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HomeMy WebLinkAboutBuilding Permit #991-2016 - 83 ACADEMY ROAD 3/22/2016 i I �%ORTH q BUILDING PERMIT o=oLE� 0646/, ✓ TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION '" —�I e Permit No#: Date Received �jgSSgCHuS��,�9 I Date Issued: Z IWORTANT: Applicant must complete all items on this page LOCATION 0 �Cf1� Y A� A 06-C Print I ' PROPERTY OWNER Print 100 Year Structureno MAP PARCEL: ZONING DISTRICT: Historic District a no Machine Shop Village es TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Z110ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units-. ❑ Commercial �2epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer _ DESCRIPTION OF WORK TO BE PERFORMED: V-) 0 a421) reS I U F � Identification\- Please Type or Print Clearly G OWNER: Name: Phone: (0 Address: HA Contract%a A T`1(U►1P P(0 t Act Phone: TA (O 6 3 3`� Email: Address: Uy\ Ml-� Supervisor's Construction License: �I �j Exp. Date: Id, / " 17 Home Improvement License: 1 o,4 10`1 Exp. Date: f 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. I Total Project Cost: $ u--�v (�u FEE: $ —' e _ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acces g, aranty fund Location vv-: � No. Zbl� 3 Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ • zr Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ' Check 7 ; 01 45 Building Inspector 1 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swunming 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 I PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS i CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature 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: FIRE D Located384 Osgood Street ti, �,_ EPAR�TrMENT --:TernpDurrmpste�xontsite= �,yes�, ' ;,,�. �no��� ""{ ;Fire,®epa�ment� ignature%date' i 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 ease) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Bnilding Pennit 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 ;r 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 OTE: 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) i6 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 I I Doc:Building Permit Revised 2014 NORTfy Town of 0 No. -A r.261 �h , ver, Mass, ,ZZ 2 T O LANE �. COCNICNE WICK V A�RATED S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System owl THIS CERTIFIES THATBUILDING INSPECTOR ....... R". ... ... .J��IS....&AA .... ............... ..... has permission to er ct ..... buildings on .... Foundation .............. .SS... . . ..... .... .. .. Rough to be occupied as . .. . .vp..... .a ........... .. 1P .. ... .. .�i ............. Chimney provided that the person accepting this permit shall in ev;y res rcconfiorm 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION RTS Rough Service ................ .... .... .. ................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. {{G 1E«L1�VL DAVID CASTRICONE, PRES. JAN i 3 2016 CASTRICONE ROOFING & SIDING INC. BY:...................... ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 231 R SUTTON STREET UNIT 3A,NO.ANDOVER,MA 01845 - In North Andover 978-683-3420 In Boxford 978-887-6147 /n Haverhill 978-374-7314 I/we 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: Owner's Name_....1.(S f�"l.t� rf' .....t.:.5..\<.i./.�.?............................................................. t n ., Job Address..........t.: 1......ii.�:Lsl� 1:2t.1.... C.<4......................City....J�:r1-).1...0'11 XC( ...................State_n --.----.. l Specifications: ................................................................................................................................................................................................................. G..CI .►:C.....t?. . ?:!.:.i2� ...r fe.�:-...!x'14�.1I�1l..lY.... ! d.. .......S ...... {'X1..a.:a.l X.......!�:�'. ....r +.. ..:.:,.. .......... t ..� ! ......«.. + -. ....... — .) 14 — C..I�r:.t.3............ .......�..kJ. 1..�?5.37.`..1.1....... /4 "...... .►���� }���.�k...... ......1.1....:. ?.. ..... L '.....� �n7„ �c� ►��(?.k.�s }....... ......u.l.`.l?X....V.t'.f:l�. .<<...iJ n�. . ....ua.d;.....(.1C:xo...s:6 ,h...a.. k-.1.r'...... '.G. .:.............i .c:...... .4:. ......... ...... .. 4�:`4'c:,�:�?��'. �.....- ..... L.lin..... t.........1.`<.-AT .................. ............... .. �.....' ."...v.. n.t....?.i. .. .........j..:� . e�...m.. ....:�'e. ..................................................................I.,........ .................................................................. ...................................................................................................................................................................................................................... ............................................................................................................................................................................................................... Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specified by manufacturer The contractor agrees toperform the work and furnish the materials specified above for the SUM of$....1..1.I..Le i`.4.:. 1.'�......... Payable..,;,.i.J..4'.