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HomeMy WebLinkAboutMiscellaneous - 5 UNION STREET 4/30/2018T.• SACRUSETTYNIFORM APPLICATION FOR PE (Print or Type) RMIT TO DO'QASFfTTINQ NORTH ANDOVER , Mass. Date/O tg Building/ J I0 v` Location_ Vjvl�- Perm)0 Owner's Name New ❑ Renovation p� pepiacement E] Plans Submitted: Yes ❑ No Cl Instaning Company Business Telephone (f .Name of Ucensed Plumber or Gas Filter I Check one: Q Corp. EJ Partnership ❑ Firm/Co. 114WRANCE COVERAGE: Check one I have a current liability Insurance policy or its substantial equivalent. Yes ❑ No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A,IlabNlty Insurance policy. Other type of Indemnity ❑ ' Bond ❑ Ceftllicate OWNER'S INSURANCE WAIVER: I am aware that the licensee docs not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Vgent Owner ❑ Agent ❑ I hereby certify that all of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit Issued lot this application will be In compliance with all pertinent provisions of the Massachusetts State OU Code and Chapter 142 of the Oetreral Lally. Type of License: TitlePlumber na ur nae for as or asfft* `,, Plumber 0 Ucense Number t CttyRown . C l ioumeyman FPITIOVED (OFFICE USE ONLY) MINN won noNon NNEWWOHNNNNNEN Ing Instaning Company Business Telephone (f .Name of Ucensed Plumber or Gas Filter I Check one: Q Corp. EJ Partnership ❑ Firm/Co. 114WRANCE COVERAGE: Check one I have a current liability Insurance policy or its substantial equivalent. Yes ❑ No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A,IlabNlty Insurance policy. Other type of Indemnity ❑ ' Bond ❑ Ceftllicate OWNER'S INSURANCE WAIVER: I am aware that the licensee docs not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Vgent Owner ❑ Agent ❑ I hereby certify that all of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit Issued lot this application will be In compliance with all pertinent provisions of the Massachusetts State OU Code and Chapter 142 of the Oetreral Lally. Type of License: TitlePlumber na ur nae for as or asfft* `,, Plumber 0 Ucense Number t CttyRown . C l ioumeyman FPITIOVED (OFFICE USE ONLY) Date.. !. ! .... !.. ' ... `.! .. . ,koRTN TOWN OF NORTH ANDOVER Oft 1'4 PERMIT FOR GAS INSTALLATION A ♦ i # This certifies that ............. .............................. . has permission for gas installation .......................... in the buildings of ............ .............................. at _ ................... i ............. North Andover, Mass. Fee......... Lic. No........... .......................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File F Location ��- �'`� No.` I? Date Z,2 ci i TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # '� 6>, 9 Building Insp�{or TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED:. U SIGNATURE: 1#d44� Ayay'11- I Building Commissioner/ImeEtor of Buildings Date SECTION 1- SITE INFORMATION 1 Property, Address: a4 / 1.2 Assessors Map and Parcel Number: ,/ pai Map Number Parcel Number 1.3 Zoning information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: " Zone Outside Flood Zone ❑ Public ❑ Private ❑ 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT .I Owner of Record �, �/J %� �I��Az� Name ( nt) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor�,�" Not Applicable ❑ CohTany 13ame 1111 ! (J Ly Registration Number Address Expiration Date Signature Telephone rn SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with in the denial of the issuance of the building nermit_ Failure to provide this affidavit will result -Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ AlterationsO N ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: oL I SECTION 6 - F.STIMATFn rOMP.TRUCTION fnCTQ I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFTCL4LUSE ONLY I . Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) x (b) / !v 4 Mechanical HVAC 5 Fire Protection 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. $� li P- a3 Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief as Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR THVIBERS 1 2 ND 3 RD SPAN DIMENSIONS OF SILLS DM ENSIONS OF POSTS DRAENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE t ?Ft Caner MMVdah of wax0efivi s 09munent of Indwtriar =idents office of Inwiti8aim 600'WasfibVwn Strut i3osw% WA 02111 worker' Cornpeasarian Inntraa:e AlMdovit Please PRINT LeQMY I sm a homeowner performing all work myself. :1 ? wr. sole proprietor and have no one welkin in my ca aeity I am an employer providing warkers' compensation for my employees working on this job . Me- W. 7* -'!P4 I. J1"fff����� /_5a7A F7 7 .J =l l am (circlt one) sole proprietor, general contractor, or homeowner and have hired %e contracters.LVzd below who baJa the following workers' compensation policies d Company Name: Addre3s' Cary: Telephone 0: Insurs ace Company: Policy * e � Ccmpany Name: Address: Ciiy: insurance Company; Telephone k. Policy th Attach additional sheet if necessary Failure to secure coverage as required under Sectior. 25A of MGL 15E can lead to the waposition of iziminal penalises of a fine ull to 51,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 11 do hereby certify under the pains and pen ties of perjury that the information above is true and co eet ��1f Signarsre:�)�:LO Dater U� Pnr:t 3damr. Q1t` 1 1 � Q g 1 : 1 as le 'none tt � � Ofnelal Use ONLY - Do not write in this area w Suiiding ;rspartment j Cly or i' , .rt PermtVLjc*nss t : r i,'rens ng Board !I D saiectmert't Offre o-+eatth DeoaRment o Check if irninediare response is required a attler — I Castricone Roofing & Siding REPAIRS FREE ESTIMATES Telephone (978) 682-4266 MARIO CASTRICONE 31 Court Street, 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 described: Owner's Name.... '..!'................................................................... �.�................................................................... .............. Job Address.^ .... /ZW�.'......................................................City....:. State ..... ••l•............................ SPECIFICATIONS .... �... ...VP ��...��...Z�O. ............................... ......... ............ — ............. . ............. ................................................................ ........... ........... ..... ............................................... ............................................................... XL .!...c.::.`.`.•.........................................y/5?`v�'ci,,.... t�.� - ../ }.3` ` ...... 2.. •� .... ..;.. >. ..,. _ ............................ ...............•..................................................... .............................. ...1 ...................... �-' ..:`.. .... %..-............ .�........................ ....��:... -i .J ........................................................... eZ-�'� ... ... ......f ....... ................ .......................�....... .... ./�..���� ........................................... ... ................ ..... .. . ..................... . .........:......... . ............................................................ �................................................................................................... .............................. Materials and labor to cost $ (��.......................... Payable on ........... and balance in............ ........................ y ......................................... ....... 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. 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 title 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. 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 parties 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 ........ ( ... ... ......... of....... .. ..... ... U... Accepted: Signed...................... �........................... ...................... Owner (OWNER HAS 3 DAYS IN WHICH TO CANCEL CONTRACT) Per. �,�%.... ....................... Representative Signed...................................................................................... Owner Signed...................................................................................... f - ✓� Va�i�nzo�r,�uea� � �aaaacfivaelta BOARD OF BUILDING REGULATIONS R License: CONSTRUCTION SUPERVISOR Number: CS 034049 Birthdate: 12/08/1923 Expires: 12/08/2005 Tr. no: 12443 Restricted: 00 MARIO T CASTRICONE. 31 COURT ST N ANDOVER, MA 01845 Administrator Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 103317 Expiration: 7/7/2004 Type:. DBA CASTRICONE ROOFING & SIDW �71ano Castricone 31 Court St. N. Andover, MA 018,45 - - 4�iniiri�atrator License or registration valid for individul use only before the expiration date. 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