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HomeMy WebLinkAboutBuilding Permit #126-2017 - 83 SANDRA LANE 8/8/2016 4 NORTH BUILDING PERMIT O�SSLEo qQ.O TOWN OF NORTH ANDOVER �� y�` , •, a APPLICATION FOR PLAN EXAMINATION Permit No#: l Date Received �A�AATEO W q gSSACHU`��� Date Issued: 1 I RTANT: Applicant must complete all items on this page LOCATION 3 5hNI X A L/A�e- Print PROPERTY OWNER °t[? \S 1-0 P, Print 100 Year Structure yesnno MAP PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ane family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others. ❑ Demolition ❑ Other Septic El Well El Floodplain ❑Wetlands ❑ Watershed D[strict ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 5►1? ( P 4 fie Eiji b(6 C-�, LC �v 6 F- a r �J J Identification- Please Type or Print Clearly OWNER: Name:�N Phone: -cJ Address: 0 LA �v , &)bOVC9 PA Contractor NamenA ADZ icyiti k b(iA Phone: q-7 g' (o� 3-3 g a 10 Email: ()01ilI C�'d 3tT!l c»e-rocs(;nc4c6 m Address: a� i S vl-Tb Y Supervisor's Construction License: g 9 L5 S Exp. Date: [ a I b 1 Home Improvement License: I (J J 9 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. �1J Total Project Cost: $ 1 ' FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund J r _ I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I TYPE OF SEWERAGE DISPOSAL, Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiumning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales 11Private(septic tank,etc. ❑ Pennanent Dwnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM k i PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS h CONSERVATION Reviewed on Signature COMMENTS f I HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes ming Board Decision: Comments �i ,,;&.servation Decision: Comments Water& Sewer Connection/Signature Date Driveway Permit ]DPW Town Engineer: Signature: FIRE a �ARaT Located 384 Osgood Street D0AX-3 T TLernp lig) sterRo_rirsit_e, liLLoc- -7j t`z10A99-..1—..in _ _ s, Fi_reDepartmentElsgnafureLdate� # C®MMENTS° 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 droprequires Electrical Inspector Yes approval of No DANGER ZONE LITERATURE: lies No j MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine i NOTES and DATA-- (For department use) i L ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 - r i 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4 Building Permit Application 4 Certified Surveyed Plot Plan 6 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) � Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses ,4. 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 Doc:Building Permit Revised 2014 I NORT1y '9 Town of 6 ndover No. � - ,� oh ver, Mass, 8 7AIL L^KSCOCMICM!WIC" 'jf.4s 4ATE D U BOARD OF HEALTH Food/Kitchen PERMIT. T LD Septic System THIS CERTIFIES THAT ............. .. . ....�'�1t/ BUILDING INSPECTOR . ........ ........................ .. ............................ ........... ......... Foundation has permission to erect .......................... buildings on ... .......... ...C..lf� �. .......... ... .. Rough to be occupied as ..:.... ��� P.................................................................. Chimney 2provided that the person acceptin this permit shall in every respect conform 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TION Rough Service .......... ...... Final BUILD INSPE OR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin, 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. L DAVID CASTRICONE, PRES. CASTRICONE ROOFING & SIDING INC. 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 In Haverhill 978-374-7314 Uwe the owner(s)of the premises mentioned below,hereby contract with and authorize-y.ou as contractor,to furnish all necessary materials,labor and workmanship,to install,construct and lace the improvements accordin the3' "VO) llowin specifications,P P p s,terms and g Pce conditions on premises below describe : 1. /a.T 1 ... .... ... yett ,r� q 2 Owner's Name-C.L. l—... Cl ........Te n '"� `.:..q 't..` . ,3 Job Address.....4.✓..... City... ...La.. .N ..Q"..j/4/�..........Stafe_... ..... Specifications: .................................... ............................................. 1/....................................................................................... Strip existing shingles(W Apply new drip edge to all edges. $ � p elm'' lr--! � ...PP Y ...............:.......... .......................................................................1 ..................................... . 1�A" 1 feet ` 9' membrane to bottom ed esof us fe t/ B� n+� in valleys and bottom edges of any unheated areas of house. 1 �J 1( 1 e, p .............................................................................................r..... ................................................. ................................... +fi�ppl apcer��nderlayment. �nst 1 ridge vent to ,J �jl.edt r.. ............................. ........... ..L.... . ................................................................................... t/>fiero f usin shingles with a��year warranty. ............ ounterflash chimney. m ew vent pipe flashing.e al disposal of all debris. US� � �, 1y4✓ Y s� ................................................................_.... ........................ .......... Area(s)to be worked on: ..... ............................................ r��. ..... -. . �. 1W• a,$. x.............................................. 3.. .....Fol....�v�-..Ls .�.c . .... '. i�at�1's..kt�Zedt'e� .� . j.. ' . . .4........�. 