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HomeMy WebLinkAboutBuilding Permit # 6/11/2015 NORTH BUILDING PERMIT o& ��Eo 6qH TOWN OF NORTH ANDOVER ,,, APPLICATION FOR PLAN EXAMINATION Permit No#: �I Date Received A°g7reo rPpy(�J AC US Date Issued: '" IMPORTANT:Applicant must complete all items on this page ,fin t Pnnt 100 YearStrucfure yes no MAP-PARCEL ZONING DISTRICT "H"4 "District yes no Machine Sho Villa a es ro, .p ,,, g, y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building IkOne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ®`Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Sept e ❑Well � ` ❑ Floodplain q UVeflands ��W tershed`Distncf; : Q U1laterlSewer DESCRIPTION OF WORK TO BE PERFORMED: 1 Identification- Please Type or Print Clearly OWNER: Name: Phone:56 C,,33 6000, Address: C Blue et G AoAo�' ())(4 Contractor Name. rho '� . f`1 Address „ , Supervisor's Construction License ( Exp Date I J� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ ® FEE: $ L Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the egguaranty fund Signature;of Agent/0wner Signature of;contractor tkOR H 'in I • 0 - lam T �O LAKE h y Verb LISS' Ta .at'a COCKICKl WICK A�4ArED S U BOARD OF HEALTH Food/Kitchen rERMT LLoor Septic System THIS CERTIFIES THAT SS�:r'�.. .. BUILDING INSPECTOR ..................... .................. ... ........................�..... .. buildings on ... ...... ( Foundation has permission to erect .......................... ...... ... . . .... ... ...................... Rough to be occupied as ...."accepp ... e. .................................s....................... Chimney provided that the perg 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 Final PERMIT EXPIRES IN PN NTH ELECTRICAL INSPECTOR UNLESS C® SR CTI R Rough Service ............... .......... ....................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. 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 978-683-3420 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 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...... a.... � 2 �1. !I ...........................:...........T e hone#.�Jk..... .��.�C v.C�Cl Job Address....1�/, �.... I.0.Q .......1. / ^ . .... ........City... .c. 5!.1f�1-.............State... Specifications: .............. ....... .................................................................................f...-.�{— ........................................................................ ly new drip .................. Ship existing..shingles.. �J 14pedge to all edges. �tl/yiJ ......................................................................................... ......................................................................................................... A //pply t0 feet ice and water shield membrane to bottom ed..es of house.3 feet ice and water shield membrane in valleys and bottom edges of any unheated areas of house, .............................................................................................................................. ..,. . ;dAppiy felt paperand I'l tynient. tstall ridge vent to r „' p1.. .L. ....... p� ..............J.. .. '/�.-r)'c i lI�eroof using shingles with a J`1/7 L .M✓dear warranty. ......................................................... ... �ounterflash chimney_1 New vent pipe flashing. `Legal disposal of all debris. P �/ .................................................... ��..ij..`.J . ................_............ �?�C+c�Ll11/ 44l��.: ?,�(ll �!Dtr..... Area(s)to be worked on: l/ F r / / l..tr....I.`�?1��..GJt 1' J .. ... . .. .V... ... . ......Y.:u.. .....� �.� ..... ............. ... . ....... ... Roof board replacement if necessary @ /sheet or z a5/foot. �1,. ��.. ............................................................................................................................................................. Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as spec' by manufacturer Thenctor aPg�, �sto perform the work d ish the to ial s ecified above for the S of t.7.9y.0.I ayabk�.>;i.t�f6 D.......on. .. Cllr. Payable......=7:...............on.............. ....C..I........ B lance payable on completion of job 8 � Owner or Owners are not responsible for Property Damage or Liability w ' is in operation. Contractor is not responsible for any damage to the interior of property,including pro-existing conditions(i.e.water stains,crumbling plaster,expose nags)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 dumpsler 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,ifpermitW 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 shell 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 hereof 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,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. Approximatestarting 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 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 Inc,231 Wtutton St.,No.Andover,MA 01845. IN WITNESS OF,the parties have hereunto signed their n is,?Z/�.QP' .