HomeMy WebLinkAboutBldg Permit Application - Building Permit - 87 COACHMANS LANE 7/15/2022 9119122, 12.22 PM Record 67570-VrawPoint Cloud
"'Building Permit
57570
Your Submission
Attachments
Guests {0
Building Department Review
Fire Department Review
Treasurer Review
Conservation Review
Planning Review
Health Review
DPW Engineering Review
DPW Operations review
Building Inspector Approval
Additions Alterations Remodeling Building Permit Fees
Building Permit Issued
Temporary burnpster Permit Issued
Your submission
Submitted Jul 15. 2022 at :55am
ontact Informs ion
Nicholas Couture
Email address
nick ci•ossroadscontracting_com
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W19122, 12:22 PM Record 67570-ViewPoifst Cloud
Prone Number
603-864-8239
Mailing Address
15 Londonderry Read , Londonderry, NH 03053
Locations
t location total
PRIMARY LOCATION
87 COACH MANS LANE
NORTH AN DOVER, MA 01845
Application Submission
Are you submitting this application as the Homeowner? "
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Primary Contractor
Firm (Buslnes ) Name
Licensee
Crossroads Contracting LL
License #
190347
License Expi�r tion Date
01/17 2024
License Type '
Home Improvement Contractor
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License Active
0
Liconse Staters
Current
aifing Address
15 Londonderry Road Unit 46 Londonderry NH 03053
Preferred Telephone #;
603-864-8239
Alternate Phone #
Email
Nick@crossroadscontracting.com
I certify, under the pairs and penalties of perjury. that the information on this application is true
and complete.
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Project Information
Type of Profect
Construction of Addition, Alteration, and Remodeling
Type of Improvement
A#teration
Proposed Use
One-Two Family
Description of Work to be Porto rmed
Basement Famiily Suite
Is property on Town water
Yes
Is property on Town sewer
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Yes
Project Cost if new construction Ease on 1 5 per square foot and if
addition alteration renovation base on actual contract price) �
265,565
Does this project require a temporary construction i umpster? �
Yes
Does thl� project require a temporary construction trailer?"'
NO
Does this project require a temporary construction sign?
YES
Danger Zone Literature MGM CHapter 166 Section 21A-E and G min. $1004t,000 fine)
Registered Design Professional
Architect En&eer Name
Architect Engineer Address
Architect Engineer Photie N umber
Architect Engineer Reg. #
Construction D€ mpster Permit Application
Nance of Dumpster Company if applicable) �
Waste Management
umpster Arrival Date
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State clearly purpose for which the Construction Du pster Permit is rearrested
Removal of construction debries
Insurance
I have a current liability insurance policy or its substantial equiovalent. �
e s
If yes, Micate the type of coverage �
Liability
If other, specify
Worker's Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Are you are employer"? Select the appropriate type. Any applicant that selects 411 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
8. Remodeling
am an employer that is providing workers' compensation insurance for mar employees.
Below is the policy and job site information.
Insurance Company Larne (Attach a copy of workers' compensation policy declaration page
showing the policy number and expiration date) �
West American Insurance CO
Policy # or Self-Iris. License ft
WW584558 7
Expiration Date
01/01/2023
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Workers' Compensation Affidavit S ignatuire
I do hereby certify under the pains and penalties of perjury that the information provided above is
true and correct. �
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Town of North Andover, MA
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