(:�if.:L�......on.....i;tt t............. Payable.............................on.................................. ✓alance payable on completion ofjob 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 preexisting 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 wort,all undersigned agree to execute and deliver to contractor,theirioinl 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 e:7z Nat this conuact maybe 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(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 the Office of Consumer Affairs and Business Regulations,Tel.(617)973-8700. Any and all,necessary'conttruction-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. II Appr Receipt oof startingth thise of workc, is herebyackndwledge�and it is fartheracknowledgedby the undersigned d that��re Recei t of a co � going 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 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...Jr ...,....day of....JC..5..!2.4. ,-t20.r. . Accepted: . ...{..... ..... .. Signed....... ..... Owner Signed............................................................................. Owner ................................................................... David Cas tricone,President The Commonwealth of Massachusetts g Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): bAV i T) C-AS-1 61 U)NC Zf )E I N s 13) 113 -. i M(- Address:---A 31 (Z S v T c-z iJ S­v�--z5 T U t\\c 3 A City/State/Zip: �J0• A M Do V e-A. MA o i 6 4 j Phone#: q 79 -4:,93-3�d-o Are you an employer?Check the appropriate box: Type of project(required): 1'm I am a employer with 0 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.[]l am a homeowner doing all work thyself[No workers'comp.insurance required.]t ❑ ❑4.❑I am homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.®ROOF repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] Any applicant that checks box ft 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 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: Policy#or Self-ins.Lic. \N Lb(0 .� �S r1 ZA \ Expiration Date: ( Job Site Address: b cc_( (AW I Qa f) City/State/Zip: )ap, Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains andpen-aaltties ofperjury that the information provided above is true and correct. Si nature: Date: Phone#: "7 (c 3 :3 q db Official 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#: i II AcoCERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD `—� 9/16/201515 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 NAME:- Select Dept. Eastern Insurance Group LLC (PAHONE (800)333-7234 x66807 F Cf No (781)586-8244 233 West Central St EA DLDRESS:selectwork@easterninsurance.com INSURERI AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER A:Western World Insurance Cc INSURED INSURERB:Commerce Insurance Company 34754 David Castricone Roofing 6 Siding Inc. INSURERCGranite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER O: INSURER E North Andover MA 01845 1 INSURERF: COVERAGES CERTIFICATE NUMBER:CL159964794 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. INSR EXP LTR TYPE OF INSURANCE I L U POLICY NUMBER M10iVDOffYYY MEFF MI DYNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE b 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGEYO RENTED PREMISES Ea occurrence S 50,000 A CLAIMS-MADE Fx_1 OCCUR NPP1404373 9/6/2015 9/6/2016 MED EXP(Any one Person) S 1,000 PERSONAL 8 ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 2,000,OD 0 i I POLICY PRO- LDC S AUTOMOBILE LIABILITY EOMaBINE DI SINGLE LIMIT S 1 000 000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BCNGCV 8/1/20158/1/2016 AUTOS AUTOS80OILY INJURY(Per accident) S X HIRED AUTOS }( NON-OWNED PROPERTY DAMAGE AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE 5 EXCESS UAB CLAMS-MADE AGGREGATE $ -sDT IRETENTiONs S C WORKERS COMPENSATION WC STATU- OTH- 4ND EMPLOYERS'LIABILITY YIN }{ TORY IIA -,vv PROPRIETOR/PARTNEWEXEGUTIVE $ 100 000 Cr ICERiMEMBE,R EXCLUDED? N1A E.L.EACH ACCIOE NT (Manuwry In NH) C003989723 /23/2014 /23/2015 E.L.DISEASE EA EMPLOYE S 100 000 ryes.descnoe under UESCRIPTION OF OPERATIONS oelow KC0039e9723 9/23/2015 9/23/2016 E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS)VEHICLES (Attach ACORD 101,Additional Remarks Schedule,A more space Is required) Roofing 6 Siccing contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Castricone Roofing & Siding THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Unit 3A ACCORDANCE WITH THE POUCY PROVISIONS. 231 R Sutton Street AUTHORIZED REPRESENTATIVE 'North Andover, MA 01845 John Koegel/KH3 ACORD 25(;i 5) INS025 r:nin ©1988-2010ACORD CORPORATION. All rights reserved. m nc+n,m Th.ARr1p 1 namn and Inns aro.nnicrornrl mar{re of Ar npn Massachusetts Department of Public Safety ® Board of Building Regulations and Standards License: CSSL-099358 Construction Supervisor Specialty DAVID T CASTRICONE 31 COURT STREET NORTH ANDOVER MA 01845 Expiration: Commissioner 12/16/2017 ''%/,� 1`•., ,.nor„irri/�/, //i., ,r/„i..,//. Office of Consumer Affairs& Rushh ess Regulation ROME IMPROVEMENT CONTRACTOR ttz. ... -registration: 104569 Type: : '' e,, ;. Expiretion: 7/1412016 Private Corporatic DAVID CASTRICONE ROOFING,SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undersecretary