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HomeMy WebLinkAboutBuilding Permit # 11/30/2015 "ORTH BUILDING PERMIT F.D TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received co Permit:No#: /11, Iss CHUS Date Issued: APORTANT:Applicant must complete all items on this page LOCATION T) S. Print PROPERTY OWNER �L I (), n 6" �-� kL Jv / Print 1 100 Year Structure yes 0 MAP______PARCEL: ZONING DISTRICT: Historic District yes bno Machine Shop Village yes 0 TYPE OF IMPROVEMENT- PROPOSED USE Residential Non- Residential ❑ New Building R--One family 11 Addition [I Two or more family [I Industrial [I Alteration No. of units: [I Commercial ;WRepair, replacement 0 Assessory Bldg [I Others: El Demolition 11 Other ®r DESCRIPTION OF WORK TO BE PERFORMED: C. a o r & J Identification- Please Type or Print Clearly Phone: OWNER: Name: J )rJ (AA Address:2) 1 _1)(P,4')C, �N�A Contractor Name: ri,15 Phone: Q _7� , C-) 93, 6` 2-0 Email: C�jL,01 co Address: ,A,3 'i P !Li 3 ,A �o Supervisor's Construction License: CV_)) � Exp. Date: 'i t I -Home Improvement License: L( S_(p"I _Exp. Date: 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: L4 �, (0-0 FEE: $ 600 Receipt No.: 3 Check No.: R - I vaccess to the guarantyfund NOTE: Persons contracting with unregistered contractors do not have or 4 %Ainpr, :', NO RTpi _t own of Andover 0- -;S�Lw a�. � o' 6 _- T (% LAME h very a.ss, COCHIC"EWICK �l.9S RATED U BOARD OF HEALTH Food/Kitchen rwERMIT T LD Septic System 2THIS CERTIFIES THAT *'(A1&....... . .. ....................................................... BUILDING INSPECTOR has permission to erect.......................... buildings on .... ......... . .41u,.... ............................. Foundation 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 PERMIT(e5)0 . OTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONA Rough Service ....................... ........................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buiddin Rough Display in a Consico s lace 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 CASTRICONF, PRI S. 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 1%we the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to fitrnish all necessary materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on premiss below described—: , Owner's Name....... 7 -eCj e .................................................. phone Job JobAddress..-I/ ..................State.... 1� Yl.•.: ...... specrijicrtioru•: ................................................................................................................................................................................................................ i 'Strip existing shingles)/l h new drip edge to all edges. lii`I rl. S' ; ............................................................................................................................................................................................................I.......... '''Apply_- _feet membrane to bottom edges of house.3 feet ill valleys and bottom edges of ally unheated areas of house. ...............•...............,.....................................................,...•..,.................................................................................................,......... ........... ./Apph felt )atter wtderlal'ment, ('Install ridge vent. to�il� -, Sy'.F.t�.i.- .c::.............��....... `1...-......f...........{. . .. ............................%va,,.,............................................ ✓Reroof using' i-krt�C 1_1t c els j F� I---shingles with a.. _Sear warrant}. ........................................................................................................................... Counterilash chiuute}. mew vent pipe Clashing.✓Legal disposal of all debris. Areas)to be woi"Iced on: • ........................................./).L....:.J..�Ll.Gr ...ta—'... :::L'z.=}.....�_.xL'.�.:. ... - �...r ,i;�-h:..6a-e` -�,1:`L"/L. �.%'�........... , r .{k'A.{.. ...........L",LS•;........l:Jr,..../. :1.t�. jrtik..`:=�.t!....................................... .. ... ......................,...............`.l� ........ .................f,.. .. fi +...............................,..... • 1.��. .... .. .t.... �...V.. k:.�' ,1.jkl..jll.F'Y .r..........., t2oofboard re1lllmelliell t•itjicccssar)_</)... /sheetor� —/foot. �.-...�..........:... . ................... .......................................................... Five year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as spe led by manufacturer The c�nk�ctor El s to rform tire work td ntsh the materials specified above for the S M of$..,��.y =. )............... / ayable 11.E�........on .5.fal �`.............. .. —� Payable...........................on.........:. .................. 