HomeMy WebLinkAboutBuilding Permit # 4/25/2017 5/4/2017 *Building Permit#24522-View Point Cloud
EI
*Building Permit—Alterations:Roofing/Siding and/or Windows/Doors O Building Permit Issued
TIMELINE
OSubmission received
Apr 23,2017 at 9:54am
Building Department
Review
Completed Apr 24,2017 at 7:58am
OTreasurer Review
Completed Apr 25,2017 at
9:38am
OBuilding Inspector
Approval
Completed Apr 25,2017 at 5:12pm
OAlteration Roofing and/of
Windows/Doors
Paid Apr 25,2017 at 7:59pm
OPermit Issued
Issued Apr 25,2017 at 7:58pm
*Building Permit#24522 Alterations:Roofing/Siding and/or Windows/Doors
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JN lips Auto Glass0 1
Applicant Location
Kurt Gauthier 28 ASHLAND STREET , NORTH ANDOVER, MA
t. 978-356-3483 Owner
@ gauthierinsulation(P)gm.. CARAMONTA, FAITH
Attachments
pdf Carainr.nta 44/827
Uploaded by Kurt Gauthier on Apr 23,2017 9:54 AM ,
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.
Firm(Business)Name Licensee* License#* License Expiration Date* License Type* License Active License Status Mailing Address
KURT R GAUTHIER CSSL-102562 05/25/2017 O Active Ipswich MA 01938
Preferred Telephone#:* Alternate Phone# Email
9783563483 gauthierinsulation@gmail.com
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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
Alteration One-Two Family insulation Yes Yes
Project Cost(if new construction base on$125 per square foot and if addition/alteration/renovation base on actual contract price)
2,130
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.#
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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*
8. Remodeling
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)
Acadia Insurance Co
Policy#or Self-Ins.License#* Expiration Date
MAARP300327 10/30/2017
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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?
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