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HomeMy WebLinkAboutBuilding Permit # 9/9/2015 BUILDING PERMIT 0. I�ED tkoRT"16 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received Ac Us Date Issued: qm/P�O—IRTANT: Applicant must complete all items on this page 1 91 LOCATION 1�66 6 /<t,0-6 pt PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: j ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Residential Non El New Building RI'One family 11 Industrial El Addition 0 Two or more family 0 commercial 0 Alteration No. of units: WRep­airrep­lacem­ent 0 Assessory Bldg 11 Others: El Demolition El Other V"V' 11 "o, DESCRIPTION OF WORK TO BE PERFORMED: ,, t,Identification- Please Type or Print Clearly OWNER: Name: ) 99i-JIl -J, MaQ/0 Phone: Address: 04 P1106 1�-Ib /A.4 e Contractor on ractor Nacme: 'D- C A&-jr( cz \E- 'Z cF /96- Phone q - 6 (OE Email ) � Address: A D, -J Supervisor's Construction License: S J,� —Exp. Date: L - I o / Home Improvement License: q S-6 1) Exp. Date: /4 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: $ i i7�� , FEE: $ Check No.: -3-6 i5..7-1 Receipt No.: 2-9,3-5�o NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ---------—--------- L4 Sic f contractb--�---L- a---� AM t%O)RTH ® _ \/ LA�� very ass, COC HIC#42WICK RATED 011111111 BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT Jes ..... ... .. ........... .. .. BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ....... .......Ill,.t.alc.....tia&........... ...°. 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 THS ELECTRICAL INSPECTOR m UNLESS TI S TS Rough Service .................. .............................I........................... 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 Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe 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 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: Owner's Name........`i,....v.••{L kt %......t....�... �C�t ` .......................................Tele�S one tt.... rSJ:.:. .�.1�......... Job Address.... �. ..... i..Yt.: _....r .t.�.0. . 1.... ja...City.... Li.y..�.yS.4lllf>.f�/.Nl` .........State.../.••.•� ..... Specifications: .. .............................................................................................................................................................................................................. Strip existing shingles�) Apply new drip edge to all edges, t~J�( r/ ..........................................................................................................................................................................................I....................... ✓Apply W feet ice and water sL;eld nienibrane to bottom edges of house.3 feet ice and water shield membrane in valleys and bottoan edges of any unlieated areas of house. ............................................................ ......................................................................... ✓Apply is#t pal er uu S.Ilerlayntent. 'I nstall ridge vent to................... ......................................... } ✓Rcroof using - . ,� �.1`r r �_�� _--shingles with a-���.I' r warranty. fir...................................... .. . vCountertlash chinwcy. New vent pipe Il:ishing."Legal disposal of all debris. r' .................................................... ..... ... �y......... .. �Area(s)to be worked on: /� ... ................................................................................. r......................'�..#f r. .........t`: !Q .....:-, k>........:::1;:Wit.({ �1,..d........................ I .`�....... .... ........................................................- ......................................... cam- -, Ii..i: �.�....yYi.ears.. ..l.:aWh ;, ...f7?.7d�... .4St.`.L` c9 rt .....kn�?. 1. .C2..V.. ..c>.....carl............................. "e ; . ..-.. .. . .1 .� 'L ...................... ... .. {................ Roof board replacement if necessary @. �D /sheet or F Moot. ............................................................................................................................................................... Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specie yanuf cturer The 9nt actor ag s to perform the work a d rnish the materials specified above for the SUM $.... 'pL '�.z........... s ayable .i � ......on... < ...........y Payable........................on........... .............I..... . balance payable on completion ofjob Owner or Owners are not responsible for Property Damage or Liability wh e-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 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 terms and conditions of the contract and/or any lien in connection herewith.Property may be subject to mechanic's lien ifunpaid.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 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. ra All Home Imprgvemerit 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 unre istered c a ff ors is/excluded )in the Guaranty Fund pr is'ons of MGL c.14 J� .'.Completion date..... f�iL..Lk9.l..<.d. tiJ... :� Approximate starting date of�.......�.. ...... ........ .......... p i . 