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Home My WebLink AboutBuilding Permit # 6/11/2015 BUILDING-PERMIT 0 tAORT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION PermltNO: ya Date Received Date Issued. CLis-I IMPORTANT:Applicant must complete all items on this page 'Mr..,..ss`-_,v......,.- IN �R1 eg, OEM= g , .te. ,ff,% W 7L 0 -.0 0 4 N TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building vOne family Addition Two or morejamily Industrial Alteration No. of units: Commercial VRepair, replacement Assessory Bldg Others: Demolition Other F IRS'– r 07. M DESCRIPTION OF WORK TO BE PREFORMED' Identification Please Type or Print Clearly) OWNER: Name: rl Phone: Address: V, v mmgpm g- A R IN 1W -4"w.4 M, g %'t .5 IBM 111,11- Rg—11! Ap_01..3z. N -7 _,g f. �Wg.R an- ............ /ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE;BULDINGPERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00PER S.F. Total Project Cost: $ FEE: Check No.: 7A —Receipt.No.:_. NOTE: Persons contracting with unregistered contractors do not have access to the guaranty.fun—d t%ORTH xU UW111 0111 Anduvel ® . LAKE h Vel'' Mass.0 coc"Ic"a Wlc. RATED ME NookS BOARD OF HEALTH Food/Kitchen FER IL T L D Septic System THIS CERTIFIES THAT BUILDING INSPECTOR . . . . .. . . .. .. ...... .... Foundation has permission to erect ......... buildings on � .. .. ................. .......... .. ............................................. Rough to be occupied as ...I........ ......... ......�....`. ................:. Chimney provided that the person accepting his 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 IT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR ® LESS C CTI® `S A 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 CONTRA6TOR 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: C� Owner's Name....../....►.4. '..... /ILtS�..... .. ...A./..........................................T hone#....6.L Job Address.......4P..... E? ...�� 1 /.... ..................City..... �. .21 {?.1r..E%f".............state.. Job Specifications: ......................................//��.��...........�.............................................................................................................................................................. f trip existing shinglesl,l� ✓Apply new drip edge to all edges. W* P', rl ....................................... ............,............................................................................................................................................ AA)Ply_,_fcet 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 alt pal1crn erlayment, nst 11 ridge vent to 3l` Y1fC 4.0...... ... ............ .............. ............. .. ...'........................ ......I......... - ✓}teroof using shingles with a�(Z year.warranty. . `........................................�.. . ................................................................................................................................................................... Cou»terflash chinnrey. - eco vent pipe dashing. mal disposal of all debris. ..................................................... ...v�............ ....................................... ................................................................. Area(s)to be worked on: ............�i.............. ............ ....1''12j�. L l`. p ... .U .(?��.................................................................. :L.,ar t .. .......... .r.....�. .....xr2r •Gt�� .................................................................................................................. ............................................................................................................................................... ...... '..... R�Cis --' 6 R BZW... j�?M) 7 6cro .................................................................... ................................................................. ........................................................................... Roof board replacement if necessary @ �a /sheet or -- /foot. ............................................................................................................................................efsre ............... Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as speciThe contractor agreesto erform the work andfurnish the materials specified above for the SUM .��............ Payable......../ on......... .... ...... . Payable....... ..�..................on..... .(. .. 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 are property of contractor. Any dumpstcr 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 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 agrcements collateral hereto,not 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 exce o the Guaranty Fund provisions of MGL c.142A. �R..� W Approximate starting date of work.................... .. .... Completion date......................................................... Receipt of a copy of this contact is hereby acknowledge nd 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 8c Siding I ic,,223{11R Sutton St.,No.Andover,MA 0118445. IN WITNESS WHEREOF,the parties have hereunto signed their names this...