HomeMy WebLinkAboutBuilding Permit # 3/13/2017 3/13/2017
*Building Permit#23316 Alterations: Roofing/Siding and/or Windows/Doors
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4DApplicant Location
Barry Carnes 102 SUGARCANE LANE , NORTH ANDOVER, MA
. 978-887-1431 owner
@ barrycarnes@ms... DI FONTE, JENNIFER A.
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
1/5
3/13/2017
Construction Supervisor O
License Status Mailing Address"
Active , Boxford MA 01921
Preferred Telephone#: Alternate Phone#
978-887-1431
Email
BARRYCARNES@MSN.COM
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
./
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 Yes
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)
16,000
Does this project require a temporary construction trailer?
2/5
3/13/2017
NO
Does this project require a temporary construction sign?rt
NO
Danger Zone Literature (MGL CHapter 166 Section 21A-F and G min.$100-$1,000 fine)
NO
Registered Design Professional
Architect/Engineer Name Arch itect/Engineer Address
Architect/Engineer Phone Number Architect/Engineer Reg.#
Insurance
I 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
3/5
3/13/2017
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
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-7-7H68075-4-16 10/15/2017
Workers' Compensation Affidavit Signature
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
I/
6 To Be Completed By Town Staff
Zoning District* G Is this a 100 Year or older structure
R1 No
4/5
3/13/2017
la Is property within an Overlay District* Is the property within the Floodplain "
Is the project within 1 00'of Wetlands? "
5/5