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Home My WebLink AboutBuilding Permit # 3/27/2017 3/28/2017 *Building Permit#23335-View Point Cloud 23331:1 5" *Building Permit—Alterations:Roofing/Siding and/or Windows/Doors O Building Permit Issued TIMELINE OSubmission received Mar 7,2017 at 9:33am Building Department Review Completed Mar 7,2017 at 9:47am OTreasurer Review Completed Mar 7,2017 at 10:15am OBuilding Inspector Approval Completed Mar 7,2017 at 11:45am OAlteration Roofing and/of Windows/Doors Paid Mar 24,2017 at 6:38am OPermit Issued Issued Mar 24,2017 at 6:37am *Building Permit#23335 Alterations:Roofing/Siding and/or Windows/Doors https://northandover m a.vi ewpoi ntcl oud.com/#/records/23335 1/5 3/28/20 17 *Building Permit#cnnno'vw*PomCloud [�oxF��U St.,/� � � \ 0xpp||cant Location kK8ordini 1FOREST STREET , NORTH ANDOVER, Kn4 t~ 508-280-0155 Owner @mmordiniCo)powerhrgz... FALLON2O14TRUST Attachments PDF ~OTZTBT1001F_Tue_K4a,_07_2017_O.PDF Uploaded March 7,2n17uvMark mn,um/ 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 MARK EMORD|N| C5'057845 09/18/2017 Construction Supervisor [] Active . NATTLEBOROMAOZ750 Preferred Telephone#:~ Alternate Phone# Email 508-280-0156 610-874-5000 mmordiniCOpowerhrgzom mps://northandovermumewpointc|oud.com/#"/rmmrdd23335 2/5 3/28/20 17 *Building Permit#cnnno'vw*PomCloud 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 Repair, Replacement Oneq\woFami|y oesc,/pt/onwwm,xmbepem,rmeu~ /sproperty onTown water ~ strip siding and install new insulated vinyl siding per code<24square>. install 1 entry door same size and location as existing no structural changes Yes |sproperty n^Town sewer ~ No Project Cost(if new construction base on$125 per square foot and if add ition/a Iteration/renovation base on actual contract price) 26.571 Does this project require atemporary construction trailer? ~ NO Does this project require atemporary construction sign? ~ NO Danger Zone Literature(IVIGL CHapter 166 Section 21A-F and G min.$10041,000 fine) Registered Design Professional mps://northandovermumewpointc|oud.com/#"/rmmrdd23335 3/5 3/28/2017 *Building Permit#23335-View Point Cloud Architect/Engineer Name Architect/Engineer Address Architect/Engineer Phone Number Architect/Engineer Reg.# 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 siding 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) hftps://northandoverma.viewpointcloud.com/#/records/23335 4/5 3/28/2017 *Building Permit#23335-View Point Cloud Harleysville Worcester Insurance Company Policy#or Self-Ins.License#* Expiration Date 2016006620967 10/01/2017 Workers' Compensation Affidavit Signature I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. 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? R1 No Yes hftps://northandoverma.viewpointcloud.com/#/records/23335 5/5