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Home My WebLink AboutBuilding Permit # 6/29/2015 l NORTH BUILDING PERMIT 0.1�tLEo bq�o TOWN OF.NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 4q co Permit No#: Date Received �g CRATED�PaRgy Date Issued: IR l SSACHUS� MPORTANT: Applicant must complete all items on this page LOCATIONi (� c � -r Print PROPERTY OWNER i �i N _ !C- Print 100 Year Structure yes no MAP PARCEL: 2, ZONING DISTRICT: Historic District yes no Machine Shop Village yes ` no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building VOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial LVRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ ,;,r,❑,, S.,.,a, ,fe►.cr, : x.ew1eN,,rrs�exr llrr ,rf , r rI-''�❑tvr 5„F tloodr�plrarn x < ❑Wetlands l r ❑'Zra�W� aters.+p hedsy'fD�'.s-cr t ,"I'll -.111,111-1,11,11, t:�;Sn❑ n,,cftt ,,.,. u, .. . ,,, ,,,,a✓aualr3l,.,. .;?d `'.0.e"`. ,.,. .,,n�-...:,'.'�,,��' rr rr f /rr DESCRIPTION OF WORK TO BE PERFORMED: �rlb at'vA r0J J Identification- Please Type or Print Clearly OWNER: Name, gbioe_r � Phone: Address: J0 ( ()r e c/-y s Nor-ik /AhAeL e-./ { A 61 Yf Contractor Name:o,(,IJ-6C 00 200 ktict Phone: ' 3 r G Email' c .cax>I�I�d (ata. fyi( _,netz(j in . (0�7 Address: . r 6' � , S r i1 , � �,, � � � t-A ()iEyj- Supervisor's Construction License: Exp. Date: I 16 ,,0 IS- Home SHome Improvement License: (t,% Exp. Date: -7 - !'4, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ (� O O `� FEE: $ Check No.: 7cl4 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund - - - - .. - F tkORTH Town of Andover ® 2'n ° LAKE h ♦ er, ass, 7�r4 _ COCKICMEWtCK a' YYY S U BOARD OF HEALTH Food/Kitchen E R MMM T�� T ` L D Septic System LOA THIS CERTIFIES THAT BUILDING INSPECTOR ' Foundation has permission to erect .......................... buildings on ...... :. .......Greep-�................ .................................. Rough tobe occupied as ......................... ........ ... ... .. . ........... ....................... ......... ............. . .......... Chimney provided that the person accepting this permit shall in every respect conform to the ter s 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 UNLESSCTI® STARTS Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy BulldlnRough 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, PRIES. CASTRICONE ROOFING & SIDING INC. �`7J 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,tenns and conditions,on premises below described: Owner's Name.....L..1r:?. ..C'-, ..../r_;./...........................................:a...........Imphone tt....4..0.. .../..l.:vl.4...... Job Address... )......��::/.`..�4'.�t 1::...s ..................city.. -vu...................State.....NI. Specifications: ................................................................................................................................................................................................................ L/Str•ip existing shingles., 6Apply new drip edge to all edges. IjJ-,W i,, Y," .............................................................................................................................................................................................................. ✓Apply_feet ice and water shield membrane to bottom edges of house.)3 feet ice and water shield 3mbrane in valleys and bottom edges of any unheated areas of house. .I( yvi O%t' ..............................................................................I........................... ✓Applylt6lt 1'.pct•un(lerlayment. i-histall ridge vent to c� t< <pa/ cSXl .1,ff1 -.......,.`........{ ...........................t..... l�aoofusing��. , {x, i` J. jfi�Fr+) y shiu Icswitha � l i ear warrant (i / / r lug,- :s 2, tiU h1 f kG�:....... g Jr�o.l r„N,y Y• e,71OW,,61W,&0l®/° .. .................................................................................................................................................................................................................. 'Counterllash chimney. *evv vent pipe flashing. 'Legal disposal of all debris. y .r Areas)to be worked on: r ) 8r...../,1'll� ". S ..h.G7.44.<.G1.,.Gi n�. •..etl:Gs&..... ....................................... D...........r � .... - \ r ............. ;�...... 1 . .(',.l`..)'k1..�.. J:. .....�.1:6..0�U u.C'. :;........................................................................................................... .......................... qtr � ...... ...^ 3 v:1................1C�. '. . ............... .... ......... ...�. .. Roof board replacement if necessm•@ ;,)pGy�i /sheet .................... ..................................................................................................................................... ................. Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specif by enufacturer Pa able... work/and fu ish tl a rJiatgrials s ecif ed above for the�t�M of$....7�1 Grt.f ........... .. Payable.T•S o n.S7R.0 4 r,�l11RC.