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Home My WebLink AboutBuilding Permit # 4/6/2017 4/13/2017 *Building Permit#23934-View Point Cloud 23934, *Building Permit—Construction of Additions,Alterations, and Remodeling O Building Permit Issued TIMELINE 0 Submission received Mar 29,2017 at 9:32am Building Department Review IP 0 O Completed Apr 1,2017 at 10:05am 0 Conservation Department Review 0 Skipped Apr 4, 2017 at 5:20pm 0 Planning Department Review Skipped Apr 3, 2017 at 8:24am 10 Health Department Revies Completed Apr 4,2017 at 8:55am 15 DPW Engineering Review Completed Apr 2,2017 at 10:31am O DPW Operations Review Completed Apr 3,2017 at 8:13am 0 Fire Department Review Skipped Apr 3, 2017 at 8:03am hftps://northandoverma.viewpointcloud.com/#"/rer,ords/23934 1/6 4/13/2017 "Building Permit#23934-View Point Cloud OTreasurer Review Completed Apr 3,2017 at 1:10pm 0 OBuilding Inspector Approval da �%//////// Completed Apr 5,2017 at 5:17pm °' OAdditions/Alterations/Remodeling Bldg Permit Fee Paid Apr 6,2017 at 11:08am OPermit Issued Issued Apr 6,2017 at 11:07am *Building Permit#23934 Construction of Additions,Alterations,and Remodeling Gly � �t Applicant Location stan baron 29 BLUEBERRY HILL LANE , NORTH ANDOVER, MA k. 978-447-0609 Owner @ stan.baron@sweepnm... GIVNER, DAVID M. Attachments PDF -OT7GLZ1001F Wed Mar 29 2017 O.PDF Unloaded March 29.2017 by stan baron https://northandoverma.viewpointcloud.com/#/records/23934 2/6 4/13/20 17 *Building Permit#cnen4 vw*PomClov 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(Business)Name Licensoo^ License#~ License Expiration Date^ License Type^ License Active DAVID 4B4NCROFT CSSL400886 03/05V2018 CSSL-8F-Solid Fuel Burning Device [] License Status Mailing Address^ Preferred Telephone#:^ Alternate Phone# Email Active 108Main SLBuilding H. North Reading K4401864 978-664-6642 dave.bancrok(davveepnmenzom |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^ Description nfWork tn be Performed~ Is property on Town water^ Is property on Town sewer~ Alteration One-Two Family install insulated stainless liner for wood burning insert Yes Yes mps://northandovermumewpointc|oud.com/#"/rmmrdd23934 3/6 4/13/20 17 *Building Permit#cnen4 vw*PomClov Project Cost(if new construction base on$125 per square foot and ifaddition/ahemtion/renovahon base on actual contract price)~ 7,5@O Does this project require atemporary construction trailer? ~ NO Does this project require atemporary construction sign? ~ NO Danger Zone Literature(MGL CHapte,150Section 214.Fand 5min.$100-$1,000 fine) NO Registered Design Professional Arch tect/Engineer Name Aohheot/Enginee,AdU,ess Architect/Engineer Phone Number Architect/Engineer Reg.# Insurance INSURANCE COVERAGE: | have a current liability insurance policy or its substantial equivalent." Yes |fyes,indicate the type ofcoverage~ |fother,specify Liability hftps://northandovermumewpointc|oud.com/#"/rmmrdd23934 4/6 4/13/2017 *Building Permit#23934-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) liberty mutual insurance Policy#or Self-Ins. License#* Expiration Date wc5-315-388139-016 12/18/2017 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 hftps://northandoverma.viewpointcloud.com/#/records/23934 5/6 4/13/2017 *Building Permit#23934-View Point Cloud 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?* https://northandoverma.viewpointcloud.com/#/records/23934 6/6