HomeMy WebLinkAboutBuilding Permit # 4/4/2017 4/13/2017 "Building Permit#24043-View Point Cloud
24,043
*Building Permit—Alterations: Roofing/Siding and/or Windows/Doors O Building Permit Issued
TIMELINE
OSubmission received
Apr 3,2017 at 9:35am
OBuilding Department
Review 0
Completed Apr 3,2017 at 4:41pm
OTreasurer Review
Completed Apr 3,2017 at 49
4:51pm
OBuilding Inspector dl
Approval
Completed Apr 4,2017 at 2:07pm
OAlteration Roofing and/of
Windows/Doors
Paid Apr 4,2017 at 2:08pm
OPermit Issued
Issued Apr 4,2017 at 2:07pm
*Building Permit#24043 Alterations:Roofing/Siding and/or Windows/Doors
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Applicant Location
—� Todd LeDuc 19QCOVENTRY LANE , NORTH ANDOVER, MA
v= 401'965'8578 Own*,
@ affordab|ebw(d-gmaiic— K4OEN |U. CHRISTOPHER/\
Attachments
PDF -OTK4RLy|OO1F_K�on_4p[_03_2O17_0.PDF
Uploaded April 3.2017byTodd LeDuc
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#|srequired.
Firm(Business)Name Licenoee^ License#~ License Expiration Date~ License Type^ License Active License Status
TODD LEDUC CSSL-105019 02/28/2018 CSSL-|C- Insulation Contractor [] Active
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Mailing Address~ Preferred Telephone#: Alternate Phone# Email
. East Greenwich R| 02818 4019558578 4707659789 affordab|ebw(4gmaiicom
|certify,under the pains and penalties of perjury,that the information on this application is true and complete.~
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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 add ition/a Iteration/ren ovation base on actual contract price). ELECTRICAL: Movement of Meter location,
mast orservice drop requires approval ofElectrical Inspector.
Type ofImprovement~ Proposed Use~ Description ofWork to be Performed~ Is property on Town water~ Is property on Town sewer~
Alteration Dne'TvvoFami|y Air sealing and insulation ofattic and common wall area. No No
Project Cost(if new construction base on$125 per square foot and ifaddition/a|temtion/renovation base on actual contract price)~
5,000
Does this project require atemporary construction trailer?
~
NO
Does this project require atemporary construction sign?
^
NO
Danger Zone Literature(MGL CHapte,156 Section 214.Fand G min.$100-$1,000 fine)
NO
Registered Design Professional
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Architect/Engineer Name Architect/Engineer Address Architect/Engineer Phone Number Architect/Engineer Reg.#
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
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Insurance Company Name(Attach a copy of workers'compensation policy declaration page showing the policy number and expiration date)
Beacon Mutual
Policy#or Self-Ins. License#* Expiration Date
70308 09/17/2017
Workers' Compensation Affidavit Signature
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
C
la To Be Completed By Town Staff
G Zoning District* G Is this a 100 Year or older structure* Is property within an Overlay District* Is the property within the Floodplain
Is the project within 100'of Wetlands?*
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