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HomeMy WebLinkAboutBuilding Permit #181-16 - 57 Peters Street 8/10/2015 C _ $- `�` I — ,. ��'��'7 BUILDING PERMIT o`NO RT b;�tio TOWN OF NORTH ANDOVER o - APPLICATION FOR PLAN EXAMINATION f Permit No#: U / 4 Date Received R Date Issued: gh 1 �gSSACHUs���y IMPORTANT: Applicant cmust complete all items on this page LOCATION 7 �7 �U U e�� -Pn t PROPERTY OWNER J 0 Print 100 Year Structure Z yes no ' MAP. / PARCEL.c���ZONING DISTRICT: Historic Distract ye no Machine Shop Village yes no f TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial j ❑Alteration No. of units: ❑ Commercial �I Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition '®'Other SdDisneptic OWell Flo ? aarshect OWater/Sewer ' DESCRIPTION OF WORK TO BE PERFORMED: I j Identification- Please Type or Print Clearly OWNER: Name: —irvl Phone: 1 Address: Y, Ah V�� Contractor Name:�1J, C'iw iwr1e. Phone: d Co Email: P obi is: ct� Address: .: >. S-1 Sf 0,y- VAC1.4 Supervisor's Construction License: 2536 Exp. bate: % /�.Y/� Home Improvement License. . . !(/f�� 9 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: $�� ` h� FEE: $ 7 1 11 Check No.: 2TAb Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 6ffiiffiis _ — ._. .: �& � _ � � r r A - _ — Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ � TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dmmpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature k COMMENTS HEALTH Reviewed on Signature COMMENTS i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature & Date Driveway Permit ]DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPAR�TiVIEIVT = Temp bumpst ear o�n'1sifeyes Located at 124 Main Street ° ':` s ,,'� ' '. ," %> • - b x d >, . # t . . ,Fire De• artment si natureldate: 4 , 2:. - a �, `zEFMill I • A 3. 3 +tom e r 3 t o n v UQ�MME �S l< a _' vky ''ytsme r� rcna�►Nw^..7 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Dieter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) i j Y i i I 5 I I ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 I� I Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits l 4. Building Permit Application 4. Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Location No. Date " t - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� 7! Foundation Permit Fee $ ! Other Permit Fee $ TOTAL $ Check# P Building Inspector, NORTH Town 2 t E. ...'.Ir ndover O No. . - y . o ^�E h , ver, Mass, �/o �-' COC MICAI IcN y1' S IJ BOARD OF HEALTH Food/Kitchen PER..MIT T LU,y Septic System -" el '/ e 41" S ��v�`" BUILDING INSPECTOR THIS CERTIFIES THAT ... ......^5....! .................................1,...... .......................................................... has permission to erect ......................... buildings on . .�.. .� .�' `::�..:�...` .................................... Foundation . Rough to be occupied as -............... chimney .............. lccJ....:5�.....!:Z ............. .. .. . ............................. provided that the person accepting this permit shall very 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TARTS Rough Service ..... .c,"' ................................ 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 CASTRICONE ROOFING&SIDING INC. ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 a 3 O R tW SUTTON STREET,ORM030,NO.ANDOVER,MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314 Uwe 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: �O n� e A 1 Owner's Name... ).��:�.:...q1� Ck(.h........ � 9.(.� 1111. ...a V.41��....Telephone#.................................................. Job Address........7o........ .. .............. ...................................City.....1p.�./..�.0.....y4y.. .. . ...........state..O! .......... Specifications: ..................................:....................................................................... ............ ..................................................... Areas to be covered. .��..S+.f:.�.! .a ' ...a ..... .. u ...cl ....S.C.�ti d................................................ ✓Apply vinyl siding and corners. Type: � r r r � CtS�L Q �►o(r t Lo i Ir,1a�f WJ ,I .....:...:..:......:... :...................... .. .:....w.11......: L�.r................ .. .. ✓Cover fascia boards and rake boards. Install vinyl soffits lid / perforated ........................................................................... l a Replace any gable vents and dryer vents with vinyl. Cover wood casings around windows. C I�................................................................................................................................................ ply underlayment. Type: �� ............:.............................. .........1 UExisting siding strippe / go-evera S j({�,,5 gal disposal of all debris .................................................................................................... ................................................................................................................ Rotted wood replaced® �S/sheet or foot. f ` ................L.e�?�"1.C�'......4...Ll°1�a. ............................................................................................................................ ...................................................................................................................................................................................................................... ...................................................................................................................................................................................................... .............. One Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specified b u The co tractor afire to rform the work an f irni h the materials specified above for the SUM of$.. . �.Q..t.. . I Payable... C.Q........on.....S.4t,............ Payable....�ytjk�Q........on....Z'... :.C.N. .1LbtM Valance payable on completion of job Owner r Owners are not respoable for Property Damage or Li ility while job is in operation. Contractor is not responsible for any damage to the interior of properly,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 mother living spaces).Upon completion of above work,all undersigned agree to execute and deliver to contractor,their'oint note in accordance with his the' requested b contractor. J (their)above obligation as req y . 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.It is further agreed that this contract may be assigned by contractor,and also that the obligations hereof shall bind and apply to thea 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).Thera 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 dirgctedto:Director,Home improvement Contractor Registration, One Ashburton Place, Room 1301,Boston,MA 02108 Tel:617-727-8598 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 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 Owner has three business days to cancel ancel this contract and incur no penalty (see notice of cancellation). IN WITNESS WHEREOF,the parties have hereunto signed their names this... of............. . y ........,20.. 5... Accepted: •.1 .. Signed. ................. Owner Signed............................................................................. Owner David Castricone,President /J The Commonwealth of Massachusetts Department of IndustrialAccid&ts Office of Investigations 600 Washington Street .Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgadzation/fndividual): _a L)10 eA_S 1 iC rj,c L lee) Address: �3 City/State/Zip: %del. Mill b6 VeX Mia Cl/f V-lr Phone#: 9�2� -6b3 jyd"O Are you an employer?Check the appropriate box: Type of project(required): 1.V I am a employer with b 4. ❑ I am a general contractor and I 6. Now construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.# 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 required.] officers have exercised their 10F]Electrical repairs or additions 3. doin I am a homeowner all work right of exemption per MGL 11.E]Plumbing repairs or additions ❑ g myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]i employees.[No workers' comp.insurance required.] 13�Other � 6— *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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 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:. 7. Q_S�617g_ Policy#or Self-ins.Lie.#: 45�,,Je_ 00&3P E y`fid 3 Expiration Date: \ _ Job Site Address: ��� % .�� Ui/�f % City/State/Zip: /t-��° D�ij�� 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 certio under the pains rind penalties ofperjury that the information provided above is true and correct. - Caa +.� Signature: �� Date: Phone#: 9 �• �� 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#: Information and Instruct iolms Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,• express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(ifnecessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit-must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Zn dustrial Accidents Office of Investigations 600 Washington Street Boston,MA.02111 Tel,#617-72.7-4900 eft 406 or 1-877,MASSABE Revised 5-26-05 Fax#617-727;7742 www.znass,govfdia A CERTIFICATE OF LIABILITY INSURANCE D IDD 9//10/10/201144 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 Susan Donnell Eastern Insurance Group LLC PHONE . (800)333-7234 a c No: 233 West Central St E-MAIL ADDRESS:sdonnell@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER AWestern World Insurance Co INSURED msuRERB 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 NUMBER3taster 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 EFF POLICY EXP LTR POLICY NUMBER MMIDD MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ENTED }� COMMERCIAL GENERAL LIABILITY DAMAGE TO R PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE Fx�OCCUR NPP1388404 /6/2014 /6/2015 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-COMP/OP AGG $ 2,000,000 X POLICY PRO- LOC S AUTOMOBILE LIABILITY EOa BINED1SINGLE LIMIT $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) S ALL OWNED FX SCHEDULED CNGCv 8/1/2014 /1/2015 AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ C WORKERS COMPENSATION WCRY STATU- OTH- AND EMPLOYERS'LIABILITY Y I N TOLIMITS I I FIR ANY PROPRI ETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N I A E.L.EACH ACCIDENT $ 100,000 (Mandatory in NH) WC003989723 9/23/2014 9/23/2015 E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/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. INS02919mnnsi n, Tho Ar f)Rr)namo�ni1 Innn ern rnniclono'i morkc of Ar llrifl Massachusetts - Department of Public Safety Board of Building Regulations and 9 Standards C„n�tructi ,n Sulu r�I� ,r Slrrrl;:li _!cense: CSSL-099358 DAVID T CASTRICONEff \ 31 COURT STREET re N - ORTH ANDOVER MAi e01M8 9:4— W X p;ratl0'1 Commissioner 12/16/2015 I Office of Consumer Affairs& Business R bulat:on ��-�4�OME IMPROVEMENT CONT .�--- RACTOR Lhsl egistration: 104569 Expiration: 7/14/2016 Type: Private Corporatic DAVID CASTRICONE ROOFING. SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undersecretar•y Town of North AndoverN'"YN o� ,,ro 11 Building Department o 27 Charles Street Non)i . ndover; Massachusetts 01 S45 �o = lc IS) 658-9545 Fax (978) 688-9542 �cSHCHUS,� DEBRIS DISPOSAL FOR.%'1 o ca ce with idle provisions of MGL c 40 s 54, and a condition of the debris resu ting from the worl� sit2ll Le utsposed ,,, permit + i. �. 0. .n 2 Droper!y licensed solid waste disposal facility as defined by MGL c) 1 sl SOa e for s be disposed of in /at Facility location Signature of ApQhcant I Da;e i. \0� A demoier rtit from p the ?own of Not?h .Andover must be obta1nc.d For this project tluough the Office of the Building Inspector. -:4 i