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Home My WebLink AboutBuilding Permit # 4/17/2017 4/19/2017 *Building Permit#24297-View Point Cloud 24297 *Building Permit—Alterations:Roofing/Siding and/or Windows/Doors O Building Permit Issued TIMELINE OSubmission received Apr 13,2017 at 7:25am Building Department Review Completed Apr 13,2017 at 9:43am OTreasurer Review Completed Apr 13,2017 at 3:11pm OBuilding Inspector Approval Completed Apr 14,2017 at 12:09pm OAlteration Roofing and/of Windows/Doors Paid Apr 17,2017 at 7:14am OPermit Issued Issued Apr 17,2017 at 7:13am *Building Permit#24297 Alterations:Roofing/Siding and/or Windows/Doors Z_ ma„, https://northandover m a.vi ewpoi ntcl oud.com/#/records/24297 1/5 4/19/20 17 *Building Permit#c4cnr vw*PomClov 0 � Applicant Location -- Peter Leblanc 5GPATRIOT STREET , NORTH ANDOVER, YN4 "~ 978-407-7538 Owner @ po|arbearinsu|atinnoOg... GDS5EL|N.JAN|CE. F. LT&CDNN0LU( Attachments nu/ 55_PATR|0T_ST_PERK4|T_pdtpdf Uploaded April 1s.zonuyPeter Leblanc Application Submission Required information varies depending on who is applying for a building permit. Are you submitting this application authe Homeowner? ~ NO Primary Contractor Search for your contractor using the search bar below. Either the Licensee Name orLicense#isrequired. Firm(ousmesy)Name Licensee~ License#~ License Expiration Date~ License Type^ License Active License Status PETER ALEBL4NC CSSL-100017 04/28/2018 Construction Supervisor Specialty O Active Mailing Address~ Preferred Telephone#:~ Alternate Phone# Email . Plaistow NH03855 978-407-7638 POLAR8EAR|N5ULAT|ONoP)GK4A|LCOm I certify,under the pains and penalties of perjury,that the information on this application is true and complete. Br mps://northandovermumewpointc|oud.com/#"/rmmrds/24297 2/5 4/19/2017 *Building Permit#24297-View Point Cloud 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 addition/alteration/renovation base on actual contract price). ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector. Type of Improvement* Proposed Use* Description of Work to be Performed* Is property on Town water* Is property on Town sewer Alteration One-Two Family AIR SEALING,ATTIC INSULATION TO R-49,VENTILATION Yes Yes Project Cost(if new construction base on$125 per square foot and if addition/alteration/renovation base on actual contract price) 3,100 Does this project require a temporary construction trailer? NO Does this project require a temporary 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 Name Architect/Engineer Address Architect/Engineer Phone Number Architect/Engineer Reg.# Insurance INSURANCE COVERAGE: hftps://northandoverma.viewpointcloud.com/#/records/24297 3/5 4/19/20 17 *Building Permit#c4cnr vw*PomClov /nave acurrent naonnvinsurance poncyn,its svostanna/enuwaenc- Yes nyes,indicate the type ofcoverage~ xother,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. | am an employer with employees(full end/or part-time) Type ofproject~ Please explain'ome,'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 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) NORGUARD |N5URANCE Policy#o,oe/wns.License#~ Expiration Date POYYC840361 01/01/2018 Workers' Compensation Affidavit Signature /uohereby certify under the pains and penalties orperjury that the information provided above/ytrue and correct. ^ hmpe:0nonxandove,muxiewpoimo|ovd.00m/#"/rmmrda/24287 4/5 4/19/2017 *Building Permit#24297-View Point Cloud 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?* https://northandoverma.viewpointcloud.com/#/records/24297 5/5