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Home My WebLink AboutBuilding Permit #879-14 - 88 DUNCAN DRIVE 6/4/2014Permit NO� Date Issued: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this page PROPERTY OWNER MAP NO: 1016 PARCEL: Print 100 Year Old Structure ZONING DISTRICT: Historic District Machine Shop Villa yes yes TYPE OF IMPROVEMENT, PROPOSED USE Residential Non- Residential ❑ New Building iii One family )LAddition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg D Others: ❑ Demolition ❑ Other 'Meptic )!Well ❑ Floodplain KWetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: � Identification Please Type or Print Clearly) OWNER: Name: Addres CONTRACTOR Name: fN2,bL--k j (-e,0Pzr wereffomm,llill=-121 �v�►� Supervisor's Construction License: Exp. Date: ` Home Improvement License: I0Ld-j `1 1 Exp. Date.- ARCHITECT/ENGINEER Kj� yorPfrnWk Phone: Address: PKk-- �V . b1P 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: $ 101A , `� FEE: $ Check No.: l l Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acces o ae fund Signature -of Agent/Owner Signature of contractor Plans Submitted K Plans Waived ❑ Certified Plot Plan ❑ Stamped P s Location'Z c6 —D u , 0 t,,J le v R— No. cl 14 Check# Date TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee $ Foundation Permit Fee $- Other Permit Fee TOTAL Boding Inspector Plans Submitted -'Plans.-Waived-II.- _.Certified Plot Plan ❑ Stamped Plans 0 TYPE OFSEWERAGEDiSROSAL 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 POFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM _:...-DATE REJECTED . DATE: AP. ED _ev� PLANNING & DEVELOPMENT D00 COMMENTS CONSERVATION Reviewed on : (r - 7 — / "t Sianc, )T COMMENTS 4 HEALTH COMMENTS_, Reviewed ka ` kri H -. _ Sianatu . AD-, J`G i -) +n AI- ,.Vrm- I(Af 1d/, j I;, .,o -�,. Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments "Water & Sewer Connection/S_ignature � Date - Driveway Permit DPW Tovv � Enganeer: Signature: LOcaiep RS4 FIRE DEPARTMENT - Temp Dumpster on site yes no Located -at 124 Mair Street -Fire Departmepit signature/date COMMENTS ooa Street t4W" 1+, 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-.Chapter166.Section 21A. -F and G min.$100-$1000 fine UJ1.WIRTM-W!IGQ • • - ® Notified for pickup - Date Doe.Building Permit Revised 2010 ent use Building Department -' The fol owing is'"a--list of.the required,forms to be filled out for. the appropriate.permit to be obtained. Roofir°,g, Siding, Interior Rehabilitation Permits U Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I:C. And/OrlC.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 apn•?al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.+.ted with the building application Doc: Doc.Bui?ding Permit Revised 2012 h d \ \ \CA 4 \!�,,4y '�A ji 4 y \\ q M ori 4 A 4 A �I \`•, 4 t4 \ NA 4 4 S14�G01`.. , _! �^ , ♦'` " c • `t \ ' �� Eip IT 9 ri �'' % ` 1 f 4 `i♦ %6S! 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Proposed Residence far Wiemann Ros BRAMHALL ARCHI7'ECfS NEW PLANS & ELEVATIONS o - — O g '^ North And—, Moa h..Its • em-ie9aara SCALE: 3118'=1'd I I I T12 1 I r 71— EM mg .� i ! i 1 mI ;- 'tl as i� y65 II I 11 Ili I;� Ii�l+'U � I I I I I I o y r HIS ro ! r z ilip i > z '#' i30 Proposed Residence for Wienwnn EXISTING Q ROB BRAmmLL ARctun r3 TEI p g4 ^�O16e PLANSBELEVATIONS 98 Dunm Drim 0 - +.. NmthAuiaon, h! �inrsefts m"•"6"' SCALE: mr=r-w Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS -069815 r ROBERT W TREPXMFR JR 14 EAST CAPITOL, ST METHUEN MA '01844,, J,•G..� �� ,� �4, `' Expiration Commissioner 09/23/2014 Office�f'Con am r a1rs c'�u4-Ae�g.l.t.- HOME IMPROVEMENT CONTRACTOR Registration: 122347 Type: Expiration: 8/2012014 DBA T" 'ANIER TILE & •REMODELING'. ROBERT TREPANIER JR, 14:E. CAPITOL ST` METHUEN, MA 01844 Undersecretary TiYep dnieY le & Remodeling Gary Wiemann 88 Duncan Drive No. Andover, MA 01845 978-689-3518 14 E.Capitol St Methuen Ma 01844 Tel/Fax 978-689-2694 bobt@trepanierremodeling. rnm IHC# 122347 CS# 069815 Estimate Date Estimate # 6/4/2014 286 Visit us: TrepanierRemodel ing. com Item Description Cost Qty Total 20x20 Addition: Materials Materials for frame, roof and siding: 9,152.78 9,152.78 Materials Cost of windows: 11,476.88 11476.88 Mat./La... Excavation/foundation/slab/waterproof and drainage: 18,975.00 18975.00 Labor Cut door in foundation to new addition: 750.00 750.00 Labor Frame 20x20, install roofing and siding, cut opening and install LVL: 15,251.00 15251.00 insulation Spray foam walls and ceiling: 3,775.00 3,775.00 Mat./La... Install 1.50LF of seamless gutters: 948.75 948.75 Electrical Install all lighting and