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HomeMy WebLinkAboutBuilding Permit # 6/11/2015 (2) t%ORTH BUILDING PERMIT of TOWN OF NORTH ANDOVER 10. APPLICATION FOR PLAN EXAMINATION `°""V,0— Permit No#: Date Received Date Issued:: CHUS 'IMPORTANT:Applicant must complete all items on this page .............. N .,n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family El Addition [I Two or more family 11 Industrial Li Alteration No. of units: El Commercial >a;Repair, replacement Ei Assessory Bldg El Others: El Demolition El Other El F 'El'Wot a ds��., VVq"'6""`r's'she' , District 3 Iain DESCRIPTION OF WORK TO BE PERFORMED: 6 e- od Identific,11on- Please Type or Print Clearly OWNER: Name. RO-k-i 'TU cSbz, Phone: 9A 6 Address: Mqk6 +-k ArVk&\ae/, M A VA"', J 7 IR rS e r tsor,s Co s rut ion/L ce se „///r/r/f,��i� r, �,,/,r��/, �i,,,Ex , ,Dae.,,/ ,,,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.:—SReceipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund I Signature:- - 11 I I o I f Agent/Owner I - - I Signature of f,-1 contractor I CILL1.11 tt®Rl'H Andover Town of 2 t e :,•�r, No. t C% h h ver, ass, -4/ �� COC NIC Ml WICK V a �%RAYeoUP BOARD OF HEALTH Food/Kitchen r. R.MI�T� T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT Tea, ' ........" Foundation .qu ildings on Rough fission to erect "' """"" has perm ................... . .. ... .......................... Chimney to be occupied as .......................... ..peri......... .. .......................rq :.... .. .. Final provided that the person accepting this permit shall in every respect to the terms f thAltepat on and on file in this office, and to the provisions of the Codes and By-Laws to the Inspection, PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final ELECTRICAL INSPECTOR PERMIT EXPIRES I 6 ® TS LESSCTI T Service Service ................. . 6............... ................................. Final BUILDING INSPECTOR GAS INSPECTOR ccul�anc� l'e�'�reit egfired t® 0CC4ff Building Rough Final Islay in a Conspicuous Place on the Premises — Do Not Remove FIRE DEPARTMENT No Lathing or Dry Wall To Be Done Burner Until Inspected and Approve y the Building Inspector. Street No. Smoke Det. DAVID CASTRICONE CASTRICONE ROOFING&SIDING INC. ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 a31 R. 2@154'UTTON STREET,9 6,NO.ANDOVER,MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314 - Uwe the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to fumish all necessary materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on premiss below descri Ownet, 1....keC ..L.kf .... ' ...................................... ..................................... L �T..eleph�# 171A... A2.ve ........Sate.t.�(s.f1../�.............C Job Address tk... . S ecu rcations: ......................................... 1 .... ............. f .......................1 Areas to be covered: ............................ .. ./. ...�.yl,�... ... . t/Apply vinyl siding and corners. Type, �/ 9l/ ........................ .... ............. ....... . ................I.............................. cx 5. l..t a... �5 �1 C . ........�................ vCover fascia boards and rake boards. k"stall vinyl soffit - solid Kperforated ............................................................. - Cover wood casings around windows. Replace any gablf,'v�ents and dryer vents with vinyl. �� Li61......................................�,. Kpply underlayment. Type: 1. .>r . ,.... ..ws: i �. ... ?. . ,...... , ............... r . . ii isting siding stripped / go-over legal disposal f all debris. ...................................................................I........I......... ciao t.. F' „r..;i.yl. �.... Rotted wood replaced(rte' /sheet ot�v� /foot. rp e 1 t�.tf l.....0-.10 ?./ .... �:�.il.. : ..... ..Yl.��.......rt2r" ..z.... .�(.J...................... ..................................... On�..�aC .... . ....R.� 1. t... .�r..S.t .. .tr ..�........................................................................................................................ Year Workmanabii Warranttt Transferaftle) Manufacturer's Warranty as specified by manufactmer The c for agree o rform the work the materials specified above for the SUM of$... . is.D........... C 1 yable.... b..Q.........on....S.Jiswlt.f............. Payable........'�...............on.........:7..................... 0l-lance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability whitojewis in operation. Contractor is not responsible for any damage to the interior of property,including preexisting 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 terms 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).Thcre 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: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 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 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 of cancellation). IN WITNESS WHEREOF,the parties have hereunto signed their names this...O.f j<.......day of.....M..f:j...........20.4x.... Accepted: Signed... .......U:......::........At—14—w...................... Owner Signed. 