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HomeMy WebLinkAboutBuilding Permit # 5/3/20175/10/2017 *Building Permit #24454 - ViewPoint Cloud *Building Permit — Construction of Additions, Alterations, and Remodeling O Building Permit Issued TIMELINE O O O Submission received Apr 20, 2017 at 9:44am Building Department Review Completed Apr 26, 2017 at 1:09pm Conservation Department Review Completed May 2, 2017 at 1:36pm Planning Department Review Skipped Apr 26, 2017 at 1:11pm Health Department Revies Completed Apr 26, 2017 at 4:31pm DPW Engineering Review Completed Apr 28, 2017 at 9:43am 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 4:04pm (d https://northandoverma.viewpointcloud.com/#/records/24454 1/5 5/10/2017 *Building Permit #24454 - ViewPoint Cloud Building Inspector Approval Completed May 2, 2017 at 7:59pm Additions/Alterations/Remodeling Bldg Permit Fee Paid May 3, 2017 at 6:55am Permit Issued Issued May 3, 2017 at 6:54am *Building Permit #24454 Construction of Additions, Alterations, and Remodeling Applicant Michael Gould t. 603-883-5326 @ mgouldOintents.com (... Attachments Location 315 TURNPIKE STREET , NORTH ANDOVER, MA Owner MERRIMACK COLLEGE PDF Uploaded by Michael Gould on Apr 20, 2017 9:44 AM Application Submission Required information varies depending on who is applying for a building permit. Are you submitting this application as the Homeowner?* https://northandoverma.viewpointcloud.com/#/records/24454 2/5 5/10/2017 *Building Permit #24454 - 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 * Proposed Use* Describe the type of use Alteration Non -Residential Building SCHOOL EVENT- TEMPORARY TENT Description of Work to be Performed * Is property on Town water * ON OR ABOUT 5/18/17 WE WILL INSTALL A 40' X 80' TENT IN FRONT OF THE ROGERS CENTER © MERRIMACK COLLEGE Yes Is property on Town sewer Yes Project Cost (if new construction base on $125 per square foot and if addition/alteration/renovation base on actual contract price) * 2,000 https://northandoverma.viewpointcloud.com/#/records/24454 3/5 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 #24454 - 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) https://northandoverma.viewpointcloud.com/#/records/24454 4/5 5/10/2017 Type of project ` Please explain 'other' project: 14. Other TENT *Building Permit #24454 - 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 P000749NHMTA2017 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 No https://northandoverma.viewpointcloud.com/#/records/24454 5/5