�.(.�itfG��jO�carl�er aa��y lkfO6C/ t pp j The contractor a �rm the Goll ID.7...�T...lOOr a ante payable on completion o job Owner or Owners are not responsible for Property Dafnage 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 work,all undersigned agree to execute and deliver to contractor,theirjoint 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 he 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 arc)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. �a All Home Improvement Oontractors 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 r} Guaranty Fund provisions of MGL c.142A. Cl. e.^ Approximate starting date of work�r?T. ..>� /..� �v!r.�l G..aL 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 patties 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,23112 Sutton St.,No.Andover,MA OI845. IN WITNESS WHEREOF,the parties have hereunto signed their names this.PZP.1:......... day of...huhu..............201.,,.. Accepted: JSighed......... ....1...: . ............................................. Owner 1 I J 1 Signed......�r�^... .f! . ................................. Owner David Castricone,President 1 h'� The Commonwealth of Massachusetts Department of Industrial Accidents Office of1'nvestigations 600 Washington Street :== Hostott, 1111 02111 wrviv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information J( Please Print LeeJbly Name (Business/orgaaizatiomgndividual): /�y 1 D 1J S('�1��t 'ROCC 1`( I`1 is t 0 1 NO �N L Address: �3 I R Su-FT-C N S'T RE-t 7 UN I T JA CityiStatc%Zip:_No . A NbOyi.6 Phone U 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 have hired the sub-contractors 6. ❑New construction employees (ill and/or part-time).* 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.$ 9. F1 Building addition 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 12XRoof repairs insurance required.] t c. 152, §1(4),and we have no employees_ [No workers' 13.❑ Other_ comp. insurance required.] *Any applicant that checls box#1 must also fill out the section below showing thea workers'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 uch.'Contractors that check this box must attached 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. 7 Insurance Company Name: C 12 A N i TF I A i C N J ti ,CA N e L o Policy#or Self-ins.Lic. #: W U) O 39 &9 U3 Expiration Date: Job Site Address: ' 816 &[M± City/Sta&Zip: no. cl }" m (��s- 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 fne 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 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 certify tinder the pains and penalties ofperjury that the information provided above is true and correct. Si�mature: —� ('_ .l Date: Phone#: 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/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: MIDDffYYY 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 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 PHONE . (800)333-7234 ac No: 233 West Central St E-MAIL ADDRESS:sdonnell@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER A:Western World Insurance Cc INSURED INSURER B:Commerce Insurance Company 34754 David Castricone Roofing & Siding Inc, DBA: INSURERC-Granite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER D: INSURER E: North Andover MA 01845 INSURER F: 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 NUMBER POLICY EFF POLICY M DDY� LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE X COMMERCIAL GENERAL LIABILITY PREMISES(Ea ENTEoccu Once $ 50,000 A CLAIMS-MADE O OCCUR NPP1388404 9/6/2014 9/6/2015 MED EXP(Any one person) $ 1,000 PERSONAL 8 ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 1,000,000 ANY AUTO BODILY INJURY(Per person) $ 13ANY SCHEDULED CNGCV /1/2014 /1/2015 AUTOS rx AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE S Ix HIRED AUTOS AUTOS Peraccident UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS S C WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROP RI ETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? C003989723 9/23/2014 9/23/2015 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Roofing & siding contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE John Koegel/MET ACORD 25(2010/05) (D1988-2010 ACORD CORPORATION. All rights reserved. IN8n25 rgmnnssm The ACr)Pn n.mo and Innn ar.rP i.+.,.r4 m9rloc of Arl"111 1 Massachusetts - Department of Public Safety Board of Building Regulations and Standards (')mtructiun Sulicr% Shrci;llth _ cense: CSSL-099358 `` ,1 DAVID T CASTRICONE 31 COURT STREET NORTH ANDOVER MAx�018, 5 ��• Exp;ration Commissioner 12/16/2015 �-,.. -''��r Hour✓iroiiiner[�/�i/��riCi.in['�[r.i�//,� _� Office of Consumer Affairs& Business Regulation 4.•l jggROME IMPROVEMENT CONTRACTOR l_L (registration: 104569 Type: \ .'8xpiration: 7/14/2016 Private Corporatio >_. DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 1 � — Undersecretary