4"' a'LL....P44.....��C I .. Owner David Castricone,President / ' h The Commonwealth of i1fassachusetts = - Department ofIndustrialAceidenis Office o Investigations 600 Washington ,Street } - Boston, AM 02111 wiviv.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �t �j ( Please Print Lel?ibly Name (Business/Orga.nization/Individuat): /��{ I Q C 1 s S('�t(-G�1r ICU G 1 1V is ti J 1 D 1 N 6- 'til L Address: X 3 1 R SU-FT-0 N S-1 RE L 7 UN t T JA City/State/zip: No, A NbOy(;6, �I A 6 ( W Phone tt: 97i (✓ 3 yt�U Are you an employer? Check the appropriate box: Type of project(required): 1.21 I am a Y emP to er with 1 4. [] I am a general contractor and I 6. F-1 New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. E] Demolition working for me in any capacity, employees and have workers' 9 building addition [No workers' comp, insurance comp. insurance.$ We are a corporation 5. Woration and its 10.0 Electrical repairs or additions required.] p d officers have exercised their 11. Plumbing repairs or additions 3.❑ 1 am a homeowner doing all work g P myself. o workers' com right of exemption per MGL y [N p. 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13Other 4 j comp. insurance required.] *Any applicant that checks box 41 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 attacbed an additional sheet showing the name of the sub-contractors and state ether or not those en�i ies 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: G R A N 1Tc J I A T E 1 N J U ZA N C l u , Policy #or Self-ins.Lic. #: W 0-0 O :.3 9 �9 `7 t 3 Expiration Date: Job Site Address: l 4 d) 1A 0 City/StaVZip: 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 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 12>0.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DLk for insurance coverage verification. I do hereby certify tinder the pains and penalties of perjury that the information provided above is true and correct. Si�mature• �J t�` Date: Phone#: C1 . 7�b 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#: A� 9/10/22014014 CERTIFICATE ®F LIABILITY INSURANCE °ATE'Mr" 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 Fac No: 233 West Central St EA'DMC)AR'LESS: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 5 Siding Inc, DHA: INSURER C.Grani te 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. INSLTR I ADOLHYPE DF INSURANCE INSR WVD SUER POLICY NUMBER MWDDY/YEYW POLICY M/DYE LIMITS L—G EN ERA L L1AB 2fTY EACH OCCURRENCE S 1,000,000 f _- I COMMERCIAL GENERAL LIA8ILITY DAMAGE T RENTED X PREMISES Ea occurrence S 50,000 A CLAIMS-MADE Fx_1 OCCUR 9PP1388404 /6/2014 /6/2015 MED EXP(Any one person) S 1,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 [GE AGGREGATE LIMIT APPLIES PER'. PRODUCTS-COMP/OP AGG S 2,000,000 X I POLICY 17 PRO- LOC S JFCT F-1�IAUTOMOBILE LIABILITY (Ea accident) SINGLE LIMIT S 1,000,000 B 1 ANY AUTO BODILY INJURY(Per person) S �iAL1i OS ED X AUTOS SCHEDULED C24GCV /1/2014 8/1/2015 BODILY INJURY(Per accident) S X NON-OWNED j X HIRED AUTOS AUTOS PROr ccidenPERTYt DAMAGE S Pea 1 I UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LlA8 CLAIMS-MADE AGGREGATE $ DED 1 1 RETENTIONS S C WORKERS COMPENSATION WC STATU- DTI+ AND EMPLOYERS'LIABILRY YIN AJNY PROPRIEfORIPARTNER/EXECUTIVE OFFICERA.lEMSER EXCLUDED? ❑ NIA E.L.EACH ACCIDENT $ 100 QQO (Mai'w;ory in NH) KCO03989723 /23/2014 /23/2015 If yes. E.L.DISEASE-EA EMPLOYE S 100,000 DESCdescribe under E.L. OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 I I I l OESCRiPTION Of OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,H more space is required) Roo-ing s Siding contractor I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Castricone-Roofing 8t 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. I1dS025 nn:rrt„m Th.A11.OPrT Ff.ma_H Innn oro rani�lnnu ri mgriro of ARrlD r1 Town of North Andover 04 pOF7H � 6 ' O Building Department o _ 27 Charles Street * f Noah Andover, Massachusetts 01845 e (978) 688-9545 Fax (978) 688-9542 OR1TtD hP�`,`4J �'cSHCHuse� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Buttd.ng permit 9 the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1 s150a. The debris will be disposed of in/at: Z�- s �N� A61Nle Facility location Signature of Appli cant Date NOTE: A demolition Per from the Town of North Andover must be obtained for this Project tluough the Office of the Building Inspector, Massachusetts - Department of Pubtic Satety Board of Building Regulations 9 and Standards (")nNtrnChnn Sulur1 iwr ShrcialtN License: CSSL-099358 DAVID T CASTRICONE t 31 COURT STREET •f NORTH ANDOVRR R, I,Io , , 45 Expiration Commissioner 12/16/2015 Office of Consumer Affairs& 131'siuess Regulation 13 _IKOME IMPROVEMENT CONTRACTOR 1� f�egistration: 104569 Type: Expiration: 7/14/2016 DAVID CASTRICONE 1. ROOFING, SIDING& Private Corporatic David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 `— Undersecretary