HomeMy WebLinkAboutBuilding Permit # 3/6/2017 (2) 3/9/2017
*Building Permit#23317 Alterations: Roofing/Siding and/or Windows/Doors
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Applicant Location
i11 Barry Carnes 61 WOODCREST DRIVE , NORTH ANDOVER, MA
IIS
978-887-1431 Owner
barrycarnes@msn.com
HELEN MULLINS KONDRA
Application Submission
Are you submitting this application as the Homeowner?
NO
Primary Contractor
Firm (Business) Name Licensee
BARRY S CARNES
License #* License Expiration Date
CS-000230 03/07/2018
License Type * License Active
Construction Supervisor
License Status Mailing Address
Active , Boxford MA 01921
Preferred Telephone #: * Alternate Phone #
978-887-1431
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Email
BARRYCARNES@MSN.COM
certify, under the pains and penalties of perjury, that the information on this application is true and complete.
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Project Information
Type of Improvement* Proposed Use
Alteration One-Two Family
Description of Work to be Performed * Is property on Town water
STRIP AND REROOF REAR ROOF SECTIONS OF Yes
MAIN HOUSE
Is property on Town sewer
Yes
Project Cost (if new construction base on $125 per square foot and if addition/alteration/renovation base on
actual contract price)
7,000
Does this project require a temporary construction trailer?
NO
Does this project require a temporary construction sign?
NO
Danger Zone Literature (MGL CHapter 166 Section 21A-F and G min. $100-$1,000 fine)
NO
Registered Design Professional
Architect/Engineer Name Architect/Engineer Address
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Architect/Engineer Phone Number Architect/Engineer Reg. #
Insurance
have a current liability insurance policy or its substantial equivalent.
Yes
If yes, indicate the type of coverage " If other, specify
Liability
Worker's Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Are you an employer? Select the appropriate type. Any applicant that selects #1 must also fill out the section
below showing their workers' compensation policy information.
1. 1 am an employer with employees (full and/or part-time)
Type of project *
13. Roof Repair
I am an employer that is providing workers' compensation insurance for my employees. Below is the
policy and job site information.
Insurance Company Name (Attach a copy of workers' compensation policy declaration page showing the policy
number and expiration date)
TRAVELERS
Policy#or Self-Ins. License # * Expiration Date
6HUB-7H68075-4-16 10/15/2017
Workers' Compensation Affidavit Signature
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1 do hereby certify under the pains and penalties of perjury that the information provided above is true and
correct.
To Be Completed By Town Staff
Zoning District* Is this a 100 Year or older structure
R1
Is property within an Overlay District
No
Is the property within the Floodplain Is the project within 100' of Wetlands?
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