HomeMy WebLinkAboutBuilding Permit #492-2017 - 92 PINE RIDGE ROAD 11/9/2016BUILDING PERMIT
�1
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: 44 c1 l - '>-0i Date Received 1 ` " 06 /
Date Issued: 1 l- a-2�9 I to
LWORTANT: Applicant must complete all items on this page
LOCATION ' `
PROPERTY OWNER NiC/7/ouAs Print
Print 100 Year Structure yes bno
MAP �4 PARCEL:_ ZONING DISTRICT: Historic District yes
Machine Shop Village yes
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
WOne family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
15-5p-tics ❑M1Nell
❑ Other _=�d
Fl: Ldp a na c �❑ o ®�W,etl nds�
�;: �Wa
1010ater/Sewer_
`
0
DESUKIF 1 IUN UI- VVUMM i U or- rr_txrvmmw.
Identification - Please Type or Print Clearly
OWNER: Name: / ho /li,� l�rA c/ Phone: ��%7L�/a �cS�i� s
Address: G' p 'A r61C d �-- //X d/illi
Contractor Name: 3aale/ °°�� Phone: 9%� O
Email: n'avic/ cd�,
Address: �23/ Sim c f l�i�. / Did/, �d ✓�>/�J��
Supervisor's Construction License: 935' Exp. Date: /a -/6 o?®/ 7
Home Improvement License: /'d V
Date: %- %% a7e/'f
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $9 5.00 PER S.F.
°a FEE: ir��
Total Project Cost: $ % d r9' �, �
Check No.: Receipt No.: 3 (1 S
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
e
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
z6 Engineering Affidavits for Engineered products
TOTE: All durnpster 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/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
Ali dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
Building Permit Application
4� 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
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
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWER -AGE 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 m U FORM
PLANNING a DEVELOPMENT
COMMENTS
Reviewed On Signature_
CONSERVATION Reviewed on Signature
COMMENTS
9 �
`.HEALTH
COMMENTS
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
I
Planning Board Decision:
U
Com
Conservation Decision: Comments
Water & Sewer Connection/Signature � Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIREDEPARtTMWE, NT TemptDum stet on sitex..,yes
Located at• 124 Mame +�i S
R
Street h ,
,�:a artment-si date zr µ-;� �����
Fire Deer gnature/-,•�e4�.,�,t}a,�:.�a' -
1
1- - !• �..a. i.1. 1.1 : 'r rl.•�. Ax•t4 �,a 'w .: "'yi3'�. ?{-iy..[.r f"�; X+ �-
l F
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 lies 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 Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
Location -r M e
No. _ _ �i'�? a " a O► '7
Check #��
31158
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
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2
DAVID CASTRICONE, FRES.
CASTRICONE ROOFING & SIDING INC. Ia'Al' /l
ROOFING, :SIDING & REMODELING REPLACEMENT WINDOWS
HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569
231R SUTTON STREET UNIT 3A, NO. ANDOVER, MA 01845
In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314
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, be low de Cribed:
Owner's Name........J...:�........... Y.�t .L`:. `..hV''`............................................ Tele one....
3�.^ ..1.....�
Job Address ......\.... (i.r1..t _ :...L.�.t. G..C:1 �................... Ciry....Ct.:.ttC?..✓..%` ........ State...%i......
Specifrcuiions
................................................................................
trip existing shingles(f A 111-7trgi�tp"}1et�os _
((j} ............. .................................
Ir
....................... .:.r... t ....... 1.'r(�.. ...�P-'..:...................
it
V'/Apply feet )�� . 1itcdr_.� e r membrane to bottom edges of house. 3 feet
in valleys and bottom edges of anv unheated areas of house.
................................1.......................
Apply ' a x;r uutlerl:n'men . lnstall ridge vent to A ,—c�a 5 r�.
�. ........ �.,. ,...... ... ........ ....... .. ,
Reroof usillty, I„ f... ._... �•;n rl.��i tie Ca i � ,-P. shingles with a 3CJ year warranty.
-eountertlash chimney. ✓Nevv vent pipe jtashing.—Y,egal disposal of all debris.
r' CC.,� ............
