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Home My WebLink AboutBuilding Permit # 4/25/2017 5/4/2017 *Building Permit#24523-View Point Cloud EI *Building Permit—Alterations:Roofing/Siding and/or Windows/Doors O Building Permit Issued TIMELINE OSubmission received Apr 23,2017 at 9:59am Building Department Review Ion Completed Apr 24,2017 at 3:33pm OTreasurer Review Completed Apr 25,2017 at 9:38am OBuilding Inspector Approval Completed Apr 25,2017 at 5:13pm OAlteration Roofing and/of Windows/Doors Paid Apr 25,2017 at 8:03pm OPermit Issued Issued Apr 25,2017 at 8:03pm *Building Permit#24523 Alterations:Roofing/Siding and/or Windows/Doors https://northandover m a.vi ewpoi ntcl oud.com/#/records/24523 1/5 5/4/20 17 *Building Permit#u4m23 wewPnmQmm —~— Kurt Gauthier 34 ELM STREET , NORTH ANDOVER, KA4 "~ 978-355-3483 Owner @ gauthierinsu|ationoP)gm' NETTLETON. DAVID J. Attachments pur Nettleton PH�5E || 431G43 _ � Uploaded uyxvuoa"mie,onApr 2s.2n1/essxm 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(Business)Name Licensee~ License#~ License Expiration mate^ License Type~ License Active License Status Mailing Address~ KURT RGAUTH|ER C5SL-102562 05/25/2017 [] Active ' Ipswich MA01938 Preferred Telephone#:~ Alternate Phone# Email 9783563483 gauthierinsu|ation^Ogmaiicom hups://nonxandove,mumewpoimo|md.00m/#"/rmmrda/24523 2/5 5/4/2017 "Building Permit#24523-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 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) 1,852 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/24523 3/5 5/4/2017 "Building Permit#24523-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* 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 hftps://northandoverma.viewpointcloud.com/#/records/24523 4/5 5/4/2017 "Building Permit#24523-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? R4 No Not Applicable hftps://northandoverma.viewpointcloud.com/#/records/24523 5/5