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Home My WebLink AboutBuilding Permit # 8/10/2015 _ n BUILDING-PERMIT Of pT�X41 gIt-gill, �,:�, I'S TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received "' �4 AcNusA� Date Issued: IM O-RTANT:Applicant must complete all items on this page �`:eaila>ry��-nor- _ _ y - - 1 �i t ::_4'�i -_ -F=`- - - -'.ins,.= _ _ - -1•_. - •-� - zw� .�,,t<•--^ - is .. ... .�.. C._. .I..�s_. ,..I...i .e r _ .., .•,... :•. r .n,:.+1C t:,.:Sr. _=4:m -i`Y'-:'_ - - 'Y",i"�%. - - - . •..:.,.-._ J., ,. c'...,,. .,.. .tet- -.:-T.. ,•:..._':u::� - - - - - - - n•. _yam,:`_`�,_ ,�_/•.� iii _ _ { :.�^',•�,�:' - - - _ - _ _ ^•�� ,.•+"}'•' ..Sat- -9: 1'a'��lit'.� .,->r' ',+'.,�_��. .•G-P_ -C.:,�',^_--_.-:f.�G, ..ra'b?' _'s)•ril..� -=7_-±;.K=��' �� d.r.:r•„-auk,;y.r,,.f,:._�._ "_...,•<-:o' a:l.. :-fiyJ_;'t,._��tfi_,�.t-c .�,�,SL,c..�', �,L`- is>=x:"=f'.- G _ _ 4�,. .:.��.?j->• ..,i�' x<�-'1. .,.t,.,. ..I;u: iy:..._...;:9i^i�_�.-- -..1. 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Nola5''_t,;e:'l!w�l•.TTl=��j:.::1e'.4�4�_d.J F;-^>_t:5;--':...._,_.�:N.e4_^_,�T4.j�.!.k'-Y_�r-�v_r^;'.TT44r•,z.��M"i,''9:i3�a�c� M _i MOVE iS,(.E•..:J•,,,.,,�:�-x-,,:r'.ra,-+.G.,��n��-:l�..�_:!'=.o,a��::,y<rgi��,.:':.5.�c*�r%-,�.i��I-ra`:�i•.�te.._e�a:r..$;�.�r-:-y.�._"_._.-�.k_" f;__L'„fiLNr--K•rr;_rpc,,'_r�n:�I'�;��r�-�l.d Wiie,-�` r��asl°%..f:�i_.'u•�'- :i- DESCRIPTION OF WORK TO BE PREFORMED., s4f 0 ajA� M (D �12 Identification PIease Type or Print CLearly) OWNER: NamePhone: US _1 IA Address: zvr_-Y:Ey:hp`-,nt.[a-:-gl•;<>rR_r,:a,�rau+.ev'�.ro.�h'e{;.�-�,�,�,>�w<J,��,{1 T�_.z+�„s<�rat_w',-�-,'._'�"•e�`.r_r-vsisce?;.N.•-`oi�_�,4r`�.I!"r,,.-rd'=-_,v"S-.tv..vj'.S�"-S�"yE'•_'^'5�f,w.,-'.f "H_X"_i�"r,51�.:,;/:a��,5.i,�;,rx�0�,1-:':�Y<r:y,lh��`.-"`<v�.il:..rN`-�•~<'^-„�.��:z"i_•=_>.;f-:.44:s'i•"��i�c-J:Hii..�wc-,�.�.,'a,,'.+,V�-�_F_.�k",.,acS-,,'':<,�:�:a,=-r7�1.i�..1+a.�;.`�::cN:..Ip.y-."c.y1,:;7�,•.ar`Pr�a��:.t;.t.-�-.rVi..e'f.�.r�-....,ix'�-1•,._Yi�.:I2.rcAsc�---_l•n.-i�ss.h,=�1.:.�..��;.-r,>:�-aa:-�r..L�d7:vt',r✓.�_.7r;�''J=-+=.;:�-a=-"!.';"u-.'r.-'<.^`_-�-'.>_<�-1�:v,s...:�',:;+:;r-.4--fim_n>�IraF�mx.''9a;_L.,�r4.�.-,r`.`d.,.1+',„-'."_�:�=�-�,,>a,ya-.te.,r,-e,-.=-+.S/-,�tuar[.,,��EYK,- u>J 03 o=-5 Eli g'- HBO f�-y•xr +,. 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'<��4 s'i:��-'_'.?I:%tz,:.I��r'..=�:?.. ARCHiTECT/ENG INEER Phone: Address: Reg. 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: $ FEE: $ Check No.: �� Receipt No.: �� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty_fund FORTH Town of A nclover 0 0 Z ,MEU ® M T _ r �' Ver, �S S',�` . � LAKE 1. BOARD OF HEALTH Food/Kitchen PEI�X� MIT T ft% � LD Septic System ..... a ................. THIS CERTIFIES THAT ....... ........... BUILDING INSPECTOR . . • Foundation has permission to erect .....................:..:: buildings on .... ..� :........�..... ... .................................... ® Rough tobe occupied as ......... . .. ............ . ... .. .. . .......................................................................... Chimney provided that the person acceptin 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 PERMIT EXPIRES IN 6 MONTH,% ELECTRICAL INSPECTOR CONSTRUCTIONUNLESS Rough Service 4. . 2r ....................... Final UILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Buildin Rough Display in a Conspicuous Place On the Premises — Do Not Remove Final Lathing Or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. _ Burner Street No. Smoke Det. ma;l�rs1 rtSS 315(,3 Crystz� Ss Ih 4 q DAVID CASTRICONE, PRES. CASTRICONE ROOFING & SIDING INC. ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS ; HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 231R 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 s hip,to install,construct and place the improvements according to the following specifications,terms and materials,tabor and workmans conditions,on premises,bellow described: Ice 7f7 Nt �.....!/�.il.`.r�.A�Q Telephone N...d. S..'S..L.3..�............... Owner's Name........ .................................... A..,.. 13 rC1{ h(u,r� s+ City....1 V,....,/l r4. .............Slata..l!..1 ......... 