY D PRO-jLCT LOC -PRODUCTS -COMP/OPAGG $ A AUTOMOBILE LIABILITY ANYAUTO 08MMBBTNKT 8/1/2008 8/1/2009 COMBINED SINGLE LIMIT (Ea ecctdant) $ ALL OWNEDAUTOS }( SCHEDULEDAUTOS BODILY INJURY (Per person) $250,000 X HIREDAUTOS NONOWNEDAUTOS BODILY INJURY (Potaccklenl) $ $500,000 PROPERTYDAMAGE (Peraoddenl) $100,000 GARAGE LIABILITY ANYAUTO AUTO ONLY -EAACCIDE14T $ OTHER THAN EA ACC $ $ AUTOONLY: AGG EXCESSIUMBRELLA LIABILITY OCCUR 0 CLAIMS MADE EACHOCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITYYLIMI WC587775G 9/23/2008 9/23/2009 X WCS U• E.LEACHACCIDENT $ 10Q QQQ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE - EA EMPLOYEE $100,000 II yyes describe antler SPEGIIAL PROVISIONSbekm OTHER E.L.DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE wni 11RR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED - BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001108) ca ACORD CORPORATION 1988 Massachusetts - Dclrauncnt of Public Safcts Board of Building Re-ulations anti Standards Construction Supervisor Specialty License License: CS SL 99358 Restricted to: RF.WS DAVID CASTRICONE 31 COURT STREET NORTH ANDOVER, MA 01845 ( �uwui..inncr Expiration: 12/16/2011 T rm: 99358 ✓Lie {n11,g zv1wvea144 o,%l&,ad leCla \ Board of Building Regulatio sand Standards — HOME IMPROVEMENT CONTRACTOR - Registration: 104569 Expiration: 7/14/2010 Tr# 270265 Type: Private Corporation DAVID CASTRICONE ROOFING, SIDING & David Castricone 200 SUTTON ST SUITE 226 NORTH ANDOVER, MA 01845 Administrator