HomeMy WebLinkAboutBuilding Permit # 4/26/2017 5/4/2017 *Building Permit#24568-View Point Cloud
2 4,
6 8c
*Building Permit—Alterations:Roofing/Siding and/or Windows/Doors O Building Permit Issued
TIMELINE
OSubmission received
Apr 25,2017 at 12:50pm
Building Department
Review
Completed Apr 25,2017 at 3:39pm
OTreasurer Review
Completed Apr 25,2017 at
5:52pm
OBuilding Inspector
Approval
Completed Apr 26,2017 at 9:50am
OAlteration Roofing and/of
Windows/Doors
Paid Apr 26,2017 at 11:21am
OPermit Issued
Issued Apr 26,2017 at 11:20am
*Building Permit#24568 Alterations:Roofing/Siding and/or Windows/Doors
https://northandover m a.vi ewpoi ntcl oud.com/#/records/24568 1/5
5/4/20 17 *Building Permit#u45no wewPnmQmm
' �.
—�c)/7/c��
QT
Applicantmc�u
--- Lawrence Morgan GOPLEASANT STREET , NORTH ANDOVER, YN4
t~ 978-570-4747 Owner
@ |morganconstructionCd— KL|S|EYY|CZ.TADEU5Z KVDD Realty Trust)
Attachments
pur Scan_000Q_Tue_Apr_25_2O17_1 �
Uploaded uyLawrence Morgan onApr zs'2n1/12:s1pm
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(ausmess)Name Licensee~ License#^ License Expiration Date~ License Type~ License Active License Status Mailing Address
LAWRENCE EMORGAN,JR C5-079476 05/03/2017 [] Active ' North Billerica MA01862
Preferred Telephone#:~ Alternate Phone# Email
9786704747 |morganconstmction#comcast.net
mps://northandovermumewpointc|oud.com/#"/rmmrds/24568 2/5
5/4/2017 "Building Permit#24568-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
Repair, Replacement One-Two Family Strip& Re-Roof No No
Project Cost(if new construction base on$125 per square foot and if addition/alteration/renovation base on actual contract price)
9,840
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)
Registered Design Professional
Architect/Engineer Name Architect/Engineer Address Architect/Engineer Phone Number Architect/Engineer Reg.#
N/A
hftps://northandoverma.viewpointcloud.com/#/records/24568 3/5
5/4/2017 "Building Permit#24568-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*
13. Roof Repair
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)
American Zurich
Policy#or Self-Ins.License#* Expiration Date
6ZZ U 65673831216 12/14/2017
hftps://northandoverma.viewpointcloud.com/#/records/24568 4/5
5/4/2017 "Building Permit#24568-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?
R 4 No No No Not Applicable
hftps://northandoverma.viewpointcloud.com/#/records/24568 5/5