switches, outlets according to plan: 3,024.07 3,024.07 plaster Hang and plaster 12' sheets of blueboard: 3,500.00 3,500.00 finish Install finish on doors, windows, fireplace, base, bench and bead ceiling: 9,975.00 9,975.00 Mat./La... Installation of wood flooring: 4,600.00 4,600.00 paint Painting of walls and trim: 3,000.00 3,000.00 Mat./La... Install vinyl railings and decking according to plan: 19,991.06 19991.06 we look forward to working with you r vv $104,419.54 �j q JoWq Total 06/04/2014 08:58 9786820713 RC LAFOND INSURANCE PAGE 01 ""ACCORE)r OF LIABILITY INSURANCE bAY)E: _ 06/0412014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFCRIIATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIV =LY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES 110 i CONSTITUTE A CONTRACT BETWEF_N THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICAT E HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL II ISURED, the polley(les) must be endorsied. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies real require an endorsement, A statement on this certificate does not confer rights to the certificate holder In lieu of such andorsomont(s). PRODUCERWN R. C. Lafond Insurance Agency, Inc. 398 Andover St. NAME: I Jim Lafond PNONE g78-688-3826 978-882-0713 ro. No. e1rn: (AIC, Nel: Norah Andover, MA 01845 e-raAAL �o,DRt:ss: 1Im@rclafond,com INSURER(yLRDINO COVERAOE _ NAIC p 39454 INSURED TTrepanler Tile & Remodeling - - -� 14 East Capital Street Methuen, MA 01844 _INSURER A: Safety Insurance Company INSURER 11: _ V INSURERS _ -.- - - lNSURER D: _ g 500,000 _ ,PgCc MED EXP (Any onepenon�` INSURER E INSURER P: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTE ) BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TWE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OI' CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSUIiA JCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS_ AND CONDITIONS OF SUCH POLICIES. LIMITS 81,01 VN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR L7 TYPE OF INSURANCe AUDI, VOR I DLICY NUMBER POLICYErr DDryyyy) POLI(:Y12V LIMITS A GENERAL LIABILITY I iMA0018173 10/27/2013 '(lIjM)CCfYYj 10/27/2014 EACH OCCURRENCE g 500,000 _ ,PgCc MED EXP (Any onepenon�` S 100,000 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F1 OCCUR $ 10,000 PERSONAL & ADV INJURY $ GENERAL AGGRrOATE 9 1,000,000 -- .. --_ GEN'LAGGRF,GATELIMIT APPLIES PER:PRODUCTS-COMPIOPAGG POLICY ,,. P 0_ El LOC 1,000,000 r .,. AUTOMOBILE LIABILITY COMBINCD GLH LIMIT �Ln eccldonll _-__ ANY AUTO BODILY INJURY (Pnrperson) S ALL OWNED SCHEDULED AUTOS AUTOS PNON-OWNED HIRED AUTOSAUTOS Y BODILINJURY POI Otoldnnt) ( _PRCP5RTY $ DAMAGE Ceceldenl) _ $ $ _ UMBRELLA LIAR OCCUR _ EACH OCCURRCNCE _ $ EXCI2SS LIAR CLAIMS -MADE AGGREGATE $ y OCD RrTRNTfnN $ — WORKERS COMPENSATION AND EMPLOYERS'LIAEIILITY YIN ANY PROPRIETORIPARTNERICXCCUTIVEN OFFICERIMR,MRED? R EXCLUDE (Mandatory In NR) ITyyes dnscrlbr+under ❑ES6RIP / A _ WC STATU- OT 11MLiS_—_ER.,, _... — ... ..... — E,L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE 1$ — 111, DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, A 01 tonal Ralnrrke Sohadulo, If mere apace la Mqulrad) Operations usual to that of tile installation and general remodel In, 1. �n A IrIVM 1 C IIVLIJCR VI41\VGLL/i 1 I MY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. Fax; 978-688-9542 Osgood Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 L� ,YYt;�e� �' ,La��r;�9/�TX►�' 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD nam � and logo are registered marks of ACORD The Commonwealth of massachusetts Department oflizdusiWftlAccie%nts Office oflnvestigations 600 Wffshington Sheet .Boston, MA 02111 -www.rnass gov1dhz Workers' Compensation bsurance Affidavit: BuildersICon racfoxs/Elecfriclans/Pliiinbers Name (Businesslorgani'zaiion&dividual): .Address: Phone #: �4 — 37 5- X151 Are you an employer? Check the appropTIate box: Type of project (required): 1. [( I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New cOnstruction employees (full and/or part-time).* have ned the sub -contractors 2. I am a sola proprietor or partner- listed on the attached sheet. 7• ❑ Remodeling ship and`have no.employees These sub -contractors have 8. [[ Demolition working forme in any capacity. workers' comp. insurance. 9. ❑ Building addition [Nb workers' comp. insurance 5. ❑ We are a corporation and its 10 r] Electrical repairs or additions required.] officers have exercised.their 3.E1 I am a homeowner dging all work right of exemption per MGL 11. [] PIumbing repairs or additions myself [No workers' comp. c.152, §1(4), andwehaveno 12.Q11oofrepairs insuraucareqafte4.1 employees. [No workers' comp. insurance required.] 