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HomeMy WebLinkAboutBuilding Permit # 4/28/2017 5/5/2017 *Building Permit#24407-View Point Cloud 24,407 *Building Permit—Construction of Additions,Alterations,and Remodeling O Building Permit Issued TIMELINE OSubmission received Apr 18,2017 at 3:08pm Building Department Review Completed Apr 19,2017 at 12:11pm OConservation Department Review Completed Apr 28,2017 at 8:40am © Planning Department Review * !!% Skipped Apr 26,2017 at 1:54pm OHealth Department Revies Completed Apr 20,2017 at 11:41am ODPW Engineering Review Completed Apr 21,2017 at 8:34am ODPW Operations Review Completed Apr 19,2017 at 2:00pm J1%% © Fire Department Review Skipped Apr 19,2017 at 4:36pm �� OTreasurer Review Completed Apr 19,2017 at 1:37pm https://northandover m a.vi ewpoi ntcl oud.com/#/records/24407 1/5 5/5/20 17 *Building Permit#u#or wewPnmQmm Building Inspector Approval ��� �� Completed Apr 2o.2onat 12:2/pm ~�~ Add idonsAA|teradona/Remode|ingBldg Permit Fee Paid Apr 2o.2nnat 2w5nm Permit Issued Issued Apr un.zo17atz:v4pm *Building Permit#24407 Construction o/Additions,Alterations,and Remodeling Applicant Location --' Kenneth Lania 1ROYAL CREST DRIVE , NORTH ANDOVER, K0A "~ 378-433-8100 Owner @ kenCd-cornerstone|and—. A|MCO/TTAM5235 Attachments PDF -0TX8YZ|OD1F_TUE,_Apr_1O_2O17_1 � Uploaded uyKenneth LaniaonApr 1a.2o17zonpm Application Submission Required information varies depending on who is applying for a building permit. Are you submitting this application asthe Homeowner? ~ hmpe:0nonxandove,muxiewpoimo|ovd.00m/#"/rmmrda/24407 2/5 5/5/2017 "Building Permit#24407-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 JOHN A VISNIEWSKI CS-014178 11/21/2017 Construction Supervisor O Active Mailing Address* Preferred Telephone#:* Alternate Phone# Email , PEPPERELL MA 01463 9784338100 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* Number of Units* Description of Work to be Performed* Is property on Town water* Is property on Town sewer Repair, Replacement Three of more family 12 Bldg 16-Foundation Drainage&Waterproofing Yes Yes Project Cost(if new construction base on$125 per square foot and if addition/alteration/renovation base on actual contract price)" 25,225 Does this project require a temporary construction trailer? NO Does this project require a temporary construction sign? NO hftps://northandoverma.viewpointcloud.com/#/records/24407 3/5 5/5/20 17 *Building Permit#u#or wewPnmQmm Danger Zone Literature(MGL CHapter 166 Section 21A-F and G min.$100-$1,000 fine) NO Registered Design Professional Architect/Engineer wame Arch necusnomee,Address Arch necusnomee,Phone Number Arch macusnomee,Reg.# John AVisniewski Z Bridgeview Circle Unit 9784338100 29775 Insurance INSURANCE COVERAGE: |have acurrent liability insurance policy o,its substantial equivalent. ~ ,es nyes,indicate the type mcoverage^ nother,specify Liability Worker's Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers To be filed with the permitting authority Are you anemployer?Select the appropriate type.Any applicant that selects*nmust also fill out the section below showing their workers'compensation policy information. ~ 1. | am an employer with employees(full and/or part-time) Type mproject~ Please explain'mxe,'project: 14.Other see scope ofwork above I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. hmpe:0nonxandove,muxiewpoimo|ovd.00m/#"/rmmrda/24407 4/5 5/5/20 17 *Building Permit#u#or wewPnmQmm Failure to secure coverage as required under k4G>c.152.25A is a criminal violation punishable by fine up to$1.5O(lOOand/or one-year imprisonment,as well as civil penalties in the form of 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) Twin Cities Five Ins.Co. Policy#o,self-mo.License#~ Expiration Date 08weccm4902 04/05/2018 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 igTb Be Completed By Town Staff la Zoning District^ la/ythis v1noYear o,older structure~ la/sproperty within anOverlay District~ /,the property within the Floodplain^ /sthe project within 1oo'orWetlands? ~ No No mps://northandovermumewpointc|oud.com/#"/rmmrds/24407 5/5