HomeMy WebLinkAboutBuilding Permit # 3/27/2017 3/28/2017 *Building Permit#23803-View Point Cloud
23803
*Building Permit—Alterations:Roofing/Siding and/or Windows/Doors O Building Permit Issued
TIMELINE
OSubmission received
Mar 23,2017 at 8:21am
Building Department
Review
Completed Mar 23,2017 at 9:51am
OTreasurer Review
Completed Mar 23,2017 at
1:08pm
OBuilding Inspector
Approval
Completed Mar 23,2017 at 4:57pm
OAlteration Roofing and/of
Windows/Doors
Paid Mar 24,2017 at 7:40am
OPermit Issued
Issued Mar 24,2017 at 7:40am
*Building Permit#23803 Alterations:Roofing/Siding and/or Windows/Doors
https://northandover m a.vi ewpoi ntcl oud.com/#/records/23803 1/5
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Applicant Location-- Pau| YNodze|eshi 53MIDDLESEX STREET , NORTH ANDOVER, YN4
t~ 503-774-7563 Owner
@ pau|&nsentryroofingnh'.. THORNLEYHAROLD& ELAINE TRUSTE
Attachments
PDF ~OTR7S21001F_Thu_Ma,_23_2017_O.PDF
Uploaded March 2s.zn1/uyPaul mnuze/e»m
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
PAULMODZELESK| C5'109955 05/23/2020 Construction Supervisor [] Active . DunbartnnNHO3O40
Preferred Telephone#:~ Alternate Phone# Email
503-2341477 pau|odyentrymofingnhzom
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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 onTown water~ |nproperty onTown sewer
~
Repair, Replacement Oneq\woFami|y Remove replace roof 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)
8,400
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.#
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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*
13. Roof Repair
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)
Berkley Risk
Policy#or Self-Ins.License#* Expiration Date
WC288300658601 03/28/2017
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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
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