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Home My WebLink AboutBuilding Permit # 3/21/2017 3/28/2017 *Building Permit#23629-View Point Cloud *BuildingPermit—Alterations:Roofing/Siding/Sidin and/or Windows/Doors Building Permit Issued 9 9 9 TIMELINE OSubmission received Mar 17,2017 at 8:44am Building Department Review Completed Mar 18,2017 at 7:18am OTreasurer Review Completed Mar 20,2017 at 4:09pm OBuilding Inspector Approval Completed Mar 20,2017 at 5:27pm OAlteration Roofing and/of Windows/Doors Paid Mar 21,2017 at 9:34am OPermit Issued Issued Mar 21,2017 at 9:34am *Building Permit#23629 Alterations:Roofing/Siding and/or Windows/Doors https://northandover m a.vi ewpoi ntcl oud.com/#/records/23629 1/5 3/28/2017 *Building Permit#cnnco vw*PomClov =^ ApplicantLocation Peter Leblanc 11PEK8BROC>K ROAD , NORTH ANDOVER, KnA t~ 978-407-7638 Owner @ po|arbearinsu|ationCd-g.' LACOLLA. MATTHEW,JAMES Attachments pur 11_pembrook_rd.pdf Uploaded March 1<2n1/uvPeter Leblanc rop ~OTP|N51001F_Fri_Mar-17_2017_O.PDF Uploaded March 1<xn//byPeter 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(ausmess)Name Licensee~ License x~ License Expiration Date~ License Type License Active License Status POLAR BEAR INSULATION CO. css|'106017 04/28/2018 CSSL4mS Windows and Siding O Active hmpe:0nonxandove,muxiewpoimo|ovd.00m/#"/rmmrdd23629 2/5 3/28/20 17 *Building Permit#cnnco vw*PomClov Mailing Address~ Preferred Telephone#:~ Alternate Phone# Email P.O. BOX 95O.ANDOVER M401O1O 978-407-7638 1 certify,under the pains and penalties of perjury,that the information on this application is true and complete. Br Project Information Persons contracting with unregistered contractors do not have access to the guaranty fund. Fee Schedule: Building Permit: Project Cost(if new construction base on $1Z5per square foot and ifaddition/ahenation/renovation base on actual contract price). ELECTRICAL: Movement of Meter|ocation, mast orservice drop requires approval of Electrical Inspector. Type wImprovement~ Proposed Use^ Description mWork muePerformed^ /sproperty onTown water~ /sproperty onTown sewer ^ Alteration One-Two Family air sealing,attic insulation to r-49,ventilation Yes Yes Project Cost(if new construction base on$125 per square foot and if add ition/a Iteration/renovation base on actual contract price) 3,500 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 Archnecusnnmee,mame Arch nerusnomrerAddress Arch necusnomee,Phone Number Arch nerusnomee,Reg.# hups://nonxandove,mumewpoimo|md.00m/#"/rmmrdd23629 3/5 3/28/2017 *Building Permit#23629-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 insurance co Policy#or Self-Ins.License#* Expiration Date POWC 840361 01/01/2018 hftps://northandoverma.viewpointcloud.com/#/records/23629 4/5 3/28/2017 *Building Permit#23629-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. RV ig 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/#"/rer,ords/23629 5/5