HomeMy WebLinkAboutBuilding Permit # 4/25/2017 5/4/2017 *Building Permit#24273-View Point Cloud
24,273
*Building Permit—Alterations:Roofing/Siding and/or Windows/Doors O Building Permit Issued
TIMELINE
OSubmission received
Apr 11,2017 at 12:28pm
Building Department
Review
Completed Apr 13,2017 at 9:01am
OTreasurer Review
Completed Apr 13,2017 at
3:13pm
OBuilding Inspector
Approval
Completed Apr 14,2017 at 7:51am
OAlteration Roofing and/of
Windows/Doors
Paid Apr 25,2017 at 8:31am
OPermit Issued
Issued Apr 25,2017 at 8:31am
*Building Permit#24273 Alterations:Roofing/Siding and/or Windows/Doors
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0xpp|icant LocationRichard Huet 23 HUCKLEBERRY LANE , NORTH ANDOVER, MA
t~ 978-255-8353 Owner
@ dt102od-verizon.net<m... DOUGHTY,JAMES
Attachments
PDF 0TXCTN|O01F_Tue_Apr_11_2O|7_1 �
Uploaded uyRichard F/uetnnApr 11.zn1/12:2npm
PDF 'UTY6VVO|O01F_Tue_Apc-11_2017_1 �
Uploaded uvRichard rmetonApr n.2n/,m:zspm
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(uusmess)Name Licensee~ License#~ License Expiration Date~ License Type~ License Type~ License Active License Status
RICHARD AFLUET CS'050710 04/22/2017 Construction Supervisor [] Active
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Mailing Address~ Preferred Telephone#:~ Alternate Phone# Email
. METHUEN M401844 978 255-8353
1 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 no/have access/nthe guaranty fund. Fee Schedule: Building Permit: Project Cost(if new construction base on $125 per
square foot and ifaddition/a|teration/venovation base on actual contract price). ELECTRICAL: Movement of Meter|ocadon, mast or service drop requires approval of Electrical
Inspector.
Type mImprovement~ Proposed Use^ Description mWork muoPerformed~ |sproperty onTown water~ |oproperty onTown sewer
~
Alteration One-Two Family Replace 9windows and one door \to Yes
Project Cost(if new construction,base on$125 per square foot and if add ition/a Iteration/renovation base on actual contract price)
10,403
Does this project require atemporary construction trailer?
NO
Does this project require atemporary construction sign?
~
NO
Danger Zone Literature(MGL cHapte,1ssSection 21*Fand smin.$1no-$1.onofine)
NO
Registered Design Professional
Arch nerusnoineer Name Arch uecusnoineer Address Arch mscusnoinee,Phone Number Arch uecusnoinee,Reg.#
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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 Window 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)
Arbella
Policy#or Self-Ins.License#* Expiration Date
9104340308 03/31/2018
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Workers' Compensation Affidavit Signature
/unhereby certify under the pains and penalties mperjury that the information provided above/strue and correct.
~
Br
igTo Be Completed By Town Staff
la Zoning District~ la|sthis a1nnYear n,older structure~ la|sproperty within anOverlay District~ |sthe property within the Floodplain~ |sthe project within 1on'of Wetlands?~
R2 No No No Yes
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