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HomeMy WebLinkAboutBuilding Permit # 6/11/2015 `►ORTH BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION _ Permit No#: I Date Received "41.ED yep" 5 o, Date Issued: ll� IMPORTANT: Applicant must complete all items on this page LOCATION r � PROPERTY ,, ', Prmtr 100 YearStructure yes no MAP PARCEL ZONfNG DCSTRICTHistonc District yes no T- Machine Shop Village TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building EkOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic o 1Nell ❑ Floodplain a 1Netlands ❑ Watershed District .�Vllater%Seinier DESCRIPTION OF WORK TO BE PERFORMED: andr ; Identification- Please Type or Print Clearly OWNER: Name: r S or)a 111 Phone: Address: Contractor Name r Su�eruisor's Construction License Exp Date �� � Home„Irnproyement 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: $ Ll Check No.: 7A Receipt No.: NOTE: Persons contracting with unregistered contractors do not have aceess,"iqu nty fi nd Signature of Agent/Owner Signature of contractor CC t%® TH Town of Andover ver Mass, iA COC MICHEWICK Q°RgriEo J`Pa,��� S U BOARD OF HEALTH IT Food/Kitchen Septic System PERM LD THIS CERTIFIES THAT ................... ..nbquildin .... ....................................................................... BUILDING INSPECTOR Foundation has permission to erect ...................... s on ... 5�..... �* .••. h Roug A to be occupied as ........ ... ...... Chimney ...... ... ................................:......................................... provided that the person accepting 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 16 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTIO AR Rough Service s:.............................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy PuiRough 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 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 described: Owner's Name.....Lv p /.. ......................................... ............ ' lephone#...�(.�C�•'• < .:- ..X_M� Job Address.... ..... $.c..7XC1 ...7`•Fes•••.••.......................City..w�.. 11 �?.✓.L'F:..................State... Specifications: ✓Strip existing shingles a/�ipply new drip edge to all edges.BI`vuliz S U ...................................................................................................................................................................................................................... Apply_feet ice and water shield membrane to bottom edges of house.3 feet ice and water shield membrane in valleys and bottom edges of any unheated areas of house. ✓Apply felt aper n r-laymen t. Install ridge vent to lyrt.. . ................................. ... .... ... ......... ..................... ............I................... -" eroof usin t ` shingles with awarranty. ...................................... v�ouutterflaslichimney. ee vent pipe flashing,v6egal disposal of all debris. f ........... .... ............................ ................. Area(s)to be worked on: :.:. ,.,'.'....... l 1..{' .5..k1..1�1. ff...t.. rS.Y{>..� . .E1 ....✓.rl. 1'!'l:t' 17 1 .1.1. ..P,� ................... . r r.l� (.... ............... ...+ � .... . ... .� -�. ..� �...�r....,�.......... � .............. Roof board replacement/f necessary @ C /sheet b"r�` /foot. .................... ................................................. Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as speci d by manufacturer The contractor agrges tp perform the work aqd fu the materials specified above for the SU of$...... .1?................. Payabl ..i .L7.0.4...........on...5.shd:.1............. Payable........... .............on.........77t�................. Balance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability while job 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 arc 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 he 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 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 MGL c.142A. Approximate starting date of work.uCompletion date...�7�. .. d. .... � �1 Receipt of a copy of this contacf is herebykcknowledged,and it is further acknowledged 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,231utton St.,No.Andover,MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their names this..t5 day of... ........20.. Accepted: Signed...... ..... C,............................ Owner Signed............................................................................. Owner 1 � David Castricone,President Y� The Connnomvealth of Afassachusetts -- �� -- Department of IndustrialAccidents Office of Investigations 600 W3 ashin�ton Street Boston, 11 LA 02111 fvwjv.