...................... I............ I............ '..4....(.............. .. ..... .....................................................
..... ...................
Area(s) to be v; orked on: )._.
.................
........................................._L
..". ... 5.r..... r........c....t..�..S.....?.,..
............................................
...
.......
tA,.,e
...
�'i.r...?�..K�...I;:....lQ {
64. .... mas A L . ...... . ...............
Roof,��ard rehlacenici>t,if�>eceti a!']'..CN...�:?....../slie et.i„�- /....Z7.F�4! .....:5`1..� X• ........................
Five Year Workmanship Warranty (Not Transferable) Manufacturer's Warranty as speci re by manufacture
The ctor age�o perform the work alld rLr�ni_sh the materials specified above for the SU of $...q..�.. G,l.... ...........
'Payabl°:.;S..C?LCL?.....:. on�'"at:..............
Payab!e..... ..-- ............... on. ...............7.............. )Balance payable on completion of job
Owner or Owners are not responsible for Property Damage or Liability wht e�ob is in operation.
Contractor is not responsible for any danwa to the interior of property, including pre-existing conditions (i.e. water stains, crumbling plaster, exposed nails) or
conditions resulting from application of m.•:crials 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 coveo ed by homeowner. All materials are property of contractor. Any dumpster placed by contractor is for his use only. Upon
completion ofabovc work, all undersigned agree to execute and deliver to contractor, lheirjoint 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 pemtitted by law, contractor :,hall 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 arra conditions of the contract and/or any lien in connection herewith. Property may be subject to mechanic's lien ifunpaid. It
is further agreed that this contract may be L.:Jgned 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 ie (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, gm:. Tunics 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 ::oaditions not herein stated. Any, subsequent agreement in reference hereto shall be binding only if in writing and signed by
all parties.
All Home Improvement Contractor:, shall be registered and any inquiries about a contractor or subcontractor relating to a registration
should be diretted to tht-Office of Consumer Affairs and Business Regulations, Tel. (617) 973-8700.
Any and all necessary construction -related permits shall be obtained by the Contractor. Any Owner who secures his own construction -
related permit of deals with unregistered contractors is excluded from the Guaranty Fund provisions of MGL c. 142A.
Approximate starting date of work..!/14................................. Completion date.....!..%..l.F........................................
Receipt of a copy of this contact is hereby acknowledged, and it is further acknowledged y 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, wi,hout 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, 23C11Sutton St., No. Andover, MA 0/1845.
IN WITNESS WHEREOF, the pao.ies hun
ave hereto signed their names this ..A1YI• day of ..(� =r•, 20../Lye ..
Accepted:
David Castricone, President)
Signetlr ti ���- G ,.. �....,( .. ev Owner
Signed
.................................... Owner
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 Letlibly
Name (Business/Organization/Individual): .D ej\- , Tle l( d N R o o F 114 G c S "0 it _LH�c
Address: ;13 i R S J i TO
N S i t CCT V N IT- 3
City/State/Zip: p. Amb 6 v e
MA 0 1 Phone M 'A-?
3 3q ,� 0
Are you an employer? Check the appropriate bog:
Type of project (required):
1. I am a with employer
4. r_1I am a general contractor and I
6. E] New construction
employees (full and/or part-time). *
2. ❑ I am a sole proprietor or partner-
have hired the sub -contractors
listed on the attached sheet.
7. ❑ Remodeling
ship and have no employees
These sub -contractors have
g, ❑ Demolition
working for me in any capacity.
employees and have workers'
9. ❑ Building addition
[No workers' comp. insurance
comp. insurance.
5. ❑ We are a corporation and its
10. F1 Electrical repairs or additions
required.]
3. ❑ I am a homeowner doing all work
officers have exercised their
11. E] Plumbing repairs or additions
myself. [No workers' comp.
right of exemption per MGL
121, Roof repairs
insurance required.] t
c. 152, § 1(4), and we have no
13. F-1 Other
employees. [No workers'
coma. insurance reauired.l
'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. c
Insurance Company Name: G (Z' A N 1-1 E S T Pr—Q.f (tA N C 6 -
Policy
Policy # or Self -ins. Lic. #: V U' U 0 J ri � -1 � 3 Expiration Date: 9 -cl 3 -c2 L j
Job Site Address: a I L Rid Ge, VC d City/State/Zip:. Y6 A46 VY -11 , AM NV)
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 ofperjury that the information provided above is true and correct.
