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HomeMy WebLinkAboutBuilding Permit #840-14 - 98 GREENE STREET 5/19/2014TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: b 0 --1 1 Date Received Date Issued: I ORTANT: Applicant must complete all items on this page LOCATION �0 eet) ,- MC -1 N b r k Print PROPERTY OWNER �C-0, 6 J1f'1U n Print 100 Year Old Structure yes o MAP NO: �0PARCEL03I2— ZONING DISTRICT: Historic District yes no Machine Shop Village 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 Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: OWNER: Name: Address: q B CONTRACTOR Name:1) Address:3 ion Please Type or Print Clearly) R lsu*r,�, Sf(cct a7� of 3 �oqy UOR fc, Phone: q79 6 Yo2 0 -SIAL qs- Supervisor's Construction License: Exp. Date: ( I I b I Home Improvement License: i��S%cl Exp. Date: L' 11 ARCHITECT/ENGINEER Address: Phone: Reg. No FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTrBASED ON $125.00 PER S.F. Total Project Cost: $1-6216,60 FEE: $ J • Check No.: 2' p Recei t No.:d%C 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 ❑ 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 ❑ ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS 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 Towi! Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 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 fleeter location, mast or service drop requires approval of Electrical Inspector Yes foto 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 o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work a Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Li Building Permit Application Li Certified Surveyed Plot Plan u Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract a Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application o Certified Proposed Plot Plan u Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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 app: al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Bui!ding Permit Revised 2012 I nrotinn q � f*'j e !S4/ZAG+ Date 4* No. Sl�� I L4 Check # g -4q � TOWN OF NORTH ANDOVER. Certificate of Occupancy $- Building/Frame Permit Fee $ Foundation Permit Fee $-,0, Other Permit Fee $ TOTAL $ Building Inspector H W LL D m s +U_+ Y O 0 A N+ O_ a)LL N ui Z z Z _ m C: O c 7 LL to 7 W ? E U LL O !JJ z Z m G J 0" to w C LL O0 U d z Q U W ui to Ln C LL OC O ui Z 7 d' LL CZ ui G Lu � W LL i i m O Z L1 Ln v cu O N FMM cn - O O = '=`n IM 3 �o0 . CL L �scn = _ CD O = __ = 0 = CL s 4).2 m LULU 0 -0O o .� O LU U N _ I— O yr _ �O _. a� E .__� as CL �a C = O t w 0 -OU 0 E a L cn .�+ _ d CD y0+ U L �1• ` : v� y J > _ 0 ' '�O C `• O c Iz c=tVa v' CD foo z a� CL cn - O O = '=`n IM 3 �o0 . CL L �scn = _ CD O = __ = 0 = CL s 4).2 m LULU 0 -0O o .� O LU U N _ I— E .__� as CL 0-0 0 O'er;.. _ C = O t w 0 -OU z 0 0 > 2 Z G Z W w CL w H W M 0 w :a C9 `m vL+ cnr Z F— • Z U cn LUJ \� �I w rw I.: d CL ^, C W m a DAVID CASTRICONE, PRES. V ii CASTRICONE ROOFING & SIDING INC. ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 231 R SUTTON STREET UNIT 3A, NO. ANDOVER, MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314 Uvve 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.....0 ................................................. Te ephone tl... l..J�..... ..}�.rt.. vfa....�.� Job Address ........ 1.'v.....(/` r i. <:...s-% z�........................City.../..Y.c?J../...1.tt.c/G.jf.t' .................state.../."./ ....... Specifications: ............................................................................................................................................................................................................. // +'Strip existing shingles. Apply new drip edge to all edges. l-Vk ............. • ........ •........................................................................................................................................................................................ /Apply _feet ice and water shield membrane to bottom edges o1' house. 