(.. .......... oo C) Accepted: -Oc/ Signed...... k:. ..:..... ......... Ow2n0e.. r Signed ,i,,....:1k,:. ;`. 1 ............. Owner David Castricone,President hY� The Commonwealth of Massachusetts Department of Industrial Accidents Office of hivestigations 600 Washington Street < Boston, !1:111 01111 wrviv.tnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pltimbers Applicant Information Please Print Leiibly Name (Business/Organizatioo/ludividuat): D AV i D C\._s S r\1 WNt 'RU Gnix is "• S t D I N(p 1W L Address:— ,)3 1 R SU -Te N ST Re-C. 7 UN i i 3A City/Statc%lip:_No, A NbOyE�r` SIA 6 (_W- - Phone lt:_q 7.�_-0 3 & YJU 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 (full and/or part-time).* have hired the sub-contractors 6. E] 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 g. ❑ Demolition working for mein any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp. insurance.4 required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ 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' 13_❑ 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 contractor;must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractor;and state v Nether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Co� 12FlN lTF ►A7� INJU �F�NCI; C Policy #or Self-ins.Lic. #: W CLQ 0 39 &9 43 Expiration Date: I a Job Site Address:_1 I U -J Iy� R,k c 6zo ad City/StafeMp: N O. NAC"Jev f`(A O ,E ft- Attach a copy of the`Porkers' 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 fonvarded to the Office of Investigations of the DLA for insurance coverage verification. I do hereby certify��un��der the pains and penalties of perjury that the information provided above is true and correct. Sicmature: - D2 . Cie Date: Phone#: 3 q Zy 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#: �`� CERTIFICATE OF LIABILITY INSURANCE19/10/2014 DATE( 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 NAME: Susan Donnell Eastern Insurance Group LLC PHONE . (800)333-7234 AIC No: 233 West Central St EMAILADDRE ,sdonnell@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC 4 Natick MA 01760 INSURER A:Western World Insurance Co INSURED INSURERB-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 01645 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. ILITR I TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM DOYNYW POLICY LIMITS G°'4 ERA LLkS fLT Y EACH OCCURRENCE S 1,000,000 AMA ET RENTED COMMS RCWL GENERAL LIABILITY S0,000 DAMAGE REMISES Ea occurrence E A CL:.IMS-MADE rx-1 OCCUR NPP1388404 /6/2014 /6/2015 MED EXP(Any one person) S 1,000 PERSONAL d ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 X I Pa_ICY Pao LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 1,000,000 ANY AUTO BODILY INJURY(Per person) S ALL OWNED X SCHEDULED CNG--V /1/2014 8/1/2015 I i AITOS AUTOS BODILY INJURY(Per accident) S N j X ON-OWNED VIREO AUTOS X AUTOS PROPERTY DAMAGE S �I Per acodent (UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LIAe CLAIMS-MADE AGGREGATE $ I DED I I RETENTIONS S C WORKERS COMPENSATION WC STATU- DTH- AN'D EMPLOYERS'LJABILRY Y I N ROPRIETOR/PARTNER/EXECUTIVE OFFIC_RA.IEMSER EXCLUDED? ❑ NIA E.L.EAC H ACCIDENT S 100,000 (Ma nGa;ory in NH) 14CO03989723 /23/2014 /23/2015 E.L.DISEASE-EA EMPLOYE 3 100 000 I.yes osssnx under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 I I I DESCRIPTION Of OPERATIONS/LOCATIONS I VEHICLES (Attach ACORO 101,Additional Remarks Schedule,if more space is required) Roofing & siding contractor I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Castricone foofing 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(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. IN.S025nn:rrt,�m THA ACOpn Hama anri Innn oro mnig4ororl mar4o of&r`ng0 Massachusetts - Department of Public Safety Board of Building Regulations and Standaras C,nstructiun Sulicr%is,,,.SI)cciulth License: CSSL-099358 DAVID T CASTRICONE, 31 COURT STRE.ET NORTH ANDOVER MAf, 5 J.•G. �11� ,, ` Expiration Commissioner 12/16/2015 ���r' �rnrurnrrrntvr�/�[�C`�lrc;.inr�ri.ir�L;` Office of Consumer Affairs& Business Regulation l;. d f.'�ROME IMPROVEMENT CONTRACTOR �1 { egistration: 104569 Type: �, Expirati , on: 7/14/2016 Private Corporatie DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 — Undersecretary