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Building Permit #736 - 94 SAUNDERS STREET 5/21/2010
BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 11 Permit NO: Date Issued: P Date Received IMPORTANT: Applicant must complete all items on this pate LOCATION q � 5(w, r&J 5hT-C-1 PROPERTY OWN Print MAP 214 410 PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Villaqe ves 4L e^ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building `-'One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: `� es h li1G Gv o v\c St a e cA Identification Please Type or Print Clearly) OWNER: Name: a►na aV)n (zaiMse�:4 Phone: WE Sl to iz) Address: q,l S ti -U (\(� w s�-k- Iv v o i N T - CONTRACTOR Name: 71 C �t Phone: � � i �r t Address: ZbO . ver Supervisor's Construction., Licenser Exp. Date: tom- ) b �)-,O a/ Home Improvement �, (o 9 Exp. Date: —7 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: $ FEE: $ Check No.: -7 ,7�Q Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund signature of AgentlOwn� 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 Private (septic tank, etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT euu CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS e 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 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street. Fire Department signature/date MENTS. 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 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 Location �` / ��U�` /��-S s r— No. f Date TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ Building/Frame Permit A MU Fee $ S Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 23, Building Inspector m m m m m m v m COO) d C � � d CO) Cl) CD az CO) CD O "0. CZ. r , C � ? o CL y c v CD CD o CL Q /� = CD CD O CD mm a. C CD CO) CD =0 CO) O I �= CD O I C 0 0 Z 0 CD O CO 0 1 cc S. to CO to C o: o 0 CL 5 H m .1 Q H ACri �1dS N .. -�. o .: Como 0 N m o ~' O o H: C) CA am a .... o � m N m c c o- m N CAD CO) cr CL 03 �C m H 1 � w CA m CD m CAO �o •o o . CD W CD a3: CA m o m d d C-) C2 g Im Cl) o co C* n m m CA a w cn R O z 0 �7► p - O OQ O 5d z � O� ch 43 C CD(� 00 7C Gz 0 o x CD M v z 0 J Omi 0 0 c Town. of North Andover Building DepArtment 27 Charles Street North Audovc:a-, Massachusetts 01845 (978) 688-9545 Fax (978) 588-9542 DEBRIS DISPOSAL FORM y4WnMW N{:1Y�7�y O� •�q l0[„�[pYW�(„ �' oR�rcn fP�Yy,��3 S�AC IU 0 - In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit # the debris re,:i.r I tint; from the work shill be disposed of in a properly licensed solid waste disposal facilit.) as defined by MGL c,11, sl 50a. The debris will be disposed of in /at - Facility ulion S16 -nature of Appliennt Date NOTE:.k demolition permit from the Town of North Andover must be obtainedfor this project t1aough the Office of the Building Inspcctor, 1 he Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 u, y tivww. mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information _ Please Print Lepibly Name(Busitness/Organizatioth/Itndividual): AV I C M7R ► c o p E R M FI1C, 1 S I N S Address:ZC>C) Su-17es ,J City/State/Zip: N. M bo JE K "A 0 19 NS Phone #: 9) 9 (p 6 3 3 q 20 Are you an employer? Check the appropriate box: t. ® 1 am a employer with i3 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors ?. ❑ I am a sole proprietor or partner- listed on the attached sheet. 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.] f These sub -contractors have employees and have workers' comp, insurance.l 5. ❑ 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' insurance 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 *.qty applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContracters 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 mast provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and joh site information. Insurance Company Name: 7�) e \ 0A (i Cry ce, Co Mj)T� S `� Policy # or Self -ins. Lic. #: W C9 9y;7 qG Expiration Date: Job Site Address: qq S"dea SfNO 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 Section 25A of MGL c. 152 can lead to the imposition of cruninal 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. 1 do hereby certify under thepains andpennallti/es of perjury that the information provided above is true and correct. Signature: �2 C.,7L ""� Date: ZO 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 S. Plumbing Inspector 6. Other Contact Person: Phone #: DAVID CASTRICONE ; j bo CASTRICONE ROOFING & SIDING INC. ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS i'/p 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 HaverhX 978-374-73 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 Name ..... 1..: aw f....AJ.L1..1:1.....�f rp :Ylct�� .� ......................... / �[ / .%..........{..�Telgphone #.......�x.�f .v11.�.Q... Job Address....... (� .....� w.H ,6'C.45.........t ........../......... City....1..Y.t:....1 a l�lr}t? k'.� 1�............. State...... A... Specifications: ...................................................................................................................................................................................................................... •strip existing shingles(JJ -Apply new drip edge to all edges. ti/%i Y �� .................................................................................................................................................................................................................. . 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. ................................................... .............................. .......................:(1.�I.................................... ....................y..... ............ I ....................... .. Apply felt paper underlayment. Install ridge vent to r�. �/ . .. , .. c „ rz, sr ...................................... . . . . .... -Rcroof using 3 t 4l .� :e n ,,, �" ( shingles with a A< year warranty. �/,J(r .......................................................^.........................................4i.N..t.r....................................................................................�... ............ ountertlash chimney. -New vent pipe flashing. -tegal disposal of all debris. .......................................................................a................................. Area(s) to be worked on:� ..."""• ................ .. ..........1...�.G..4!.�.....:.5..�:r>w�...... � ........ .t.t`...........1,ull..x.4...... ta:.t E£ uLhe' ...... l l`rrzt ..Mt.e.e ....lt.�.k, r........ ................./.................................................... ................... ................................................................................................................ Roof board replacement if necessary @ V4foot. ...................................................................................................................................................................................................................... Two Year Workmanship Warranty (.Not Transferable) Minufacturer's Warranty as specified by manufacturer The contractor agrees to perform the work and fiq'sh the materials specified above for the SUM of $.....j./. zi ............... ©Payable ........1& ............... on ......51 . ........... ............................ on .......... ...—............... 0-alance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability while job rs m 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). 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, attomey 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). There are no representations, guaranties or warranties, except such as may he 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 .... f.l.ylt... day of.. D Accepted: Signed/may) �..l't;-, �l'' 2f q,112'%. t,�.........Owner Signed.............................................................................. Owner David Castricone, President 590 ���