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information SiPlease Print Legibly Name (Business/Orgaaization,7ndividual): 'DA\) 1 b C\J S P\1 WiNr 'RO C 1=i 1`l is J b I N Ln I N C Address: a31 Su-FT-0 N ST RE C- 7 UN 1 ► 3A City/State/Gip: No, AN 60\•E_r, 6 ( W Phone tf: �7 �� 3 �� Yc�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 (full 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 g_ ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.l 9. r]Buiing addition ld required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ g P 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 r't,l 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 nein affidavit indicating such. Contractors that check this box must amcbed an additional sheet showing the name of the sub-contractors and state ether 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}Workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: _GRAN 1 TE 1 ATE I N J U Z/\N (_ C co Policy#or Self-ins.Lic. #: W CLQ O :3 9 &9 q d3 Expiration Date: Job Site Address: G()C) C:{ City/State/Zip: 0, AVNA6 (1 NIA L I M� 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 forwarded 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: C Date: Phone#: L 1, 3 J YL() Official use only. Do not write in this area, to be completed by city or town official City or Toren: 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#: TE A� CERTIFICATE OF LIABILITY INSURANCE DA10/2DO14 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(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)333-7234 No: 233 West Central St AOE-MAILDRE .sdonnell@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC p Natick MA 01760 INSURER A:Western World Insurance Co INSURED INSURERB:Commerce Insurance Company 4754 David Castricone Roofing & Siding Inc, DHA: INSURERCGranite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURERD: INSURER E North Andover MA 01645 1 INSURERF: 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. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR POLICY NUMBER MMlDO/YY`!Y MwDD/YYYY LIMITS I{�G EN ERA L LIAB ILJTY EACH OCCURRENCE S 1,000,000 � occ AMA ET RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea urrence S so,000 A CLAIMS-MADE OCCUR RPP1388404 /6/2010 /6/2015 MED EXP(Any one person) S 1,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 L:__EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPlOP AGG S 2,000,000 X 1 POLICY I PRO- JrCT LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 1,000,000 B ANY AUTO BODILY INJURY(Per person) S U111 X AUTOSOWNED S ULED ONGCV /1/2014 8/1/2015 BODILY INJURY(Per accident) S X ) NON-OWNED j HIRED AUTOS X PROPER ^ TY �i AUTOS Per accident DAMAGE S i S I UMBRELLA LIAB OCCUR • • EACH OCCURRENCE S EXCESS LJAB HCLAIMS-MADE AGGREGATE $ I I DED I 1 RETENTIONS S C :YORKERS COMPENSATION WC STATU- OTt4 AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PA.RTNER/EXECUTIVE OFFIC ERA.tEMSER EXCLUDED? ElNIA E.L.EACH ACCIDENT S 100,000 (Mandatory in NH) 0003989723 /23/2010 /23/2015 E.L.DISEASE-EA EMPLOYE S 100,000 If yes oescnoe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 I I j I DESCRIPTION Of OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Roo-fing & siding contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Casbicone'-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. I NSD 25 r7n irr-,n, Tho ar.()Qn Hama�nH Innn�ro mniatororf mar4e of ar�an Massachusetts - Department of Public Safety Board of Building Regulations and Standards C moi-ticlinn SuhcrN i,nr Slu'cialth `+cense: CSSL-099358 DAVID T CASTRICONE 31 COURT STREET �a NORTH ANDOVER Mb`018 5 x p f ratl0n Commis stoner 12/16/2015 _ Office of Consumer Affairs&Business Regulation 1"ANL�OME IMPROVEMENT CONTRACTOR j- -r ly iegistration: 104569 Type: , Expiration: 7/14/2016 Private Corporatio DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undersecretary Town of North Andover NnkT)y Building Department o � 27 Charles Street * 1 Nonh Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 -9S, SACHU5�` 9CSNCHU5�` DEBRIS DISPOSAL, FORM ;n accordance with the provisions of MGL c 40 s 54, and a condition of Budding permit 9 the debris resulting from the wort: sliall be disposed Of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 502 The debris/will be disposed of in /at G� Z— r S C Facility location Signature of Applicant Date NOTE A demol,tiot; permit from the Town of North Andover must be obtained Cor this project tluough the Office of the Building Inspector.