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HomeMy WebLinkAboutBuilding Permit # 4/16/2015 O0 FORTHBUILDING PERMIT 0 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received � ArEo SSACHUS Date Issued: IMPORTANT:Applicant must complete all items on this page L CTI, �j/��///�/�////���/: �����/ �/„ r%r �, /�/r�/��,� r „/ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building IrOne family 0 Addition [I Two or more family [I Industrial 11 Alteration No. of units: El Commercial 0/Repair, replacement ii Assessory Bldg El Others: El Demolition 11 Other El' ".a Izn/a DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: )C- /) Z /0/(!IS > Phone: Address: Mv "41coo�161 /j elblj- ,Add ess�,, u /I��i�l,�� ��� /��,/?��%rr,� <l/,/,� ,Fi„�///i,..,/„/ 1,�, „//,nir,,/i ///�///iL�iri,,/�/l��%/l//////%/D /ii�cr„ i vc, 001 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT. $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ /f3 F6, e C FEE: $ Check No.: Receipt No.: 7 NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund ,Signature of Agent/Owner Signature of contractor NORTH Town of2 . � E . .� ndover O � - to it List C, h ver, Mass, 2 coc KM New1CK y1' - �®AORgTE O Jkf' �5 S fJ BOARD OF HEALTH vERMIT T L �D Food/Kitchen Septic System THIS CERTIFIES THAT ...........armotil . .................................................................. BUILDING INSPECTOR Ahas perm\ission to erect ......... ............. buildings .....51.1.4 0........... Foundation Rough to be occupied as .... ............................................................. ... ChimneyC 04 provided that the person accepting th ermit shall in every respect conform to the terms of the application Final on file in 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final E IT IRS I MONTHS ELECTRICAL INSPECTOR UNLESS ST Rough Service .. ... .. ... .... ..... Final BUILDING INSP TOR GAS INSPECTOR Occupancy Permit Required to Occupy Bulldln Rough Islay 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. Smoke Det. DAVID CASTRICONE, PRES. 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 978-663-3420 InBoxford 978-887-6147 In Haverhill 978-374-7314 1/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. ............................................................71��hone#....6.4 .�.. State..,N14......... Job Address...A/ T ..... ­. ).:_I�_r.........................City...We. ......... Specifications: .......... ........................­­...... ..................................................................................... ......... /Strip existing shingles, /Apply new drip edge to all edges. W4;'f, y// .................­­.....I.,........,........................................................................................................................................... V/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, .............................................................. Apply' paper, ...und-ei'll'a"y'....cI 1.'4'**n,s*,t*a*,jl*l**I.i,(I*,g*e*"vent**t,0*­_­'�*_­­r­)' d'9­-­ P0., a*r,I*,,a*a*t*Y. -oof using "�ouute•flash chitmtey. �-iVevv vent pi>e flashing. �egal disposal of all debris. ..............I.............................. ...................... .......... ...................... Area(s)to be worked on: ......................... i- t,).el............................................................. ................. .................................... .............................. ..............................................­1....................... ......... .................................................................................. ..................................................................a...................... .........­­­*........... Roof board replacement if necessary /sheet W� ............................................................................................................................ a.S..spec' .Pc: .....It.........I.. ............... e -, , - r Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warrant ;r Mbymanu cture' Th I rf the work-_d the materials specified above for the SU of$..,. 0...... .... "or 0 10 ftiQls .. OV 71 7.,.bT.' . ;:.,.on...5.701rf Payable..#.'... i .0.......on........ payable on completion ofJob W..00 1 * 3 Owner or Owners are not responsible for Property Damage or Liability whi 4isinoperation. Contractor is not responsible for any damage to the interior of property,including pre-existing conditions(i.e.water stains,crumbling plaster,exposed rat 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 Spam). Items in attic may need to he covered 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,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)ail 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.Pro"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)theowners(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 be 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 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 