13.[]Othex Mny applicantthat checks box Of must also fill out the section bel6w showingtheir workers' compensationpoliq information. t -Homeowners who submitihis affidavit indicatingthey tie doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that checkthis box must attached an additional sheet showingthe name of the sub. -contractors and their workers' comp, policy information. .Tarn are employer that is providing workers'compensation insurance for any employees Below is the policy arzd fob site information. Insurance Company Policy # or SeZ£ ins. Lic. #: Expiration Date: lob Site Address, 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 requiredunder Section 25A. ofMGL o.152 can lead to the imposition 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 WORD ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of investigations of the DIA. for insurance coverage verification. X do liereby ce j upfer the ' s and penalties of verjuiy tliat the information provided alcove ids true and correct. Official use only. Do not write in iliis area, to he completed by city or town official City or Town, Permit/License Issuing Authority (circle one): 1. Board. of Health 2. BuildingDepartment 3. City/Town. Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person:. Phone /#: Information and Instrnctions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "..,every person tri the service of another under any contract ofhixe,• express orimpR4 oral or written.,, An emNoyd is defined as "an individual, partnership, association, corporation ox other legal entity, or any two ormoxe of the Foregoing engaged in a j oint enterprise, and including the legal representatives of a• deceased employer, or the receiver ox trustee of au individual, partnership, association or other legal entity, employing employees. 1%wever the owner of a dwelling house having notmore than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be, deemed to bean employes." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states `Neither the commonwealth nox any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements o£this chapter have beenpresented to the contracting authority." Applicants Please fill. out the workers' compensaiion affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) nam.e(s), addresses) and phone numbers) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are notrequired to carry workers' compensation insurance. If an LLC ox LLP does have employees,apolicyisxequired. Daadvised fhatthisaffidavit maybe submitted tothe Department of Industrial Accidents fox confirmation of insurance coverage. Also be sure to sign and date the affidavit. the affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain, a workers' compensation policy, please call the Department at the number listed below. Self insured companies should enter their self-insurance license number on the appropriate line. City or Torun Officials Please be sure that the affidavit is complete andprinted legibly. The Department has provided a space at the bottom of the affidavit for you to fill, out in the event the Office of Investigations has to contact you regarding the applicant. Please be -sure to fill in the permit/license number whichwill be used as a reference number, In addition, an applicant thatrnust submitmultiple pennif/hicense applications many given year, need only submit one affidavit indicating current PORGY information (ifnecessmy) and under "Yob Site Address" the applicant should write "all locations in (city or fowir) " A' copy of the af.�davit that has been oftxciaily stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit -ii on file For future p ennifs or licenses, .A new affidavit must be filled out each year. 'Where a home owner or citizen is obtaining a license ox permit not related to any business or commercial venture (i.e. a dog license orpermit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office df Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone andfax number: T'.�.o Ca oR-wealth ofM-;u9,aV*afjtts Depax x�e t o ndustxzaI Accident Ofte of TAwstiga-don,, do was ag(on st=-t BWnn, 02111 TO— # 617-721` -4.900 at 406 Qx I- 877W Revised 5-26-05 Fa& 9 617-727-7749 ' w�vx:�ass,g0.vfdz`a BUILDING PERMIT Nvnrry o`t<,.2° ,6gtio TOWN OF NORTH ANDOVER �p APPLICATION FOR PLAN EXAMINATION Permit NO: 70 - Date Received �SSACHU`�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 'Don a-4 3/-! a- Print PROPERTY OWNER WiPIAAArl J Print MAP 210 L,4! • !j PARCEL:<71-74 ZONING DISTRICT: Historic District Machine Shop Vil yes no ves no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial i/ Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer oESGRiPTiON OF WORK TO BE PREFORMED: , /A OWNER: Name: Please Type or Print Clearly) one: Address: _ Ainra, bof ve- Ayq-,( ,A41 ve, q14 CONTRACTOR Name:OASTRICok(. 