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,231 R Sutton St.,No.Andover,MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their names this A!P.444,1 day off1� .$.tra f�Q..,20.1.1 Accepted: Signed.. ....�,) .fir. ::z............;....... Owner r) �� Signed............................................................................ Owner G�z ... ..........f ..... d SG:i?71,� David Castricone,President/�L� �r�N711 -110N,Yll of North Andover °� . �� 6 �" O Building Pep artu�ent }, Cha Tr CS Street , t c N.onli k dove; Massachuseps O1 845 o c ^ ° F ax (9-78) 688-9542 ,4\ Q,r,� s� Sx�Nu DEBRIS DISPOSAL FOI��'1 ce ,;;th r�?e provtslons of v1GL c 40 s 54, and a condition of jzt t the debris resulting from the word slLll Le disposed y_ -gip v i,censed solid waste disposal facility as defined by MGt cl 1 , s1 �0a disposed of in ;at / i S Faci'.i?y ioca,.ion \ ; Signature of Apph, ant D6'.e �;OT- A demol1t10n perrrut from the Town of?vor?h .Andover must oc obtalneu for tl?is oc:c ??„e v h the Orrice of the k3uild ng Inspector 'i a The ConintonweL nth oj'TVa,Ssac1m1-,eas Depar•tineiii of Industr ial.Accidejzts -, �V.it �f� , s ig otiojrs (s:�y �: =t_ ice of In e l •�;T `=1 600 T-Mrisfiinalon Street L Boston, AM 02111 zviviv.lirass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Conti-actof's[Electi-icians/PlilYA bets 4-pplicant Information Please Print Legibly %Tame (Business/Organization/Individual):a)AV iii address: I � S0 17'io U I q �- Phone 9: re you an employer? Cheek the appropriate box: 'Type of project (required): I am a employer with A. ❑ 1 am a general contractor and I employees(full and/or pari s-time).* have hired the sub-contractor6. New construction 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 workingfor me in an capacity. employees and have workers' y P h'• 9. OB.uilding addition No workers' comp. insurance comp. insurance.t b required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions I am a homeowner doing all work officers have exercised their I1.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL Roof repairs insurance required.] t c- 152, l(1); and the have no employees. [No workers' 13.❑ Other comp. insurance required.] applicant that checks box#1 must also full out the section below showing their lvorkers' 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. tractors that check this box must attached an additional sheet shot-in-2 the name of the sub-contractors*and state whether or not those entities have oyees. If the sub-contractors have employees, they must proVidc their %V0Tkers'comp.policv number. u an employer that isproviding workers'compensation utsurr;nce for r,w emplovees. Below is the policv and job site irmalion. trance Corn pany Name:�Ll ti cq s 1'1�T� IJ cy it or Self-ins.Lic. 11: U\J COQ Sei k !j D�,3 Expiration Date: Site Address: T i/t e_ /e b 6 _ Il, /� City/State/Zip: /Y� �/�e�y � �`l� J� ach 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 MGL c. 152 can lead to the imposition of criminal penalties of a 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 !tstigations of the DIA for insurance coverage verification. 1 hereby certify under the aifJs and peen_alltiiess of perjury that the information provided above is trite and eorrect. nature: ' ', C""'""�'�`" Date: Oficial uve only. Do not write in this area, to be completed by city ar tOwn, officiaL City or Town:— PcrmitFLWs nse # issuing AutFority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerlt 4. Electrical :rtspector 5. Plumbing )Inspector DATE(MMiDDIYYYY 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(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 FAXAIC No: 233 West Central St E-MAIL ADDRESS:sdonnell@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC p Natick MA 01760 INSURER A Western World Insurance Co INSURED INSURERB: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 TYpE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MWDDYf LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 50 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE [XI OCCUR NPP1388404 9/6/2014 9/6/2015 MED EXP(Any one person) S 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 EO aBGNEDtS INGLE LIMIT S 1 000 000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED XSCHEDULED BCNGCv 8/1/2014 /1/2015 BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S P X HIRED AUTOS X AUTOS er accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ C WORKERS COMPENSATION WC STATU-CRY OTH- AND EMPLOYERS'LIABILITY YIN ER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? NIA 0003989723 9/23/2019 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 $ 500 000 DESCRIPTION OF OPERATIONS I 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 rgmnnsl m The Ar r)Pr)n.m.and Innn ara ronictcrorl mar4c of ACrwn Massachusetts - Department of Public Safety Board of Building Regulations and Standaras Cn�hurtinn Suimr�n��r �Iuru:IR —cense CSSL-099358 DAVID T CAST1 CONE 31 COURT STREET , NORTH ANDOVTR MAS=0118 5 J.G. =Xpi.1atiOn Commissioner 12/16/2015 Office of Consumer Affairs& Business Regulationimmy :�� HOME IMPROVEMENT CONTRACTOR registration: 104569 '` t_ Type: ;,,';Expiration: 7/14/2016 Private Corporatic DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845— Undersecretary