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HomeMy WebLinkAboutBuilding Permit # 4/21/2017 5/4/2017 *Building Permit#24359-View Point Cloud *Building Permit—Alterations:Roofing/Siding and/or Windows/Doors O Building Permit Issued TIMELINE OSubmission received Apr 17,2017 at 6:47am Building Department Review Completed Apr 18,2017 at 8:25am OTreasurer Review Completed Apr 18,2017 at 9:23am OBuilding Inspector Approval J 1 , Completed Apr 18,2017 at 1:OOpm OAlteration Roofing and/of Windows/Doors Paid Apr 21,2017 at 9:23am OPermit Issued Issued Apr 21,2017 at 9:23am *Building Permit#24359 Alterations:Roofing/Siding and/or Windows/Doors https://northandover m a.vi ewpoi ntcl oud.com/#/records/24359 1/5 5/4/2017 *Building Permit#u43oe wewPnmQmm Applicant Location -- WILLIAM N|CH(]LG 22GABBOTT STREET , NORTH ANDOVER, YNA t~ 978-255-7255 Owner @ nicho|svvrod-pe||ebouto— REICH, MARK R Attachments pur DDCO41717-U04_Mon_Apr_17_2017_0 � Uploaded uyWILLIAM w|cnoLsnnApr 1<2nns:«oxM 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(ausmess)Name Licensee~ License#~ License Expiration Date~ License Type~ License Type^ License Active License Status WILLIAM RN|CHOLS C5-089853 10/25/2018 Construction Supervisor O Active Mailing Address~ Preferred Telephone#:~ Alternate Phone# Email . HAVERH|LLMAO183O 9782657255 nicho|awr(OpeUabogonzom mps://northandovermumewpointc|oud.com/#"/rmmrds/24359 2/5 5/4/2017 "Building Permit#24359-Mew Point Cloud I certify,under the pains and penalties of perjury,that the information on this application is true and complete. G 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 Repair, Replacement One-Two Family 17 replacement windows Yes Yes Project Cost(if new construction base on$125 per square foot and if addition/alteration/renovation base on actual contract price) 46,000 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.# hftps://northandoverma.viewpointcloud.com/#/records/24359 3/5 5/4/2017 "Building Permit#24359-Mew Point Cloud 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 17 replacement windows 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) nh employers ins co Policy#or Self-Ins.License#* Expiration Date 8007024 07/01/2017 hftps://northandoverma.viewpointcloud.com/#/records/24359 4/5 5/4/2017 "Building Permit#24359-View Point Cloud 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* Is the project within 100'of Wetlands? R3 No No No No hftps://northandoverma.viewpointcloud.com/#/records/24359 5/5