3 feet ice and water shield membrane in valleys an([ bottom edges of any unheated areas of louse. .............. ......................................................................................... ....... ............................................................................. Apply felt paper underlayntent.stall ridge vent to f`t, p� «�4 y� i, n�,fyjX .C..............................•.•......................................................................................................... i �y.� .. Reroof usinr shingles with a i% year warranty. �rl�./J >> ........... �U.... `Zounterllash chimney. ''kesv vent pile dashing. ,l:egal disposal of all debris. � � ...-- Wo 4A ........................................................................................................................ Area(s) to be worked on: � _�a11 /. 1.�ua r'....5: t*t.rcry r►. �....................... .............................................................................................................................. 7. .......... C.... ,,. , il................................ ...................... Roof board replacement if necessary leo /sheet o —/foot. _._. Five Year Workmanship Warranty (Not Transferable) Manufacturer's Warranty as specif by manufacture c.) The c ctor ages to perform the work a d fuE4is_h.the materials specified above for the SUM $...�%.G.0............. --� !)Payable ...... .F'..(?........ on.....5•/.4..:.!•• ..........&1.anc,,.,. Payable .........-:................ on.............-"................ able on completion ofjobOwner or Owners are not responsible for Property Damage or Liability whn opeion. -- 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 ofabove woik, all undersigned agree to execute and deliver to contractor, theirjoint 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. Property may be subject to mechanic's lien if unpaid. It is further agreed that this contract may be assigned by contractor, and also that the obligations hercof 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 arc no representations, guaranties or warranties, except such as may be herein incorporated, if any, not 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 fmprdvemtnt Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to the 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 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 the 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, without 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, 231 R Sutton St., No. Andover, MA 01845. IN WITNESS WHEREOF, the parties have hereunto signed their names this.... .... day of ..../.'. (�a.........., 20.%..`.. Accepted: Signed..... .:................................................ Owner C,,.e.e.., Signed............................................................................. Owner ...................................................... David Castricone, President The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/clia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): b A\/) p Y1 \V-- I M L� S i D ► N (, 1 hl t_ Address: X31 &u rrot3 ST(u % Uti i T 3A City/State/Zip:No, A IJ DOU E(C HA MYS Phone #: 97 � 03 Are you an employer? Check the appropriate box: 1. RT I am a employer with _ 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. # 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. ElI 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 constructio 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F1 Electrical repairs or additions 11. E] Plumbing repairs or additions 12,'Woof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they a:re doing all work and then hire outside contractors must submit anew affidavit indicating such. #Contractors 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. A Insurance Company Name:. Policy # or Self -ins. Linc. 9:: o—O n '35 Expiration Date: Q ([ Job Site Address: 1 i�S U �l _,—,Tye City/State/Zip: p U0 V - I v 1 t? 7 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 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 andpenalties ofperjury