Loading...
HomeMy WebLinkAboutBuilding Permit # 10/13/2015 , y NORTH 11IL I PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ® _ Permit NoM .°Y ._ Date Received >y ,q Argo i` �( SSAGHUS Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION ( Vc- sv VQ A'/ Print , PROPERTY OWNER G P Print PROPERTY /J Print 100 Year Structure yesno MAP t PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ®'One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other `/r%//,�V./.. / We I/ / /, , // d r land Iain, r ❑/ r / � � D, � , ❑ e t f i/i ���>✓'f,�>�rr,,rr�// /r r r J, /, r 1, �� DESCRIPTION OF WORK TO BE PERFORMED: I A iU o C L- 9 F /AL,(-. S H t N&Lr— A-t4AS e x CE P T- k E/k/C.- Identification- Please Type or Print Clearly OWNER: Name: H A K,(c HC--Li.. Phone: t 1q ,5-6 ) ° )ff Address: I C)3 'WAY - HA 6 1 � `f S Contractor Name: &—SI R ICoL6 F-00,71146- ' Phone: 3- Email: 0 i c)L 6�iccat+i r7ac�C�il� ; c t + Address: ,,3i Supervisor's Construction License: 9 9 s '�, Exp. Date: Home Improvement License: i bq ( cl Exp. Date: '1 .- lq 26 l �- ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ C( u, FEE: $ Check No.: - � Receipt No.: i NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 4// t%®RT'H own ofi _E..:...,, -Andover ® � _ _ •, 9 / 4 .___ h ver, Mass, O LAKE COCHIC NE WICK V 9 A°RgTED rP���S S 11 BOARD OF HEALTH PFMRMMIT I Food/Kitchen AW MRL D Septic System THIS CERTIFIES THAT ......... ...... ..�.. :...G�..... .............................................................. BUILDING INSPECTOR Foundation ... buildings on,`Q .. �� has permission to erect ....................... .....�. .��....................................... .�. Rough tobe occupied as ..................... ..�.�,/,�. ... 0 .......................................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT THS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S ARTS Rough .............. Service ��r.4,-r,-I-.-P.. ............... ......... ..../'x: .../ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Bulldzn Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathingor all 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 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 descri ed: ) Owner's Name......... .............A...� T phone N. 7: Jl� .. .. ........... 0Ci ty... �` .......Job Address...././3......./ .State.....MW(. .....F. i Specifications: ...............................:..................................................................................I..... ............1................................................................................ f trip existing shingles.,O) ►Apply new drip ctlge to all edges. w4 it ...................................................................................................................................................................................................................... yttpply 6_feet ice and water shield membrane to bottom edges of house 3 feet ice snit water shield membrane in valleys anti bottom edges of any unheated areas of house. ............................... ............................�....................................................... Apply flit p 1 ren underlaynrent �.rstall ridge vent to vfieroof sing n — -` shingles with a�jytly �warrauty. //. .................................................. ::............................................................................................................. "ounterflash chimney. tdVew vent pipe flashing.r'f cgal disposal of ull debris. N ...... ..........­*...... Area(s)to be worked on: ........................................... �.....f�.D• .G G�7 .....�??�.c .0 .. .......j'�u� l ..S..L4lt1Q. �...................... i le V)q D.y. . .... ......r. .... . ti ...... ... ..N. ................. 7"',..... ... r r �.................. j� ..... .................................................................................. e,v/foot. ............ Roof board replacement if necessary a. /sheet o tri• ....................................................................................................................................................... Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specirte manufacturer The contractor agrees to erform the work�fu is the materials specified above for the SUM f$.....�.�j p•�••........ ., r, I Payable...:. . ..M!0.......cn..5..,ri f. ............... Payable.............................oP................................... Balance payable on completion of job 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 matelinls specified above(i.e.objects coming loose from walls,crumbling plaster,exposed nails,dust in attic cr 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 ag ee 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 tray 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 shill 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 andfor 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;hey 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,guarataies 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 conJitions not herein stated.Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all parties. .i 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...................................I............ 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 TRIS CONTRACT IF THERE ARE ANY BLANK SPACES This contract may be cancelled,without penalty or obligation,withhi three business days of the below-referenced date.Mail or deliver a signed and dated notice or send a telegram to Castricone Roofing&Siding itic,23/I1 R Sutton St.,No.Andover,MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their names this.... .!......day of.. .........201.5... Accepted: Owner Signed U_1U--__--_--_.__-_-,-............. Signed............................................................................. Owner ................................................................... David Castricone,President The Commonwealth of Massachusetts Department of Industrial Accidents Ant, Office of Investigations 600 Washington Street w�a� ; Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �1• Please Print Legibly Name(Business/Organization/Individual): DAV' lD CAS-I l l cope- c co fr I KG- 4 S l b(p G 1 N f ' Address: i So-t'-MP �-rc��tiT � l�t` r T 3 ✓� City/State/Zip: 1V 0. k0 A C JtA HA M f f Phone #: 9-)'6 tv Z 3 3 Y 2,V Are.v an employer?Check the appropriate box: Type of project(required): 1I am a employer with p 4. ElI am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.E] I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9_ ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.EJI am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12. Roof repairs insurance required.]t employees. LNo workers' 13.0 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 acid their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: C�f� I'"ice N t.��LAML Policy#or Self-ins. Lic.#: UIS C--0() 3 9 U I?13 Expiration Date: 20 1 Job Site Address: t d C S-r W Pc4 I- City/State/Zip: NO. 14t�QijA 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,certifyu�undder thepains andpenalties ofpeijury that the information provided above is true and correct.* Signature: .`J 01— Cum Date: Phone#: 3 3y)-0 Offacial 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 5. Plumbing Inspector 6.Other Contact Person: Phone#: DATE YYY a� CERTIFICATE OF LIABILITY INSURANCE 9/16/2015 ) 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(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 Select Dept. Eastern Insurance Group LLC PHDNE (800)333-7234 x66807 lAJC( No):(781)586-8244 233 West Central St EMAIL ADDRESS:selectwork@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER A.Western World Insurance Co INSURED INSURERB:Commerce Insurance Company 34754 David Castricone Roofing & Siding Inc. INSURERC:Granite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER D: INSURER E: North Andover MA 01845 INSURER F: 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 ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DDIYYYY MMIDDlYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED COM MERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE OCCUR PP1404373 9/6/2015 9/6/2016 MED EXP(Any one person) S 1,000 }{ 2 PERSONAL 8 ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPIOP AGG S 2,000,000 PRO- LOC $ X POLICY AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 11000,000 13ANY AUTO BODILY INJURY(Per person) $ ALL OWNED Ex SCHEDULED CNGCV /1/2015 /1/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS X NON-OWNED PROPERDAMAGE HIRED AUTOS AUTOS Pe'..'TY' S S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTIONS S C WORKERS COMPENSATION X WC STATU- I OTH- AND EMPLOYERS'LIABILITY YIN EQRY UM T, ANY PROPRIEfOR/PARTNER/EXECUTIVEO N/A E.L.EACH ACCIDENT S 100,000 OF FICERIMEMBER EXCLUDED? (Mandatory in NH) 0003989723 /23/2014 9/23/2015 E.L.DISEASE-EA EMPLOYE S 100,000 If Yes,deScribe under DESCRIPTION OF OPERATIONS below C003989723 9/23/2015 9/23/2016 E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 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 Castricone Roofing & Siding THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Unit 3A ACCORDANCE WITH THE POLICY PROVISIONS. 231 R Sutton Street AUTHORIZED REPRESENTATNE North Andover, MA 01845 John Koegel/KH3 r� ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 onlnnsm Th-Ar:rlRll ar.r)pn Massachusetts - Department of Public Safety Board of BuildingRegulations gulations and Standards (-nnNtruL iim, Sul)crN IN,,Slx•c,lt\ cense CSSL-099358 DAVID T CASTR[CONE . . 31 COURT STREET x NORTH ANDOVER MA,40118 5 ��• =xp,,=anon ,ornmissioner 12/16/2015 =' Office of Consumer Affairs& 13usuiess....... Regulas o/nl rf/ ' ice` ,GOME IMPROVEMENT CONTRACTOR 1 { egistration: 104569 I "., Type: ;�. �;Expiration: 7/14/2016 ., Private Corporatic DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undersecretary