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HomeMy WebLinkAboutBuilding Permit # 6/11/2015 n BUILDING-PERMIT O&4"°oT" TOWN OF NORTH ANDOVER o el_ 6 APPLICATION FOR PLAN EXAMINATION a Permit NO; � �1 Date Received • n �SSRGHUS�� Date Issued: IMPORTANT:Applicant must complete all items on this page , = _ _ . fn .�.�iit Y " - - `.,:t�-a�. :LA.:-:i=vY'�i i:.y�'CKr?s.:;.i�•=?i.�. - i,:I-.-.,-�;-5�v {1 _ �..J-'_l _ ^N\aii%S•K.,�:l^L".0,Fy ,F�i.n •F - -�•-,.;. - -NN n.- - - .�'r�.!..-. ..s.�me_+'1•''-=.0 `-1 ..n'."''`�`-'`a `_�5�• -,>�.. - s.y: '"-g�ti;�='ro>n-rn �7 s•;" - •. e� - ,<..:.,:-L"".ea_,;a ,.1.:«:-.d� ,:l.-�d-:_�vJ^-fi,:�'�-r.,•,. v._- �'-->T-'a:� 'r N.���-.;r^: �. �='�+il':-• ,�-'et�F��,,��'1.' `-rte g_�- 'a.'1i:_,^.-:' �>t� � _-',r,'S�S ,a F, - - - ,-� -:�,_,. 7:?:`t.' '„5•-S➢, -.�'r.•�,.•IL-�c`14�rr _ _ �Csct>�r-�'�'�.'1'��,'�+�:Vf',:r",---�r^%w,1F•` - - _'a....- - _iF. 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No. FEE SCHEDULE:BULDING PERMIT.$12,00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125,00 PER S.F. Total Project Cost: $ - i S -7�S_ FEE: $ . Check No.: 7/' Receipt No.: }” NOTE: Persons conts ae ng with un>i ebaistered contractors do not have access to e ga ,I"an fund - �.9___;��.�_�...�_..=9z.,.uv--_-.�,._.� -- -_ _gnatu�re=of mon'ray: - •�_� ...._ t%O T town of An over 0 �• , het ® J �1 ver, aSSqq O LAKE l coc"Icp1EWIc" X1,9 A°RATE-D J1.V MEMO,,ro"% BOARD OF HEALTH Food/Kitchen 111 111111111--m rwER JIT LD Septic System III THIS CERTIFIES THAT BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ... ..... .•.•••.•••..••.••• Rough tobe occupied as ............... . ..... ........... ................................... ° :.. ...................................... Chimney provided that the person accepting this permit shall in every respect conform to th 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 T ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST Rough Service ........................... ;. .. .................................... BUILDING INSPECTOR.. Final GAS INSPECTOR Occupancy Permit Required t® Occupy Building 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 'y/ CASTRICONE ROOFING& SIDING INC. ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 200 SUTTON STREET,SUITE 226,NO.ANDOVER,MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In HaverhUl978-374-7314 Uwe 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 premisesta elow described: �1 Owner's Name..... t. 1... l ... /'.f.LJ.... �G J ..1,Y.1 r...........................................Tel�'_".V.fd one#..:G.IJ�F..: Job Address.....L-Lf-J...... lZ. .:i L1 Q.......t�la...............City...WV..�....� 1J ............State... A"..... Specifications: (Areas to be covered: y) /..7J .�1...,:a.1. :..9..1�.4....r�,t �5....r� .. .IhS..f_ 1t....................................................................... ,Apply vinyl siding a�-oena"& Type: ZA 11 ?c-:.................... �..1..!..� ...Q9.?. ......./... i..�'.c�./'a ..ah�.. � ��.t....... over fascia boards and rake boards. Anstall vinyl soffit - solid perforated ......... ....................................................................... ..... /Cov r wood casings and windows.�11a jil9c eplace any gable vents and dryer vents with vinyl. aucj... /.,�Y.�r.s�................................................................................................................................................................... t/AApply underlayment. Type: ...... ..... �r.....'..... ...,s.t. �,�r.. ���y ✓Existing siding stripped go over vLegal disposal oPall debris. q �Y� ...............P............... .. ............. a� O v................... r 7 Rotted wood replaced /sheet o! _ /foot. v f c-r{2 o n (=,:L%1 �'�!. F l �.F............ - 1..9..x.5. . .... .. 1 ' 1 S.o4)..ver... ...1 1 1.1I.G..a.i ....P.-g�..L-1.4'.k i..t .P,.e.{.....�r11. .:........./..4a.�.......,.44 /2 One �r. �d�... ��..',�,. . ?�........ L�,/..�1xl.e......��..e�,-.�'.....�....!%.li...�:.�. 1.`.•.... .�c,r..l. s.�.... .,�� ea One Year Workmanship Warranty(Not Transiteruble) Manufactu r's Warranty as spThe ctor ages to perform the workand ish the aterials specified above for the ...... l ayable...�.1 .....on..Eatinage cti payable P J Payablel.t6_0.Cl G1........on . yl rZ Balance a able on com letion of•obe orowners are not responsible for Property 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).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 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 terns and conditions of the contract and/or any lien in connection herewith.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 conshall be binding only if in writing and signed by all parties, conditions not herein stated.Any subsequent agreement in reference hereto All Home Improvement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to:Director,Home Improvement Contractor Registration, One Ashburton Place, Room 1301,Boston,MA 02108 Tel:617-727-8598 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 staring date of work................................................ Completion date......................................................... t Receipt of a copy of this contact is hereby acknowledged,and it is further acknowledged by the undersigned that the. he 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 Owner has three business days to cancel this contract and incur no penalty (see notice if cancellation). // 12 IN WITNESS WHEREOF,the parties have hereunto signed their names this 1.i5 day of...rel.,. .........,20..fr Accepted: Signed.. 1,�0'... ... .. ..`. ..,...... Owner \\ Signed............. ................... Owner David Castricone,President hyo The Commonwealth of Afa:ssachits etts Departfnent oflndustrialAceiderits = ' Office of Investigations 600 Washinz7ton Street <== I30stvn, 111 02111 w)VJVJnass.go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Or�aaization/Individual): D Ail t D C\J S R 1 CON 'RU c F t 1V 6 ti S t D I N Ln I N L Address: �3 1 SU-FTO N ST Re-L 7 UN i i JA City/St<tte%Gilx%, ANbo\iL✓r, 61W Phone #: 97i 03 & ` .vo 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. [-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' [No workers' comp. insurance comp. insurance.1 9. ❑Building addition 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 most also fill out the section below showing their workers'compensation policy information. t Homeowner 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 Thether or not those en6ties have employees. If 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: 6R AN I T r S I A I e- I N J U ch NCL Co _ Policy#or Self-ins.Lic. #: W Ce) 0390 q(�3 Expiration Date: I a I J 5 Job Site Address: 50 C A'a I Y Il_Jt City/StafeMp: k) � , A"( 6yey 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$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 fonvarded 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. S12nature: Z) C Date: Phone#: Q )b ( 8 3 -3�L [[Official use only. Do not write in this area, to be completed by city or town officiaL City or To��rn: Pcrmit/i iccnse 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//10/201410/2014 9 ' 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 NAME: Susan Donnell Eastern Insurance Group LLC PHONE . (800)333-7234 'FAXNo: 233 West Central St ADDRES . rEMAIL .sdonnell@easteninsurance.com INSURERS AFFORDING COVERAGE NAIC 4 Natick MA 01760 INSURER A:Wes tern World Insurance CO INSURED INSURER B.Commerce Insurance Company 4754 David Castricone Roofing & Siding Inc, DHA: INSURERC..4Granite 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 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, ILTR I ADDLTYPE OF INSURANCE INSR WVD SUER POLICY NUMBER MMIDDY� POLICY EXP LIMITS LTR GENERAL lIAB 2fTY EACH OCCURRENCE S 1,000,000 I DAMAGET RENTED I COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence S 50,000 A CLAIMS-MADE X❑OCCUR P1388404 /6/2014 /6/2015 MED EXP(Any one person) S 1,000 L PERSONAL 8 ADV INJURY $ 1,000,000 H GENERAL AGGREGATE $ 2,000,000 L___ENl AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 X (POJCY I PRO- LOC S 'AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 1,000,000 B ArvY AUTO BODILY INJURY(Per person) S CI ALL OWNED X SCHEDULED CNGCV /1/2014 8/1/2015 BODILY INJURY Per accident S I.AITOS AUTOS ( ) j X �iIREO AUTOS X NON-OVMED PROPERTY DAMAGE $ I I Per accident LAIUMBRLL.A LIAR OCCUR EACH OCCURRENCE S �LXCESS LLAB I CLAIMS-MADE AGGREGATE $ �DEC) I I RETENTIONS 5 C :YORKERS COMPENSAnON WC STATU- DTH. AND EMPLOYERS'LIABILITY Y/N ER :.NY PROPR1=fOR/PA.RTNER/EXECUT1VE OFFIC=R/MEMcER EXCLUDED? N/A E.L.EACH ACCIDENT S 100,000 (I.ta nca;ory in NH) C003989723 /23/2014 /23/2015 E.L.DISEASE-EA EMPLOYEE S 100,000 If yes oescnx under OESCR1 TION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 I I I 1 , I DESCRIPTION OF OPERATIONS/LOCATIONS f VEHICLES (Attach ACORO 101,Additional Remarks Schedule,if more space is required) Roo'ing s siding contractor I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Castricona-ftofing 8r, 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 MSD 25 nn: m Tho Ar)r1R1)ammo nnri Innn oro mnigferori marLo of Ar,.rTAr) Massachusetts - Department of Public Safety Board of Building Regulations and Standards Cnnstructinn SuhcrN isnr Slicci;ilth Lcense CSSL-099358 ' DAVID T CASTRICONE 31 COURT STREET NORTH ANDOVtR MAkl018.5 lxp,ratton Commissioner 12/16/2015 =' Office of Consumer Affairs&Business Regulation gEgl _ -'ROME IMPROVEMENT CONTRACTOR (= s = ,(registration: 104569 Type: ..` ,=Expiration: 7/14/2016 Private Corporatic DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845p — Undersecretary Town of North Andover F N,Ok7,y Building Department o � L 27 Charles Street Nonh A aduver Massachusetts 01845 ( 78) 688-9545 Fax (978) 688-9542 ' °9F �d 7 QTR `P�•�, 4j CSXCHU5,� DEBBJS DISPOSAL FORM ;n accordance with the provisions of MGL c 40 s 54, and a condition of Bui!dng permit # the debris resulting from the work; s11211 be disposed of n ia Properly licensed solid waste disposal facility as defined by MGL cl l sl S Tne debris will be disposed of in /at Z, s l Facility location Signature of Applicant Date NOTE A demos,tion permit from the Town of North Andover must be obtained for project tluough the Office of the Building lnspector, this