HomeMy WebLinkAboutBuilding Permit Application - Building Permit - 12 TRINITY COURT 9/21/2022 *Building Permit
68652
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Submitted Sep 21, 2022 at 2:39pm
Contact Information
Fred Doucette
Email address
fdoucette@blackdogbuilders.com
Phone Number
(603) 401-3939
Mailing Address
7 Red Roof Lane, Unit 1 , Salem, NH 03079
Locations
1 location total
PRIMARY LOCATION
12 TRINITY COURT
NORTH ANDOVER, MA 01845
Application Submission
Are you submitting this application as the Homeowner?
NO
Primary Contractor
Firm (Business) Name
Licensee
BLACKDOG BUILDERS INC TOTAL BASEMENT FINISHING
License
106877
License Expiration Date
07/27/2024
License Type
Home Improvement Contractor
License Active
0
License Status
Current
Mailing Address
7 RED ROOF LN. #1 Salem NH 03079
Preferred Telephone #:
16038980868
Alternate Phone #
6034013939
Email
fdoucetteP-blackdogbuilders.com
I certify, under the pains and penalties of perjury, that the information on this application is true
and complete.
FVJ
Project Information
Type of Project*
Construction of Addition, Alteration, and Remodeling
Type of Improvement *
Addition
Proposed Use
One Two Family
Description of Work to be Performed
Build new 14'x25' addition w/full foundation
Is property on Town water
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)
209,000
Does this project require a temporary construction dumpster?
Yes
Does this project require a temporary construction trailer?
NO
Does this project require a temporary construction sign?
YES
Danger Zone Literature (MGL CHapter 166 Section 21A-F and G min. $100-$1,000 fine)
Registered Design Professional
Architect/Engineer Name
Arch itect/Engineer Address
Arch itect/Engineer Phone Number
Architect/Engineer Reg. #
Construction Dumpster Permit Application
Name of Dumpster Company (if applicable)
K-Town
Dumpster Arrival Date *
01/30/2023
State clearly purpose for which the Construction Dumpster Permit is requested
Construction debris
Insurance
I have a current liability insurance policy or its substantial equivalent.
Yes
If yes, indicate the type of coverage
Liability
If other, specify
Worker's Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
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*
10 Building addition
I am an employer that is providing workers' compensation insurance for my employees.
Below is the policy and job site information.
Insurance Company Name (Attach a copy of workers' compensation policy declaration page
showing the policy number and expiration date)
Selective Insurance Group
Policy # or Self-Ins. License #
WC9056762
Expiration Date
07/01/2023
fi
Workers' Compensation Affidavit Signature
I do hereby certify under the pains and penalties of perjury that the information provided above is
true and correct.
E.?
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Town of North Andover, MA
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