2 Balance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability win c 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 hose 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 dumpsler placed by contractor is for his use only.Upon completion of above 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(lien 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 if unpaid.It is further agreed that this contract may be assigned by contractor,and also that the obligations hereof shalt bind and apply to their heirs,successors or estates of the parties.The undersigned wurrant(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 diredted id the`Oflice 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 farther acknowledged by the undersigned that the foregoing provisions have been read mid 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 THIS CONTRACT IF THERE ARE ANY BLANK SPACES This contract ntay 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 nam this....5(��y of... Jq,1.".`�.........20.,i. Accepted: Signed. r... - - „r. .,. .........I.......... Owner Signed... _ � .,�=.,...5,.. , �.............. Owner ....................... � David Castricone,President DATE(MMIDDff ACGOR0 CERTIFICATE OF LIABILITY INSURANCE 9/16/20115) 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 NONEACT Select Dept. Eastern Insurance Group LLC IA . . (800)333-7234 x66807 FAX 781)586-8244 IC C No,: 233 West Central St E-MAIL ADDRESS:selectwork@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC 4 - Natick MA 01760 INSURER A:Western World Insurance Co INSURED - INSURERS 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. 1178 TYPE OF INSURANCE jam A DL U POLICY NUMBER POLICY EFF POLICY M DDY/YEYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 }{ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES 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 S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP70P AGG S 2,000,000 }{ POLICY PRO. LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 1,000,000 B ANY AUTO BODILY INJURY(Per person) S ALL OWNED X SCHEDULED CNGCV AUTOS AUTOS /1/2015 /1/2016 BODILY INJURY accident) S '.. X HIRED AUTOS }� NON-OWNED PROPERTY DAMAGE AUTOS Per accident S 5 UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE S DED RETENTION S S C WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN X ANY FROPRIETOR/PARTNER/EXEC ''" a NIA E.L.EACH ACCIDENT S 1QQ QQQ OFF CERW EMDER EXCLUDED? (Mandatory in NH) WC003989723 /23/2014 /23/2015 11 yes,oesoioe under E.L.DISEASE-EA EMPLOYE S 100 000 DESCRIPTION OF OPERATIONS below KC003989723 9/23/2015 9/23/2016 E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Roofing b 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. INS025 inninnfil ni Th.Ar:rlpl'1 namo anri Inns aro rcnicfororl mar4e of Ar.r)pn The Commonwealth of Massachusetts Department of Industrial Accidents a I Congress Street, Suite 100 Boston,MA 02H4-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information / Please Print Legibly Name (Business/Organization/Individual):, (1,. f f, p t�l,,J iG Address: 1 t �s /!�1/d. A City/State/Zip: o A di P//f Phone#: F ' Are you an employer?Check the appropriate box: Type of project(required) L "am a employer with employees(full and/or part-time).* 7. E]New construction 2.®I am a sole proprietor or partnership and have no employees working for me in $, ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.[—]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑ Building addition 4.®1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.®Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.®I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. oof repairs These sub-contractors have employees and have workers'comp,insurance.$ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'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 and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. f Insurance Company Name: Ural)l Policy#or Self-ins.Lic,#: 'rttr Expiration Date: /_ ° .W Job Site Address: ,� 'i l"11 :7Y"c f City/State/Zip: Ale/ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under tl:ep ins andpenalties ofperjury that the information provided above is true and correct. Signature: ��—' J . l�.o-a Date: , )JO d /0 Phone#: C� �� 6�� 7'K 0 Official 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#: ��7N7;-� � owl, of North Ando�'er °� `�° 2 �� D oO Building ]�epart�ent �`�� „} Y Chiles Street ` assachusens 01S4 5 9 - % l oRR 954 Fax (9?R) 6RR 9542 9S SACH05t DL-BR1S DISPOSAL FORM ,;;;th Ij1e provisions of lel z ael rls resulting from the worn slLll Le disposed _ ty MGL X11 , s1S0A �r1, !,ceased solid waste disuosal facility as definr d b disposed of in fat i Facia?y iouTion n Si=nature of Apol ,.ant D ,0 i e mol,, on permit from the Town of Norm Andover must `Dc �btaine0 for it is ;l, o Qn. tlje off[ce of the Build ng Inspector l Massachusetts - Department of Public Safety Board of Building Regulations and Standards C+n�h ucti+m Suhcr�i�"r Sln•ri;ili� ,cense: CSSL-099358 DAVID T CASTRICONE 31 COURT STRE.ET ,t+ NORTH ANDOVER NW0 5 p J..G..w � `x +ration Commissioner 12/16/2015 iirririn,,1111 r j r ='• Off-tee of Consumer Affairs& Business Regulation 7/ ROME IMPROVEMENT CONTRACTOR 1•Segistration: 104569 E� Type: � ;Expiration: 7/14/2016 Private Corporatic DAVID CASTRICONE ROOFING, SIDING& i David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 l � Underseeretary