HomeMy WebLinkAboutBuilding Permit # 3/10/20173/13/2017
*Building Permit #23357 Construction of Additions, Alterations, and Remodeling
Bertucci"s Kitchen & Bar
North Andover
Auto School
Applicant
Paul Morris
t. 978-851-9200
@ anng@pinnco.com
Application Submission
Are you submitting this application as the Homeowner? *
NO
Primary Contractor
Location
203 TURNPIKE STREET , NORTH ANDOVER, MA
Owner
NANO PROPERTIES, LLC
Firm (Business) Name Licensee *
PAUL R MORRIS
License #* License Expiration Date
CS-044300 02/22/2018
License Type * License Active
Construction Supervisor O
License Status Mailing Address *
Active , Tewksbury MA 01876
Preferred Telephone #: * Alternate Phone #
9788519200
Email
I 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 *
Alteration
Describe the type of use *
Existing Dental Office
Is property on Town water *
Proposed Use *
Non -Residential Building
Description of Work to be Performed *
Interior Fit up of Existing Dental Office
Is property on Town sewer *
Yes Yes
Project Cost (if new construction base on $125 per square foot and if addition/alteration/renovation base on actual contract price) *
102,000
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
Jim Jozokos 1147 Main Street Tewksbury, MA 01876
Architect/Engineer Phone Number Architect/Engineer Reg. #
9789851813
Insurance
I have a current liability insurance policy or its substantial equivalent. *
Yes
If yes, indicate the type of coverage *
Liability
If other, specify
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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. I am an employer with employees (full and/or part-time)
Type of project*
8. Remodeling
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)*
Citizens Insurance Co
Policy # or Self -Ins. License # * Expiration Date *
WBN D00115200 08/02/2017
Workers' Compensation Affidavit Signature
I 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 "
B4 No
Is property within an Overlay District" Is the property within the Floodplain *
No No
Is the project within 100' of Wetlands?*
Not Applicable
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