HomeMy WebLinkAboutMiscellaneous - 5 HILLSIDE ROAD 4/30/2018 (3) Location
No. Co Date o
gORTq
TOWN OF NORTH ANDOVER
O?O•,"•D ,•,MO ni
O
1. 9
• : Certificate of Occupancy $
'SsAcMusE`� Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $ _
ff_ TOTAL $ _70
f
Check #
gR.r^'•y
18480
Y Building Inspector
l
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Vib
�sC t)sI'
BUILDING PERMIT NUMBER. DATE ISSUED:
l a X
SIGNATURE:
Building Comnlissioner/Inspector of Buildings Date Z
SECTION 1-SITE INFORMATION O
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required Provided Required Provided
v
1.7 We.Supply M.Gi7C'.40. 54) 1.5. Flood Zane Infotmrtion: 1.8 Sewerage Disposal System:
Public ❑ Private '-—b N Zane Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT sit r e7 M
2.1 Owner of Record
Name(Prini) Address for Service
Signature Telephone
2.2 Owner of Record:
Owe-<
Name Print Address for Service: Z
Signature Telephone Am
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor: /q
License Number M
Address
Expiration Date
i Signature Telephone r
I
3.2 Registered Home Improvement Contractor Not Applicable ❑ 0
Commpany Name
Registration!Number r..
Address
1Expiration e ^
S`t ture Tel hone Y/
Al
SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes.......❑ No.......❑
SECTION 5 Description of Proposed Work check ail a cable
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
-4-9_Ae2391
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY
Completed by permit applicant
1. Building (a) Building Permit Fee
e
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 Plumbing Building Permit fee(a) x (b)
4 Mechanical HVAC
5 Fire Protection 70
6 Total 1+2+3+4+5 Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner/Authorized Agent of subject property
Hereby-authorize to act on
My behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION '
1, As Owner/Authorized Agent of subject
property f'
Herebv declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief
Print N e �.
Siaafure of er/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS iST2ND3RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS %
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X s rr`l'
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
I ne Uurnrrwrtweudrn vl lYlUJJId( l�GiJGLW
Department of Industrial Accidents
Office of investigations
600 Washington Street
Boston, MA 02111
M 5� 1vww.mass.gov1dla
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
�j nn r
Name (Business/Orgarization/Individual):
Address: Rz)
City/State/Zip: L/r f 66z)e.,� ��5 Phone #:
Are you an employer? Check the appropriate 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 hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
officers have exercised their 10.❑ Electrical repairs or additions
required-]
3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 L Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers'
comp. insurance required.] 13.❑ Other
*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 their workers'comp.policy inforTnation.
I am an employer that is providing workers'compensation insurance for my employees. Below is the.policy and job site
information.
Insurance Company Name:AAohn -S _zv_r la <
Policy#or Self-ins. Lic. #: '��� / � � Expiration Date:
Job.Site Address: Al A C City/State/Zip: ZV_Al
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 insuzance coverage_venfication.
I do hereby certify under the pains andpenalties ofpe►jury that the information provided above is true and correct-
Signature:
orrectSi ature: Date: t I� ,67
Phone#: c �1264
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):
I.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
ntot°mtion ana instructions
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 in the service of another.under any contract of hire,
express or implied,oral or written."
An employer is defined as "an individual,partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
employees. However theto
receiver or trustee of an individual,partnership, association or other legal.entity, employing em p y
having not more than three apartments and who resides therein, or the occupant of the
owner of a dwelling house g P
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 be an employer."
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 nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary, supply sub-contractors)name(s), addresses) and phone number(s) 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 not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised thatthis affidavit may be submitted.to the Department of.Industrial
Accidents for 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 Town Officials
Please be sure that the affidavit is complete and printed 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 pernudlicense number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
"all locations in (City or
should waste a
policy information (if necessary)and under"Job Site Address the applicants o ( ty
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit
The Office of 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 and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 4066r 1-877-MASSAFE
Fax# 617-727-7749
Zevised 5-26-05 www.mass.gov/dia
I
REPAIRS CASTRICONE CONSTRUCTION LLC FREE ESTIMATES
CASTRICONE ROOFING & SIDING CO.
