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Home My WebLink AboutBuilding Permit # 3/29/2017 3/30/2017 *Building Permit#23900-View Point Cloud 23900 *Building Permit—Alterations:Roofing/Siding and/or Windows/Doors O Building Permit Issued TIMELINE OSubmission received Mar 28,2017 at 9:25am Building Department Review Completed Mar 28,2017 at 9:42am OTreasurer Review Completed Mar 28,2017 at 12:51pm OBuilding Inspector Approval Completed Mar 29,2017 at 7:59am OAlteration Roofing and/of Windows/Doors Paid Mar 29,2017 at 8:40am OPermit Issued Issued Mar 29,2017 at 8:39am *Building Permit#23900 Alterations:Roofing/Siding and/or Windows/Doors https://northandover m a.vi ewpoi ntcl oud.com/#/records/23900 1/5 3/30/2017 *Building Permit#23900-View Point Cloud Applicant Location Kurt Gauthier 1619 SALEM STREET, NORTH ANDOVER, MA t. 978-356-3483 Owner @ gauthierinsulation(P)gm.. DALY,THOMAS M Attachments PDF ^'OTJ2U31001F Tue Mar 28 2017 O.PDF Uploaded March 28,2017 by Kurt Gauthier Application Submission Required information varies depending on who is applying for a building permit. Are you submitting this application as the Homeowner? NO Primary Contractor Search for your contractor using the search bar below. Either the Licensee Name or License#is required. Firm(Business)Name Licensee* License#* License Expiration Date* License Type* License Active License Status Mailing Address KURT R GAUTHIER CSSL-102562 05/25/2017 Construction Supervisor Specialty O Active Ipswich MA 01938 Preferred Telephone#:* Alternate Phone# Email 9783563483 hftps://northandoverma.viewpointcloud.com/#/records/23900 2/5 3/30/20 17 *Building Permit#cneoo vw*PomClov 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^ Description mWork muoPerformed~ /oproperty onTown water~ /sproperty nnTown sewer ~ Alteration One-Two Family air sealing;cellulose in attic;ventilation Yes Yes Project cos (if new construction,base on$12sper square foot and xadd monmIteration/renovation uaseonvcma/contractnnoe)~ 4.677 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.# mps://northandovermumewpointc|oud.com/#"/rmmrdd23900 3/5 3/30/2017 *Building Permit#23900-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) Acadia Insurance Co Policy#or Self-Ins.License#* Expiration Date MAARP300327 10/30/2017 hftps://northandoverma.viewpointcloud.com/#/records/23900 4/5 3/30/2017 *Building Permit#23900-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. 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 No No No hftps://northandoverma.viewpointcloud.com/#/records/23900 5/5