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HomeMy WebLinkAboutBuilding Permit # 8/10/2015 BU q- IJILDING PERMIT 0� N4EORTy D /6�"YO TOWN OF NORTH ANDOVER �� y. 16 ,,. APPLICATION FOR PLAN EXAMINATION ® A O j my M � p �q cocNl<Mewc V Permit No#: ` Date Received �4 ORATED SSACHUS� Date Issued: 16 IMPORTANT� Applicant must complete all items on this page , / LOCATION r1 f R Lei T -b Print PROPERTY OWNER ( Ic .S ► 0 Print 100 Year Structure yesno MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Buildingne family [IAddition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial >PRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Sepfic, ❑Well ❑ Floodplain ❑Wetlands ❑ WatershedrD�stnct Q Water/Sevuer 1 � f �1 DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: a 's Y.OLU 1 Phone: . l- Address: b(�A /K) 0,�b r+° zd HA E4.- Contractor Name: GI's fn 60tvJ-1-1 Phone: ) 7 �- 3 3 Email <,r�-o;�C C(,k-,� co ;,�q Address: 123i R too r4-1- ,��rc>Jn / k Supervisor's Construction License:( Exp. Date: Q­ -J(,-- --1Y Home Improvement License: Re I Exp. Date: 17 ARCHITECT/ENGINEER 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: $ V Check No.: 7 011 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyf and -- - - - ... c tkORTH Town of Andover 0 • ® L^Kf h Ver, ass, COC "I L BOARD OF HEALTH Food/Kitchen PEK I �T� T L �T Septic System A?C- THIS CERTIFIES THATBUILDING INSPECTOR ................................... ? . . .. . .... ...... ........ .... ® Foundation has permission to erect ....... ....:.:..... buildings on ... ..�. ..... . ... .... ....f............ ............... . Rough p .. to be occupied as ............ ......... ........... . ......................................................................... Chimney provided that the person accepting t is 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 ELECTRICAL INSPECTOR UNLESS CONSTRUCT!.IO ARTS Rough - AService .. ........................ 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. 8 11 7. 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 materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on premises below described: IqOwner's Name...L1.11!.. exS./.lt2.lAL. ... ............................:............. lephone#...(.. A.. 1 �. '..tv.l...L.c� Job Address... l. .. r.. 'a ,`Y /�/� a..........City.. ...a:A ..Q..l!-1-4...................State..l..:.t. Specifications: ................................................✓.............................................................++..................................................................................................... Strip existing shingle/,� Apply new drip edge to all edges. Wk,7;t; g'' .........................................................................•................................. ...............•......................................................................................... (Apply--(t2—feet ice and water shield membrane to bottom ed..es of house.3 feet ice and water shield membrane in valleys and bottom edges of any unheated areas of house. ] n i A..p..p....l.y�....yy..n.. �t... .......a....1.~.-....-....-...'. C. a_a ........................................................... ........... . ....p.a..p........ m 'I . . ..... un 'Install ridge vent to . ............Leroofusing ........ii naes with � y..14 ..z..r.. yearwarrant • u, owiterflash chimney. shrew vent pipe tlashing. egal disposal of all debris, �• r' � \ ✓Area(s)to be wm ked on: f................... ...'. ....s .� �1...L1 E 'at�$....Q .. .Q.ta+....... ........................ 1 ...... .... ...S..l. ..,t.yt ... ..��^�-r�......�. �e.�.,�...�.ul. .....1.'.0.�.......y.��. .5.......�.....ts�.©,�1......•.............. ........�(.�.k.1.... ....o»S.hZ........�.n...�/ '.:� .�:....... � ..e�.i-P ....17.�1:t:t°�..C.. !-:..C�. �a.4.�:�`.d.:Ft. "" r Roof board replacement if essary /sheet /foot.(1�l (� - fr• "' ......................................... .....�Xf.�t r\.C1.xYt1t )' n. i r .... .... Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specy manufacturer The contractor agr, to perform the work and fu 'sh the materials specified above for the S of$...�/�.C�fid............ Payabl on.,,-I--� ....... fir................ Payable.............................on.................................. Balance payable on completion ofJo 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 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,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 tents 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) names(s).There 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 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 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 ontained 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 o the below-referenced date.Mail or deliver a signed and dated notice or send a telegram to Castricone Roofing&Siding Iric,23 S tton St.,No.Andover, A 01845. IN WITNESS WHEREOF,the parties have hereunto signed th ' es thi .... . .. ..day of. .... err, Accepted: Siged...... . . . . ..................................................... Owner Signed............................................................................. Owner David Castricone,President The Co: imorrwea h ofTlassachuse/t's Depar•tinew of lit dustr irl Accidents Qf ICE' of Invesd ations ,41V=3 1 600 f-Mashinglon Street Boston, l'a,tt4 021 11 7viviv.ntass.golr1dia Workers' Compensation Insurance Affidavit: Baildel-s/Conti•actor•s/Electil-icians/Plumbet•s Oplicant Information _ Tease Print Legibly Tame(Business/Organization/Individual): G>t� address: Q _� / 6" S I j A .ity/State/Zip: . i D[ �_ AtvA6vn' NA 66ff Phone #: C-ok 6 3 � re you an employer? Check the appropriate box: Type of project (required): I am a employer with 4. ❑ I am a general contractor and I 6- ❑ New constriction employees(full and/or pari-time).