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Home My WebLink AboutBuilding Permit # 3/27/2017 3/28/2017 *Building Permit#23787-View Point Cloud 23787 *Building Permit—Alterations:Roofing/Siding and/or Windows/Doors O Building Permit Issued TIMELINE OSubmission received Mar 22,2017 at 4:35pm Building Department Review Completed Mar 23,2017 at 9:54am OTreasurer Review Completed Mar 23,2017 at 1:07pm OBuilding Inspector Approval J tli, Completed Mar 23,2017 at 4:57pm OAlteration Roofing and/of Windows/Doors Paid Mar 24,2017 at 8:18am OPermit Issued Issued Mar 24,2017 at 8:18am *Building Permit#23787 Alterations:Roofing/Siding and/or Windows/Doors https://northandover m a.vi ewpoi ntcl oud.com/#/records/23787 1/5 3/28/2017 "Building Permit#23787-View Point Cloud Applicant Location Eric Bennett 265 SALEM STREET , NORTH ANDOVER, MA t. 603-647-2200 Owner @ ericCotristatewindow.c... DIAZ,JAIME Attachments pdf WC_Affidavit=_265_Salem_Street_Wed_Mar_22_2017_1.pdf Uploaded March 22,2017 by Eric Bennett pdf Deb ris_Affidavit=_265_Salem_Street_Wed_Mar_22_2017_1.pdf Uploaded March 22,2017 by Eric Bennett pdf Licences=_265_Salem_Street_Wed_Mar_22_2017_1.pdf Uploaded March 22,2017 by Eric Bennett PDF Insurance Customer Wed Mar 22 2017 1.PDF Uploaded March 22,2017 by Eric Bennett PDF Insurance Town Wed Mar 22 2017 1.PDF Uploaded March 22,2017 by Eric Bennett pdf Flores_MA_signed_contract_Wed_Mar_22_2017_1.pdf Uploaded March 22,2017 by Eric Bennett Application Submission Required information varies depending on who is applying for a building permit. Are you submitting this application as the Homeowner? NO https://northandoverma.viewpointcloud.com/#/records/23787 2/5 3/28/20 17 *Building Permit#cnror vw*PomClov Primary Contractor Search for your contractor using the search bar below. Either the Licensee Name or License#is required. Firm(ousincs$Name uc=nsc=~ License#~ License Expiration Date~ License Type~ License Active License Status TRI-STATE WINDOW&SIDING 102828 03/28/2017 Home Improvement Contractor [] Active Mailing Address~ Preferred Telephone#:~ Alternate Phone# Email PO. BOX 102O. LONDONDERRY NHO3053 503-647-2200 ericCo)tristete»windovxcom I 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 $125 per square foot and if addition/alteration/renovation base on actual contract price). ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector. Type mImprovement~ Proposed Use~ Description mWork wuePerformed~ |sproperty nnTown water~ |,property onTown sewer ~ Repair, Replacement Oneq\woFami|y Vinyl Siding,15Harvey Replacement Windows Yes Yes Project Cost(if new construction base on$125 per square foot and if add ition/a Iteration/renovation base on actual contract price) 22,700 Does this project require atemporary construction trailer? ~ NO Does this project require atemporary construction sign? ~ NO Danger Zone Literature(MGL Cnapte,/osSection z1*-Fand smin.$non'$1.onofine) YES hups://nonxandove,mumewpoimo|md.00m/#"/rmmrdd23787 3/5 3/28/2017 *Building Permit#23787-View Point Cloud Registered Design Professional Architect/Engineer Name Architect/Engineer Address Architect/Engineer Phone Number Architect/Engineer Reg.# N/A N/A N/A N/A 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 Vinyl Siding and Replacement Windows I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. hftps://northandoverma.viewpointcloud.com/#/records/23787 4/5 3/28/2017 *Building Permit#23787-View Point Cloud 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) Guard Insurance Company Policy#or Self-Ins.License#* Expiration Date TRWC656654 04/04/2017 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* G Which Overlay District* Is the property within the Floodplain R3 Yes Watershed Protection District Yes Is the project within 100'of Wetlands?* hftps://northandoverma.viewpointcloud.com/#/records/23787 5/5