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Home My WebLink AboutBuilding Permit # 3/21/2017 3/28/2017 *Building Permit#23515-View Point Cloud *Building Permit—Alterations:Roofing/Siding and/or Windows/Doors O Building Permit Issued TIMELINE OSubmission received Mar 14,2017 at 8:44am Building Department Review Completed Mar 15,2017 at 8:03am OTreasurer Review Completed Mar 15,2017 at 12:36pm OBuilding Inspector Approval Completed Mar 15,2017 at 2:50pm OAlteration Roofing and/of Windows/Doors Paid Mar 21,2017 at 8:23am OPermit Issued Issued Mar 21,2017 at 8:22am *Building Permit#23515 Alterations:Roofing/Siding and/or Windows/Doors https://northandover m a.vi ewpoi ntcl oud.com/#/records/23515 1/5 3/28/2017 *Building Permit#23515-View Point Cloud C10bovn Wornen's Care 0 Applicant Location WILLIAM NICHOLS 30 ALCOTT WAY, NORTH ANDOVER, MA t. 978-265-7255 Owner @ nicholswr(d-pellabosto... ron wells Attachments pdf D00031017-003_Tue_Mar_14_2017_0.pdf Uploaded March 14,2017 by WILLIAM NICHOLS Application Submission Required information varies depending on who is applying for a building permit. Are you submitting this application as the Homeowner? NO Primary Contractor Search for your contractor using the search bar below. Either the Licensee Name or License#is required. Firm(Business)Name Licensee* License#* License Expiration Date* License Type* License Active License Status Mailing Address WILLIAM R NICHOLS CS-089853 10/26/2018 Construction Supervisor O Active HAVERHILL MA 01830 Preferred Telephone#:* Alternate Phone# Email 9782657255 9782657255 nicholswrC@pellaboston.com hftps://northandoverma.viewpointcloud.com/#/records/23515 2/5 3/28/20 17 *Building Permit#cnn o'vw*PomClov I certify,under the pains and penalties of perjury,that the information on this application is true and complete. Project Information Persons contracting with unregistered contractors do not have access tothe guaranty fund. Fee Schedule: Building Permit: Project Cost(if new construction base on $125 per square foot and ifaddition/a|temtion/enovation base on actual contract price). ELECTRICAL: Movement of Meter|ocadon, mast or service drop requires approval of Electrical Inspector. Type mImprovement~ Proposed Use~ oosc,/pt/onmwm,xmuepexu,mou~ /sproperty vnTown water~ |sproperty onTown sewer ~ Repair, Replacement One-Two Family 2 replacement windows no structural Yes Yeo Project Cost(if new construction,base on$125 per square foot and if add ition/a Iteration/renovation base on actual contract price) 7,000 Does this project require atemporary construction trailer? ~ NO Does this project require atemporary 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 mame Arch uecusnomee,Address Arch uecusnomee,Phone Number Arch uecusnomee,Reg.# mps://northandovermumewpointc|oud.com/#"/rmmrdd23515 3/5 3/28/2017 *Building Permit#23515-View Point Cloud Insurance INSURANCE COVERAGE: 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 To be filed with the permitting authority 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 window replacement I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Failure to secure coverage as required under MG>c.152,25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Insurance Company Name(Attach a copy of workers'compensation policy declaration page showing the policy number and expiration date) nh employers ins co Policy#or Self-Ins.License#* Expiration Date 8007042 07/01/2017 hftps://northandoverma.viewpointcloud.com/#/records/23515 4/5 3/28/2017 *Building Permit#23515-View Point Cloud Workers' Compensation Affidavit Signature I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. G tl To Be Completed By Town Staff la Zoning District* la Is this a 100 Year or older structure* la Is property within an Overlay District* Is the property within the Floodplain* Is the project within 100'of Wetlands? hftps://northandoverma.viewpointcloud.com/#/records/23515 5/5