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HomeMy WebLinkAboutBuilding Permit # 7/22/2015 11 0ORT11 BUILDING PERMIT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received CHUS Date Issued:- ' IMPORTANT: Applicant must complete all items on this page LOCATION "EcO . Sfe-\icr) S1+ruJ PROPERTY OWNER 16 Y-e-o �0-4-N Print (Z-1cy- le, ill Print 100 Year Structure yesno MAP PARCEL: ZONING DISTRICT: Historic District yes no 0)Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building PlOne family 11 Addition 0 Two or more family 11 Industrial 11 Alteration No. of units: Li Commercial M"Repair, replacement Li Assessory Bldg 0 Others: 11 Demolition 11 Other t UU ""'us", a r/S />I//���� � , �l�l�l /�/ 1r,����yr������'�c���rlf 1�� �, �6� r����1���i�,����' /�/�,��/i DESCRIPTION OF WORK TO BE PERFORMED: J J Identification- Please Type or Print Clearly OWNER: Name: I ,OLA c S Aej- Phone: Address: Contractor Narne:)- , J� S�j(Gjv� CL & `il Phone: Email: o Lie-n.)("fl Vaca 1? rl ne- Address: —A-�-Ao,�Jer- 3 A Supervisor's Construction License: _Exp. Date: 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. 6 C Total Project Cost: $ 7 � 6 FEE: Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund FORTH & I Mk lown Of M. Andover No. �ioAh LAK ver, ass, 01�01� COC LCNEW,CK �d ARRAYED !'Q�,`�(�J S u BOARD OF HEALTH Food/Kitchen rERMIT Limp Septic System THIS CERTIFIES THAT .......... . ..... ........ ........94..'�'.......................................... BUILDING INSPECTOR c Foundation has permission to erect .......................... buildings on ....... ..l/010..:......S............................. ... ......... Rough to be occupied as i ............... ..... .. .................. ............. ....0�. :...A........................................ Chimney provided that the person accepting is permit shall in every respect con 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 PERMIT I E IN 6 MONTHS ELECTRICAL INSPECTOR Ar x ff AM LESS CONSTRUCTION Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wail 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 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 below described: r Owner's Name.... •Clad..`)..r.! .....�...C'S..'.:(.. .. Telephone N...... : .......... Job Add . ... ..R................ ... .,..t � .,:<.E..., .............State.. ... . I ......,... Specifications: ..................................................................................................................................//.............. . .................................................................. v5h•ip exisling shingles.l� ✓Apply new drip c(Ige to all edges. K/7`I "e d .......... .....:.............'...................................................,..5......................................................................................................... i'Apply�_fect ice and water shield inembrole to bottom ed res of house.3 feet ice.11,(1 water shield membrane in valleys and bottom edges of any unheated;ureas of house. :a. k ..............ne ........n..tall..............................`.................... ..................................................................................I......... ,.Apply,.... I )' tt. :4nstall ridge vent to��� C�1'�+,'i�s �,�� t�t-I'',t(,u,uudcrla mcu ................................... ...K.....;...................,........ ,. .. .............................................................. vRcroof'usingCa ,n 'e./� ��j��„f il�l�1 J{y��` shingleswithawarranty. ................................................................................. ::........................................................................................................................ vCountcrll;lsh chimney. ^eco vent pipe flashing. gal disposal of all(lebris. .................................................................�'.................._...F:....................................... .. ..,h.'. Area(s)to be worked on; -- �. .. ....................................................... j �.- ... �1. a ,.� ?r ?`.......:71. r�: ..fhkGC 7v� F? ... .::sc....................... ......... c�i ext.< .. Es....... w...... .............................. ...................................................... ......................................................................................................... ­ar.... .................................,....................................... .................................................................. ..................../. ........!........................................................................................................... Roof board replacement if necessary @ LC) /sheet orl.c c/foot. ................................................................................................................................y.......P............",..,.............................................. Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warrant ass ecified b manufacturer The contractor a ees to erform the work a d specified above for the SUM of$.. ish the materials s ... !:............... Y Pa abl P 'Y° '>� � • Payable.............................on.................................. Balance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability white job is 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). 