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HomeMy WebLinkAboutBuilding Permit # 3/27/2017 3/28/2017 *Building Permit#23580-View Point Cloud *Building Permit—Construction of Additions,Alterations,and Remodeling O Building Permit Issued TIMELINE OSubmission received Mar 15,2017 at 1:38pm 10 Building Department Review IP 0 Completed Mar 15,2017 at 4:07pm © Conservation Department Review Ono Skipped Mar 16,2017 at 9:15am © Planning Department Review Skipped Mar 15,2017 at 9:30pm OHealth Department Revies Completed Mar 23,2017 at 9:36am ODPW Engineering Review Completed Mar 15,2017 at 4:26pm ODPW Operations Review Completed Mar 16,2017 at 10:36am J1%% © Fire Department Review Skipped Mar 21,2017 at 1:38pmQ OTreasurer Review Completed Mar 17,2017 at 8:18am https://northandover m a.vi ewpoi ntcl oud.com/#/records/23580 1/5 3/28/20 17 *Building Permit#cnnoo vw*PomClov Building Inspector Approval �� � 15 �� Completed Mar 2s.2onate:ssam ~�~ ��� Add idonsAA|teradona/Remode|ingBldg ���� Permit Fee �� Paid Mar 2<2nnat 12:53pm Permit Issued �� �� �°~ Issued Mar zT2o1rat 12z3pm *Building Permit#23580 Construction°/Additions,Alterations,and Remodeling r� \�^ ~' Applicant Location -- Adam Brien 13O4PPLETOy4STREET , NORTH ANDOVER, YN4 t~ 378-4791526 Owner @ adambricoCd-gmai|zom.. 8|ARD. DANIEL Attachments uocx Giard_Repairs.docx Uploaded March 1s.2o1/uyAdam Brien pu, Certificate-16.pdf Uploaded March 1s.2nvuyAdam Brien pu, Certificate_of_Liobi|ity_|nsurence_20160713_093814-5.pdf Uploaded March 1s.aonuyAdam Brien pu/ 149_App|eton_we_ef[pdf Uploaded March 1s.aonuyAdam Brien hmpe:0nonxandove,muxiewpoimo|ovd.00m/#"/rmmrdd23580 2/5 3/28/20 17 *Building Permit#cnnoo vw*PomClov uocx Giand_Contract.docx Uploaded March z2'2m7uvAdam Brien 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(ousmess)Name Licensee~ License#~ License Expiration Date~ License Type~ License Active License Status Mailing Address ADAM JBR|EN CS'104428 05/12/2018 Construction Supervisor [] Active .North Andover MAO1845 Preferred Telephone#:~ Alternate Phone# Email 9784791526 adambrico(ogmaiicom 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 ofImprovement~ Proposed Use~ o*so/pt/onmwm,kmuepexu,m*u~ /sproperty onTown water ~ Repair, Replacement Oneq\woFemi|y Remodel of kitchen, bathroom,3 season room flooring, misc interior repairs, new front entry door Yeo mps://northandovermumewpointc|oud.com/#"/rmmrdd23580 3/5 3/28/2017 *Building Permit#23580-View Point Cloud Is property on Town sewer No Project Cost(if new construction base on$125 per square foot and if addition/alteration/renovation base on actual contract price) 4,500 Does this project require a temporary construction trailer? NO Does this project require a temporary 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 Name Architect/Engineer Address Architect/Engineer Phone Number Architect/Engineer Reg.# 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 hftps://northandoverma.viewpointcloud.com/#/records/23580 4/5 3/28/2017 *Building Permit#23580-View Point Cloud 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* 8. Remodeling 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) Travelers Insurance Policy#or Self-Ins.License#` Expiration Date 7PJUB4618P50716 04/19/2017 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/23580 5/5