Signature: ?.�'�Date:
Phone #• US (J 3 .3 4 c�y
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 #:
acoRo CERTIFICATE OF LIABILITY INSURANCE
D/27/ 201IDDIY
9/27/6
6
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(les) must be endorsed. if SUBROGATION IS WAIVED, 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
Eastern Insurance ar011p LLC
233 West Central St
Natick MA 01760
CONTACT NAME: Select Department
PHONE . (800),572-4538 q1C No): 781-586-8244
ADDRESS.selectwork@easterninsurance.com
INSURERS AFFORDING COVERAGE NAIC f
INSURER A: Western World Insurance Co
INSURED
David Castricone Roofing & Siding Inc, DBA:
231 Rear Sutton Street, Unit 3A
North Andover MA 01845
INsuRERB:MAPFRE Coamnerce Insurance 34754
INSURERC:Granite State Insurance Co.
INSURERD:
INSURER E :
INSURERF:
1..VVCKNb M0 CERIIFICATE NUMBER -Master 16/17 DCvIeIAK1 MHU01=0
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,
LTR
TYPE OF INSURANCE
INSR
SUBIR
WVQ
POLICY NUMBER
POLICY EFF
MMIDDIYYVY
POLICY EXP
MMIDDIYYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $ 1, 000 , 000
_11A�AGE
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE Fx� OCCUR
rBA GL 2016
/6/2016
9/6/2017
TO RENTED
PREMISES Ea occurrence $ 50,000
MED EXP (Any oneperson) $ 1,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
X I POLICY PRO LOC
PRODUCTS - COMP/OP AGG $ 2,000,000
$
AUTOMOBILE
LIABILITY
Ea BIKED SINGLE 1,000,000
B
X
ANY AUTO
ALL OWNED r_,_1 SCHEDULED
AUTOS AUTOS
HIREDAUTOS X AUTOS NON -OWNED
AUTOS
BCNGCV
/1/2016
/1/2017
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
Per accident $
UMBRELLA
EXCESS
OCCUR
CLAIMS -MADE
EACH OCCURRENCE $
AGGREGATE $
DEDION
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
OFFICERIMEMBER EXCLUDEW CUTIVE Q
(Mandatory in NH)
fins desaibe under
$
X STATLI- OTRH-
C
NIA
003989723
/23/2016
/23/2017
E.L. EACH ACCIDENT $ 100,000
E.L. DISEASE - EA EMPLOYE $ 100,000
E.L. DISEASE -POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS below
T_
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
ROOFING & SIDING INSTALLATION
rcoTlclrATC!' Unr nye
TOWN OF NORTH ANDOVER
BUILDING INSPECTOR
1600 OSGOOD STREET
NORTH ANDOVER, MA 01845
Arnon is ronimnal
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Koegel /MET
- v Tyau-,dU-IU ACURD CORPORATION. All rights reserved.
INS025(2010051.01 Tha ACARn names anrt Innn ars raniRtararl marks of ArORI")
��lN ('rill gtrrmrn�/� r��' 1t/n ,Jnr�u.ir//,
;L--;• Office of Consumer Affairs & Business Regulation
WHOME IMPROVEMENT CONTRACTOR
104569 Type:
rRegistration:
' Expiration: 7/14/2015 Private Corporation
� ;�;
DAVID CASTRICONE ROOFING, SIDING S
David Castricone
231 R SUTTON ST SUITE 3A —
NORTH ANDOVER, MA 01845 Undersecretary
License or registration valid for individual use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston,,MA 02116
Not valid without' signature
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CSSL-099358
Construction Supervisor Specialty
DAVID T CASTRICONE
31 COURT STREET
NORTH ANDOVER MA 01845
Expiration:
Commissioner 12/16/2017