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Home My WebLink AboutBuilding Permit # 4/25/2017 5/4/2017 *Building Permit#24525-View Point Cloud E^ E^ *Building Permit—Alterations:Roofing/Siding and/or Windows/Doors O Building Permit Issued TIMELINE OSubmission received Apr 23,2017 at 10:04am Building Department Review Ion Completed Apr 25,2017 at 7:26am OTreasurer Review Completed Apr 25,2017 at 9:40a m OBuilding Inspector Approval Completed Apr 25,2017 at 5:35pm OAlteration Roofing and/of Windows/Doors Paid Apr 25,2017 at 8:01pm OPermit Issued Issued Apr 25,2017 at 8:01pm *Building Permit#24525 Alterations:Roofing/Siding and/or Windows/Doors https://northandover m a.vi ewpoi ntcl oud.com/#/records/24525 1/5 5/4/20 17 *Building Permit#u4m25 wewPnmQmm Applicant Location —~— Kurt Gauthier 30 SETTLERS RIDGE ROAD , NORTH ANDOVER, YN4 t~ 978-355-3483 Owner @ gauthierinsu|ation«P)gm' BRA|T ROBERT H Attachments pur Broit 44��@ _ � Uploaded uyKurt Gauthier onApr 2s.2m/1uosxm pdf H|C_Update_exp, 2O18 � Uploaded uvKurt Gauthier onApr 24.zn/,r:sspm pu, updatedCS�:;L � Uploaded uyKurt Gauthier onApr z4.2nv/:sspm 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 orLicense#iyrequired. hmpe:0nonxandove,muxiewpoimo|ovd.00m/#"/rmmrda/24525 2/5 5/4/2017 "Building Permit#24525-Mew Point Cloud 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(Ogmaii.com 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) 2,568 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 hftps://northandoverma.viewpointcloud.com/#/records/24525 3/5 5/4/2017 "Building Permit#24525-V ewPoint Cloud 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) 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 hftps://northandoverma.viewpointcloud.com/#/records/24525 4/5 5/4/20 17 *Building Permit#u4m25 wewPnmQmm Policy#n,semns.License#~ Expiration Date~ MAARP300327 10/30/2017 Workers' Compensation Affidavit Signature /uohereby certify under the pains and penalties nfperjury that the information provided above/strue and correct. ~ Br ig To Be Completed By Town Staff laZoning District~ la|sthis a1ooYear o,older structure~ la|sproperty within anOverlay District~ |sthe property within the Floodplain~ |sthe project within 1oo'of Weuanus~ hftps://northandovermumewpointc|oud.com/#"/rmmrds/24525 5/5