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HomeMy WebLinkAboutBuilding Permit # 10/13/2015 ... . .. � pp taonva� BAIL I PERMIT ®�Ky Leo /6.06 TOWN OF NORTHA V o , . APPLICATION FOR PLAN EXAMINATION - � 2 `n Date Received °RArEv �y Permit No#: �SSgcoaus�� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 13,1vi — .. Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT:_ Historic District ye no Machine Shop Village yes no TYPE OF IMPROVEMENT tPRED USE Non- Residential l❑ New Building mily ❑ Industrial❑Addition more familynits: ❑ Commercial ❑Alteration ❑ Others: ,'KRepair, replacement ❑Assessory Bldg ❑ ❑ Other a r , ,-r r /i o i rv9 r rur%dy ii/Il ri//°i/( ✓iii i /i//Jl%/ij//%ji i! Demolition // 00), r,! ! I 1/ � DESCRIPTION OF WORK TO BE PERFORMED: Identificat' - Please Type or Print Clearly Phone: & OWNER: Name: Address:_ 6 ^� ��) Contractor Name: ( �� / Phone: 97 Email: - Address: ar � Supervisor's Construction License: 4 —Ex p. Date: Exp. Date: Home Improvement License: fF�� 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. FEE: $ Total Project Cost: $ /`l� — Receipt No.: Check No.:_ � � NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund t%®RT H Town of ndover . 41— T - �„Ka h ver, ass, COCNICN@WICK y1' AOoArED, P���S S U BOARD OF HEALTH PERMIT Food/Kitchen Septic System THIS CERTIFIES THAT .............. .�r,�... . .. . ...... . �h. ....................................................... BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .. . ..... ...................................... Rough tobe occupied as .... ...... ..... .. ... .... .... .. ........................................................... Chimney provided that the person accepting this permit shall in a ery 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 IT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR ' UNLESS CONSTRUCTION T RTSRough Service . . ......................................... 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 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: Owner's Name....t��f2 t7.tr....t°....... /r(�C.. /� / .................... ..........Tele one#..... ' ". `d`. ......... Job Address....teT.. �...� til}1,� city... JiSy. r,Yb LY1�. ..... �.................. ...........State.... .... ......... Specifications: Strip existing shingles ,ply new drip edge to all edges. g ItflitP� ............................................................................................. ............................................................................................................... Apply_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. /J O i So- .......................................................... . .........�....,.............`........................... .. ....................................................... .............................. Apply felt pp r nderlayment. nstall ridge vent to . xr1. . @ /eriQ;A ..................... .. ......................r.,..- __ ✓Reroof usin shingles with a _year warranty. / ........................................................................................ .. ...............P_i� f ........ Counterflash chimney. t'l�1ew vent pi a asating,"Legal disposal of all debris. n , ........... ............................................... ..... .. ........ ............................. . .................... \ Area(s)to be worked on: rr ... ................. �.r..... . ...,� . . 01 ..i�..X.. ... . �.... ...��. n.. ................... tit ................ ... ..a r.... 1-:1.......................... Roof board replacement if necessary sheet obv/foot. ............ ........................................................................................... ........ .......... .................... Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as spe ' ed by ma f cturer The ctor a s to erform the work d i the materials specified above for the S of$....$. L.�....... ........... I Payabl „tr�E? ).........on...Sct� ......... Payable.............................on................................. � glance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability wh o 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 woilq 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 agroed 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 arc)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 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 Iti�c,22331j�utton St.,No. dovor,MA 011845 IN WITNESS WHEREOF,the parties have hereunto signed their names this..PY..(..tt day of... 1. i.......,20..`!7... Accepted: ..�'� 6e e v,7/lir�h Signed........ ....ll�/.......�.. ........................................ Owner — �1 Signed............................................................................ Owner �.t� .. r .. David Castricone,President The Counnonweatilh oj'AlassCIchu-,eas Departinew of Industrial Accidents Ofj Ice oj Investlg a,tiolls 600 I-Mashin Bion Street Boston, Tam 02111 1ViV➢VJ11aSS.gov1dlll STy� Workers' Compensation Insurance Affidavit: Buildei-s/Conte-actor-s/Electii-icians/Plumbei-s kpplicant Information _ Please Print Legibly Tame (Business/Organization/Individual): / address: :ity/State/Zip: ./VO, 11 y7 C1�'�o , Hyl d%[VjP-hone #: 9`VD 0 re ou an employer? Clteck the appropriate box: A. ❑ I am a general contractor and I Type of project (required): I am a employer with 6. ❑ New constniction employees(full and/or part-time).* have hired the sub-contractors 1 am a sole proprietor orpartner- listed on the attached sheet. 7. F-1Remodeling ship arid have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Buildin- 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 1 am a homeowner doing all work 11.❑ PIumbing repairs or additions myself. o workers' com right of exemption per MGL y p c 2, 1 l and we have no IZ Roof repairs insurance required.] t 15z ( ) employees. [l'Jo workers' 13.❑ Other comp. insurance required.] I applicant that checks box ifl must also fill 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 shoving the name of the sub-contractors'and state whether or not those entities have oyees. 1 f the sub-contractors have employees, they must provide their %+•orkers' comp.policy number. rt an employer that is providing Workers'compensation insurance f r mil employees. Below is the policy acrd job site winar'iott. Trance Company Name: �l'��/�i `� � l�J✓���1y'��O cy it or Self-ins. Lic. fl:_&C C Expiration Date: Site Address: V/� 6d/mUl') �_%h City/State/Zip:10Q, Ad1)W&_ A/ XV- ach a copy of the workers' compensation policy declaration page (shoving 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 astigations of the DIA for insurance coverage verification. r hereby certify under the pains acrd penalties of perjury that the in ornzation provided above is trite and correct. nature: C Date: me 9: , �tijt 3��� �. Officitrl use only. Do not write-in this area, to be completed by c; r or tort"n o fch L City or Town:_ Permit/Licet;se 9 Issuing Authority (circle one): 1. Board of Health 2. Building Deparainent 3. City/Tovm Clerlt 4. Electrical inspector +. Plu-robing Inspector A CERTIFICATE OF LIABILITY INSURANCE 9/1;/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 PHONE (800)333-7239 x66807 FAX (781)586-8244 A/C No 233 West Central St E-MAIL DDRESS:selectwork@easterninsurance.com A INSURERS AFFORDING COVERAGE NAIC k Natick MA 01760 INSURER A.-Wes tern World Insurance Co INSURED INSURERS Commerce Insurance Company 34754 David Castricone Roofing & Siding Inc. INSURER C: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 A L UBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIYYYY MWDDfYYYY LIMITS GENERAL UABIUTY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISES Ea occurrence S 50,000 A CLAIMS-MADE Fx_1 OCCUR NPP1404373 9/6/2015 9/6/2016 MED EXP(Any one person) S 1,000 PERSONAL 8 ADV INJURY 5 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG S 2,000,000 X POLICY IRO- JPCIT M LOC g AUTOMOBILE LIABILITYEOa a"'NEDt SINGLE LIMIT $ 1,000,000 13 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED CNGCV /1/2015 /1/2016 AUTOS AUTOS BODILY INJURY(Per accident) $ X X NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident S $ UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ C WORKERS COMPENSATION LIMSTATU- OTH- AND EMPLOYERS'LIABILITY YIN EEL x WC ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMSER EXCLUDED? NIA E.L EACH ACCIDENT 5 100,000 (Mandatory in NH) HC003989723 /23/2014 /23/2015If es.descnbe under E.L.DISEASE-EA EMPLOYE S 100,000 DESCRIPTION ON Of OPERATIONS below KC003989723 9/23/2015 9/23/2016 E.L.DISEASE-POLICY LIMIT $ 500,000 L__ _ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 701,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 REPRESENTATIVE North Andover, MA 01845 John Koegel/KH3 ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025nnlnnslm Tho Ar--r1Rr1 nomo 2nri Inns aro roniefa—H mnr4e of Armon Massachusetts - Department of Public Safety Board of BuildingRegulations gulations and Standards C nstructin❑ SuhCrN iv,r SIiCClAh ,_cense: CSSL-099358 - DAVID T CASTRICONE 31 COURT STRE.ET ; NORTH ANDOVER MA35 ��• C�Xp+ratl0'1 ,,ommissioner 12/16/2015 Office of Consumer Affairs& Business Regulation ;lt}OME IMPROVEMENT CONTRACTOR IE egistration: 104569 = Type: ,.,;Expiration: 7/14/2016 ;_ Private Corporatie DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undersecretary