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,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,231R Sutton St.,No.Ano verMA01845. IN WITNESS WHEREOF,the parties have hereunto signed their names this JJ ) day of .....20../-.... .... Accepted: .. Owner Signed............................................................................. Owner tJ David Cas.tricone,Presiderild", The Coininonwealth ofMrissachusetts --- - Departtiient of Industrial Accidents Office of.Investigatioits ) 600 Washington Street Boston, AM 02111 )vxnv.inass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly ' ( �I C. Name (Business/Orgatuzation/Individual): D Ml D �F\J j('�1 COIN Kr �U C�( IV is � J 1 1� I N C`� Address: X31 R sv-ro N 5"i R UN I i JA City/State/Zip: No, A NDow e_(t Phone It: 97_i _03 131 0) 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. listed on the attached sheet. 7. ❑ Remodeling ❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have $_ E] Demolition working for me in any capacity. employees and have vTorkers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance., required.] 5. F] We are a corporation and its 10.F_1 Electrical repairs or additions �.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 1311 Other comp. insurance required.] *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 attacbed an additional sheet showing the name of the sub-contractors and state %, ether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp_policy number. I am an evaployer tliat is providing itorlcers'compensation insurance for my enaplo}rees Below is the policy and job site information. Insurance Company Name: 6 R A h!t TL �1 A T e- I N J U KA N CC O — Policy#or Self-ins.Lic. #: W CLI O 39 &9 X10 Expiration Date. I a ob Job Site Address: ` E .Vt. A �/�/'�..�tcc City/State/Zip: o � �A . ' r 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 fonvarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby certify u r thApains and penalties of perjury that the information provided above is true and correct. C Sicnature: Date: rh Phone#: 7 1 ,d o 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/To-wm Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: A CERTIFICATE OF LIABILITY INSURANCE DADD 9/11 0/20/201144 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 CONTACT Susan Donnell NAME: Eastern Insurance Group LLC PHONE (800)333-7234F'AXX No: 233 West Central St ADDRErOII E sdonnell@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC k Natick MA 01760 INSURER A:Wes tern World Insurance Co INSURED INSURERB:Comnerce Insurance Company 4754 David Castricone Roofing & Siding Inc, DHA: INSURER c.Granite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER D: INSURER E: North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER:Master 14-15 REVISION NUMBER: 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. ADCLINSR EXP TYPE OF INSURANCE JNSR SWVD UER POLICY NUMBER MM/DOYMM/DDEFFY/YYYY LIMITS GENERAL LLkB LTY EACH OCCURRENCE S 1,000,00 0 DAMAGE T RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea Occurrence S 50,000 A CL.:IMS-MADE a OCCUR NPP1388404 /6/2019 /6/2015 MED EXP(Any one person) 5 1,000 � PERSONAL 8 ADV INJURY $ 1,000,000 H GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $ 2,000,000 ''.. X POLICY( I PRO- F LOC S AUTOMOBILE UABILITY COMBINEDSINGLE LIMIT(Ea acodent) S 1 000 000 ' B ANY AUTO BODILY INJURY(Per person) S AU OWNED X accident) S AUTOS (SCHEDULED CNGCV /1/2014 8/1/2015 BODILY INJURY Per i ALTOS ',. i NON-OWNED PROPERTY DAMAGE I j X 0 AUTOS X AUTOSS I I Per accident) UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS L1A8 I CLAIMS-MADE AGGREGATE $ DED I RETENTIONS S C WORKERS COMPENSATION WC STATU- OT'. AND EMPLOYERS LJABILMY Y/N :.NY PROPRIETOR/PARTNER/F_XECUI V OFF, CEPVEMSER EXCLUDED? ❑ NIA E.L.EACH ACCIDENT S 100,000 (Mandatory in NH) RC003989723 /23/2019 /23/2015 It yesdesa?be ttllder E.L.DISEASE EA EMPLOYE S 100,000 . DESCRIPTION OF OPERATIONS balow E.L.DISEASE-POLICY LIMIT S 500,000 I I OESCRIPTION Or OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,A more space is required) R00=ing & siding contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POL)CIES BE CANCELLED BEFORE Castriconeftofing $ Siding THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Unit 3A ACCORDANCE WITH THE POLICY PROVISIONS. 231 R Sutton Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 John Koegel/MET ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INSD 25 r�n:r»t,n, Th.ar'r)pn n�ma anri Innn�ro ronia/crorl mar4o of ernQn Massachusetts - Department of Public Safety Board of Building Regulations and Standards Cunctructiun Supur%isnr Slrrrinith L+cense: CSSL-099358 DAVID T CASTRICONE, . 31 COURT STREET -W NORTH ANDOVER Milo 5 �XplratlOn Commissioner 12/16/2015 _ = Office of ConsumerAffairs& Business Regulation J1 =—E{OME IMPROVEMENT CONTRACTOR egistration: 104569 e= Type: �,''J_xpiration: 7/14/2016 Private Corporatio DAVID CASTRICONE ROOFING,SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undersecretary