HomeMy WebLinkAboutBuilding Permit #826 - 308 MASSACHUSETTS AVENUE 6/22/2010BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO:
Date Issued,
IMPORTANT:
LOCATION,C--�
Date Received
)hcant must complete all items on this
Print
PROPERTY OWNER1
Print
MAP 210FARCEL: ZONING DISTRICT; Historic District
Machine Shop Village
OL
o 'A
4E
\rye4p°gwre° /
yes no
ves no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Buildingr.
ne famil
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Others:
. e air, re- la—
Assessory Bldg
Demolition
Other
Septic , Well
Floodplain Wetlands
Watershed District
WaterlSewer _
f d AJ'.S °f- .7-, L"
OWNER: Name:
oEscRiPTiON OF WORK TO BE PREFORMED:
Please Type or Print Clearly)
M t-er
/ 7—Y3u —
Address: /f/rte 00f,
CONTRACTOR NameIlir" Phone:
Address: -,`'' e #6t'r'l
Supervisor's Construction License; 11lsZeExp. Dater
Home Improvement License: //0 723S Exp. Date: Ido/
ARCHITECT/ENGINEER
Phone:
Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $1 5.00 PER S.F.
Total Project Cost: $ 1 ` FEE: $
Check No.: f % l2— Receipt No.: :�) 30 2,b
NOTE: Persons contracting with unregiste ntractors do not have access to the guaranty 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/Crossection/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
❑ 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
NOTE: 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 2008
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 Dumpster, on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS f
CONSERVATION Reviewed on Signature
COMMENTS
HF'ALTH
COMMENTS
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Locatea 664 Us ooa Street
FIRE DEPARTMENT :- Temp Dumpster on site yes no
Located at 124 Main Street
Fire Departmentsignatureidate
COMMENTS
Dimension
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
DANGER ZONE LITERATURE: Yes
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
No
I m7
NOTES and DATA – For department use
❑ Notified for pickup - Date
—....__.... -...... ....... _-... __..................... _.......................... ------ .......... ._............. --- ........................ _._.._.....___.-_............. ^._..-... ................. ---.................... --.................... -.-._-........................ -- ........... _._
Doc.Building Permit Revised 2010
Location
No. Date
NORTh TOWN OF NORTH ANDOVER
O • O�
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` Certificate of Occupancy $ "
sArM A ��' Building/Frame Permit Fee $
us
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Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 119-2.
230;
Building Inspector
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The Commonwealth of Massachusetts
Department o f Irzdustrial _9ccidents
Office of£nvesligations -
600 N"ashi baton Street
Boston; X4 02111
www.niassgov/die .
Workers' Compensation Insurance Affidavit: guilders/
A Iicant Information Contractors/ElectriC aus/plumbers
�-- Please Print Leaibl.
Name (Business/Organization/lndividual : 5
Address: c� �
e
City/State/Zip: YAxr ,i 01P
Phone #:_ 7�� _
Are you an employer? Check theappropriate box; i
1. (� I am a
employer with –�_ 4. ❑ I am a Q F
roject (required):
employees (full and/or part-time).* have hired contractor and I
2• ❑ I am a sole proprietor or the sub-contractorse construction
partner- listed on the attached sheet t odelingship and have no employees These sul�contracworking for me in an ca aci tors have olition
Y P t3'• workers' comp. insurance.[No workers' come• insurance 5.❑ We are a c rp and its ding additionrequired ] o orationofficers hake exercised their trical
3.0 .I am a homeowner doing all work right of ex repairs or additions
Myself [No workers' comp. C. 152 I emption per MGL 11.
❑ Plumbing repairs or additions
insurance required.] t ' � (4), and we have no
employees. 12.❑ Roof repairs
[No workers
Pomp. insurance required j 13•❑ Other
`°.ui' �iicLnt that cli��, i
bOx 4• ml!St LIEU r I oL't the sectio^ , i
homeowners who submit this affidavit indicatin they o@'aLl Fool' Wb �'"~' workers' c,mps�oe
lContractors that check this box must attached an additional sheeshowmwork and tben hire o r=fc'm"fion
trtuide contractors must submit a new affidavit indicating such.
o the name of the sub -contractors and their workers' comp. oI'
I am an employer that is providing workers' compensadon insurance or m e P n � information
informafion. f y mployee& Below is the policy and job six,
Insurance Company Name;
�S.
Policy # or Selff ins. Lie. #:
Expiration Date:JOld
p/�j
Sob Site Address: Ave h�
City/State/Z' �Af —
Attach a copy of the workers' compensation policy declaration page (Showing rP oV 4�✓li��.tt� �/ of
Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the Policy
imposition and expiration date).
