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HomeMy WebLinkAboutBuilding Permit # 6/29/2015 l tAORTH BUILDING PERMIT o��tLEo ,b�tio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION _ Permit No#: Date Received A�Rareo�PP�R5 Date Issued. I CHUSE� IMPORTANT: Applicant must complete all items on this page LOCATION 60 Print PROPERTY OWNER i c o�®-s i Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 9 One family ❑ Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial )KI Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other { ❑ Septic g❑1Nell ❑ Flaodpla�n ❑Wetlands ,❑ Watershed District DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: 6 /'7-'SCJ L ` 3 Q Address: 1 q� H l �oa-c), Nor4v . uAo�&d � f Contractor Name: f\!� Phone: 9 b 3 ,J d-Q) Email: LkA)t c A Address: -t 3 Ror-} �, Azov-e'er NA c�1 eta Supervisor's Construction License: 9 q Exp. Date: I I (o ,- \S' Home Improvement License: Exp. Date: 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.: ��� Receipt No.: a,' NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund tAO R'T'H Town of Andover '� _ "1'' ® O No. 60 2b 1p A��O LAKE h Ver, ass, �S/ �` COCKICMEWICK �®AORATE0 7S 11 BOARD OF HEALTH Food/Kitchen P F= RIVI IT T L Septic System THIS CERTIFIES THAT ..... z! ��� BUILDING INSPECTOR has permission to erect buildings on 2�°-� Foundation Rough tobe occupied as ............ ........, .... .. .... . ....... .................................................................. chimney provided that the person accepting this 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 UNLESS CONSTRUCTIO ARTS 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 Approvedy 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.b low descriaed: Owner's Name...... (t� /r� �/ /� / /L 1.. �........ J/..<�.'(f?. 1�.t......................................�............T lephone tl...la/..L..'.L���1.:... Job Address.....1... .... �'�.. !•...J....t :j.................................city... .C1i. X1 G.Y•.0?. .................State.... PIA .... Specificalions: ................................................................................................................ .................................................................................................... /Strip existing shiugles�/) ✓pply new drip edge to all edges. ./ /..........................•........................................................................................................................................................................................... v `Spp _ ly feet ice and water shield membrane to bottom edges of hot{,e.3 feet ice and water shield 11 mbrn.ne in valleys and bottom edges of any unheated areas ofhouse. If ....................................................:.........................................................................1., ..1................. ........................................ ii! rApply felt >a}l'�'a tdcrlayment. 4ustall ridge vent to i; .............r.'. ii r.C! 1.L�......E...�...........Sl.........�.�........ ..... /Reroof usin� y�/1 shingles with a yAar warranty. ...............................:...........................................................................,,.�... ............................ /Counterflash chimney. VNe%v vent pipe flashing,-Legal disposal of all debt-is. .......................I.............I......%. J.::...;3.".............. ..................................... ............/.. .�rrci �: ,.:...1 ....il✓t. c�. ...;.y Areas)to be worked on: l.C,cf,%..:�.}:..1..� s...' '���.. ............ 11„S. to . ........../'.,`s;:4.. . .� ................... Roof board replacement if necessary @ � /sheet 6r V.e_L/foot. � t- .......:.................................................................................................................. b.1 .. . ".......... ..................... ........ ........... Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specifie by ipanufacturer The contractor agrees to perform the work and fu ish the materials specified above for the SUM $.... .. .�! 1 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 prc-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 dumpster placed by contractor is for his use only.Upon completion ofabove woik,all undersigned agree to execute and deliver to contractor,theirjoinl 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 acid 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. w 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 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 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&Siding Inc,231R Sutton St.,No.Andover,MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their names this. ..day of...