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HomeMy WebLinkAboutBuilding Permit # 6/11/2015 BUILDING IT o�"°oT 6�tio TOWN OF NORTH AV /APPLICATION FOR PLAN EXAMINATION Permit No#: l� Date Received SS US Date Issued: IMPORTANT:Applicant must complete all items on this page / r1vlr,i�,,� / r r rrr r ( r ,���� ����i/r� I �Jl�, r� � f r fr ✓/� r r r/� r„�_ / r r rrr , / 1 /, ,, r / r ✓ a r / ,/, r r TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial . Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic// ❑/Well p Floodplain ❑Wetlands ❑r,Waters,/, District �!%�% ,,. r/ r /%// /�,,. „a,,,,�� ,�,,.,,,r„/p/ ,i�G�iii,a,rr/ Gr/r/.rii,lir/�i,,, :,..�,,r,„/,c%�.,, //r/,n,,,,, ,,,,, // r; / ,,, � r i����. r r r/,/J/o ,�l✓//%/,//,, DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: ° C°-�c _Tu d I's C Phone: 6m 6 l 16 Address: '-7q e:OLk6-k-� )C N&r +k _ ' i /,a�%�/i%///�j/ ��/,/!/ /r/// �.r j� /r;:/ /r,%,., r� r j r ¢/¢i ✓� r / // / / .✓ / �r ��,, Co tractor,/rNrne / r r/ / rr No,- / /, /.. / r//// ,/,r ,,..! /i,,,r / ,., ✓/.., ,v/... r ,ger, ,.. Iry ,c.// / .r/, r / /i .,., /i / ,... r, „/. r ,., .✓/ / r,rr rr/ 1 r r / / / rrir / + ri�u ,';o �o/,rr.r r r/ ,rrr ,� er r, ,,: / r-•r r r / r / i/ / a /, i / i/ ✓ / r ..ria...., r rr / � � � � 1 /�///// / r ,, / r �, ,,,,rr �.,/ �// ✓r / r it , rr, r� ,/�// /,�/ /�'� � �/�///: /, r f / /,�, / , /ir ,, ,rrr r< �/, /r r� ✓, „� /.. r ,.JO I n, ., e,�: �r//l/ �i ,1.,/r; h////%i�/.✓/�.:r. �/. �I � ../ /I ,/ r r p- ,, ,,r r„rr , 1, r r, ,,,,.,,,�, �%. ,,, ►/�a� r� O,;E?,I ° GOUe,, entr„ a Se //,�/ rr c, a/,a/ ,%, � ///%//ii i.,r/rel /,,r r�i, r� ✓//1/r, rD//i l„�i/ r r� / 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.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor �MInk-n Amliftdover Town oi q , to . /ba 14T &_ * ASr _. h ver, ass, SY __, 2 0 ..- COCHIC"t WICK V u BOARD OF HEALTH PER.MtT T L �D Food/Kitchen Septic System 1%.A 0 BUILDING INSPECTOR THIS CERTIFIES THAT ........................... Foundation le has permission to erect .......................... buildings on ........ ... ......... ........ .••W.?•••.••.••.••••••• o Rough tobe occupied as ............. . ......`. .......... ... ... ......... ........................... ........................................... Chimney provided that the person accepting 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 6 S ELECTRICAL INSPECTOR LESS C C T R. Rough Service ................. ........... ..................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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 !n Haverhil1978-374-7314 Ilwe the owner(s)of the premises mentioned below,hereby contract with and authorize youas 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.....& L �,.. 'S .d..................................... ....... �...� T phone#.`6,7d.. ..(�/ ?y./ ..,.f..1 .......... :.............Ci ty.. .. ...............State...... .Job Address........./ f. / � � Specifications: .....................................................................................---.............................j..�..........1 ............................................................................... Strip existing shingle LAp��ply new drip edge to all edges. Ltl ile- Q ..............................................................................................................................--....................................... o6pply_feet ice and water shield membrane to bottom edges of house.3 feet ice and water shield membrane in valleys and bottom ed.-cs of any unheated areas of house. ' / pply felt 1pc nd rI yment. Idnstall ridge vent to ,? ``�I. 11L2................... ........� ...... -- eroof usi6g-[x,r n is ,�.� � �gy� `i r� �'s shingles with a �year warranty. i nterflash chimney. yi�w vegt pipe flashing. �al disposal of all debris. t ........................................................... rea(s)to be worked on: n ""'"""" ................ k:.�... L.1.t .............. ..tnL�P/....fJ. ..G ....,�....r' 1?�..S..i� S. t.f.�.� 1s............ ............ e � r- p... r..�rl.r.. .......... � :...1s......� . �. .....�� cam-..c t� n.. .. t' ......... .. �c r rep .................................................................................................0 Roof b and replacement if necessary @ t7 /she t D�lfoot. ............................................................................................................................................................ ................................ Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as spe ' by manufac u The c ntractor agrees to perform the work anj grni�h the materials,specified above for the SU of$..... .�b! ............. .... Payable-L:..1?..C7.Fl.......on... x T............... Payable.............................on.............................. alance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability •e 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 be covered by homeowner.All materials are property of contractor. Any dumpster placed by contractor is for his use only.Upon completion ofabove 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 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 arc 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 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 Iric,231R Sutton St.,No.Andover,MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their names this...Q ...day of.... ........20........... Accepted: Signed�` ,, x . ..... ......................... Owner 1 Signed.. ......IX......l..,.. .. ................. Owner .............. ....... David Cas tricone,President Y� The Connnonwealf i of.11lassachusefts Department of Industrial Accidents Office of,hivestigations 600 Washington Street sr == Boston, 111"102111 _n ivivw.rrrass.gov/dia Workers' Compensation. Insurance Affidavit: Builders/Contractors/Electi-icians/Plumbers Applicant Information ( Please Print Ledbly Name (Business/OrcanizatioolIadividual): D A\j t p C 1J S�,1 LUiVC_ RU C F 1 P1(s ti J i D I N Ci �W L Address: �3 I R Su rr C N UJ i RE.L 7 UN i T JIB 6� 3 � �7.