3 Job Address................... Specii(icarionr: It r J / j `/Strip ezisIing sltiuglcs.t j} YApply'new drip edge to all edges. e (t�f,v�{ V�pply feet ice and water shield membrane to bottom edges of house.3 feet ice and water shield membrane in valleys and bonom edges of any unheated areas of house. ,.3 . ...... ......... ✓Apply telt grape natftfiauzL�Q 0 Q X 0 .......... , ................................................... shin les with a year warranty. croofusing t:r •.. g _ 2.L1_— .................................. ............ .......................................................................... .. Counterflash chimney. �w'vent pipe flashing.vLegal disposal of all debris. ............................................... ..... .. 4 Area(s)to be worked on: �..5r1l i�-.t 1 PO�S.....rbF...�R.u.SB -•........._................................................... ............................. .. I -.......................................................... P.................... ................................................ ........................lace..._... ifne......... ft�/foot. Roof board replacement it necessary Q f66/sheet or ....................................................................................................................................................... Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty u specified b man rer week an fit ish the materials specified above for the SUM of 5 ...91#8©•• .............• The cottaeetor agras�q Pe Payable...... �((Z .1Y4 on.....5 . ry1 Payable.................7:.........orL..........f....,.............. alance payable on completion of job owua or Owners arc not nspons{bta for property Damagc or Liability while job is in operation. _ Contractor B not responsible fa my danugc to the mlcri of pmpcny,including prcexisung conditions(ie.rater tains,wm*ling pinw,exposed mss)or ere of raatatats specified above(i.e.objects coming loose from walls,crumbling plasUr.etgeaed antis,dint in attic or other Irving """chaos rauhlag dem y nccd ii All rnatrriwb uc property of coauaosor.Any duopa gland by codmcaor is for his sac only.upon sponge).Itcma is otic m+Y need oo be cor«cd by horrnwwoa. dwaaphow otabove wok au undersigned ago to sxeeute and deliver to contractor,that joint note in ucadana with his(their)abmro obi podw as rsquttted by 000e 5". Upon ndtual to do so,contractor msY M its option teeing the entire contract prig or so murk tm as then rw)ns unpwi4 umaadiattly'Qts gad peyWn. '1 agrtod that,if perrnitad by law,mnaaelQ shall be paid by the owner(s)all rasonabk costs,attorney toes and expenses,in addition to the amora8 due and wspald,Ow shall be inc urod In entoreieg the to res wad conditions of the cunurwl and/or any lien in coanectioo herewith Property entry lx subject to asech+oe's Ilea Itunpald,It is further agreed that this ootutut may be usWa by wnaaaor,and also dhu the obligations hereof than band rad apply to their beta,aucceswn or calm of the partes.The,nndm*W wannest(.)that hr is(they are)the oAuem(s)of the above mentioned pramm and that team tine thaoo staods of record it hA(their) arr+cs(a).These ase ao sspraauationc.ou"wia or wmmoa, ted except such as may be herein incorporated,if any.nor any aamco mu cotlaical bert$%a"Is ft conditions not herein sated.Any subsequcat�cegrast m reference baxto stall be binding dtty if in vtitiaa wad signed by coetrad Thm ss upon a wbjed to AH panics. All Home Improvement Contractus shall be registered and any inquiries about a contractor or subcontractor rotating to a registration should be directed to the Office of Consumer Affairs and Business Regulations,Tet.(617)973-9700. Any and all-tucessttry eonsuuction-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 MOL c.142A. Completion date......................................... .............. Approximate stetting tau of work............................................... p Receipt of a copy of this contact is hereby acknowledged,and it is further acltnowledged by the undersigaai the the twine lag provisions have beroad and the contents thereof understood and that no representation or agreement not Isem 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 throe business days of the below-referenced data•Mail or deliver a signed and dated notice or send a telegram to Castricone Roofing&Siding Inc,2318 Sutton St.,No.Andover,MA 01845. les have txseunto signed their s is...........�..... y of., ....... 20...