that the information provided above is true and correct. Signature: C Date: Phone#• 979 9i 03 39 -0 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 #: ACS CERTIFICATE OF LIABILITY INSURANCE DaTE(MM'DD;YYYY) 1Oi7 2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI! CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE`. BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE[ REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(las) 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 thl certificate holder in lieu of such endorsement(s). P. o'�UcER CONTACT NAME: Eas+ern Insurance Group LLC - Main PHONE FAX 233 West Central Street E-MAIL [AJCNo E 0 1.7700 IA+c No1.781 586-820.4_.- _ mallck MA 01760 40DRESS:� I c k ern nsur nce co _ INSURER(S) AFFORDING COVERAGE I NAIC x INSURER A.Commerce Insurance Company !34754 INS JR,c 31969 INSURER Commerce & lnduSlr- I �C,2vio Castnccne Rooting & Siding Inc INSURER C: C asiricone =looting inc P't Rear SuitINSURER 0;on Street, Unit 3A ----- PJor±h Andover MA 01845 IINSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 17ninf 1487 REVISION NLJMRFR THIS IS TC CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOL rdDICATED NOTY^;'ITHSTANOING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIE CERTIFICATE &114,Y BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SU&JECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOVYN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYRE OF INSURANCE A INSR WVD POLICYNUMBER POLICY EFF MMJDD!VYYY POLICY EXP MM/00,YYYY LIMITS r c_.�RAL�IA31UTY I-. I PP1350515 !8/2013 / ii2011 EACHnCCURRENCE IS1,000,000 ! �% COI-II'JERC:IAL GENERAL LIABILIT i C DAtN 1MAGE To —j PR MI occurrence1550.000 r.lE D EXP IAn; o+xJ person) , S 1,000 CL-Ir.IS I•:IaDE 1- 1 OCCUR PEASONAL A ADV INJUPY _ S 1 ,000,000 _ I GENERAL hGCiREGATE $2,000.000 I I PRODUCTS COMPa)P AGG 52,000 000 ----I _rL AGGREGATE UPAIT APPLIES PEPI —' PRQ. PpLICY I I . F•. LOC I i— $ 6UTOM031L=LIABILITY i`+Eaaccide,u' BC:NGCv h.i2013(/1i2014ibINLL) SINGLE: LIMIT S1.000,0co ;nY=.UT::; -- 0 dN'c0 X SCHEDULED :;TOS I I AUTOS ..�c�IGT('S�lIUTOS6VNED I ( I &)DILY INJURY;PeipBrsnnl S -- BODILY INJURY (Pei acrx3em) l S PROPEPTYDAMAGE I$ ------ rcc Pel accident) _---I --- Is U!,f;RFLLA LIAB I OCCUR EAChIX—CUP.RENCE S "XC :SS LIAS CLAWS MADE i ( AGGREGATE S ' Ot v` I i RETENTIONS �------ _ C n'KE R5OrrP ENI ATI ILIT I^ LIABILITY Y;N ?O?n1ETOR.?Aa7NER�E )cECUiI';E❑ E:11: _PAcEN EnCLUDED? N / A VVC003989?23 !23!2013 ri23J20td I NIC 5T.4TU I tJ�H i Y MIT _ E. L. EACH ACCIDENT 5100.000 W) )0.00 ct+r)' in N..) i 6S CE SC�iLtE wUer I E L DISEASE EA EMPLOYEEI 5100,000 DISC.+PTii)I'dl?•OPE PATKTI'ISbelow EL. DISEASE POLICY LIMIT I S500.000 I _ D -SCRIPT ION OF OPERATIONS; , nraTlnkm r vcw,r , __ _ _-.__..._.._....��........��........ ,�.���ic-p—is —4—vu) I CERTIFICATE HOLDER CANCELLATION Castricone Roofing & Siding Unit 3A 231 R Sutton Street North Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEO REPRESENTATIVE A © 1988.2010 ACORD CORPORATION. All rights reserve AC09D 25 (2010:05) The ACORD name and logo are registered marks of ACORD Massachusetts - Department of Public Safety Board of Building Regulations and Standards construction SuhenisorSpcci:llth License: CSSL-099358 DAVID T CASTRICONE . 0 31 COURT STREET NORTH ANDOVER MA�01845 txplration Comrnissioner 12/16/2015 SCA 1 0 20M•05/11 i�niir,rrc•,uuc•rr�C� Ci.;,;rir�rr.;elY.; Office of Consumer Affairs d ) usihei!lt ss Regulation 21.-')OME IMPROVEMENT CONTRACTOR _ egistration: 104569 ' — Type: ;a -'Expiration: 7/14/2014 Private Corporation \` r,• DAVI[ CASTRICONE ROOFING, SIDING & David Castricone 231 R SUTTON ST SUITE 3A _ NORTH ANDOVER, MA 01845 Undersecretary Town of North Andover Building Department 27 Charles Street Norah Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM NCJk7�N``0 ; O O ` 13 �c f SSACHUS�� 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 c.l 1, Sl 50a. The debris will be disposed of in /at: Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project tluough the Office of the Building Inspector,