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Home My WebLink AboutBuilding Permit # 3/21/2017 3/28/2017 *Building Permit#23640-View Point Cloud *BuildingPermit—Alterations:Roofing/Siding/Sidin and/or Windows/Doors Building Permit Issued 9 9 g TIMELINE OSubmission received Mar 18,2017 at 1:05pm Building Department Review Completed Mar 20,2017 at 7:36am OTreasurer Review Completed Mar 20,2017 at 4:11pm OBuilding Inspector Approval J 1 , Completed Mar 20,2017 at 5:28pm OAlteration Roofing and/of Windows/Doors Paid Mar 21,2017 at 9:34am OPermit Issued Issued Mar 21,2017 at 9:33am *Building Permit#23640 Alterations:Roofing/Siding and/or Windows/Doors https://northandover m a.vi ewpoi ntcl oud.com/#/records/23640 1/5 3/28/20 17 *Building Permit#cno4o vw*PomClov Applicantmc�u -- Peter Leblanc 8OCHESTNUT STREET, NORTH ANDOVER, WY4 "~ 978-407-7638 Owner @po|arbearinsu|ationCdg.' ROKOU5. MARGARET RUTH Attachments pur 80_CHESTNUT_5T_PERK4|T.pdf Uploaded March 1o.zo17uyPeter Leblanc Application Submission Required information varies depending on who is applying for a building permit. Are you submitting this application asthe Homeowner? ~ NO Primary Contractor Search for your contractor using the search bar below. Either the Licensee Name or License#is required. Firm(uusmess)Name Licensee~ License#~ License Expiration Date~ License Type~ License Active License Status Mailing Address PETER A LEBLANC CSSL'105017 04/28/3018 CSSL'|C Insulation Contractor O Active . Plaistow NHO3805 Preferred Telephone#:~ Alternate Phone# Email 978'4077638 mps://northandovermumewpointc|oud.com/#"/rmmrdd23640 2/5 3/28/20 17 *Building Permit#cno4o 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^ Description mWork muoPerformed~ |sproperty o^Town water~ /nproperty onTown sewer ~ Alteration One-Two Family AIR SEAL|NG/\TT|CINSULATION TOR-49)/ENT|LAT|ON Yeo Yes Project Cost(if new construction,base on$125 per square foot and if add ition/a Iteration/renovation base on actual contract price) 4,000 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/#"/rmmrdd23640 3/5 3/28/2017 *Building Permit#23640-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 INSULATION 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) NORGAURD Policy#or Self-Ins.License#* Expiration Date POWC840361 01/01/2018 hftps://northandoverma.viewpointcloud.com/#/records/23640 4/5 3/28/2017 *Building Permit#23640-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? R-3 No hftps://northandoverma.viewpointcloud.com/#/records/23640 5/5