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Home My WebLink AboutBuilding Permit # 4/14/2017 4/19/2017 *Building Permit#24307-View Point Cloud 24307 *Building Permit—Alterations:Roofing/Siding and/or Windows/Doors O Building Permit Issued TIMELINE OSubmission received Apr 13,2017 at 12:39pm Building Department Review Completed Apr 13,2017 at 12:45pm OTreasurer Review Completed Apr 13,2017 at 3:09pm OBuilding Inspector Approval J 1 , Completed Apr 14,2017 at 12:08pm OAlteration Roofing and/of Windows/Doors Paid Apr 14,2017 at 3:34pm OPermit Issued Issued Apr 14,2017 at 3:34pm *Building Permit#24307 Alterations:Roofing/Siding and/or Windows/Doors https://northandover m a.vi ewpoi ntcl oud.com/#/records/24307 1/5 4/19/2017 "Building Permit#24307-View Point Cloud C:'a 0yr uiuiuu� IIIIIIIIIW Applicant Location Jaime Morin 31 SPRUCE STREET, NORTH ANDOVER, MA t- 508-351-2241 Owner @ brian.labaire@anderse..• CLAUSSEN, NANCY J. Attachments pdf Claussen_Workmans_Comp_and_Liability_Insurance_Thu_Apr_13_2017_1.pdf Uploaded April 13,2017 by Jaime Morin pdf Claussen_Contract_Thu_Apr_13_2017_1.pdf Uploaded April 13,2017 by Jaime Morin pdf Town_of_North_Andove r_Thu_Apr_13_2017_1.pdf Uploaded April 13,2017 by Jaime Morin pdf CSL__HIC_Thu_Apr_13_2017_1.pdf Uploaded April 13,2017 by Jaime Morin pdf 200_Series_Thu_Apr_13_2017_1.pdf Uploaded April 13,2017 by Jaime Morin 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. https://northandoverma.viewpointcloud.com/#/records/24307 2/5 4/19/20 17 *Building Permit#c4nor vw*PomClov Firm(ausmess)Name Licensee~ License#^ License Expiration Date~ License Type~ License Active License Status Mailing Address JAIME L MORIN CS-090125 10/05/2018 Construction Supervisor LJ Active . LYNN MA 01905 Preferred Telephone#:^ Alternate Phone# sm"o 5083512277 brian]abaire^Oanderaencorpzom I certify,under the pains and penalties of perjury,that the information on this application is true and complete. Br 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 Ite ration/ren ovation base on actual contract price). ELECTRICAL: Movement ofMeter location, mast orservice drop requires approval ofElectrical Inspector. Type ofImprovement~ Proposed Use~ meso/pt/onmwm,xmu*peno,meu~ /sproperty onTown water~ /sproperty o^Town sewer ^ Repair, Replacement One-Two Family Replace Patio Door Yes Yes Project Cost(if new construction base on$125 per square foot and if add ition/a Iteration/renovation base on actual contract price) 5,005 Does this project require atemporary construction trailer? ~ NO Does this project require atemporary construction sign? ~ NO Danger Zone Literature(MGL cHapte,1ssSection 214pand Gmin.$1nn-$1.nnofine) NO Registered Design Professional hftps://northandovermumewpointc|oud.com/#"/rmmrds/24307 3/5 4/19/2017 *Building Permit#24307-View Point Cloud HrcrinecUCnglneer NarTle HrcnnecUCnglneer HDuress Hrcnaecucrlglneer 1-none NurlDer Nrcnnecucrlglneer Keg.N 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 Door Replacement 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) Old Republic Insurance Company Policv#or Self-Ins.License#* Expiration Date hftps://northandoverma.viewpointcloud.com/#/records/24307 4/5 4/19/2017 *Building Permit#24307-View Point Cloud M WC30823100 10/01/2017 Workers' Compensation Affidavit Signature I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. 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" R4 No No No Is the project within 100'of Wetlands?' Yes hftps://northandoverma.viewpointcloud.com/#/records/24307 5/5