0 F1 N6 i S11 tN(gPhone: 9 q 8 !08 5 3 g Z o Address: &Q Su 7To O St- Su IT-- ZZ.Q AND 0V EA HA 01 815' Supervisor's Construction License: qR 3S e Exp. Date: Home Improvement License: ARCHITECT/ENGINEER Address: Phone: Reg. No. 7-m 24o -- FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ Z3 6 6, I'll FEE: $ 4?fr Check No.: lG �z J"- Receipt No.: :::?, 4//-// 7 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor E:�Ls [�J- C41 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 ❑ 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: Building Permit Revised 2008 r 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED Reviewed on Signature Reviewed on Signature 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 DEPARTMENT - Temp Dumpster on site yes Located at 124 Main Street Fire Department signature/date Locatea 364 Usgooa Street no COMMENTS 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 use ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 Location 126� A No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Its Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Aw /(Pding Inspector z -Ni Cd p o w2 c a cn w .r C w neo U cli w a�' w F a cn w � a�' w O N cn CO m U 0 v 4-4 2 O rte' U) uj U) W W V9 W cc o o � O N C ' r O vV Q, c m m m c = o :.� M L o C O O 0 U : S a N �• � O m O O m C A m ® CL �/• L O N H •O m �C c y c CA O } o -v 16.:m N_ m IQ O C7 QC= CA � m \\\3-�J► y : C' :2 � O +.: A O . c O. O C! C •O = m : L 3 N CD WC �.=...'C10 .Ca MD m Q E c=c O— m•N Z O o C* a m� W.— cm = a.m� m U 0 v 4-4 2 O rte' U) uj U) W W V9 W cc 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/Organization/Individual): bAV i I CAV41( ONE POO F (NG- i Sl b/i%l(r INC. Address: 20 Cj Su ,-Too ST2r.&T Su , Tc 2L(o City/State/Zip: N o. A N Do,tefc. NA d 1 45 Phone #: 9) B b% 3 3 4 '2 Are you an employer? Check the appropriate box: 1. ® I am a employer with 8 4. ❑ I atn a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I atm a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t 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 H.[] Plumbing repairs or additions 12.❑ Roof repairs 13.] Other *Any applicant that checks box # l 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. xContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. 1 am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: l . Ill A (ZTA S Policy # or Self -ins. Lic. #: VN C 012 q M 9 a3 Expiration Date:VI Job Site Address: b t) City/State/Zip: �) , Nixed HA 61 k q,' 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 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: T / �J C- Date: Phone #: 61'1% � 3 J q aO Official use only. Do not write in this area, to be completed by city or town offrciaL 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 #: 6 0 1,111 C C of Cu 11 S u i n c r A ffn i rs & It iA- i ji c s S It e l; u I a ti 0 is -,,.HOME IMPROVEMENT CONTRACTOR Registration. 104569 Type: Expiration: 7114J2012 Private Cofporatio DA06CASTRICONE ROOFING, SIDING & David Castricone 200 SUTTON ST SUITE 226 NORTH ANDOVER, MA 01845 Undersecretary VBu;u'tl Construction Supervisor Specialty License License: CS SL 99358 Restricted 1u: RF,WS DAVID CASTRICONE .0 31 COURT STREET NORTH ANDOVER, MA 01845 ExPiratim): 12116/2011 I'm: 99358 6 0 1,111 C C of Cu 11 S u i n c r A ffn i rs & It iA- i ji c s S It e l; u I a ti 0 is -,,.HOME IMPROVEMENT CONTRACTOR Registration. 104569 Type: Expiration: 7114J2012 Private Cofporatio DA06CASTRICONE ROOFING, SIDING & David Castricone 200 SUTTON ST SUITE 226 NORTH ANDOVER, MA 01845 Undersecretary ACORDrr CERTIFICATE OF LIABILITY INSURANCE 7U272MIDDIYYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE 010 PRODUCER Pho)ie: 508-651-7700 Far:: 508-653-8089 Eastern Insurance Group LLC -Commercial Lines 233 West Central Street Natick MA 01760 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POLICY NUMBER INSURERS AFFORDING COVERAGE NAIC # INSURED David Castricone Roofing & Siding Ir,c 200 Sutton St INSURERA:Citatjon Insurance 40274 INSURER B:CHART IS INSURER C: Suite 226 114SURERD: N•e' 1. th Andover MA 01845 _ INSURER E: DAMAGE TO REPTED PREMISES(Eaoccwence) $ COVERAGES THE POLICIES OF INSURANCE LISTED BELO'r; HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, PERM 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER PVEOLICY EFFECTI