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Home My WebLink AboutBuilding Permit # 5/5/20175/10/2017 *Building Permit #24450 - ViewPoint Cloud *Building Permit — Alterations: Roofing/Siding and/or Windows/Doors O Building Permit Issued TIMELINE Submission received Apr 20, 2017 at 9:25am Building Department Review Completed Apr 26, 2017 at 1:16pm Treasurer Review Completed Apr 26, 2017 at 3:59pm Building Inspector Approval Completed May 5, 2017 at 9:08am Alteration Roofing and/of Windows/Doors Paid May 5, 2017 at 9:09am Permit Issued Issued May 5, 2017 at 9:09am *Building Permit #24450 Alterations: Roofing/Siding and/or Windows/Doors https://northandoverma.viewpointcloud.com/#/records/24450 1/5 5/10/2017 Applicant Michael Gould t~ 503-8X83-5326 Attachments Location Owner 1160GRE4T POND ROAD, NORTH ANDQVER'M4 BROOK55CHOOL PDF'OILSJL00FhuApc20 1207 0 Uploaded by Michael Gould on Apr 20, 2017 9:25 AM PDF UT9071001FZhuApc20 2017 0 Uploaded by Michael Gould on Apr 20, 2017 9:26 AM Application Submission Required information varies depending onwho isapplying for abuilding 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 (Bvsmess)Name Licensee ~ License # * License Expiration Date * License Type * License Type * License Active License Status Michael PLeBlanc CS-007484 00/ 2/2O18 Construction Supervisor 0 Active � � hftps://northandoverma.viewpointcloud.com/#"/rer,ords/24450 2/5 m10co r Mailing Address ~ Preferred Telephone #:~ Alternate Phone # Email . Leominster MAO1453 6032344750 | certify, under the pains and penalties mperjury, that the information onthis application istrue and complete. ~ GB 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$125per square foot and if addition/alteration/renovation base on actual contract price). ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector. Type mImprovement ' Repair, Replacement Is property on Town water Yes Proposed Use ~ Non -Residential Building Is property on Town sewer * Yes Describe the type muse ~ Temp. tent Install a 60'x 100'tent at the Brook Lower Field on 5/11/17 and remove 5/14/17 Description mWork to bePerformed ~ Project cn, (if new construction base on$nzsper square foot and nadd n/owaneramon/renova onuasennactua|cuntractp,/ue)' 3,000 Does this project require atemporary construction trailer? ' NO Does this project require ntemporary construction sign? ' NO Danger Zone Literature (MGL CHapter 166 Section 21A-F and G min. $100-$1,000 fine) NO Registered Design Professional hftps://northandoverma.viewpointcloud.com/#"/rer,ords/24450 3/5 5/10/2017 *Building Permit #24450 - 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) Type of project" Please explain 'other' project: 14. Other TEMPORARY TENT 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. https://northandoverma.viewpointcloud.com/#/records/24450 4/5 5/10/2017 *Building Permit #24450 - ViewPoint Cloud Policy # or Self -Ins. License # * Expiration Date * P000749NHMTA2017 01/08/2018 Workers' Compensation Affidavit Signature I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. a 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 • a Which Overlay District * Is the property within the Floodplain R1 No Yes Historic District No Is the project within 100' of Wetlands? * Not Applicable https://northandoverma.viewpointcloud.com/#/records/24450 5/5