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Home My WebLink AboutBuilding Permit # 4/28/2017 5/5/2017 *Building Permit#24693-View Point Cloud 24,693 *Building Permit—Alterations:Roofing/Siding and/or Windows/Doors O Building Permit Issued TIMELINE OSubmission received Apr 27,2017 at 11:22pm Building Department Review Completed Apr 28,2017 at 7:51am OTreasurer Review Completed Apr 28,2017 at 9:33am OBuilding Inspector Approval Completed Apr 28,2017 at 9:38am OAlteration Roofing and/of Windows/Doors Paid Apr 28,2017 at 4:07pm OPermit Issued Issued Apr 28,2017 at 4:06pm *Building Permit#24693 Alterations:Roofing/Siding and/or Windows/Doors https://northandover m a.vi ewpoi ntcl oud.com/#/records/24693 1/6 5/5/2017 *Building Permit#u46on wewPnmQmm 0 Carl Thomas Field �� Andover_ Ear ' And Throat C er 0xpp|icant Location Nathan 198MASSACHUSETTS AVENUE (mn)' NORTH ANDOVER, YN4 t~ 978-793-6429 Owner @ npf|eegoroger|ingcon— 19OMASS AVE REALTY LLC Attachments pur Permit_Set_D3272O17_Thu_Apr_27_2O17_2 � Uploaded uyNathan pneenn,nnApr 2<zo17n:21pm puf Control_Construction_Affidavit_Thu_Apr_27_2017_2 � Uploaded uvNathan pnoeoo,onApr 27,zonn:2zpm pu, CSL_Thu_Apr_27_2O17_2 � Uploaded uyNathan rneeoo,onApr 2<2on11o2pm nuf VVC_Thu_Apr-27_2O17_2 � Uploaded uvNathan pnoeoo,onApr 2z2onn:22pm pu, Con troI_Coits truct|on_Affidmv|t_Tue_War_28_2O17_O7-36-11_GMT'O4OO_(Eastern_Dmyl|ght_T|meLFr| Apr_38_3O17_1 � Uploaded uyNathan pneeoo,onApr 2V.2onssspw vuf CSL_Tue_IMar_28_2017_O7-38-17_GIVT-O4O0_(Eastem_Day|ight_Time)_Fri_Apr_28_2O|7_1 � Uploaded uvNathan pneeoo,onApr aa.annysepm pu' Pe,m|�_Get_O]�72O17_Tue_Mar_28_2O17_O7-36-3G_SIVT'O40O_<Eaotern_Daylight_Time) Fri_Ap,_38_3O17_1 � Uploaded uyNathan Poceoo,onApr 2V.zo17a:5ypm puf VVC_Twe_Wr_28_2O|7_O7-38-31_GMTO4OO_(Eaeiem_Dey|ig[it_Time)_Fri_4pc- 8_ 17_1 � Uploaded uvNathan pneeoo,vnApr 2a.uony:sepm pu' OTUNJN4|OO1F_Thu_Apr_OG_2O17_14-3O-11_GMT-O4OO_(Eastern_Doy|iQht_T|meLFrLApr-2B_2O17_1 � Uploaded uyNathan pneeoo,onApr zo.2o/r«oopm hmpe:0nonxandove,muxiewpoimo|ovd.00m/#"/rmmrda/24883 2/6 5/5/2017 "Building Permit#24693-Mew Point Cloud 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 NATHAN PFLEEGOR CS-077958 01/16/2018 O Active Maynard MA 01754 Preferred Telephone#:* Alternate Phone# Email 9787936429 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* Describe the type of use* Description of Work to be Performed* Is property on Town water* Is property on Town sewer Demolition Non-Residential Building Business Minor interior demolition Yes Yes Project Cost(if new construction base on$125 per square foot and if addition/alteration/renovation base on actual contract price) 4,250 Does this project require a temporary construction trailer? hftps://northandoverma.viewpointcloud.com/#/records/24693 3/6 5/5/2017 "Building Permit#24693-Mew Point Cloud 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.# Maugel Architects 200 Ayer Road Harvard, MA 978-456-2800 5554 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* hftps://northandoverma.viewpointcloud.com/#/records/24693 4/6 5/5/2017 "Building Permit#24693-View Point Cloud 9. Demolition 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) Liberty Mutual Insurance Corp. Policy#or Self-Ins.License#* Expiration Date WC531S612902016 05/28/2017 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 Q 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? GB No No No No hftps://northandoverma.viewpointcloud.com/#/records/24693 5/6 5/5/2017 "Building Permit#24693-View Point Cloud https://northandoverma.viewpointcloud.com/#/records/24693 6/6