�6V.tL /........20... Accepted: Signed ............ .... ... ............ ............................ Owner Signed............................................................................. Owner David Cos tricone,President <� The Commonwealth of Afa.ssachusetts Department of Industrial Accidents _ Office of Investigations 600 Washin-ton Street Hoston, AIA 02111 wtviv.inass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information J( Please Print Leiyibly Name (Business/Or�aaizatiouZndividual): D A\J l b C 1\6 S R 1 C UNt_, RU C F( IN lr " I D 1 N Address: )31 R SyTTG N Si Re-L7 UN ( i 3A City/Stmc/lip:__ b. A N60\ierr, — -- -, — _i N ��A U I �`f-J Phone #: 97 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 (fitll 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 S. ❑ Demolition working for mein any capacity. employees and have workers' NO workers' comp. insurance comp. insurance.I 9. F1 Building addition ❑ We are a corporation required.] 5. oration and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 1 Roof repairs i-rsurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other_ comp. insurance required.] *Any applicant that checks box 91 most also fill out the section below showing their avorkers'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 trhat check this box must amcbed an additional sheet showing the name of the sub-contractors and state vyhether or not those entities 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 any employees. Below is the policy and job site information. Insurance Company Name: � C ►2FlN (rF SiA i� � NJU �hNc % Co Policy#or Self-ins.Lie. #: W 0_0 O :3 9 q d3 Expiration Date: Job Site Address: I i ` kb&� City/Sta&Zip: %- A "SMA Q 1�V,- 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 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 under the pains and penalties of perjury that the information provided above is true and correct. Siznature: J . C Date: Phone#: , 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 S. Plumbing Inspector 6. Other Contact Person: Phone#: A CERTIFICATE ®F 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 No: 233 West Central St EMAILADORE .sdonnelI@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURERA:Western World Insurance Co INSURED INSURERB:Commerce Insurance Company 4754 David Castricone Roofing 6 Siding Inc, DSA: INSURERC:Granite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER O: INSURER E: North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER:Mas ter 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, INS R I TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR POLICY NUMBER MWDD/YYYY) IMMJ0DfYyYy1 LIMITS GENERAL LAB f11TY EACH OCCURRENCE $ 1,000,000 DAMAGE T RENTED tX COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ S0,000 A CLAIMS-MADE Fx�OCCUR NPP1388404 /6/2014 /6/2015 MED EXP(Any one person) S 1,000 PERSONAL 8 ADV INJURY S 1,000,000 GENERALAGGREGATE $ 2,000,000 Lf___ENL.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 I x I POLICY 1 PA O LOC S AUTOMOBILE LLABIUTY COMBINED SINGLE LIMIT Ea accident S 1 000 000 BAMY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED OS X AUTOS ��V /1/2014 8/1/2015 RiAU7BODILY INJURY(Per accident) S j X l HIRED AUTOS X NNOTN-OWNEDOS PROPERTY DAMAGE I S I Per accident I I UMBRELLA LIAR OCCUR EACH OCCURRENCE S EX CF S-S LL4B I CLAIMS-MADE I AGGREGATE y DEC) I I RETENTIONS C WORKERS COMPENSATION WC STATU- OTH- S AND EMPLOYERS'LJABILfTY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICEP"ME.MSER EXCLUDED? ❑ NIA EL EACH ACCIDENT S 100,000 (Ma ncatory to NH) WC003989723 /23/201d /23/2015 E.L,DISEASE-EA EMPLOYEE 5 100,000 If yes,desaix under DESCRI:--TION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 I DESCRIPTION of OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Roo_ing & Siding contractor I CERTIFICATE HOLDER CANCELLATION Castricone f ,iofing & Siding SHOTHEULD ANY OF EXPIRATIONHDATE ABOVE THER OF, NOTICE I ES CBE CDELVERED BEFORE N 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. INsD25 miws,nr THA An()Or1 name�nrf Innn aro_niaf._A mar,_of&rr)Qn Massachusetts - Department of Public Safety Board of Building Regulations and Standards C"n,tructiun .SuhCYN isnr Slierialt, +cense: CSSL-099358 11 DAVID T CASTRICONE,. 31 COURT STRE.ET x NORTH ANDOVRR Mi,101,8`5 ✓,.�, ,11 Expiration Commissioner 12/16/2015 Office of Consumes Affairs& Business Regulation ;lLp t{OME IMPROVEMENT CONTRACTOR J — I� s —(egistration: 104569 Type: ' xpiration: 7/14/2016 Private Corporatio DAVID CASTRICONE ROOFING,SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undersecretary