HomeMy WebLinkAboutBuilding Permit Application Lot 1 - Building Permit - 122 MILLPOND 4/10/2023 4/11/23,4:05 PM 71910
QTown of North Andover, MA 4/11/2023
71910 Primary Location Applicant
*Building Permit 122 MILLPOND 19 Thomas Zahoruiko
Status: Active NORTH ANDOVER, MA 01845 j 978-852-4002
Submitted On: 4/10/2023 @ tzeke@comcast.net
4 High Street
Suite 201
North Andover, MA 01845
Application Submission
New Field Who is submitting this application*
Are you submitting this application as the Will you(the Homeowner)serving as General
Homeowner?* Contractor be doing all work yourself or will you be
NO hiring contractors to conduct all work on property?
Workers'Compensation Insurance Affidavit* Workers'Compensation Insurance Affidavit*
Primary Contractor
Firm(Business) Name Licensee*
Thomas D Zahoruiko
License#* License Expiration Date*
CS-055417 04/05/2024
License Type* License Type*
Construction Supervisor —
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License Active Type of Business
License Status* Mailing Address*
Active 4 High Street Suite 201, North Andover,
MA, 01845
Preferred Telephone#:* Alternate Phone#
978-852-4002
Email I certify,under the pains and penalties of perjury,
Tzeke@comcast.net that the information on this application is true and
complete.*
New Field
Project Information
Is this permit in conjunction with a building permit Applicant Name
(select yes or no)*
Type of Project* Applicant Phone Number
New Construction
Type of Improvement* Proposed Use
New Building One-Two Family
Proposed Use* Total Number of Units*
Estimated Value of Electrical Work(when required Describe the Type Of Use
by municipal policy):*
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Is property on a Septic System* Description of Work to be Performed*
— New two family dwelling
Date Work is to Start(inspections to be requested in is property on a well*
accordance with MEC Rule 10,and upon
completion)*
Is property on Town water* Are you installing a generator?*
Yes —
Is property on Town sewer* Is property within the floodplain*
Yes —
Project Cost(if new construction base on$125 per Total square footage of additional impervious area
square foot and if addition/alteration/renovation
base on actual contract price)*
575000
Does this project require a temporary construction Does this project require a temporary construction
dumpster?* trailer?*
Yes NO
Does this project require a temporary construction Number of Stories
sign?*
NO
Architect/Engineer Phone Number Architect/Engineer Address
Danger Zone Literature(MGL CHapter 166 Section Architect/Engineer Reg.No.
21A-F and G min.$100-$1,000 fine)
YES
Total Project Cost(total including labor and Is this permit for NEW CONSTRUCTION
materials)*
New Field Total Land Area,sq.ft.
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If NEW CONSTRUCTION what is the Total Square Total square footage of additional impervious area
Feet of floor area,based on Exterior dimensions
If NEW CONSTRUCTION what is the Total Square Architect/Engineer
Feet of floor area,based on Exterior dimensions
New Field
Construction Dumpster Permit Application
Name of Dumpster Company(if applicable)* Dumpster Arrival Date*
CRL 07/31/2023
State clearly purpose for which the Construction Dumpster Permit is requested*
Construction debris
Insurance
I have a current liability insurance policy or its If yes,indicate the type of coverage*
substantial equivalent.
Liability
Yes
If other,specify Applicant Phone Number
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Worker's Compensation Insurance Affidavit:
Bu i Iders/Contractors/Electricians/PI u m bers
Are you an employer?Select the appropriate type. Type of project*
Any applicant that selects#1 must also fill out the
7. New Construction
section below showing their workers'compensation
policy information.*
2. 1 am a sole proprietor or partnership
and have no employees working for me
in any capacity. (No workers' comp.
insurance required).
Workers' Compensation Affidavit Signature
New Field I do hereby certify under the pains and penalties of
perjury that the information provided above is true
and correct.*
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