HomeMy WebLinkAboutBuilding Permit #618 - 87 GLENNCREST DRIVE 4/6/2006Of NORTH 1M
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Permit NO: -
Date I
LOCATION_
PROPERTY OWN
MAP NO.: 16 q
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
IMPORTANT: A
7 &Ip44C-t-.
PARCEL:
Tt/TT . ATT TTQU 1iC " 1111 nrtv%_
Date Received:# 61
icant must complete all items on this
nt
Print Q
ZONING DISTRICT:
UMT"P IC nifiTR 1CT VF.: n
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
C New Building
CAddition
Alteration
ane family
L Two or more family
No. of units:
Industrial
epair, replacement
E' Demolition
❑ Assessory Bldg
❑ Commercial
Moving (relocation)
r; Other
❑ Others:
r Foundation only
DESCRIPTION OF WORKTO BE PRE OF—ME0
IF
pt�
A. n l � .p l� 6 h
OWNER: Name:
Address: 2
CONTR
Address
Identification Please Type or Print Clearly)
I% >
dILL'.ciw
Supervisor's Construction License: Exp. Date:
Home Improvement License: 1 6 F Exp. Date: g
ARCHITECT,'ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE: BOLDING PERMIT: e10.00 PER 51000.00 OF THE TOT1 L ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost :$_�7 %d x10.00==FEE:$ `l
Check No.: 1 Co �S , Receipt No.: b
Page Ior4
Location 4- j
No. Date 4116161(lel
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee pa�- $
TOTAL $
)(082
Check #
19083 Building Inspector
TYPE OF SEWARGE DISPOSAL
—
Tanning/Massage/Body Art J
Swimming Pools r
Public Sewer
Well L
Tobacco Sales
Food Packaging Sales
Permanent Dumpster on Site
Private (septic tank, etc. J
Electric Meter location to
project
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of Contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Water & Sewer connection signature & date
DATE REJECTED
n ❑
[]Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
DATE APPROVED
DATE REJECTED DATE APPROVED
❑ ❑
DATE REJECTED
El
Comments
Comments
Temp Dempster on site yes ... no_ Fire Department signature,'date
Building Permit ,Approved and Issued by:
Page 2 of 4
❑
DATE APPROVED
Building Setback (ft.)
DIMENSION
Front Yard Side Yard Rear Yard
Required
Provided Required
Provides -Required
Provided-
rovided
DIMENSION
Number of Stories:
Total land area, sq. ft.:
,m)iti, anaUAIA —(hor
Pave 3 o
Doc: I NS
Cre,rtad JMC. I.m.-UOn
Total square feet of floor area, based on Exterior dimensions.
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
Addition Or Decks
❑ Building Permit Application
❑ Surveyed Plot Plan
o Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crosseetion/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic
Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
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
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 SER% K ES Dh:P.1R'f\11:\'I':131'FOR\IIIS
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Board of Building Regulations and Standards
HOME iMPROVEMENTCONTRACTOR
Registratio», 104569
Expiration: 7/14/2006
Type: Private Corporation
DAVID CASTRICONE R,QOFING,:SIDING &
David Castricone
7 Hillside Road
Boxford, MA 01921 Administrator
Q
Town of North Andover tA0RTH g,
Building Department o
27 Charles Street `
North Andover Massachusetts 01845 $ .^
978 688-9545 Fax 978 688-9542q`
C6GNI[NwKk 1'
7.o TED PpP .gay
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 c11, s150a. #'
The debris will be disposed of in /at:
1,4'fS InC- , S
G7
Facility location
c �
Signature of Applicant
Y /�" /0';
Date
NOTE: A demolition permit from the Town of North Andover must be obtained for this
project through the Office of the Building Inspector.
The Commonwealth of Massachusetts
Department of Industrial Accidents
2 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): a n/ N R k/N fir'
Address: $ % 6 LEN G/2izt-' Drelve-
City/State/Zip: A16 AV" ✓El- /yf G jM' Phone #:
9')r 7f y x.5'79
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).*
2. ❑ I am a sole proprietor or partner-
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.] t
have hired the sub -contractors
listed on the attached sheet. t
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.❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.❑ Roof repairs
13. ❑ Other
-.ftny appucam mai cnecxs oox o i must also till out the section below showing their worker;' 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 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: • ..L• _�
Policy # or Self -ins. Lic. #: y C 4OO l 4 0 OO l el A
aCJ�
VV T Expiration Date:
Job Site Address: fl 7 GcZN C,c.Fs T D2I116— City/State/Zip: Na . ARJb c veli'. /M 411JV!
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-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 and the pains and penalties of perjury that the information provided above is true and correct
A -L-:o Ir
Phone #:
Oficial 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 #:
�j
3 /,7_
DAVID CASTRICONE
ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS
HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569
200 SUTTON STREET, SUITE 226, NO. ANDOVER, MA 01845
7 HILLSIDE ROAD, BOXFORD, MA 01921
In North Andover 978-683-3420 In Boxford 978-887-6147
In Haverhill 978-374-7314
Ca
6�2-ts�a/- �z?8
I/we the owner(s) of the premises mentioned below, hereby contract with and authorize you as contractor, to fumish 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: 6/12 5-17NI— 329.o
Owner's Name ......D.r•„s,, ,................................................................ Te hone #..... 1..�..G.....-.I> L..9............
ti...<..
Job Address ....... .... L 7 ./P n,v P-mr, ............. city ......4 . 474...,t•I a.u+.e d ............. State...............
Specifications:
✓§tripexisting shingles{J ......+fply new drip edge to all edges.
.................................................................................................................................................................................................
✓Apply _� 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.
✓A............................................................................................................
pply felt paP/e*r unde a ent. Install ridge vent to
..............JAJ.... rµ�,,d,.. .......... ....... P ........................... Y'/9JC.f.....................................................
.A7eroof using X 0 3 / !� IRe c n� T shingles with a 3 D year warranty.
.............................5g). .............I ............................................................................................................
.%Iounterflash chimney. --New vent pipe flashing. +regal disposal of all debris.
.........................................................A.+...r.�..y......................................... .................................................
Areas) to be worked -AR
A P
.............. f} on; .�.ht. - -s .......b.
P.� ..r>.......r.. ............rt .,t ���.J.... �...'���..s
Fr..n...!...l...R...............f..t...0.. ..V.r......7......... ..�.....�.................................
.................
................... 3.......tS.......�...Gt.to.............
e. .......... 2.LI.o..................
One Year Workmanship War tof Transferabl
Manufacturer's Warr as s�eci ed by man turer [/
Materials and Labor to co $.....;/.....1-0........... Payable ......... ............ on ......
Payable ..... =. ................ on ................. rr:=......... Balance 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, water stains when roofing shingles have not had adequate time to cure).
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.
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 shall be excluded from access to the Guarantee Fund.
Approximate starting date of work..................................................................... Completion date ..............................................................
Receipt of a copy of this contract 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 Knalty. /-
IN WITNESS WHEREOF, the parties have hereunto signed their names this - r ............... day of .A rf.....�.....I............. 20.1 .. (Q.
Accepted: }
Signed.. ....... ..........Owner
Signed......................................................................................... Owner
Per.......................................................................
Representative