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Home My WebLink AboutBuilding Permit # 4/25/2017 5/4/2017 *Building Permit#24456-View Point Cloud *Building Permit—Construction of Additions,Alterations,and Remodeling O Building Permit Issued TIMELINE OSubmission received Apr 20,2017 at 9:55am Building Department Review Completed Apr 21,2017 at 9:12am OConservation Department Review IP 0 Completed Apr 24,2017 at 10:35am Planning Department Review M�i O * !!% Completed Apr 21,2017 at 9:37am OHealth Department Revies Completed Apr 21,2017 at 9:15am ODPW Engineering Review Completed Apr 24,2017 at 4:25pm ODPW Operations Review Completed Apr 21,2017 at 11:12am J1%% Fire Department Review IP Completed Apr 21,2017 at 12:27pm � OTreasurer Review Completed Apr 21,2017 at 12:13pm https://northandover m a.vi ewpoi ntcl oud.com/#/records/24456 1/5 5/4/2017 *Building Permit#24456-View Point Cloud Building Inspector Approval Completed Apr 25,2017 at 5:03pm OAdditions/Alterations/Remodeling Bldg Permit Fee Paid Apr 25,2017 at 5:10pm OPermit Issued Issued Apr 25,2017 at 5:09pm *Building Permit#24456 Construction of Additions,Alterations,and Remodeling Pr Applicant Location Michael Gould 1160 GREAT POND ROAD , NORTH ANDOVER, MA t. 603-883-5326 Owner @ mgouldCOintents.com(... BROOKS SCHOOL Attachments PDF 0 1 200DIO0III Thu Air .'�20 20170 ; Uploaded by Michael Gould on Apr 20,2017 9:56 AM , Application Submission Required information varies depending on who is applying for a building permit. Are you submitting this application as the Homeowner?' https://northandoverma.viewpointcloud.com/#/records/24456 2/5 5/4/2017 "Building Permit#24456-Mew Point Cloud NO Primary Contractor Search for your contractor using the search bar below. Either the Licensee Name or License#is required. Firm(Business)Name Licensee* License#* License Expiration Date* License Type* License Type* License Active License Status Michael P LeBlanc CS-067484 06/22/2018 Construction Supervisor O Active Mailing Address* Preferred Telephone#:* Alternate Phone# Email , Leominster MA 01453 6032344760 1 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* Describe the type of use Repair, Replacement Non-Residential Building TEMPORARY TENT Description of Work to be Performed* ON OR ABOUT 5/23/17 WE WILL INSTALL A 100'X 120'TENT ON THE NORTH SIDE OF ALUMNI HOUSE IN THE OPEN FIELD# BROOKS SCHOOL. REMOVAL WILL BE ON 5/30/17. Is property on Town water* Is property on Town sewer Yes Yes Project Cost(if new construction base on$125 per square foot and if addition/alteration/renovation base on actual contract price) 5,000 hftps://northandoverma.viewpointcloud.com/#/records/24456 3/5 5/4/2017 *Building Permit#24456-V ewPoint Cloud 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: 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) https://northandoverma.viewpointcloud.com/#/records/24456 4/5 5/4/20 17 *Building Permit#u#on wewPnmQmm Type mproject~ Please explain mx*rproject: 14.Other TENT 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 ofthe DIA for insurance coverage verification. Insurance Company Name(Attach a copy of workers'compensation policy declaration page showing the policy number and expiration date) NHMOTOR TRANSPORT ASSOC. Policy#o,se|wns.License#~ Expiration Date P000749NHMTA2017 01/01{2018 Workers' Compensation Affidavit Signature I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.~ Br ig To Be Completed By Town Staff laZoning District~ la|othis a1ooYear o,older structure~ la|sproperty within anOverlay District~ |sthe property within the Floodplain~ |sthe project within 1oo'ofWetlands? ~ hftps://northandovermumewpointc|oud.com/#"/rmmrds/24456 5/5