HomeMy WebLinkAboutBuilding Permit # 3/29/2017 3/30/2017 *Building Permit#23755-View Point Cloud
*Building Permit—Alterations:Roofing/Siding and/or Windows/Doors O Building Permit Issued
TIMELINE
OSubmission received
Mar 22,2017 at 8:18am
Building Department
Review
Completed Mar 22,2017 at 12:48pm
OTreasurer Review
Completed Mar 23,2017 at
8:26am
OBuilding Inspector
Approval J 1 ,
Completed Mar 23,2017 at 4:48pm
OAlteration Roofing and/of
Windows/Doors
Paid Mar 29,2017 at 9:34am
OPermit Issued
Issued Mar 29,2017 at 9:34am
*Building Permit#23755 Alterations:Roofing/Siding and/or Windows/Doors
https://northandover m a.vi ewpoi ntcl oud.com/#/records/23755 1/5
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ApplicantLocation
]amesdebmceni 5UNION STREET , NORTH ANDOVER, MA
t~ 978-583-5127 Owner
@ infoCdf mi|yroofemoet' CURLEY, BRYAN R
Attachments
PDF ~OTAJAR1001F_VVed_K4a,_22_2017_0.PDF
Uploaded March 22.201/uy]amesueu,ecen/
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
JAMES JDEBRECEN| C5SL'099085 12/05/2017 C55L-RF Roofing O Active ' LONDONDERRY NHO3O53
Preferred Telephone#:~ Alternate Phone# Email
978'683-5127 infoCeDfa mi|y/oof rs.net
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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 One-Two Family strip and revoofgamge 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)
2.650
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)
aim
Policy#or Self-Ins.License#* Expiration Date
awc40070259002016a 05/11/2017
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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?
GIB Yes No No No
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