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Home My WebLink AboutBuilding Permit # 5/2/2017 5/10/2017 *Building Permit#24636-View Point Cloud 1 *Building Permit—Alterations:Roofing/Siding and/or Windows/Doors O Building Permit Issued TIMELINE OSubmission received Apr 26,2017 at 1:52pm Building Department Review Completed Apr 27,2017 at 8:08am OTreasurer Review Completed Apr 27,2017 at 11:56am OBuilding Inspector Approval Completed Apr 28,2017 at 12:15pm OAlteration Roofing and/of Windows/Doors Paid May 2,2017 at 3:13pm OPermit Issued Issued May 2,2017 at 3:13pm *Building Permit#24636 Alterations:Roofing/Siding and/or Windows/Doors https://northandover m a.vi ewpoi ntcl oud.com/#/records/24636 1/5 5/10/20 17 *Building Permit#c4nnn vw*PomClov nD Applicant Location -- Mark Niadna 401 MASSACHUSETTS AVENUE , NORTH ANDOVER, MA t~ 401-699-2439 Owner @ mike_w_bedardCdhom— 5OM. LEAKHENA Attachments pur M=a N_Andover_4-28-|7_VVed_Apr_25_20|7_1 � Uploaded uyMark w/aunaonApr 26.zo1/1:s2pw 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~ Preferred Telephone#:~ QimitryNovak C5SL'099823 06/26/2016 [] Active . Manchester NHO310S 5034745453 Alternate Phone# Email discoot#hotmai|zom hmpe:0nonxandove,muxiewpoimo|ovd.00m/#"/rmmrda/24836 2/5 5/10/2017 *Building Permit#24636-View 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 replace 13 windows, no structural changes Yes Yes Project Cost(if new construction base on$125 per square foot and if addition/alteration/renovation base on actual contract price) 8,424 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/24636 3/5 5/10/2017 *Building Permit#24636-View 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) National Union Fire Insurance company Policy#or Self-Ins.License#* Expiration Date XWC6583145 03/01/2018 hftps://northandoverma.viewpointcloud.com/#/records/24636 4/5 5/10/2017 *Building Permit#24636-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 No No Not Applicable hftps://northandoverma.viewpointcloud.com/#/records/24636 5/5