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HomeMy WebLinkAboutBuilding Permit # 9/17/2015 BUILDING PERMIT ,ovD ". F TOWN OF NORTHA R APPLICATION FOR PLAN EXAMINATION N . 1F my Date Received �RA�gATED y Permit Rlo#: y SSAC biuS�R Date Issued: I PORTANT: Applicant must complete all items on this page LOCATION L ks Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: _ZONING DISTRICT:_ Historic District yes no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building I�One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial 1Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other c ❑W /, / / r , ,r, , �, DESCRIPTION OF WORK TO BE PERFORMED: 6Ad t/ le Iden , Location & Date OWNER: Name: ,�d i � No. ,,ALJ. 7 (, �I Address:...Lg MMU t N OF NORTH ANDOVER SII T'®W � Contractor Name:, tit eft" $ of Occup anc Email: C, I,ie bC� ��/�/Or' /i Certificate Address: : _ ��°�w I� Building/Frame Permit Fee $ Foundation Permit Fee $ ' Supervisor's Construction Lice Other Permit Fee Horne Improvement License: -TOTAL ARCHITECT/ENGINEER Address: Check Building Inspector FEE SCHEDULE:BULDING PERMIT:$12. ' r Total Project Cost: $ Check No. Receipt No. P _ DOTE: Persons contracting with unregistered contractors do not have access to the uar uty fund ria t4ORTH own ot ndu VC11 ®.71 411)e 01 h V�>t', SSS, C0CIg1CMEW'CK y1. ��QDRATED PP��.�S S U BOARD OF HEALTH Food/Kitchen PERMIT IL LD Septic System Aft THIS CERTIFIES THAT ,,,,,,, „Ik,,.., BUILDING INSPECTOR .......... ... . .. ... ........... ... ........ .. . . . ... .. . .. .. ..... . Foundation has permission to erect .......................... buildings on ....... .. ........ ..�r. ......... . ..... . .® Rough ..... ..................................................... to be occupied as ..................... ... ........ ...... ... ......... chimney provided that the person accepting this pe it 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 16 MONTHS ELECTRICAL INSPECTOR UNLESS C SR N TS Rough 4v+" Service ........ ..... .............................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy BulldinRough 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 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: 4 Owner's Name � :........................... ' .. C.1 .. Job Address....�.. .3 r..............City... �'..:/ :.i...lit.1,,,.G..k:C:.lf................State.. `1A. Specifications: ...............,.�............................. .... ............ ................................................................................................................... YStr•Ip CXIShng Shingh'sL O 1/Pply new chip edge to all edges. Wit i�L_•• �....................................1•...................................•............................................................................................................................................ t/Apply C_ feet ice and water shield membrane to bottom edges of house.3 feet ice and water shield membrane in valleys and bottom edges of any unheated areas of house. u 1 4.1/ Y►1�i7b�(`cE y� C� �C>66 ! �C>t7 S r vApply felt pa cr ul>ticrlaymcnt.i`Inshnll rulge vent to _ f�ig �t(`y�1 5 _ ..... -T^ i VAcroof using(i �^ ! r Syr e.+'l t►�o. '"4/.17 shiuglcs with a 3C! year warranty. ..................................................................................... ..................f�................................................... .. Cnttntrrflash el}rri+my. /New vent pipe flashing. Legal disposal of all debris. ......... ............... ? ................... ................................................................................�.. Area(s)to be worked on: l 1 ................................. 1 i...15..�2.l..xJ.l �:. ........................ .� .1:Y.lG..,�f..�.: .�.!P.I..I.kL.t.k).. ..G?,:t�,:r:�.).�1.l..Gt.1:4`)...K�.►�.f..�v �.E:: '�t1L•.v �.J.II:ti ,i ...3.�':1.19:c..('..zJ'.Jr�%�c4.4'C=;, AIL.tyt.. .l.G....;� .r,�:.�..1:c .. ••.... .1..4(:.A C..iz/ tt.s t`.:.t.., ...\>�/i. ...fr t �.f�Lc:,t` ...J.:G�tr/..r............. o .f .t+............. 5�f!� 1.�...... �.;.. ,.......... . ;. ................... .... 1..................... Roof board replacement if necPssar / /sheet or-, j /foot. i 1 Y ei >'7�� S�ie v %r'�✓N)C' 'a�l�,_Cn C ��.; .................................................................................................................................................................................................. Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as spe 'firTby msnulac3ure The c7agrees to perform the work n¢ ish the materials specified above for the S�of s.... 31—C7..........:..... �)1Payabla .(J..?�.����........on. S�ca.1 :................. . -- , Payable...........................on........... , Balance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability whi e 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 dumpster placed by contractor is for his use only.Upon completion ofabove work,all undersigned agree to execute and deliver to contractor,theirjoint 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 owners)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 he 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) name.s(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. All Home Improyement Contractors shalrbe 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. l t Ll r)v nailj -bo-i" Approximate starting date of work.. `.z..........a.1.