Telephone. (978) 682-4266 Fax. (978) 794-0910
MARIO CASTRICONE • DAVID MICAL
P.O. Box
441 North Andover
Mass. 01845
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 below des ibed:
Owner's Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . .
Ci . . . Stat
ty •�
Job Address , •�� ��
SPECIFICATIONS
e .
4r,
4 . . . . . . . . . . . . . . . . . . . .I• . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . '. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Materials and labor to cost$ .r�lc o . . . . Payable . . . . . . . . . . . . . . and balance in . . . . . . .
monthly installments of$. . . . . . . . . . . each, payable on . . . . . . . .day of each and every month thereafter until paid
in full (. . . . .%charge per year is to be added to above cost of labor and materials and is included in monthly payments.)
Contractor will do all of said work in a good workmanlike manner.Workmanship is warranted for one year.
Upon completion of above work,all undersigned agree to execute and deliver to contractor,their joint note in accordance with his(their)above obligation and a
completion as requested by the 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 this contract and/or any lien in connection therewith.
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 owner(s)of the above mentioned premises and that legal titre thereto stands of record in his(their)name(s).
PROVISO:This contract shall be void and of no effort if credit approved of owner(s)is refused.
There are no representations,guaranties or warranties,except such as may be herein incorporated,if any,nor any agreements collateral hereto,nor is this 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.
Cover attic storage cleaning not included.Not responsible for ice back up,Not responsible for broken plants or rip-offs.
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 partes and that all of the agreements and
understandings of said parties are contained herein.
Owner or Owners are not responsible for Property Damage or Liability while job is in operation.
IN WITNESS WHEREOF,the parties have hereunto signed their names this. , , . day of ,/ � .20 . �.
Accepted: Signed.,r ;►r ¢. c��:a: .✓.".�/ .
_V Owner
ER
WAS 3 DAYS IN WHICH TO CANCEL CONMACn Signed . . . . . . . , . , , ,
Owner
Per . . . G� . . . . . Signed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Representati e
NORTFI
0 of 4 over
o .1
No. -
� �
•—• �`y C" L E dover, Mass.,
KIC
T O fME /�.
COCwICK V
!�S RATE D
BOARD OF HEALTH
Food/Kitchen
PERM. IT T ,
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT............... �� ............... ... ........ ..... .. ................................ .......... ............. Foundation
has permission to erect.... ..... buildings on.......Is... /.! �.. ..... .. ... ................ Rough
Chi
t0 be occupied as. ..r*40:�.�.......... ! .�. .:.' C.. ...... .................:.......
Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. C? a. / PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION ST TS Rough
...�..... ...... ...................... Service
BUILDING INSPECTOR Final
Occupancy Permit Required to Occitpy Building GAS INSPECTOR
Rough
Display in a Conspicuous -Place on the Premises Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
a
Location
No. Date
E NoRTM TOWN OF NORTH ANDOVER
e: .•. o;L
, Certificate of Occupancy, $
Building/Frame Permit Fee $
Et Foundation Permit Fee $
s�cMus _
i
/ther Permit Fee $ :a 1 Z
Sewer Connection Fee $
ECater Connection Fee $
1D By CH
JUN2 TOTAL $
0 ,
99.1)/ /
6 9 U I'(( Building Inspector {
Andcyer C011edor _—
Div. Public Works
PER311T NO, APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1
MAP h�0. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE
ZONE I SUB DIV. LOT NO. I
LOCATION PURPOSE OF BUILDING� �p-il-11pe A21I �fcf��C�,C�(mAL5i6
OWNER'S NAME .Q_ t I� NO. OF STORIES SIZE /vv��� �I�'��+
OWNER'S ADDRESS �i BASEMENT OR SLAB
�
. --
ARCHITECT'S NAME �4s�dy SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME 4_ SPAN
DISTANCE TO NEARE T BUILDING Y/ DIMENSIONS OF SILLS
DISTANCE FROM STREET POSTS
DISTANCE FROM LOT LINES-SIDES REAR " " GIRDERS
AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW p,l� SIZE OF FOOTING X
IS BUILDING ADDITION A,/® MATERIAL OF CHIMNEY
IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
3 PROPERTY INFORMATION
LAND COST
SEE BOTH SIDES
EST. BLDG. COST 00
PAGE 1 FILL OUT SECTIONS 1 - 3
EST. BLDG. COST PER SQ. FT.
PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED 4,41
BOARD OF HEALTH
SIGNATURE OFNER OR AUTHORIZED AGENT
F E E " v
PLANNING BOARD
PERMIT GRANTED
ad
sl
9I
BOARD OF SELECTMEN
BUILDING INSPECTOR
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY StORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA-
APARTMENTS I I RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
2 FOUNDATION- 8 INTERIOR FINISH
CONCRETE i--1 _ d 1 2 13
CONCRETE BL'K. PINE
BRICK OR STONE HARDW D
PIERS PLASTER
_ DRY WALL
UNFIN.
3 BASEMENT
AREA FULL FIN. B'M'T' AREA _
y, 1/1 1/ FIN. ATTIC AREA _
NO 8 M FIRE PLACES _
HEAD ROOM MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS B 1 2 3
DROP SIDING CONCRETE
WOOD SHINGLES EARTH _
ASPHALT SIDING HARDVJ'D
ASBESTOS SIDING _ COMfdCN
VERT. SIDING WH. TILE _
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STIRS. 8 FLOOR _
BRICK ON FRAME
CONC. OR CINDER BILK.
STONE ON MASONRY WIRING
STONE ON FRAME _
SUPERIOR I-1 POOR —
ADEQUATE NONE
5 ROOF 10 PLUMBING
GABLE I HIP BATH (3 FIX() _
GAMBREL MANSARD TOILET RM. 12 FIX.) —
FLAT SHED WATER CLOSET _
ASPHALT SHINGLES LAVATORY
WOOD SHINGES KITCHEN SINK _
SLATE NO PLUMBING _
TAR & GRAVEL STALL SHOWER _
ROLL ROOFING MODERN FIXTURES _
TILE FLOOR
TILE DADO
6 FRAMING I 11 HEATING
WOOD JOIST PIPELESS FURNACE
_ FORCED HOT AIR FURN.
TIMBER BMS. &COLS. STEAM
STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR
WOOD RAFTERS _ AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS GAS
OIL
B'M'T 2nd _ ELECTRIC
1st 13rd NO HEATING
r
OF Non rh, .. .
OFFICES OF: � ...•, ti°4 Town of
APPEALS
EATSBUILDING NORTH ANDOVER r:•.III. .\..aL.,, !.
CONSERVA'T'ION s�°""e�4 I M'VtiR)N(W
l;WI i T".
HEALTH
PLANNING PLANNING & COMMUNITY DE'VI?LUI'l111sN'I'
KAREN II.P. NFI-SON, I)Iltla:lt >It
In accordance with the provisions of MGL c 40, S 54, a condition of Buildinl; Permit
Number 2 is that the debris resulting Iroln this wort; shall be
disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S
150A.
The debris will be disposed of in:
ti 1J�
sr
Ts o
(Location of Facint)•)
I
Si6natutc I Permit Applicant _
lite •
NOTE:
l Demolitionermit from rom the Town of North Atldover must be obtained for
this project through the Office of the Building Inspector.
CUNT_PNVATION---- FINALPLANNINGF����
-- No H SEN! R/WATER� FINAL
. F —
own
_ n , over of, 6 O
L
0
No. na
-IIVEWAY ENTRY PERMITy M19 S,
HE ICK
er, Mass.,
BOARD OF
HEALTH
THIS CERTIFIES THAT... .. ...�
". ""' .' BUILDING INSPECTOR
has permission to erect .. ........ buildin2fikon Rough
• Chimney
to be occupied as
... ... P.. ..... ................................. Final
provided that the person accepting this permit shall in every respect conform o the terms of the application on file in
PLUMBING INSPECTOR
this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough
Buildings in the Town of North Andover.
Final
VIOLATION of the Zoning or Building Regulations Voids this Permit.
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
Rough
UNLESS CONSTR TIO TARTS Service
Final
•
BUILDING INSPECTOR GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Final
Display in a Conspicuous Place on the Premises FIRE DEPT.
Do Not Remove Burner
No Lathing to Be Done Until Inspected and Approved by Smokke°'
Building Inspector