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Home My WebLink AboutBuilding Permit #407 - 83 SANDRA LANE 11/24/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION f-6 Ld-,Ae. P,nt PROPERTY OWNER Rtsk ,i. SCJ Print MAP NO: PARCEL:- V ZONING DISTRICT:_Historic District.. yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ✓One family Addition Two or more family Industrial Alteration No. of units: , Commercial V Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 4-- re6 h l nG'(- ru O4 se- t u1, s n cit-t � cc,A+r,;7-(t Identification Please Type or Print Clearly) OWNER: Name: b�� Sic ' Phone: L17 qS 43 S�� Q Address: �6 Sid+ = �► CONTRACTORName: . ' �4 Phone: 3 Address: suf�b V\ SUAP ?21 fyU, t W1 AfV1 0i� `�3h Supervisor's Construction License: 35 Exp. Date: Home Improvement License: In" 16,g Exp.- Date; ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 5U FEE: $ l" Check No.: Receipt No.: !2,q,(4 S3 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ignatu_re of Agent/Owner Signature of contractor , 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 ' a Private(septic tank,etc. Permanent Dumps ter on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature CbMMENTS 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: Located 384 Os'bod'Street FIRE DEPARTMENT #Temp Dumpster on site yes no Located at 924 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 i NOTES and DATA— (For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 C 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 4 ❑ Building Permit Application ❑ Workers Comp Affidavit i ❑ 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 DAVID CASTRICONE CASTRICONE ROOFING& SIDING INC. ROOFING,SIDING&REMODELING REPLACEMENT WINDO� v �lr V HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 200 SUTTON STREET,SUITE 226,NO.ANDOVER,MA 01845y In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-737 01- 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: IiL- p /J Owner's Name.......3 n e—L1 ...........................................................L...../jT�JT��ephone#... � �L.� '...f..•..,.......-...S.r�ta.te.......:.. .`�! ......Job Address......t ......�'. ......��.............city... � Specifications: .................................................................................................................................................................................J 1 lnl. . .......'(/.d 6rt /LZ , ..�.... .....e 1`... �/.. {�pa p yc r r ......�?h..G� ........�..Ta�t�..�1... �.c'�tC ..a........La:.1....:a,1GI.a .... ..�fM••1.1`�l.�............ .....t�Cd�-�UL.e '.....1.Yt......�. / .........p.a�,J�........�......s...C�........ . . ....... :.yJr .....�✓..G..nd. ...s.475: �...... . �. fir... � .......-....................................�....... ....�.. C_s_ ......—..`'G S'. Q......... . r ./..... f ...... ...... ...... --,A.. ....LD,�........ Piz, r . ........................................................................�v -. Y.0.0................. ......................................................................................................................................................................... Two Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specifie y manufacturer The c�ctor agrees i�erform the work an11_ s the materials specified above for the SUM o $.../..fir .ilh...:.'-.... J ayablc.......�..Z.............on....5. c Payable.............................on.............* ............�j balance payable on completion of iob= Owner or Owners are not responsible for Property Damage or Liability whr a tobis 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 Gore 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 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 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 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).Thcre 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...�..........day of 2001.... Accepted: _7 i Signed........ ........! _ta........................ Owner cSigned............................................................................. Owner David Castricone,President 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/Orgarizationgndividual): e AM 1 C 0NE 00 L ETT a SiA 1 N�T I N Address: top Su-rT-et3 S-y2�__r:!r Su s✓ -22 1. City/State/Zip: NAN 0 46I(. MA 01 K 4S Phone#: 9-)9 (P t 3 3 q 2-0 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 and/or Part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling These sub-contractors have and have no employees 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ 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.