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HomeMy WebLinkAboutBuilding Permit # 4/16/2015 * t&ORTH BUILDING PERMIT 0 (yFD 06 0 TOWN OF NORTHA O APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received 0 Date Issued: IMPORTANT: Applicant must complete all items on this page i O. ,EON �,/�l /,//� /r � /�//af „�r��,� /,/i�,,,, /i,,,�i�r�/iii/i/� ��/ ,/ �, 1/ , , i/ r,, .� // roc✓ / ///P/ OP `TYCO NE r n�����,,,���'��%��, �i/,24 . � /. � �,it/1, I / ��//i,/���D i%J,/i�.. o/�./, //. ri is //i r o / r r 1 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building One family [I Addition El Two or more family El Industrial El Alteration No. of units: El Commercial P/Repair, replacement El Assessory Bldg 11 Others: El Demolition 0 Other El, ator,§h' d'Di§tribt ,, s V DESCRIPTION OF WORK TO BE PERFORMED: ,5�6,Q 6LrAd e- Identification- Please Type or Print Clearly OWNER: Name: '-VLJ1 +Ae-A&+ cb Phone: Address: ac L) Oatcs �e- t4 o- &-\A o vce, "I......................... ............ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED CqSTBASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fiend 5ignature of Agent/Owner Signature of contractor t%®RT'H Town o AimE ,, ndover ® . - . --� - q tfN h ver, Mass, COCKICKl WICK ��• �®A�RATEO I•P��,�S 1S U BOARD OF HEALTH Food/Kitchen PER I LD Septic System THIS CERTIFIES THAT .VV.. . .... .� .K ....... .................. BUILDING INSPECTOR ............. .. ....... ....... ....... .... ........... ... has permission to erect ....................... . buildings on .�...� l�ew........ Foundation Rough tobe occupied as ........ .. . ....... .. �.. . ........................................................................ Chimney provided that the person acceptin this permit 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 3D Final PERMITI ES IN 6 MONTHS ELECTRICAL INSPECTOR S 10 Rough Service ..... .M- D ....... ........ FinaUILDING I PECT R GAS INSPECTOR Occupancy Permit Required to Occupy RuildinRough 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. ,�y, 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 1/we the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to famish all necessary materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on prem' es be ow des rib : Owner'sName.... .. ...... .e .. :../../•.27k!l ................................. ............Te hone#...��.t../...:"..Gr.(..11...-' 4z..rJyf Job Address....J.t C/...Gr.C�';........ .............................City...�C).i...�1 t q..)/iv ..............State....MA...... Specifications: ...................................................................................................................................................................................................................... /Strip existing shingles f� /Apply new drip edge to all edges. ............................................................................................................................................................................................................ /Apply 6 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. G ..............................................:......... ............... /Apply felt paper un erlmeat ✓Install ridge vent to ' ....................S. .n /•I• ....................�.............. ......r ...... '...........................................�........................................................ — s iteroof using�,,, ,y� y�;lrr h r ..A, � s singles with a JQ year warranty. i /Counterflash chimney. ✓New vent pipe flashing.�egal disposal of all debris. Area(s)to be worked os: ` .......................................�r4..5.1 P,�%...fz ..f'tt.t........ .G�.l� !.A n:...a ... .( .. ...Z.......... C� rLkl.�. -. ... ��. �....../ ..l. �r,i� ....ry.t . ... . .1�: ............................ i , �ra!11.�. ... ..e� ......Js......1.t!.0 ..t ,......................................................................................................... ............... Roof board replacement ff necessary a �� /sheet or L ��'�/foot. ............ ....................................................................................................................................... .............. .............. Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specyma fiurer The c etor agrees to erform the work a d ish the materials specified above for the SUM o $.—M..r2....... ..... ayable...:.. .1?Z1.....on... t ............ Payable.............................on..................................,Z alance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability w ' fob is in 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 he 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,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 wanant(s)that he is(they are)the owners(s)of the above mentioned premises and that legal tine thereto stands of record in his(thew) 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. f � Approximate starting date of work.. ....wtl., 5.:............ Completion date......................................................... Receipt of a copy of this contact is hen'eby knowledged,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.An over,MAl0I88445. IN WITNESS WHEREOF,the parties have hereunto signed their names this..,1 y..(.k day of..�.:tt^i..I.: 20..!".... Accepted: -- Signed...............:ji........................................................... Owner I1� Signed............................................................................. Owner _ ..... .....Tor chi.....i..r.l..,G: David Castricone,President Z\ The Commonwealth ofllfassachusetts Department of Industrial Accidents - Office of Investigations `G=a `' 600 Washington Street Boston, M 02111 =�-* )vlviv.tnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers Applicant Information Please Print Letyibly Name (Business/Organiza6on/Individual): D A\l i b C AJ S 1',t(Ay t, Ro G F( IN is S i D f N L, 1 N L Address: a,3 1 R Sy TTC N ST RE L-" '7 Um i I JCA City/State/zip: N0. A NDO\it;R M� I ��f Jr - :Phone #: 9 U_Are you an employer? Check the appropriate box: Type of project(required): 1.® I am a Y emP to er with 4. [] I am a general contractor and I 6. F1 New construction employees (full and/or part-time).* have hired the sub-contractors 2.F-1I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g_ Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp.insurance comp. insurance.1 required.] 5. F] We are a corporation and its 10.❑ Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 3.F_] I am a homeowner doing all work g P myself. [No workers' comp. right of exemption per MGL 152, 1 4 ,and we have no 12 Roof repairs c. insurance required.] t § O 13.❑ Other employees_ [No workers' comp. insurance required.] *Any applicant that checks box 91 must also fill out the section below showing theirworkers'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. tCcntractors that check this box must attached an additional sheet shoeing 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 employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: C IR A N ae '►A T e I N J U KA N C l o _ Policy#or Self-ins.Lie. #: W U) 0 3`l &9 g t 3 Expiration Date: I a 15 Job Site Address: J f, 23 Jn( 1�f_ City/State/Zip: �p �l 6 ALV 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 under the pains and penalties of perjury that the information provided above is true and correct. Si�maturc: J C Date: n ��p� Phone# "! . (/r)t" 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/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: DATE(MMIDDIYYYY) A`OR f® CERTIFICATE OF LIABILITY INSURANCE 9/10/2014 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(ies)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)333-7234 FAX No): 233 West Central St AE-mADDRE,'ESS:sdonnell@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER Western World Insurance Cc INSURED INSURER Commerce Insurance Company 4754 David Castricone Roofing & Siding Inc, DBA: INSURERC-Granite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURERD: INSURER E: North Andover MA 01845 INSURERF: COVERAGES CERTIFICATE N UMBERklas ter 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. NOTVVITHSTANDING 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. INSR �ypE OF INSURANCE ADDL SUBR POLICY NUMBER MIO DDY EFF POLICY YYXYPY LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO X COMMERCIAL GENERAL LIABILITY PREM SES(Ea RENTED occurrence) $ 50,000 A CLAIMS-MADE Fxd OCCUR NPP1388404 /6/2014 /6/2015 MED EXP(Any one person) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRI LOC $ OMBINED SINGLE LIMIT AUTOMOBILE LIABILITY C Ea accident 1 000 000 ANY AUTO BODILY INJURY(Per person) $ BALL OWNED Lxx SCHEDULED CNGCV 8/1/2014 /1/2015 BODILY INJURY(Per accident) $ AUTOS AUTOSNON-OWNEDX HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ IAUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR FCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ C WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN 1@EEL ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) 0003989723 9/23/2019 /23/2015 E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Roofing & siding contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE John Koegel/MET ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025r9mrrKt ni Tho Ai (1Rn norma anti Inn^mra mniahomri marlra of arnpn Massachusetts - Department of Public Safety Board of BuildingRegulations gulations and Standards Construction supersisor SpeciultN License: CSSL-099358 DAVID T CASTRICONE- 31 COURT STREET NORTH ANDOVER MAO18 5 rn `' F xpirafion Commissioner 12/16/2015 n��earirnro/nr e�rr/ni�r nc�rr.le/%1 \ Office of Consumer Affairs&Business Regulation ( rROME IMPROVEMENT CONTRACTOR egistration: 104569 xpiration: 7/14/2016 Type: Private Corporatie DAVID CASTRICONE ROOFING,SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undersecretary