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HomeMy WebLinkAboutBuilding Permit #461-2017 - 21 PETERSON ROAD 11/2/20161 i ��lor, SCAN.�BD /i 'I, BUILDING PERMIT {✓ r�d J TOWN OF NORTH ANDOVER 'i APPLICATION FOR PLAN EXAMINATION Permit No#: "f(Of Date Received /O'tt Len f6*11WO = y r Date Issued: TYPE OF IMPROVEMENT PROPOSED USE BRORTANT: Applicant must complete all items on this page Residential i ❑ New Building One family ❑ Addition 60CAIL 00N Alteration No. of units: 0 Commercial PROPERfftY'yOWNERH71.5 ❑ Assessory Bldg ❑ Others: ❑ Demolition MAPS. Rnnt fl-No Yma'Struce t©sr yam; 4 nod y!__, es no' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑ Addition ❑ Two or more family ❑ Industrial Alteration No. of units: 0 Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other DiSepficN O4GVe"_p Water/S?ewerr ❑Fof odplain�•T ❑1N.etland�sk :�4Watershed'.F®istnct OWNER: Name:= Address: 2c -N 3o DESCRIPTION OF WORK TO PERFORMED: A&4 i�2cn to Identification - Please Type or Print Clearly 47'5 1A -1A-VLA-L01 Pal L_'' Phone: 3613 — �/d-�-- i?Ad:cir__..�ess�0(V��� __ -� ��h C t Supe_rrs©rr s Cr©nstructi©n Li'ee:nsey ��S U� f %��Exp. 1 --- E iH�om �lmpr�o�ve t F ent 11,Jp n -seg: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE; BULDING PERMIT: MOO PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. _�rotal Project Cost: $ FEE: $ 3 Check No.: elLf 7 Receipt No.: 3-1/ O7 NOTE: Persons contracting with unregistered contractors do not have: acces^theguarayty fund 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 ❑ Building Permit Application ❑ 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 NOTE: 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 NOTE: 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 o 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products VOTE: 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 Plans Submitted El )F -6F SEWERAGE, Plans El Plans Waived. El. Certifietl Plot Plan ElStamped Sewer 'Tanning/Massage/Body Art ❑ Swimming Pools ElPublic Well 0 .-. -Tobacco, Sales ElFood Pack �Sales El�., Private (septic-tank,etc ;; . Permanent Dumpsteron Site F1 THE FOLLOWING SECTIONSjFOR OFFICE_U$E ONLY INTERDEPARTMENTAL SIGN OFF - O FORM PLANNING .& DEVELOPMENT Reviewed On Signature_ COMMENTS --HEALTH, Reviewed on Signature COMMENTS .r Zoning Board; of Appeals Variance,: Petition No _Zoning Decision/receipt submitted yes f Planning Board b&ision' Comments Conservation. Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW 'Town Engineer: Signature: Located 384. Osgood Street FIRE DEPARTMENT -Temp )SI on'site `Eyes no` " Located at 1*24 (Vlain�Street�� '•a��t�� ``t :�� "` � - � � � � � °. -�,., ��; ' Fire Departtnentsi,gnature/date ��r s F :,<� r 'rV, 3 `44 r .F..d -r vrr �, F �. y-i'� , •. �'�� - 3 `u' it ,b C ®M M E N Ti • 't ,'2+& d�£ S�a�'ka � i. u t r .,i a'�� • �� r -imension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.:'! ELECTRICAL: Movement of Meter location, mast or service drop.,requires approval of Electrical Inspector ! Yes No DANGLER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine Doc.Building Permit Revised 2014 Location g / pe Q r Sca�-) No. 9(0 Check # ) yd Date / //a 0-1 Of 6 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ ,30, Foundation Permit Fee $ �. Other Permit Fee $ TOTAL $ Building Inspector v C O CD CDo-0 Err CL�•N O vCD CDQ cr - C CD O 00 00 � a CD v CD �i C I � v 0 z CD 0n O CD 3 CD 0 v N m z m cn O CO) N C cn D m ic x a m cn z 0) EIMWO Iz cn o O (D N O CD co su O ca .o m N cn CD 000MO c0 MN s U) = <. m (n 0 = OCD . CD C) _CL -! O =,=r -0 N. O y (D y 0 O Q 0 CD O O CD O. Cs N T O 3 C _! O 7 to Q rt OSU :Jw W O O 2 D 2 rt= CD � CD -0 --I�� w. O < (Q * EA: 5 A O 0 N cn 0 Cr (D (A D 0co Q. 0CO_ Q o - U) (CD U) �• O O � � < � O (D FL N (D ca .a C.) 0.14o O .-f . t S F.; O (D N :e C CN D O D - n• � o CL O r v 0 3 O 7 O M K Ln �' N rF z c (D T m v D m T d ,T1 C 3 y N O T O Ln_T N n (D O m 3 m r- m -nl H m � 7 .