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the fo f criminal Of up to $250.00 a daya Pities of a
against the violator. Be advised that a co of a STOP WORK O�g�and a fine
Investigations of the DIA for insurance coverage verification. PY of statement may be forwarded to the Office of
I do here sins and
hereby u r the p realties of perjury thrtt the in or
f madon pro
Signature-vided above is true and correct
Pho Date:. !¢ ....2
Official use only. De not write in this area, to be completed
by city or town official
City or Town:
1"uin,-' Authority (circle one):
L Board of Healtb 2. Buildiab Department
6. Other
1"'ermit/License #
3. City/Town Clerk 4. Electrical Inspector
Contact Person:
Phone #:
5. Plumbing inspector
Information an- d Instructions
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 t1he 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 maintemame, construction or repair work on such dwelling house
or on the grounds or building appurtemant thereto shall not because of such. employment be deemed to bean 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 monstruct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of comnplimce 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 unmil acceptable evidence of compliance with the insurance
requirements of this chapter have been presented tolhe 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-contractor(s) name(s), address(es) and phone number(s) along with their cerdficate(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 siure to sign and date the affidavit The affidavit should
be returned to the city, or town that the application for the perrmit or license is being requested, not the.Departamont of
Industrial Accidents. Should you have any questions regardirag 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 (if necessary) 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 burn leaves etc.) said person is NOT required to complete this affidavit.
The Office oflnvestigations 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 Commanwealth oaf Massachusetts.
Department of Industrial Accidents
Office ofbnvesiadatims
600 Washingtan Street
Boston, MA. 02111
Tel. # 617-72.7-4900 ext 406 or 1-877-MASSAFE
Fax # 617-72.7-7749
Revised 5-26-05
mrurw.mass.. aovfdia
✓ = HOME IMPROVEMENT CONTRACTOR
-- Registration: 107738
Expiration: 8/5/2010 Tr# 0
Type: Individual
JAMES C. MARTINOU
James Martinoli
22 WHITTIER ST.�
Haverhill, MA 01835 Administrator
`1: .
Isachusctts t>Iu'nt of P
Board of Buildin,f Rc�ulati
nblic S:Ifch
, 10"Sand
Standards
Construction Supervisor License
License: CS 11756
Restricted to: 00
JAMES C MARTINOLI
22 WHITTIER ST
HAVERHILL,$
MA 01830
( omnri,.i ur r, Expiration: 5/29/2012
Tom: 25051
I.J.art 1i & sans
BUILDING REMODELING MODELING i A.
www.mai-tinolibuilders.com
22 Whittler St., Havei-hill, ISA 01830
(978) 521-4958 Fax: (978) 794-9692
May 24, 2010
Mr. & Mrs. Trepanier
308 Mass Avenue
N. Andover, MA 01845
To remodel existing Second Floor Bath as follows:
Obtain necessary permits.
Disconnect existing plumbing fixtures, saving toilet for reuse.
Remove wall tile and plaster down to framing.
Remove floor tile and underlayment.
Electric
Install new wall exhaust fan Panasonic Whisper Quiet. Install FGIC for under floor electric
radiant heating.
Check all other circuits for bathroom.
Replace all devices and face plates.
Hang all supplied light fixtures and medicine cabinet light.
Electrical Allowance $950
J. Martinoli & Sons is covered by full liability insurance to protect your expensive investment and to keep your minds at ease.
All work to be performed in a workmanlike manner according to standard practices. Any alteration of deviation from the
specifications above involving extra cost will be executed only upon written orders and will become an extra charge over and
above the estimate.
Page 1 of 3
Mr. & Mrs. Trepanier
308 Mass Avenue
N. Andover, MA 01845
Plumbing
Martinoll' &- Sons _
NARK
w4 w.iiiartii1olibLilI(fel-S.COIII
22 Whittier St., Haverhill, MA 01830
(978) 521-4958 Fax: (9 8) 794-9692
May 24, 2010
Install new Symmons shower valve or equal with shower head to existing water pipes.
Install new Sterling by Kholer Ensemble tile bath/shower unit 32" x 60" from Vikrell material.
Install new sterling Sacramento pedestal Lav or equal.
Install a two handle faucet.
All valves and faucets to be chrome.
Run new Y2" Pex tubing for water to second floor.
All drains to be PVC.
Remove radiator fro floor installation and reinstall. Reuse existing toilet.