(0..1.Y11.day of...UFsyl,G..1....,20../J.... Accepted: Signed.. ..:`.`....`..U. Owner Signed ............................. Owner David Castricone,President �� h'� The Commonwealth of11fassachusetts Department ojlndustrialAccidents Office of.Investigations L , = 600 Washington Street Bosto�: - n 11 , M 0211.1 wiviv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ( Please Print Legibly Name (Business/Orgaaizabon/ladividual): D A\J 1 D C F\6 S R t CONI G 1 ( 1V is J I D I N( I WC Address: Su TT6 N S'T Re-L 7 UN 1 I JA C1hj/SL1tC/Zip: No , ANoOvlrr Phonet�:_q ?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 6. F1 New construction employees (full and/or part-time).* have hired the sub-contractors 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 me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. iusurance.I required.] 5. ❑ We are a corporation and its 10.❑ 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 l oof 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 a orkers'compensation policy information. 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 attacbed an additional sheet showing the name of the sub-contractors and state v�hether 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. 7 Insurance Company Name: G R AN 1 TF 51 AT e N,S U Qh N C L o : Policy#or Self-ins.Lic. #: W OW 0 3 9 &9 �43 Expiration Date: Job Site Address: Pe `l�(J �1 f�1 City/StafeMp: a woff, Q� h �� 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 DLA for insurance coverage verification. Ido hereby certify under the airs andpenalties of perjury that the information provided above is true and correct. Signature: C pDate: Phone#- 1 ,� � 3 64 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/Tovvn Clerk 4.Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE 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(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 PHONEIA1c No F,, (800)333-7234 _FAX No: 233 West Central St AE-MAIDDRLE .sdonnell@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC# Natick HA 01760 INSURER A Western World Insurance Cc INSURED INSURERB,4Commerce Insurance Company 4754 David Castricone Roofing & Siding Inc, DHA: INSURER CGranite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER D: 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 NDICATED. 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. )NSR I ADDL SUBR POLICY EFF POLICY EXP .LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MMIDONYYY LIMITS I GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 rl COMMERCIAL GENERAL LIABILITY AMA E T RENTED PREMISES Ea OCcurrencel $ $0,000 A EP CLAIMS-MADE �OCCUR P1388404 /6/2014 /6/2015 MED EXP(Any one person) S 1,000 PERSONAL d ADV INJURY $ 1,000,000 �) GENERAL AGGREGATE $ 2,000,000 LGFN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 x I POLICY E-1 PRP LOC S AUTOMOBILE LIABILITY (Ea �OM8tNEOtSINGLE LIMIT 5 1,000,000 3 I ANY AUTO BODILY INJURY(Per person) S '.. 11:.CLOWNED X SCHEDULED lGCV /1/2014 8/1/2015 ACTOS AUTOS BODILY INJURY(Per accident) S j X }',IREO AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident I I UMBRELLA LIAB OCCUR EACH OCCURRENCE S ExCESS U CLAIMS-MADE AGGREGATE $ I I DED 1 1 RETENTIONS S C WORKERS COMPENSATION WC STATU- DTI+ AND EMPLOYERS'LIA81Ln-Y ANY PROPRIETORIPA,RTNER/EXECUnVE Y I N ER OF FIC RAM EMBER EXCLUDED? ❑ NIA E.L.EACH ACCIDENT $ 100,000 (Mancr,Oryrn NH) KC003989723 /23/2010 /23/2015 E.L.DISEASE-EA EMPLOYE S 100,000 Il yes oesc nx under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 I I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,0 more space is required) Roo-ing & siding contractor I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Castricona 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(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. I NS025,m Tho A!`Opn Hama�nrt Innn�ro ronigferori mariro of A!`.11gn Massachusetts - Department of Public Safety Board of Building Regulations and Standards C instruction Suhen isol.Slmciulth ucense: CSSL-099358 DAVID T CASTRICONE 11 0 31 COURT STREET NORTH ANDOVER MAOI$ 5 ✓.. �1 expiration :ommissioner 12/16/2015 =. Office of Consumer Affairs& Business Regulation FWWROME IMPROVEMENT CONTRACTOR �iegistration: 104569 Type: xpiration: 7/14/2016 Private Corporatie DAVID CASTRICONE ROOFING, SIDING& i David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845p Undersecretary Town of North Andover F Ni0RT� o 6 �ti Building Department o 27 Charles Street Noah Andover, Massachusetts 01845 i (978) 688-9545 Fax (978) 688-9542 ro4 cSHC"i DL-BRIS DISPOSAL FORM 1rn accordance with the provisions of MGL c 40 s 54, and a condition of Buiu:ng permit # the debris resulting from the wort: slt2ll be disposed Or irl a properly licensed solid waste disposal facility as defined by MGL cl 1 sl50a The debris v,-ii] be disposed of in /at Z- r s lN(f- 'S" A) Facility location Signature of Applicant Date NOTE A demol,t or permit from the Town of North Andover must be obtained for this Project duough the Office of the Building Inspector.