� O DO S r C W z (A m � 0 T n S ro A O 04 s T O 3 C _! O 7 C r C z (A m 0 Ln N L^ M (D 3 T O O_ S (D W O O 2 D 2 0 fD EnsigniaMail 1.4.23 [SVN] https:/ibox6O79.bluehost.com:2096/cpsess4456115350/3rdparty/squir... Wd £b:1 910Z/t,1/01 Z3o Z v E-mail G' Compose & Addresses r Folders A QfjAmartinobuilders.com v Forward Forward as Attachment Reply Reply All Message List Unread Delete + y Subject: Message to building inspector, North Andover From: "Satish Takkalapalli" <tsatishchandra@gmail.com> Date: Tue, October 18, 2016 12:39 pm To: jay@martinolibuilders.com (more) Priority: Normal View Full Header I View Printable Version I Download this as a file I Add to Address Book I View Message Options: Details I View as HTML Hi Jay As per our conversation this morning, I convey that you are not responsible for the improvement work done in the past. You can either forward/show the below email to the building inspector, in this regard. To The Building Inspector Buildings Department Town of North Andover MA U184b Sir, Sub: Representation by Mr.Jay Martinoli (martinoli builders) on my behalf for pulling the required permits. I, Satish Takkalapalli, home owner of the property at 21 Peterson Road, North Andover MA 01845, here by authorize Mr.Jay Martinoli, from Martinoli Builders, to pull the required permits for the home improvements done in 2013, on my behalf. Mr.Jay Martinoli,is not responsible for the past improvement works, as these were done by another contractor, Mr.Patrice Yodj from IMC Constructions. As a homeowner, I will take the responsibility to get any corrections done as deemed towards the compliance, with the professional help of Mr.Jay Martinoli. Thanks Satish Takkalapalli 704 303 4222 untitled-[2].html 1.4k Download view Move to:; INBOX Move I l of l l tulq-aureapuud/aILIdura;/ooCljpd/alnpowAiipod/tuoo•;lnlu! •Ioauuoo//: sduq Delete & Prev Unread & Prev unread &Next r)alata % Navt 10/19/2016 2:45 PM r A O revised 2/25/15 The Conunonwealt/t of Massachusetts / Department of Industrial Accidents I Congress Street, Suite 100 Boston, MA 02114-2017 www,massgov/dia \Yorkers' Compensation Insurance Affidavit: Builders/ContractorsMectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Org`,anii`zrationtindividual)--lI / QS %V�/f I ^iEX Address: t9a W �/1��= " i e.,— • City/State/Zip:1�itiij/!�✓�jl, j s3 d1,4 Phone M Are you an employer? Check the appropriate box: Type of project (required): I. _tim I am a employer with employees (full and/or part -e).• 7. New construction ❑ 2.� 1 am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 8 -Remodeling 9. gDemolition 3.E]1 am a homeowner doing all work myself. [No workers'comp. insurance required.]' 4.❑ I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10 ❑ Building addition ensure that all contractors either have workers' compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. • 12.E] Plumbing repairs or additions 5.❑ 1 am a general contractor and 1 have hired the sub -contractors listed on the attached sheet. 13. ❑ Roof 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. ❑ 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 ouLside contractors must submit a newaffidavit 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 am an employer t/tat is providing workers, compensation insurance for my emplovees. Below is the policy and job site information. < _ Insurance Company Name: If Policy # or Self -ins. Lic.#:�C�Ij 3 l 5S—? P 7c�o3 `i Expiration Date: % Job Site Address:(i1 City/State/Zip:V_Ipxwe-- -lam Attach a copy of the wo kers' 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 n STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A copy ofthis statement may be forwarded tdithe Office of Investigations of the DIA for insurance coverage verification. I do hereby cr rjy tti er t4Lo�ns and penalties of perjury that the information provided above is true and correct �'M_—WAKIQ Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # PF Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other II Contact Person: 'Phone M 11 Page 7 of 8 41-�N r7JJ��c�RJef/J Office of Consumer Affairs & Business Regulation `� - HOME IMPROVEMENT CONTRACTOR Registration:_.107738: Type: Expiration.,8/5/2018 Individual 'JAMES C. MARTINOLI Y . James Martinoli 22 WHITTIER ST. Haverhill, MA 01835 Undersecretary -- - - Depa�menf of'Fub'•ic-Safety, Standards. Massachusetts i 1 Board of Building Regulations and CS -011756 License: construction Sup ervisor �', • - JAMES C MARTINOLI 22 WHITTIER ST MA 01830 HAVERHILL n , lJ`f E,Xpiration: 0512912018 commissioner r Plans Submitted -El Plans Waived Certified Plot Plan ❑ ' Stamped Plans ❑ TYPE'DF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL'SIGN OFF - U,.FORM PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals'. Variance, Petition No: Zoning Decision/receipt submitted yes L Plant ing Board Decision: Comments a Conservation Decision: Comments Water & Sewer. Con flection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 • .... -- VIVA R' - .,,.r r".ed_. •4.�t' 6 ' 7. a. ,* ef. i. .� . 4�i fF� '3�p •i,it•.y,♦1 '+ ,;y�, ,. , t �.r•. 1 � "��y � ,'�' � �t �,r"af�,i s c�,,��j� y �� � � � ~ �`� `d � � �ri• � pry sf � f �� i7'.��• G i,+,7ccu'.