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Home My WebLink AboutBuilding Permit #854 - 83 HERRICK ROAD 6/25/2007BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 91-Y Date Issued: g,6 -,O 7 IMPORTANT: 2 A ION DESCRIPTION OF WORK TOB PREFORMED: s�•k Acj`c o V Cil' &% � L1l It •i 01- y 1� r..t rf C u A Q. Identification Please Type or Print Clearly) OWNER: Name: J6KA i4,aLZt E -f Phone: q:Sc L-73 - _I I \. I A_1 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $112.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ `T FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund S nature afi'Agentt wrier Si. nature o contract6t, _ w t,_. J 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH jEl COMMENTS Zonind 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 Located at 384 Osgood 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 2 1 A —F and G min.$100-$1000 fine Doc -Building Permit Revised 2007 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 o Photo of H.I.C. And C.S.L. Licenses L3 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 2.2007 Location No. Date ViONTPI TOWN OF NORTH ANDOVER 00 0 - Certificate of Occupancy $ MU Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ed Check# IqI13 2 0 '1) 1� 1) �'_' —Building I<sybctor (A m x m 4 m CA m y v m CO2 .p Z CD O ar Co dS. n� .p o o p CL c� CD O C CD dp tC CD y CD ColM 0 O CD CD y� CD O CD 0 CD d = ti CO2 mC9 3 M H � H T y O a CD � ro.. d ° M H C M P-0 -0 o C "yyy O'v d t7l NO Q So C O Z z ro y °z= n `` � (FQ =ao0 d z M H 0 �tO A r O d o x m y 0 d0 O 7d Z . �= 0900 CL CL .► Sr m CD N POOH_ > � > m o O CO -.4.,— W O � r CT] zr a too= a cn ham: O 0 O H d y ; D. IN C/) scc CL y CD 1"^ CA ? C m C y ;z SCD, N nom.► CD ON so O O 0 0 r O�o Cn z= y �....] J 'fl O CD N CD 0. dd: a� rZ yIWo n rt = �7 O d = ti CO2 mC9 3 M H � H T y O a CD � ro.. d ° M H :_v- oc "yyy O'v d t7l =- Z z ro y °z= n `` � (FQ O o d z M H 0 �tO A r O d o x 7d 0 z 1 43 0 omi 0 9 O C CDK 1 he Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibly Name (Business/Organization/Individual): __I) a j a ca.S+R Cone. - -RQC 46 nG % S i 0 Address: City/State/Zip: N p. AC&At Phone #: 9-7 X 6 8 3 3 �1 o Are you an employer? Check the appropriate box: 1.)6 I am a employer with % 4. ❑ I am a general contractor and I employee's (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet t ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] # These sub -contractors have workers' comp. insurance. ❑ 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. El Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. r airs 13.❑ Other —Y QFFLI o It umi �uc�w oun tt 1 lnum n15p 1111 OUT the section below showing their workers' compensation policy information f 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 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: _• Policy # or Self ins. Lie. #: Q �' Y Q I Q �U� Expiration Date: 9.0�,3� o 19 Job Site Address: (t City/State/Zip: �p &Lr, , 44 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 tine up to $1,500.00 and/or one- ear"un risonmen as well Y p t, e 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: I,,- Phone , Phone #: O),Tieial use only. Do not write in this area, to be completed by city or town offieiaL 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 Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM t%ORT , .: 0��t4�o O L COCNILII�WN11 T us��y 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: Facility location Signature of Applicant Date fi NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. S -1A �16 ? 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 InBoxford 978-887-6147 In HaverhX 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 plate the improvements according to the following specifi6ations, terms and conditions, on premises below described. Owner's Name....... 6--L ..... .. t 1.0 ..... .......................................................... 3Te.,phone # .... 22.?=4�17 .. 174.66 Job Address ...... 93 ..... A4 r . ........................ City..A -st.tLe4 . ............... State............. Specifications: A1011 existing shingles.4) Kpply new drip edge to all edges. 0c, 4 ply --�,—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. . ...................... X ...................... oi��F ....................... w I . Lc - h ........................ -- X - �ih rid vent to C. ................ I .. . . ..... . ... ................ . ........................................ . ............ ................................ 1,4eroof using -shingleswitba c10 year warranty. ..................... 4 ................................... ... P.. -�O-Unterflash chimney. O(e-w vent pipe flashing. A-I:iga'l*'d*'is*p*'o*'s"a'l"o"f**a"H**"d*'e**b'*rM "*"*** ... if / I ................................................. .4 ... .....V ..... .... ..... I ........ I .................. ............. :7 ............................................... Areas) to be worked on: ............................................ -.04,4 ..... .... , - " .b....o. .J ....... ". .. . ..... 1J ..... ...... LAK,;;: W. . ....... .......... ...... ;.F.- 7* Jr ............................................ Roof board replacement if necessary @ /sheet ................................................................................................... ..... I .......................................................... . Gam....... .... I ..... .... Two Year Workmanship Warranty (Not Transferable) Wanufacturer's Warranty as specif Y manu u i .... yy The c9"tor ages to perform the work an the materials specified above for the SUM f ,_;ge U,,'Payable.. on ..... .......... Payable .............................. on ............ . .................. Qalancepayable .oncompletion of.]'Ob Owner or Owners are not responsible for Property Damage or Liability while job isin 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 rtor. 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 fiirdw 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 am) 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 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 .... /C -)L- ............ day of ....... �J&,4j ........ 20.. 07. Accepted: Signed ........... n ..... ...... Owner Signed... ......................................................................... Owner . c , .. David Castricone, President