[X Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 131-1 Other comp, insurance required.] *Any applicant that checks box 41 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 isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Natne:S\p e_ r_G�cc, Cp cAp 6-6 ti G Policy #or Self-ins. Lic. #: raj( rq']S%q y (o Expiration Date: 9-d,3- 201 0 Job Site Address: b J S'(, j��/ City/State/Zip: A ' 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 h imposition g q to posit on 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$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. Signature• Date- Phone#: 10 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#: NORTH viver of And 0 No. q07 171 7: CS LAKE dover, Mass., COCHICHEWICK O'R'ATE F' BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D BUILDING INSPECTOR THIS CERTIFIES THAT... .................................................................................................. Foundation .......... buildings on ..kq has permission to erect........................ 0 ....... .............................................. Rough Chimney tobe occupied as.......0. ......r....................................... . .............................................................I........... provided that the person a-c"Aiing this permit shall in every respect form to the terms of,the application on file in 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 3 — PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTK)TR STTS 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. ACORaDATE(MMIDD/TYYY) 1N CERTIFICATE OF LIABILITY INSURANCE DATE PRODUCER (5087651-7700 FAX 508-653-8Da9 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC - Commercial 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. Select Ext.53389 INSURERS AFFORDING COVERAGE MAIC# IN6uREU David Castri cone Roo Tng & 5iding Inc INSURERA: The Insurance Co of State PA 200 Sutton St INSURER B: Suite 226 A INSUR4R G; North Andover, MA 01W INSURER D: INSURER E. COVERAGES THE POLIGIES OF INSURANCE LISTED BELOW HAVE BEEN 155UED TO THE INSURED NAMED ABOVE FOR TI-IE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY R90IJIREMENT,TItRM OR CONDITION Or ANY CONTRACT OP OTHER DOCumgm'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 BEEN REDUCED BY PAID CLAIMS. INSRDD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCI_ $ COMMERCIAL GENERAL LIABILITY DAMAGE TO I&NTEU y S AISCS fr.,o�ga,ypp. CLAIMS MADE ❑OCCUR MCD CXP(Any one person) S PERSONAL S ADV INJURY $ fiLNt-HAI AGQRCGAYC $ GtML AGOMPGATE LIMIT APPLIES PER. F'RODUG I S-COMPIOP A00 S POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (I a PCndenr) 3 ALL OWNEt)AVIOZ SCHEOULEDAUTOS BODILY $ (I19i Oef6on)0nl HIRED AUTOB NON-OWNED AUTOS (;DOILY INJURY 8 (Pro:accident) PROPF.111V IMMACP $ (Per AWdent) GARAGE LIABILITY AUTO ONLY,EA ACCIDENT $ ANY AUTO OTHER THAN EA ACS $ AUTO ONLY: AGO S EXCESSAIMBRELLA LIABILITY CACI I OCCURRENCE S OCCUR F1 CLAIMS MADE AGGttLGnTE $ 3 0LV VC 1'18LL: S RETENTION S WORKERS COMPENSATION AND WC9752746 09/23/2009 09/23/2010 XWC Sj TORYTATU- DTN EMPLOYERS'LIABILITY A ANY PROPRIRTORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED'? II yYoos,daicnbe under E.L.DISEASE-EA EMPLOYE S 100,000 SPECIAl.PROVISIONS below F.L,DISEASE-PpI,ICV LIMIT $ 500 000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS)VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT)SPECIAL PROVISIONS TI AT NCELL61ION SHOULD ANY Or THE ABOVE 0E5C915E0 POLICIES SE 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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION DR LIABILITY OF ANY KINb UPON THE INSURER,ITS AGENTS OR RUPRESENYATIYES. AUTHORIZED REPRESENTATIVE `,( ( ; StaceyBrice PKG T I `"` r` ACORO 25(2001 108) ®r ACORD CORPORATION 1989 �ifze Cno�nirroruueaGr/. 0/:`4./i' ,�;lrcrfiree�i Board of Buildin, Re.!ulmtiuns mill Strtndartls U`� Board of Building Re�ulatiofis end Satandnrtls %•--,+ Construction Supervisor Specialty License HOME IMPROVEMENT CONTRACTOR License: CS SL 99358 Restricted to: RF,WS 'S Registration: 104569 V� DAVID CASTRICONE Ype: Private Corporation 31 COURT STREET t { DAVID CASTRICONE ROOFING,SIDING& NORTH ANDOVER, MA 01845 ' " .;� , ,;„C:•t David Castricone 200 SUTTON ST SUITE 226 NORTH MA 01845 � Expiration: 1211612011 ANDOVER, Administrator ('l nwii...iunrTr#: 99358 r 0 i Town of North Andover 01 t��o Building Department 27 Charles Street a North Andover, Massachusetts 01845 978 688-9545 ( ) ` Fax (978) 688-9542 �,�o�„�,r, ,�� # �R�rto �P�•y,��3 IS, 15t't DE13:RIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit # the debris re.<slLing from the work sludl be disposed of in a properly licensed solid waste disposal facility as defined by MGL 01, s150a. The debris will be disposed of in/at: Facility .] -- Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project ilurough the Office of the Building Inspector, Location No. Y Date / �! r NORT1TOWN OF NORTH ANDOVER F 9 0 • Certificate of Occupancy $ �'�s'•'•°'E<'�' Building/Frame Permit Fee $ s�CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check It �3 T 22653 Building Inspector