12.La.r....' y....................... ` Roof board replacement,if necessarv.. ................./sheet or' /foot.,,•,,,,,,,,,,,, ............................... ................... Five year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specif y manufa rer The for ogre s to�erform the work n is the materials specified above for the S ayable.. L7ir7Q.Q.....on .� r .... ayabte...t fl.j�t QQ...on...1.�CLtrk1F?� lace payable on completion ofjobb r Owners are not responsible for Property Damage or Lifability 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,expose nam 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 arc property of contractor.Any dumpster placed by contractor is for his use only.Upon completion ofabove 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,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 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 wanant(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 allpecessary 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. p�d�x: �� ........................................zeal 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 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.,/JNo.Andover,MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their names this..a �.Sl..day f..11.. .LVX1v.t�_...,20-/4-- nes _ figned................ ................... .................. Owner Imo..... signed "�' ,&I 0'4, r�........................ Owner r : ................................................. '\\ .. ..... .. . David Castricone,President� • The Commonwealth of Massachusetts = Department of Industrial Accidents d 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. AvOicant Information Please Print Leeibly Name (Business/Organization/Individual): 'L AV 11) CAST et C6 NE Rnui F I N 6 + s i-D i lJ i M(- Address: T 0(\is 3A City/State/Zip: �Ip. IIIA Phone#: q 79 6 G 3.3 Yd-O Are you an employer?Check the appropriate box: Type of project(required): I am a employer with _employees(full and/or part-time).* 7. ❑New construction I am a sole proprietor or partnership and have no employees workin �C6 g for me in 8. ❑Remodeling any capacity.[No workers'comp,insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. [will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 I.❑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. These sub-contractors have employees and have workers'comp.insurance., 13.r�rioof repairs 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#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. +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: G ( A N I TC ST^-T 1� XfA N C L7 Policy#or Self-ins.Lic.#: Cu C 3 9 S 9 7-A Expiration Date: 3 .._�r✓ (o Job Site Address: SAo l)a Lm3 8 City/State/Zip: 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 and penalties of perjury that the information provided above is true and correct. Signature: Date: e Phone#: .7 L n :3 :3`i<dU 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#: DATE(MMIDDIrM) A� CERTIFICATE OF LIABILITY INSURANCE 9/28/2015 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 WANED,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 CONTANAME: Select Dept. Eastern Insurance Group LLC PHONE..,,,, (800)333-7234 x66807 FAX No:(781)586-6244 233 West Central St ADE-MAILDRESS:selectwork@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER A Western World Insurance Co INSURED INSURER B:Commerce Insurance Company 4754 David Castricone Roofing & Siding Inc. INSURER C:Granite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURERD: INSURER E: North Andover MA 01845 INSURER F: 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 ADOL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCElua J= POLICY NUMBER MM/DDIYYYYI (MMIDDfYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 }{ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED A CLAIMS-MADE a OCCUR P1404373 /6/2015 /6/2016 PREMISES(Any occurrence $ 50,000 MED EXP(Any one person) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY JECTPRO- LOC $ AUTOMOBILE LIABILITY EOMaBr I�NdED SINGLE LIMIT $ 1,000,000 13 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED CNGCV /1/2015 /1/2016 AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ I $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ C WORKERS COMPENSATIONWC STATU- 11TH-' - AND EMPLOYERS'LIABILITY Y/N XER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ 100,000 ( and yes,describe under Mandatory in E.L.DISEASE-EA EMPLOYE $ 100,000 If DESCRIPTION OF OPERATIONS below WC003989723 9/23/2015 9/23/2016 E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) ROOFING 6 SIDING INSTALLATION CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING INSPECTOR 1600 OSGOOD STREET AUTHORIZED REPRESENTATIVE NORTH ANDOVER, MA 01845 John Koegel/KH3 ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 r9ninn51 m Tha ar npn nama nnrl Innn aro raniatararl mnrlra of arnpr1 i Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099358 Construction Supervisor Specialty DAVID T CASTRICONE 31 COURT STREET 13- NORTH ANDOVER MA 01845 Expiration: Commissioner 12/16/2017 011f I'll 1,1110111111 Office of Consumer.Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration: 104569 Type: % Expiration: 7/14/2018 Private Corporation DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A _ NORTH ANDOVER, MA 01845 Undersecretary I i Location �� `✓' - �''�-t:, No. 'c,IC %-7 Date f h/4114-1 • - TOWN OF NORTH ANDOVER . Certificate of Occupancy $ Building/Frame Permit Fee $- Foundation Permit Fee Other Permit Fee $_ TOTAL $` } C � Check# Building Inspector 6/ V s a y