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HomeMy WebLinkAboutBuilding Permit # 5/4/2017 5/10/2017 *Building Permit#24695-View Point Cloud *Building Permit—Construction of Additions,Alterations,and Remodeling O Building Permit Issued TIMELINE OSubmission received Apr 28,2017 at 9:18am 10 Building Department Review Completed Apr 28,2017 at 9:25am © Conservation Department Review Ono Skipped May 2,2017 at 11:14am © Planning Department Review * !!% Skipped Apr 28,2017 at 9:26am OHealth Department Revies Completed May 3,2017 at 8:27am ODPW Engineering Review Completed Apr 28,2017 at 9:47am ODPW Operations Review Completed Apr 28,2017 at 10:01am J1%% © Fire Department Review Skipped Apr 28,2017 at 1:40pm �� OTreasurer Review Completed Apr 28,2017 at 9:32am https://northandover m a.vi ewpoi ntcl oud.com/#/records/24695 1/5 5/10/2017 *Building Permit#24695-View Point Cloud Building Inspector Approval O Completed May 3,2017 at 2:11pm OAdditions/Alterations/Remodeling Bldg Permit Fee Paid May 4,2017 at 11:46am OPermit Issued Issued May 4,2017 at 11:45am *Building Permit#24695 Construction of Additions,Alterations,and Remodeling c " 0 Applicant Location Steven Poussard 163 OLYMPIC LANE , NORTH ANDOVER, MA t- 207-312-1755 Owner @ steve.poussard@revis... SECONDO,THOMAS,C. Attachments pdf N. Andover i ri Apr 28 .12017 0 ; Uploaded by Steven Poussard on Apr 28,2017 9:17 AM , pdf Fv...t...(i(...i I`i,_A. oi...",?8 20'17,.._0 Uploaded by Steven Poussard on Apr 28,2017 9:17 AM , pdf "u1r"x i (16) Fri Apr .28 20171,10 Uploaded by Steven Poussard on Apr 28,2017 9:18 AM pdf ..Fir .err 2 20'17 0 Uploaded by Steven Poussard on Apr 28,2017 9:18 AM , https://northandoverma.viewpointcloud.com/#/records/24695 2/5 5/10/20 17 *Building Permit#c4nno'vw*PomCloud jpg Mew_CSL_FriApr_28_2O17_O � Uploaded uySteven PouosardonApr 2a.2onexaAm pdf H|C_Fri_4pc-28_2O17_O Uploaded uvSteven poussa,donApr zu.2onexuxm 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(aysmess)Name Licensee~ License#~ License Expiration Date~ License Type~ License Active License Status Mailing Address~ Preferred Telephone#:~ John DCullen CS-056846 04/03/2019 [] Active .Wakefield MAO1000 2073121755 Alternate Phone# Email steve.poussordoOao|zom I certify,under the pains and penalties of perjury,that the information on this application is true and complete. Br 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 ofImprovement~ Proposed Use~ Description orWork touePerformed~ |sproperty onTown water~ |sproperty onTown sewer ~ Repair, Replacement One'TwoFami|y YVeatherization Yes Yes hmpe:0nonxandove,muxiewpoimo|ovd.00m/#"/rmmrda/24885 3/5 5/10/2017 *Building Permit#24695-View Point Cloud Project Cost(if new construction base on$125 per square foot and if addition/alteration/renovation base on actual contract price) 3,757 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.# 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 hftps://northandoverma.viewpointcloud.com/#/records/24695 4/5 5/10/2017 *Building Permit#24695-View Point Cloud 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: 14.Other Weatherization 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) Costello Insurance Agency Policy#or Self-Ins.License#* Expiration Date PACEP305047 04/20/2018 Workers' Compensation Affidavit Signature I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. G ig 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? R1 No No No Yes hftps://northandoverma.viewpointcloud.com/#/records/24695 5/5