HomeMy WebLinkAboutBldg Permit Application_Lot 0110_aka_Lot13 - Building Permit - 0 WINTER STREET 6/1/2023 6/1/23,4:47 PM Record 72038-ViewPoint Cloud
*Building Permit
72038
Your Submission
Attachments
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p Building Department Review
Fire Department Review
Treasurer Review
Conservation Review
Planning Review
Health Review
DPW Engineering Review
DPW Operations Review
Building Inspector Approval
New Construction Building Permit Fees
Building Permit Issued
Temporary Dumpster Permit Issued
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Your submission
Submitted Apr 19, 2023 at 7:O3am
Contact Information
Gordon Glass
Email address
gordon@jbllclaw.com
Phone Number
9784754488
Mailing Address
12 Chestnut Street ,Andover, MA 01810
Locations
1 location total
PRIMARY LOCATION
0 DALE STREET
NORTH ANDOVER, MA 01845
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Application Submission
Are you submitting this application as the Homeowner?
NO
Primary Contractor
Firm (Business) Name
Licensee
THOMAS M PATENAUDE
License #
CS-014261
License Expiration Date
12/09/2023
License Type
Construction Supervisor
License Active
O
License Status
Active
Mailing Address
100 Salem Street, North Andover, MA, 01845
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Preferred Telephone #:
978-815-7692
Alternate Phone #
Email
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
G
Project Information
Type of Project
New Construction
Type of Improvement *
New Building
Proposed Use
One-Two Family
Description of Work to be Performed
Construction of single-family home
Is property on Town water
Yes
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Is property on Town sewer
No
Project Cost (if new construction base on $125 per square foot and if addition/alteration/renovation base on actual contract price)
389,125
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?
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
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Architect/Engineer Reg. #
Construction Dumpster Permit Application
Name of Dumpster Company (if applicable)
Waste Management
Dumpster Arrival Date
07/01/2023
State clearly purpose for which the Construction Dumpster Permit is requested
Removal of construction materials
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
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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.
5. 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have
employees and have workers' compensation insurance. Contractors that check this box must attach an additional sheet showing
the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,
they must provide their workers' comp. policy number.
Type of project
7. New Construction
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
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Town of North Andover, MA
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