HomeMy WebLinkAboutBuilding Permit # 3/13/2017 3/13/2017
*Building Permit#23400 Construction of Additions,Alterations,and Remodeling
Haffner's Service Stations North Andover
0 Barber Shop
Applicant Location
�01 Michael Joy 4 LINCOLN STREET , NORTH ANDOVER, MA
1,fi�o
C. 508-382-2087 Owner
info@milicityener... Olawole, Ibrahim
Application Submission
Are you submitting this application as the Homeowner?
NO
Primary Contractor
Firm(Business)Name Licensee
MICHAEL JOY
License License Expiration Date
CS-110041 08/07/2019
License Type License Active
1/5
3/13/2017
Construction Supervisor O
License Status Mailing Address"
Active , Manchester NH 03102
Preferred Telephone#: Alternate Phone#
508-382-2087
Email
info@millcityenergy.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
Repair, Replacement One-Two Family
Description of Work to be Performed * Is property on Town water
air sealing; insulate exterior walls & rim joist No
Is property on Town sewer
No
Project Cost(if new construction base on $125 per square foot and if addition/alteration/renovation base on actual contract price)
2,781
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* Please explain 'other'project:
14. Other Weatherization
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)
Clarke Insurance
Policy#or Self-Ins.License#* Expiration Date
MIWC791896 04/29/2017
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
R-4
Is property within an Overlay District*
4/5
3/13/2017
No
Is the property within the Floodplain* Is the project within 1 00'of Wetlands?
5/5