� � �O clry/st<{�o/zlp:_No._ Naov�� �j _ A U IPhone #: `�_��f�-- -------- _�_.--- -------- -..._ 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. F-1 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. F1 Building addition [No workers' comp. insurance comp. insuraice.1 required.] 5. corporation We are a oration and its ME] Electrical repairs or additions ❑ P 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' 131-1 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 attached an additional sheet showing the name of the sub-contractors and state; hether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ani an employer that is providing ixlorkers'compensation insurance far any enxployees. Below is the policy and job site information. Insurance Company Name: � P y C� r� FlN IT ►ATC INJU �f�NCI; Co Policy #or Self-ins.Lic. #: W CC) Q 39 &9 `7t 3 Expiration Date: I I J 5 Job Site Address: 'J q )0 6, C ly fCity/Stafe/Zip: n6. nL�e� NA 6)�t 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 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DLA for insurance coverage verification. I do hereby certif under thepains and penalties of perjury that the information provided above is true and correct Si�mature: / / Date: Phone#: f 30-c' Official use only. Do not write in this area, to be completed by city or town official City or Town: Pcrmit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Tovs n Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: DAM A 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 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 FA/AX No: 233 West Central St EMAIL ADDRE .sdonnell@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER A.-Wes tern World Insurance Co INSURED INSURER B;Commerce Insurance Company 4754 David Castricone Roofing & Siding Inc, DHA: INSURER C:Granite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER 0: INSURER E, North Andover MA 01845 INSURERF: 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. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR POUCY NUMBER MMIDD/YYYYI lmwootyyyylLIMITS GEN EPA UAB raTY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED x50 000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence S A CLAIMS-MADE 7 OCCUR NPP1388404 /6/2019 /6/2015 MED EXP(Any one person) S 1,000 iPERSONAL d ADV INJURY $ 1,000,000 H GENERAL AGGREGATE $ 2,000,000 CNL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 5 2,000,000 X (POLICY II PRC- n LOC S AUTOMOBILE UABIUTY _(Ea SINGLE LIMIT 5 1,000,000 � � I ANY AUTO BODILY INJURY(Per person) 5 ALL OWNED X SCHEDULED CNGCV AL11OS AUTOS /1/2019 8/1/2015 BODILY INJURY(Per accident) s j X (HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per.7ER l 5 L_UM.8RE.L1.A LIAB OCCUR CE SS L1A6 EACH OCCURRENCE S I- CLAIMS-MADE I I AGGREGATE S I I DED 1 1 RETENTIONS S !✓ WORKERS COMPENSATION WC STATU- I+ DT AND EMPLOYERS'UABILnY Y/N .DRY ANY P SOPRIcTOR/PARTNER/EXECUTIVE 05-tC=RAAEMSER EXCLUDED? ❑ NIA E.L.EACH ACCIDENT S 100,000 (Ma nc:a;ory in NH) KC003989723 /23/2019 /23/2015 If ye S,Ce soibe UIUEf E.L.DISEASE-EA EMPLOYEE 5 100,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 500 000 i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Roo`in.g & siding contractor I CERTIFICATE HOLDER CANCELLATION Castricone,# oofing 8 Siding SHLD ANY OF TE ABE DESCRIBED POUCES BEBEFOE THE EXPIRATIONHDATE THEREOF, NOTICE I WILL CBECDELVANELLEDERED RIN Unit 3A ACCORDANCE WITH THE POLICY PROVISIONS. 231 R Sutton Street AUTH OR ZED REPRESENTATIVE North Andover, MA 01845 John Koegel/MET ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS.02517n,msrn, Th.A(Tf1Rr)Hama�nri Innn�ro ronialerori mark of Af'rlAr1 Town of North Andover � N0kK�H o �1 0 �ti Building Department o _ � m 27 Charles Street p Nonh Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 7 p�p�reo �Pry•(h DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Bui!d.ng permit 9 the debris resulting from the work spall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, si50a. The debris will be disposed of in /at Facility location Signature of Applicant Date NOTE A demolition permit from the Town of North Andover must be obtained for this project tluough the Office of the Building Inspector. Massachusetts - Department of Public Safety Board of Building Regulations and Standards andards C„nctructinn Suixr,i,nr Shrci;�lh License: CSSL-099358 = DAVID T CAST1 CONE 31 COURT STRE.ET NORTH ANDOVER MA 018 5 J..L. . �/ i ilk ' Expiration Commissioner 12/16/2015 _ = Office of Consumer Affairs& Business Regulation Ijl t{OME IMPROVEMENT CONTRACTOR 11 registration: 104569 Type: �' xpiration: 7/14/2016 Private Corporatie DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undersecretary