� IN WITNESS WHEREOF,the part Accepted: Ow®er Signed... . .... ».z ». ... » . Signed» ...... . »..... ,....» ...... .»....»...------ Owner David Csstrkoae,President The Commonwealth of Massachusetts Department of Industrial Accidents v Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly Name (Business/Organization/Individual): �� (0)M Ent, ("!e� Address: C�213 S46 n t City/State/Zip: Phone #: Are on an employer? Checkpe appropriate box: Type of project(required): 1. I am a employer with : 4. ❑ I am a general contractor and I 6. ❑New construction have hired the sub-contractors employees (full and/or part-time).* listed on the attached sheet. 7. F1 Remodeling 2.❑ 1 am a sole proprietor or partner- ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers'comp. E] Building addition [No workers' comp.insurance comp. a corporation 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 12.?Roof repairs insurance required.] c. 152, §1(4), and we have no q ] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 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 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 my employees. Below is the policy and job site information. ( 1- � r l Insurance Company Name: G cLI.V�►'td Policy#or Self-ins.Lie.#: WO O Q 3q � 9 D3 Expiration Date: r1 "C� , ow '~�'U1� City/State/Zip:lub, f`1i'lc(6mv. Job Site Address:�� 1 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 forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the-pains and penalties ofperjury that the information provided above is true and correct. Signature .4 J C Date: �T5 Phone#: q y� ` 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#: DATE ACERTIFICATE 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(les)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 nArc NO: 233 West Central St E-MAIL DDRESS:sdonnell@easterninsurance.com A INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER A Western World Insurance Cc INSURED INSURERB:Commerce Insurance Company 4754 David Castricone Roofing & Siding Inc, DBA: INSURERC:Granite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURERD: INSURER E: North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBERklaster 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 LTR TYPE OF INSURANCE INSR WVD SUER POLICY NUMBER POLICY EFF MM/DDY� LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGEPREMISESS( RENTED 50 000 Ea occurrence $ r A CLAIMS-MADE lil OCCUR NPP1388404 9/6/2014 9/6/2015 MED EXP(Any one person) 5 1,000 PERSONAL&ADV INJURY $ 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 S AUTOMOBILE LIABILITY EOa BINEDt SINGLE LIMIT S 1,000,000 ANY AUTO BODILY INJURY(Per person) $ BALLOWNED SCHEDULED CNGCV 8/1/2014 /1/2015 AUTOS X AUTOS BODILY INJURY(Per accident) S X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ IAUTOS Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ C WORKERS COMPENSATION I WC STATU- OTH- CRYAND EMPLOYERS'LIABILITY Y/NI ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) 0003989723 9/23/2014 9/23/2015 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/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. INSn25 t9ninnsi m Th.Ar r)Pn Hama and 1—arc+r ichamrl m-11—of Arrwn Massachusetts - Department of Public Safety Board of Building Regulations and Standards (-111INhllL11i)71 Sul)CrNnj)r Slic.1;1IIX ,-,cense* CSSL-099358 DAVID T CASTRICONE. 31 COURT STREET . NORTH ANDOVER MA'4'011%'s Commissioner 12/16/2015 Office of Consurner Affairs& Business Regulat�n :i4�OME IMPROVEMENT CONTRACTOR {registration: 104569 E Type: .'.>, , Expiration: 7/14/2016 Private Corporatic DAVID CASTRICONE ROOFING, SIDING & David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845— Undersecretary crown of North Andover o "07" Building Departmento 27 Chasies Street 144 P �onL oover Massachusetts 01845 "Y ' r o , (C"78) 688-9545 Fax (978) 688-9542 C EZ S.v CAH U s DEBRIS DISPOSAL FORM a 0 `aTice with tJhe provisions of MGL c 40 s 54 and a condition of 1 2Z perrniI the debris resulting from the wort: shall be disposed o .r: a oper!y i ceased solid waste disposal facility as defined by MGL cl 1, sl 502 T ne �-ebrrs , i be disposed of in /ar Facility location Signature of Applicant Date NOTA A demoh[lorn permit from the Town of North Andover must be obtained for this Pr o ect tIucuoh the Office of the Building Inspector. h