�.....t.,... ...... ompletton 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 NOTSIGN 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 file,231 R Sutton St.,No.Andover,MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their names this...1.0.......day of AcceprLted Signed......... ..l.1 .i.. a. .. ........................... Owner cSigned............................................................................. Owner ............................................................. David Castricone,President l.e ~✓Qrrdrra:r�t�ecrftid Of` IEirssrcl?ldSeild's Depar'tinew of hidushr ic1.Accideiz6 u t=-= '` Qf ICE.' of Inveslig tions 600 Ulashinalon Street cP:7 IBoston, ALA 02111 lVTV DV.111ass.govIifllZ Workers' Compensation, Insurance Affidavit: Buildei-s/Conti-actor-s/Eiecii-icians/P6umbers kp-pficant Information Tease Print Legibly %Tame (Business/Organization/Individual): address: SAk U A S f lA Ul(, 3A :ity/State/Zzp: No AY\ lirv� M A MK Phone #: 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 ❑ have hired the sub-contractors employees(full and/or part-time).* 6. New constntction Listed on the attached sheet. 7. ❑ Remodeling I am a sole proprietor or partner- ship and have no employees These sttb-contractors have g• ❑ Demolition workingfor me in an capacity. employees and have worlcers' Y P h'• 9. F-1Building addition [No workers' comp. insurance comp. insurance.) required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. o workers' com right of exemption per MGL Y p• 12." Roof repairs insurance required.] t c. 152, 1(l), and xve have no employees. [leo workers' 13.0 Other comp. insurance required.] I applicant that checks box ill 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. itractors 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. If the sub-contractors have employees, they must provide their workers' comp. policy number. ti an employer that is providing Workers,compensation insurance fir inY ernplauees. Below is the policy and job site trmation. [ranee Company Name: cy It or Self-ins. Lic. N eon . Expiration Date: 7 A �j No nktgt ,� 0 �s Site Address: (QI � 1� '� � ��'�' CirylState/Zip: (� ��' ach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). tire 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 Nvell 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 2stigations of the DIA for insurance coverage verification. r hereby cerci ;�de; e aril acrd penalties of petjury�that the information provided above is trite and correct. nature: Date: me 9: Ise � 3Lt'gC X. Official use only. Do nor write M this area, to be completed by c.'tr or town offlci:rL City or Town:_ P ermitrLicetsse # Issuing Authority (circle oue): i. Board cif health 2. Building Deparii-nent 3. City/Tov n Clerl, 4. Electrical inspector- +. Plumbing Inspector ecoCERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `.� 9/9/2015 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 Select Dept. NAM Eastern Insurance Group LLC PHONE (800)333-7234 x66807 A1C FAX o (701)586-8244 233 West Central St E-MAIL seleettaork@easterninsuranee.com ADOREAILs, INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER Western World Insurance CO INSURED INSURER B COMMerCe Insurance Company 4754 David Castricone Roofing & Siding Inc. INSURERC:Granite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER D: INSURER E: North Andover MA 01845 INSURERF: COVERAGES CERTIFICATE NUMBER:CL159964794 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 ADD SUER POLICY EFF POLICY EXP LTR POLICY NUMBER MM1DD MM1DD UMITS GENERALL ABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE FXI OCCUR rBA GL 2015 /6/2015 9/6/2016 MED EXP(Any one person) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,000 X POLICY PRO-JECT LOC $ AUTOMOBILE LIABILITY O aBccidenlSINGLE LIMIT $ 11000,000 BANY AUTO BODILY INJURY(Per person) $ ALLOWNED X SCHEDULED BCNGCV /1/2015 /1/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ IAUTOS Peraccident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETEN 1 $ C WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N ER ANY PROPRIETORIPARTNEPJEXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? N I A (Mandatory In NH) 003989723 /23/2014 9/23/2015 E.L DISEASE-EA EMPLOYE $ 100,000 Lf yes,ESCRIPTIONbe under C003989723 /23/2015 9/23/2016 E.LDISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below 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/KH3 ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 roMnnsi ni Tho Arnnn nnmo Anel Innn Aro mniefororf mnrkc of AnnRn Massachusetts - Department of Public Safety Board of Building Regulations and Stan dards C mstructiun Sulzer,i,nr Sluciult, cense: CSSL-099358 _, 1 ., F.t DAVID T CASTR[CONE 31 COURT STREET x NORTH ANDOVER NUM010A 5 nt `x p anon Cornmissloner 12/16/2015 11/0 11 W(W11,11 Office of Consumer Affairs& Business Regulation T;1ROME IMPROVEMENT CONTRACTOR (? registration: 104569 ;;Expiration: 7/14/2016 Type: Private Corporatic DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A4�� NORTH ANDOVER, MA 01845 Undersecretary O� 4�`eo 6 �ry0 oIY'vn of North Andover o O Building DepartaIcnt x Cha Fics Street ' O l R45 � r°� dove;, Massachuserts .0 6RS 9;4j Fax (p?R) 6RR R19542 '4ssuc`NUSe DL-BMS DISPOSAL FORM c ,ce ku,th tie provisions of�IGL c 40 resu!aind from�he worition l±� :1L 11 Le i ispos d pe ^fit the del.-iris o-cn r,,, ceased solid waste disposal facility as defined by MGL L:) 1 , sl �Oa he disposed of In /at i Faci:ity ioca[,on �j n Signature of Apc)h;-an[ Da.t i a eemo !t!o ; rer;Tut from the Town of NOr?.n •AndOver must Ov '�U[dlll�Q 101 llll� ouch. thz Office of the su6ding lnspec�or