HomeMy WebLinkAboutBuilding Permit # 5/2/20175/10/2017
*Building Permit #24455 - ViewPoint Cloud
*Building Permit — Construction of Additions, Alterations, and Remodeling 0 Building Permit Issued
TIMELINE
Submission received
Apr 20, 2017 at 9:48am
Building Department Review
Completed Apr 26, 2017 at 1:04pm
Conservation Department
Review
Completed May 2, 2017 at 2:21pm
Planning Department Review
Skipped Apr 26, 2017 at 1:10pm
Health Department Revies
Completed Apr 26, 2017 at 4:15pm
DPW Engineering Review
Completed Apr 28, 2017 at 9:42am
DPW Operations Review
Completed Apr 26, 2017 at 2:00pm
Fire Department Review
Completed Apr 28, 2017 at 7:27am
Treasurer Review
Completed Apr 26, 2017 at 4:06pm
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5/10/2017 *Building Permit #24455 - ViewPoint Cloud
Building Inspector Approval
Completed May 2, 2017 at 2:48pm
(6)
Additions/Alterations/Remodeling Bldg
Permit Fee
Paid May 2, 2017 at 3:09pm
Permit Issued
Issued May 2, 2017 at 3:08pm
*Building Permit #24455 Construction of Additions, Alterations, and Remodeling
„„„„„Mem
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Attachments
Applicant
Michael Gould
t. 603-883-5326
mgouldOintents.com (...
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Location
315 TURNPIKE STREET , NORTH ANDOVER, MA
Owner
MERRIMACK COLLEGE
pdf SKIM_22717050213160..pdf
Uploaded by Michael Gould on May 02, 2017 2:14 PM
Application Submission
Required information varies depending on who is applying for a building permit.
Are you submitting this application as the Homeowner?
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5/10/2017 *Building Permit #24455 - ViewPoint 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
Michael P LeBlanc CS-067484 06/22/2018 Construction Supervisor O Active
Mailing Address * Preferred Telephone #: * Alternate Phone # Email
, Leominster MA 01453 6032344760
I certify, under the pains and penalties of perjury, that the information on this application is true and complete. *
K
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 *
Alteration
Proposed Use* Describe the type of use
Non -Residential Building TEMP TENT
Description of Work to be Performed *
ON OR ABOUT 5/18/17 WE WILL INSTALL A 40' X 60' TENT ON THE LAWN ACROSS FROM THE VOLPE ICE RINK. REMOVAL WILL BE ON OR ABOUT 5/22/17.
Is property on Town water * Is property on Town sewer
Yes Yes
Project Cost (if new construction base on $125 per square foot and if addition/alteration/renovation base on actual contract price) *
1,600
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5/10/2017
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
*Building Permit #24455 - ViewPoint 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. I am an employer with employees (full and/or part-time)
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5/10/2017
Type of project ` Please explain 'other' project:
14. Other TENT
*Building Permit #24455 - ViewPoint Cloud
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) *
NH MOTOR TRANSPORT ASSOC.
Policy # or Self -Ins. License # ' Expiration Date
P000719NHMTA2017 01/01/2018
Workers' Compensation Affidavit Signature
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
ii To Be Completed By Town Staff
a Zoning District a Is this a 100 Year or older structure ' a Is property within an Overlay District ` Is the property within the Floodplain ' Is the project within 100' of Wetlands? '
R3 No No No
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