Plumbing Allowance $3,500
Insulate exterior wall with 21b spray foam.
Apply over existing ceiling and wall framing Y2" blue board with veneer plaster.
Install tile selected by owner on walls up to ceiling including installation of tile crown.
Install tile selected by owner to prepared floor.
Allowance for Tile & Grout $3,170
J. Martinoli & Sons is covered by full liability insurance to protect your expensive investment and to keep your minds at ease.
All work to be performed in a workmanlike manner according to standard practices. Any alteration of deviation from the
specifications above involving extra cost will be executed only upon written orders and will become an extra charge over and
above the estimate.
Page 2 of 3
Martinoli �o& Sons NARI
BUILDING & REMODELING :.
w�,7w. iiiartiiicfiibtiildei-s.cvtn
22 Whittier St., Haverhill, MA 01830
(978) 521-4958 'axe (978) 794-9692
Mr. & Mrs. Trepanier
308 Mass Avenue
N. Andover, MA 01845
Install under tile floor approx 10 sq. feet of electric radiant heat with thermostat.
Apply 2'/ colonial pre -primed trim to window and door.
Remove all debris
Painting by others
May 24, 2010
Total Cost: $14,474.00
J. Martinoli & Sons is covered by full liability insurance to protect your expensive investment and to keep your minds at ease.
All work to be performed in a workmanlike manner according to standard practices. Any alteration of deviation from the
specifications above involving extra cost will be executed only upon written orders and will become an extra charge over and
above the estimate.
Page 3 of 3
tl
Martinol' & Stens
BUILDING & REMODELING.' R .
vvw.mgginoli%uilders.coin
22 Whittier St., Haverhill, MA 41830
(978) 521-n4958 Fax: (978) 794-9692
CONTRACT
May 24, 2010
Homeowner Information Contractor Information
Mr. & Mrs. Tre anier
J. Martinoli & Sons Building & Remodeling
308 Mass Avenue
James Martinoli
N. Andover, MA 01845
22 Whittier Street
617 834-5680
Haverhill, MA 01830
978 521-4958
FIN: 20-3401421
Re . #: 107738
E. 8/05/2010
Payment Schedule
Uponsigning........................................................................... ..$ 3,500.00
.............................
When new tub & rough plumbing & electric installed ..............................................$ 3,000.00
Wall insulated, plastered & wall tile started............................................................$ 4,000.00
Wall & floor the finished, plumbing & electrical complete ........................................$ 2,500.00
Uponcompletion.................................................................................................... 1,474.00
Total.............................................................................................................. .474.00
Page 1 of 2
Mr. & Mrs.
Martinolli & Sons
JILDING &REMODELING
wi. w.inartinolilni_i!de.rs.c ofn
22 Whittier St., Haverhill, NIA 048 0
(978) 521-4958 Fax: (9 78) 794...9692
CONTRACT—CONT.
Homeowner Information
308 Mass Avenue
N. Andover, MA 01845
834-5680
May. 24, 2010
Contractor Information
J. Martinoli & Sons Buildi
James Martinoli
22 Whittier Street
Haverhill, MA 01830
(978) 521-4958
Reg. #: 107738
Work will begin on June 28, 2010
Work will be substantially completed by July 16, 2010
/Homeowner's Signature/ ^ "
& Re
FIN: 20-3401421
8/05/2010
clo ! ck)l&
Da e
-61,
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Dat
By signing this contract I agree to the terms and conditions of the contract. If payment in full is not received within the
terms of the contract, J. Martinoli & Sons shall be entitled to costs of collection, including its attorney's fees and costs,
and interest at the rate of 18% per annum. This contract may be canceled within three (3) business days after
signing without penalty by giving the Contractor written notice.
Page 2 of 2
NARI"
May. 24, 2010
Contractor Information
J. Martinoli & Sons Buildi
James Martinoli
22 Whittier Street
Haverhill, MA 01830
(978) 521-4958
Reg. #: 107738
Work will begin on June 28, 2010
Work will be substantially completed by July 16, 2010
/Homeowner's Signature/ ^ "
& Re
FIN: 20-3401421
8/05/2010
clo ! ck)l&
Da e
-61,
r� lJ
Dat
By signing this contract I agree to the terms and conditions of the contract. If payment in full is not received within the
terms of the contract, J. Martinoli & Sons shall be entitled to costs of collection, including its attorney's fees and costs,
and interest at the rate of 18% per annum. This contract may be canceled within three (3) business days after
signing without penalty by giving the Contractor written notice.
Page 2 of 2