HomeMy WebLinkAboutBuilding Permit # 5/3/2017 5/10/2017 *Building Permit#24811-View Point Cloud
24,811
*Building Permit—Alterations:Roofing/Siding and/or Windows/Doors O Building Permit Issued
TIMELINE
OSubmission received
May 2,2017 at 3:18pm
Building Department
Review
Completed May 2,2017 at 5:13pm
OTreasurer Review
Completed May 3,2017 at
9:02am
OBuilding Inspector
Approval J tli,
Completed May 3,2017 at 2:13pm
OAlteration Roofing and/of
Windows/Doors
Paid May 3,2017 at 2:53pm
OPermit Issued
Issued May 3,2017 at 2:52pm
*Building Permit#24811 Alterations:Roofing/Siding and/or Windows/Doors
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5/10/2017 *Building Permit#24811 wewPnmQmd
0ApplicantLocationJaime Morin 46 SHANNON LANE , NORTH ANDOVER, MA
t~ 508-351-2241 ext. Owner
@ brian]abaie4aendeme— Richard Lowe
Attachments
pdf
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hups://nonxandove,mumewpoimo|md.00m/#"/rmmrda/24811 206
5/10/2017 *Building Permit#24811-View 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* Preferred Telephone#:
JAIME L MORIN CS-090125 10/06/2018 O Active LYNN MA 01905 508-351-2277
Alternate Phone# Email
rbabostonpermitting@andersencorp.com
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 10 windows Yes Yes
Project Cost(if new construction base on$125 per square foot and if addition/alteration/renovation base on actual contract price)
16,861
Does this project require a temporary construction trailer?
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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.#
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* Please explain'other'project:
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14.Other Window replacement
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)
Old Republic Insurance Co.
Policy#or Self-Ins.License#* Expiration Date
MWC 30823100 10/01/2017
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?
R2 No No No Yes
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