POLICY EXPIRATION OMITS EACH OCCURRENCE $ GENERALLIABIUTY DAMAGE TO REPTED PREMISES(Eaoccwence) $ COM GENERAL LIABILITY CLAIMSMADE FlOCCUR MEDEXPIAnyoneparson) $ PERSONAL 6 ADV INJURY $ GENERALAGGREGA'iE $ ' GEN'LAGGREGATE LIMIT APPLIES PER : PRODUCTS-COMPIOPAGG $ POLICY PRLl T LOC A AUTOMOBILE LIABILITY ANYAUTO BCNCCV 8/1/2010 8/1/2011 COMBINED SINGLE LIMIT (Eaacciderv) $ 1, 000, 000 ALL OWNEDAUTOS X SCHEOULEDAUTOS BODILY INJURY S (Per per son) X HIREDAUTOS X NON4DWNEDAUTOS BODILY INJURY $ (Pei accident) PROPERTY DAMAGE $ (Per acclderl) GAR AGE LIABILITY AUTO ONLY - EA ACCIDENT S ANYAUTp OTHER THAN EAACC $ AUTOONLY: AGG S EXCESSIUMBRELLA LIABILITY OCCUR 71 CLAIMS MADE EACHOCCURRENCE S AGGREGATE $ $ DEDUCTIBLE 5 RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC003989723 9/23/2010 9/23/2011 }{ WCSTATU- 9:0 W 7 i E.L. EACHACCIDENT $ 100 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEM6EREXCLUDED9 E.L. DISEASE - EA EMPLOYEE $100 000 Ilyyesdesaibeundef SPE�:JAL PROVISIONS below OTHER E.L. DISEASE - POLICY LIMIT S 0 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATFunI nGa _...__.. -_._.. David Castricone Roofing & Siding Inc 200 Sutton St Suite 226 North Andover MA 01845 ACORD 25 (2001 MS) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 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 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE OACORD CORPORATION 19BS DAVID CASTRICONE CASTRICONE ROOFING & SIDING INC. j 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 In Boxford 978-887-6147 In HaverhUl 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 place the improvements according to the following specifications, terms and conditions, on premises below described: , Owner's Job Addi ....... J4.2.../ ..£.1........ State..,.,!? ... P Specifications: r ...................................................................................................................................................................................................................... Areas to be covered: .................................................... Apply vinyl siding and corners. Typee .. ........//...................................................... -Cover fascia boards and rake boards. --Install vinyl soffit - solid /perforated ....................................................................................................................................................-................................................................. .Cover wood casmn around windows rya../ ,-' Replace any gable vnts and dryer vents with vinyl. yXe....................................................................................................................................................................... Apply underlayment. Type: — !C { �lYYc/ hr o AS e- t . ............. ....................................... ipp go over legal disposal of all debris ...........................................;.......................... ........................................................................................................................................... Rotted wood replaced @ LD / sheet or / foot. r) ............... • u i e: v......:>.!.t1....,C.x....................... .. tCT............................................. .... �....... I.........................`d...................................�-...:.......... L '✓.t...".1 ... ..... CA_1.!5......art....�i.1 �.<d`t..J.�11?:r.........(Z..�....................... ..........................................:...................................:..............................:..................................Co... .... .... .......... � �e.:o:..::::... ..._.. as The Year p=lorr�ees to perform the work an famiTransferable) sh the materials Manufacturer's specified above four the for f Sby.nufat lure r Payable ..........:::.............. on..........`................� Balance payable on corn letion of •ob Owner or Owners are not responsible for Property Damage or Liability while joti is m operatiott. Contractor is not responsible for any damage to the interior of property, including preexisting conditions (i.e. water stains, ambling 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). 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 warnings) 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 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 .................. dayof ............................ 20........... Accepted: ` Signed . » . 1v e r�� ' :............ Owner Signed ....» ........................................... _....... ................ .. Owner David Castricone, President