- have hired the sub-contractors 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition 'k v d h employees and workers'working forme in any capacity. 9. MB.uildin- addition [No ,workers' comp. insurance comp. insurance.t b required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions officers have exercised their I am a homeowner doing all work o 11.❑ Plumbing repairs or additions myself. o workers' com right of exemption per MGL Y , P c. 15?, 1(4), and %ve have no 12. Roof repairs insurance required.] 1 13.❑ Other i employees. [No workers' COMP. insurance required.] /applicant that checks box it] must also till out the section below showing their workers' compensation policy information. meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ttractors that check this box must attached an additional sheet showing the name of the sub-contractors'and state whether or not those entities have oyees. )f the sub-contractors have employees, they must provide their XYorkers`comp.policy number. rr an employer flint is providing tvorkers'compensation hisurance for m), employees- Beloiv is the polici;and job site t rfil a2'1011. /�'� \ trance Company Name: l_ (--Cc-t\ 1 YlSC3Y�s�� � cy tt or Self-ins. Lic. /l: 3 1 �q 9a__5 Expiration Date: 1 Site Address: G W-o �(�r" City/State/Zip: &L ' _ acts a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Lire to secure coverage as required under Section 25A of h4GL c. 152 can lead to the imposition of criminal penalties ofa. 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 !p to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of astigations of the DIA for insurance coverage verification. r hereby certify udder the pains acrd penalties of peijury that the in orination provided above is true and eorr•ect. nature: Date: me 9: qJA Official Ilse only. Do iloi write in this area, to be completed by cityr or town offrciaL City or Town:_ Per9Tttt/I,tCOise H issuing Authority (circle one): 1. Board of health 2. Building Department .i. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector. A�® CERTIFICATE OF LIABILITY INSURANCE DATE 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 FAX 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 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 N UMBER: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. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MMIUDD� LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE _ $ 1,000,000 DAMAGE TO RENTED 50,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrenceS A CLAIMS-MADE [i]OCCUR NPP1388404 /6/2014 9/6/2015 MED EXP(Any one person) S 1,000 PERSONAL&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 S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 1,000,000 B ANY AUTO BODILY INJURY(Per person) S ALLOWNED rX SCHEDULED CNGCv 8/1/2014 /1/2015 BODILY INJURY(Per accident) S AUTOS AUTOS XHIRED AUTOS NON-OWNED PROPERTY DAMAGE S AUTOS Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTIONS S - C WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS FIR ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? 0003989723 9/23/2014 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 I 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) ©1988-2010 ACORD CORPORATION. All rights reserved. 1NS025/9mnnsi m Tho Ar r1Rr1 n-.nri Inns pro roniotnror)mor4c of,&nnp T Massachusetts - Department of Public Safety Board of Building Regulations and Standar as C„n�tructi,ur 5uhcrN nm-Shr.t;:ltN —cense CSSL-099358 DAVID T CASTRICONE 31 COURT STREET b NORTH ANDOVER Ak 90145 =xpi tali 0!1 Commissioner 12/16/2015 1`,..... .....,r,r Office of Consumer Affairs& Business Regulation ;i -ROME IMPROVEMENT CONTRACTOR l �egistration: 104569 Type: Expiration: 7/14/2016 Private Corporatic DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845— Undersecretary µ�k7N rFowii of North Andover �0� 4 ro , L Building Department 2% Cha-rles Street , " f , Nonli A-1-idover, Massachusetts 01845 ` � 1 t ( %8) 68 8-9 54 5 Fax (978) 688-9542 * zy%R, Is, +cHUS�� DL-BR1S DISPOSAL FORtVI erdaJ ce with the provisions of MGL c 40 s 54, and a condition of 1)ca Derma the debris resulting from the worl�- s.Itall be disposed or 2 aroperly licensed solid waste disposal facility as defined by MGL cl 1, s150a ^e deb,is tbe disposed of in ;at L, s /All Facility location ` 1 Signature of Apoh,:ant Dave l ' NOT' a demoi tion per rtit from tate Town of North Andover must be obtained for this prcject tlueu,-h rile Office of the Building Inspector. i f r i i