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,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 touch 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) namcs(s).There arc no rpresentations,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 shalite registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to the C?ftice 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. jj < Approximate starting date of workA,,, :4'-,.1 �.;l1 ....J..L,............... 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 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,231 R Sutton St.,No,Andover,MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their this.c 5 .::. .. .day :......,20..,..?... Accepted: Signedr � .� �.....�'�' .k. ............... Owner Signed............................................................................. Owner rE.,.�_s..:;�:I.N.Si'::iri.:/•n...r,I..�.:,i;:I.:SG..... David Castricone,President The Commonwealth of Massach usetts Departtnent of Industrial Accidents — Office of Investigations 600 Washington Street - Boston ilM 02111 wwty.inass.go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information SiPlease Print Legibly Name (Business/Organization/Individuat): /�\J 1 D C 1J S('�L Coyt U d i ( 1�l is ti J D 1 N L I N L Address: X31 SuTTO N ST REC'T UN ( I 3A City/State/Zip: No. A NDO\i6-t` W 6 ( N S Phone #t: q ? i 60 ,3M0 Are you an employer? Check the appropriate box: Type of project(required): 1.M I am a y emp to er with 4. E] I am a general contractor and I 6. F-1 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 g. D Demolition working for me in any capacity. employees and have workers' comp. insurance., 9. F] Building addition [No workers' comp.insurance p required.] 5. F1 We are a corporation and its 10.❑ Electrical repairs or additions officers have exercised their 11. Plumbing airs or additions �.F-1 I am a homeowner doing all work g re P myself. [No workers' comp. right of exemption per MGL 12.0 Roof 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 arorkers'compensation policy information. I Homeowners who submit this affidavit indicating,they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether 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: G R A N TF IJ Ale- I N J U i'�-A N C l o Policy#or Self-ins.Lic. #: \N CLQ 0 3 9 &9 q 43 Expiration Date: I a I I S Job Site Address: 4L Q 5 i-e e l-) si-(CC A City/State/'Zip:W0` Ao_�p�&" �-IA O I 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 fore-arded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sitrnature: �E)2 C C Date: Phone (A3-3 q )�® Official use only. Do not write in this area,to be completed by city or town officiaz 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#: DATE(MMIDDffYYY AC" CERTIFICATE OF LIABILITY INSURANCE9/10/2014 ) 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 EMAIL ADDRESS:sdonnell@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER A:Western World Insurance Co INSURED INSURERS Commerce Insurance Company 4754 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 ADDLTYPE OF INSURANCE INSR WVD SUER POLICY NUMBER POLICY EFF MM/DD� LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RNTED X COMMERCIAL GENERAL LIABILITY PREM SES(Ea Eoccurrrence) $ 50,000 A CLAIMS-MADE [k]OCCUR NPP1388404 9/6/2014 9/6/2015 MED EXP(Any one person) $ 1,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- LOC S AUTOMOBILE LIABILITY COMBINED SSINGLE LIMB Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED X SCHEDULED CNGCV 6/1/2014 /1/2015 BODILY INJURY(Per accident) S AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE S AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ C WORKERS COMPENSATION WC LIMJU OTH- AND EMPLOYERS'LIABILITY Y/NORY I ER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $ 100 000 OFFICERWEMBER EXCLUDED? N/A 0003989723 9/23/2019 9/23/2015 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 100 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 i9nir)n51 n I Th.Arrwn—A-i I—wro rani-fomri mark-of Af npn Massachusetts - Department of Public Safety Board of Building Regulations and Standar ds MINtrlll' IM] Slx•ru:lt\ cense CSSL-099358 DAVID T CASTRICONE 31 COURT STREET , NORTH ANDOVER Nu.,;0188 5 ��• _xp+rat+on Co-missioner 12/16/2015 %/r t, Office of Consumer Affairs& Business Remulation / -// -� EOME IMPROVEMENT CONTRACTOR' ,y z _-M-gistration: 104569 Type: ' 'Expiration: 7/14/2016 Private Corporatic DAVID CASTRICONE ROOFING, SIDING 8 David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 — Undersecretary Town of North Andover � NA0RTH o � o Building Department 27 Charles Street Nonh A-ndover, Massachusetts 01845 'x (978) 688-9545 Fax (978) 688-9542 -P`oR, �S, CHUSE� DEBRIS DISPOSAL FORI,4 1n accordance with the provisions of MGL c 40 s 54, and a condition of Bui!d:ng permit 9 the debris resulting from the word shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL el l sl 50,1 The debris \gill be disposed of in /at r S l/V(�-- 'S , Facility location Signature of Applicant Date NOTA A demoii1101; permit from the Town of North Andover must be obtained for tllis project tluou�h the Office of the Building Inspector.