Loading...
HomeMy WebLinkAboutBuilding Permit # 6/11/2015 BUILDING IL®INV PERMIT NORTH�.1.TLED 16�•yO TOWN OF NORTH ANDOVER oa h;y'`- . oZ.� APPLICATION FOR PLAN EXAMINATION '' Permit No#: Date Received A�� " 7q Q0R17E0 pPR��S SSACHLIS Date Issued: 1-4 MPORTANT:Applicant must complete all items on this page LOCATION Pri ; PROPERTY OWNER `E� ' � , Pnnt 100 Year Structure yes no MAP " P,�l�2CEL ZONING DfSTRICT HistoncDtstrrct ye Machire Shop Village ayes. ',no ' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Q-One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other r ❑ Septic` "❑UVell D Floodplain- E]V1/etlands,,,,, D Watershed Distract `� Water/Sewer; DESCRIPTION OF WORK TO BE PERFORMED: j� l l r 1 cc -S Y�i 0 C Identification- Ple e Type or Print Clearly OWNER: Name: �- Phone: Address: ?k\At' 0J Contractor Narne (p�fi -r� c� rye , Address t � � 1 Supennsor's Construction License , Exp Date r P Home lrnproement LiceDate , 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: $ FEE: $ Check No.: (/I Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access totheguaranty fund Signature of Agent/Owner Signature of contractor -J AM tk0RTH Ar-M O"W ® No. _ h ver, ass, O LC"t& 1, COC "IC KL'WICK A04ATED S UOakPER BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR .............. .... .... ... .. ... .............. . . ....�.. .................. . Foundation has permission to erect ... buildings on .5 ....... ....... A .............. ..... r ....... ... .................. Rough tobe occupied as ............ ........... ....... .. r1.ad................................................................ Chimney provided that the person accepting t is 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION S T Rough Service ......... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy.Buildina 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 231R SUTTON STREET UNIT 3A, NO.ANDOVER,MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314 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 desc ' ed• Owner's Name....I Q(` O I' r., fv '0 � .......... ....... .. ...�. .. .................... el phone#....���.""..(r.�„�..... 2© , Job Address...ly�F... .. ..J..1).l• -.5... ... /s•.........................Ci tY�Q•i••��1• .p.�(..>C.r'./................State.:......... Specifications: S . ............................................/�...............................................................y....-.�............................................................................................. ✓Strip existing shingles ✓Apply new drip edge to all edges. �/hms��� ...................................................................................................................................................................................................................... ,/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, r" j J ) _ 1^L�6( Y14�4Yrf�i`D-�+•rtJ 01',•• � ........................................................................................................................ .............I.................. ✓Apply felt papgr;un ej layi nt. Install~vent to yl.. �.L'/ ....................... ........... ......................................... ................................... ................................ VReroof u n , shingles with a,3� year warranty. ....... ................................... .......................................................................................................................... fCounterflash chimney. eco �rt pi a flashing, egal disposal of all debris. J ................... Area(s)to be worked on.. �/... .. .. ...........E...... ..................................................................... ...... F.................:::.: .. ..Fe e......d,S......�rG �................................... ............ ..... ..........................I.................. ....................................... ...................................... .f-.'". �.a..n .. •{ ,��.i.....................I-........ ....................r,e-...................................................................�................. Roof board replacement if necessary @ ,r- lsl�ect•or�`�foot.............................................................................. ............................................................................................................................................................. .................................... ................ Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as spa ted by mya-�nufacturer T tractor a es to pe orm the work and sh the materials specified above for the S of$... r„i 8.� ....... ..... Payabl i:.S V........on,.:fir..? .......... Payable.......=................on..................................DA ,.a!ance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability ws 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 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,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 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 are 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 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./.f.................................... r :.....`v JU.,.. Completion date........................ Receipt of a copy of this coritact 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 be,2231 utton St.,No.Andover,MA 0 . IN WITNESS WHEREOF,the parties have hereunto signed their names this.. .. day of. { .............2024 Accepted: ,X Signed,,` �,.....✓`.............. Owner r........................ Signed ................. Owner David Castricone,President The Commonwealth oflllassachusetts — _- Department ofbidustrialAccidents = = Office of Investigations I • 600 Wcishington Street Boston, MM 02111 == '` iviov.inass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ContractorsfElectricians/Plumbers Applicant Information ( Please Print Legibly Name (Business/Organizatioo/ladividual): /�� I D C I\J S('�I IAy t 'RU 6 F t 1V J 6 � t D 1 NC, I N L Address: )31 R SvT--Fo N Si REL" 7 UN 1 I 3A City/SLttC%lip: No , AN 60\j E_ �IA 6 ( W -Phone #:_97 i 0 3 1,3y)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 employees (fi.tll and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have S. Demolition working for mein any capacity, employees and have workers' 9. Building addition [NTo workers' comp.insurance comp. insurance.$ ❑ required.] 5. corporation We are a oration and its 10.[:] Elect-ical repairs or additions ❑ P 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions self. o workers' com right of exemption per MGL myself p 12.�Ooof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other_ comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below shotvin�their workers'compensation policy information. Homeotivners 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 v�hetber or not those entities have employees. Lf the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing}i,orkers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: � C� RFlN 1Tt �►ATC INJU ��i'�NC % C.0 : Policy#or Self-ins.Lie. #: Vy 0-6) O :3 9 9 q c 3 Expiration Date: Job Site Address: J cg Y\ i t,1 D`S LLY-� City/StafePZip: �)a Arf Q v/(*6 Rs 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 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forivarded to the Office of Investigations of the DLA 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�ature: -�Jam✓ C Date: Phone#: 1 nn � 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#: A�® CERTIFICATE OF LIABILITY INSURANCE 9�io/ o1a' 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 pollcy(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 No: 233 West Central St A-MDEAILDRE r.sdonnell@easteninsurance.com INSURERS AFFORDING COVERAGE NAIC p Natick MA 01760 INSURER A:Wes tern World Insurance CO INSURED INSURER B.Commerce Insurance Company 4754 David Castricone Roofing & Siding Inc, DHA: INSURERC-Granite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER 0: INSURER E: North Andover MA 01845 1 INSURER F: COVERAGES CERTIFICATE NUMBERMaster 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. LEXP sn I TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMIDOYYYYY MM/DDEFFY/YYYY LIMITS G°NERAL LIABg1TY EACH OCCURRENCE S 1,000,000 —I AMA ET RENTED COMMERCIAL GENERAL LIABILITY 50,000 PREMISES Ea occurrence S A CLAIMS-MADE OCCUR P1388404 /6/2019 /6/2015 MED EXP(Any one person) S 1,000 PERSONAL d ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 LGE11 AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 XI PO'_ICY I1 PRO- LOC S AUTOMOBILE LIABIUTY EOMIIINQ I SINGLE LIMIT S 1,000,000 000 000 B ANY AUTO BODILY INJURY(Per person) 5 ----IALL OWNED X SCHEDULED CNGCV /1/2014 8/1/2015 .ALNOS AUTOS BODILY INJURY(Per accident) S j X �I7ED AUTOS }{ NON-OWNED PROPERTY DAMAGE AUTOS Per accident) S UMBRELLA L1A0 OCCUR EACH OCCURRENCE S Ex CE SS L.0 CLAIMS-MADE AGGREGATE $ DEC) 1 1 RETENTIONS S C WORKERS COMPENSATION WC STATU- DTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFF:C_RIVE.MSER EXCLUDED? NIA E.L.EACH ACCIDENT S 100,000 IMa rcatory in NH) WC003989723 /23/2014 /23/2015 E.L.DISEASE-EA EMPLOYE S 100 OOO I;yes oesaibe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 I I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,R more space is required) Roo'i n.g G skiing contractor I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Castncone-ftofing & 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. INS.025r�n:rrz;ln: Th'At'nRf)n=mo—H Innn aro roniot>rorl marLo of A('t'lAf1 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Ci)mtruction Suhcr%iSnr Shcri;jlt,� icense: CSSL-099358 DAVID T CASTRICONE 31 COURT STREET NORTH ANDOVER MOOM5 Expiration Commissioner 12/16/2015 w ''%�c �oiicnconrnrw�/�r jr?.��c;,irrc•�rc,n/L; =. Office of Consumer Affairs& Business Regulation c-- HOME IMPROVEMENT CONTRACTOR (registration: 104569 Type: �T='---,---,".Expiration: 7/14/2016 Private Corporatic DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 — Undersecretary Town of Forth Andover NokrH o�t,,.�o 6 etio � o Building Department o 27 Charles Street Nonh Andover, Massachusetts Ol 845 * J u (978) 688-9545 Fax (978) 688-9542 �R� QPM y SNCHUS� DEBRIS DISPOSAL FORM ;n accordance with the provisions of MGL c 40 s 54, and a condition of Bui!d ug permit 9 the debris resulting from the wort- sltall be disposed of in a properly licensed solid waste disposal facility as definzd by MGL cl i, sl 5o2 The debris ,vil) be disposed of in /at Nle Facility location Signature of Applicant Date NOTE A demolition permit from the Town of North Andover must be obtained for this prosect tluough the Office of the Building Inspector