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Home My WebLink AboutBuilding Permit # 4/5/2017 4/13/2017 "Building Permit#23613-View Point Cloud 23613 *Building Permit-Alterations: Roofing/Siding and/or Windows/Doors O Building Permit Issued TIMELINE OSubmission received Mar 16,2017 at 9:08am OBuilding Department Review 0 Completed Mar 16,2017 at 9:42am OTreasurer Review Completed Mar 17,2017 at 49 8:21 a m OBuilding Inspector Approval 0 Completed Apr 1,2017 at 9:34am OAlteration Roofing and/of Windows/Doors Paid Apr 5,2017 at 2:42pm OPermit Issued Issued Apr 5,2017 at 2:41pm *Building Permit#23613 Alterations:Roofing/Siding and/or Windows/Doors - https://northandover m a.vi ewpoi ntcl oud.com/#/records/23613 1/6 4/13/2017 *Building Permit#23613-View Point Cloud NorthOver Sane Five ark - North . KinderCare 0 Andover (Chickering Rd) Shadli's Restaurant r and LOUnge Choice Fitness North Andover Applicant Location Kevin Camponescki 595 CHICKERING ROAD , NORTH ANDOVER, MA k. 978-479-1684 Owner @ camponescki@hotmail... Carl Berger Trustee Attachments PDF ^'OTJ4M01001F Thu Mar 16 2017 O.PDF Uploaded March 16,2017 by Kevin Camponescki 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 KEVIN A CAMPONESCKI CS-084282 02/04/2019 Construction Supervisor O Active https://northandoverma.viewpointcloud.com/#/records/23613 2/6 4/13/20 17 *Building Permit#236 n vw*PomClov Mailing Address~ Preferred Telephone#: Alternate Phone# Email . Reading K44O18G7 9784791584 |certify,under the pains and penalties of perjury,that the information on this application is true and complete.~ R 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~ Describe the type of use~ Repair, Replacement Non-Residential Building Gym Description ofWork to be Performed~ Is property on Town water~ Is property on Town sewer~ Remove 180 feet of back nailer and lower roof 1 inch. Install new rubber and metal. Yes Yes Project Cost(if new construction base on$125 per square foot and ifaddition/a|teration/,enovation base on actual contract price)~ 12.650 Does this project require atemporary construction trailer? ~ NO Does this project require atemporary construction sign? ~ NO Danger Zone Literature(MGL CHapter156Section 21A,FanU G min.$100-$1,000 fine) NO hups://nonxandove,mumewpoimo|md.00m/#"/rmmrdd23813 3/6 4/13/2017 *Building Permit#23613-View Point Cloud Registered Design Professional 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* 13. Roof Repair hftps://northandoverma.viewpointcloud.com/#/records/23613 4/6 4/13/2017 *Building Permit#23613-View Point Cloud 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) star insurance Policy#or Self-Ins. License#* Expiration Date wc071933505 02/26/2018 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 GB Is the project within 100'of Wetlands? No hftps://northandoverma.viewpointcloud.com/#/records/23613 5/6 4/13/2017 "Building Permit#23613-View Point Cloud https://northandoverma.viewpointcloud.com/#/records/23613 6/6