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Home My WebLink AboutBuilding Permit # 3/21/2016 1 OORTH BUILDING PERMIT �_�` TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No# Date Received 1 iF �SSacaauSE� Date Issued: '' t IIY RTANT Applicant must complete all items on this page \\\\\\\\\\ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential 0 New Building fl One family Addition 0 Two or more family 0 Industrial 0 Alteration No.of units: 0 Commercial 0 Repair,replacement 0 Assessory Bldg 0 Others 0 Demolition 0.Other \ \\\ eI\`\\ F aotl lain \ UVet(apds \ \.Wade site Dafnc 0 \\\� \\.:, F� DESCRIPTION OF WORK TO BE PERFORMED: } Identificati"- Please Type or Print Clearly OWNER: Name` a d Phone Address: ARCHITECT/ENGINEER Phone: I Address: Reg.No. FEE SCHEDULE:BULDHIG PERMIT:592.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. >- Total Project Cost:$ L,2 FEE:$ \<\ Check No.: E l Receipt No.: NOTE: Persons contras ing with unregistered contractors do not have access to the guaranty fund Signature of Agerit(Owtxer� Signature,of contractor `' 1 Plans Submitted J Plans Waived❑ Certified Plot Plan ❑ Stamped Plans D FPublic EyrTERAGE DISPOSAL i er Tanning/Massage/Body Art ❑ Swimming Pools ❑Tobacco Sales Food PackaginglSales ❑ Private(septic tank,etc. ❑ I Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM PLANNING&DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on (`"I ,=` Signature f -, COMMENTS i. ,l_ '� / l l ( z F ,. HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer:Signature: Located 384 Osgood Street ARE DEPARTMENT Temp Dumpster on site yes nom Loaated at 124 MaiYt Street ti IAORT Town o Andoyer No. 4 41 - h MaVer, ss, CRATE BOARD OF HEALTH Rfi Food/Kitchen PER=.,.=. 1�1 TO ILU Septic System THIS CERTIFIES THAT... ...�-I!�/�"",z)..........I........................................................... ... BUILDING INSPECTOR Foundation has permission to erect....................... buildings on..' .... ROU21 to be occupied as..............a.10( :�/&.....P.. . ............................................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulaftns Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC I TART Rough Service ....... _ _�7 .............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises—Do Not Remove Final No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. o¢NORTH ay TOWN OF NORTH ANDOVER 3a >'.. ..`• °� OFFICE OF bi, p BUILDING DEPARTMENT a a 1600 Osgood Street;Building 20,Suite 2035 �4SSacxusfgge North Andover,Massachusetts 01845 Gerald A.Brown Telephone(978)688-9545 Inspector ol'Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: _jf - JOB LOCATION 1Q�t3 f l Number Str6et Address Ma of HOMEOWNER s '- '" r `X` r €` Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for"home-owners"was extended to include owner occupied dwellings of one or two family '.. dwellings and to allow such homeowners to engage an individual for hire who does not possess a license,provided '.. that the owner acts as supervisor. '.. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one-or two-family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.(780 CMR Section 110.R51.2) The undersigned"homeowner"assumes responsibility for compliance with State Building Code and other applicable codes,tw-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE:.. APPROVAL OF BUILDING OFFICIAL r Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-4541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts DepartrnentofXndUStTittlAceidents Z Congress Street,Sate 100 Boston,IVTA 02114--2017 Svivivniass.govtdia `Workers'compensation insurance Affidavit:Builders/ContractorslEleehicianslPlumhers. TO BE FILED WITH THE PERNATTING ATiTHORTTY- -.EIease Print Le•bl AptilleantInfermation Nsojo(BusinesslOigamzation/Individual). Address: J .- ,S _- r- t -Phone# city/state/zip: PE Pr Type oRprolect(regmred):.' -Areyouan employ rr Checkfh a r iat box: _ em le es fill and/orparl,time).* 7. ❑Netivcaflstrdctlon l.[]Iron a employer wifh �. P Ye (' 2-❑I_.sole proprietor or partnership and have no employees Working frmoin 8. ❑Renualo iig anycapacity.[Noworkers'comp.insurnee required.] 9. ❑Do n clition IE]Tam ahomeownerdoingal2workmyselpFe Workers'camp.insuanee required.]t 10 Voilding addition Tam aleac_,aer and will be bhin ,caraetors to conduetall work on my property-twill II❑$Ie-triealrepairsoradditimol eoorcetbat all contractors Gbborhavc""rkers'camm`n tion insmancoorora sole proprietors wrthno i'Sziployees. IZ 'Plumbing repairs oT additions 5❑Iamageneralcentractorand Tfiavehired the sub-contractors listodonthe attached sheet 13❑RoOfrel7air$ These sub-contraetsirs haed employees end havewarkers'comp.insurance j 14 Other - We We are acorpera idiiand ifs.officers bare exereisedtheirrignt ofrorereptianpor IAUL c. 252,§1(4)ondwehveno employaes:[No wrnkers'comp.insaraneerequired.] _ *Any applicantthat checks b jX#1 most also ffil outtho seetionbelow shovringtheirworkers'compensatienpolicy iuformation. I Homeowners who tGontractors subm{ttM afdavitaindichd gtheyre odnimeofrethoeusub d-ecocnotracto srsandssttasaubwmhiet8aerotrpotfhvoei.n ntige,hgava thatcl,Athis lixinustattched'nadditiond eheetshowingth employes,ifthesub-contractors have mployes,theylnust provide their workers'com,policy number. XQm aF2 en2pZOyeY tbatisprovidingwoF'Zcers I compensation inSurancefor my eFt2pZ*08-Below is thepolicy andrab Site information. InsuranGe Company Name: ExpirationDate_ Policy#or Self-ins.Lio.#: City/State/Zip- fob Site Address: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). paiture to secure coverage as requited under MGL o.152,§25A is a criminal violation punishable by a foie up to$1,500.00 andfor 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 Offica of Investigations of the DIA for insurance coverage verification. I do hereby ceYtifv_under tlzepains andpnalties ofpeljany that the infortnauon providedd above is trme and correct. .-�"� Srmratarr `Phone#•�� -R'�" � � Official use only.Do not write in this area,to be conspleted by city or town official. Permit/License# City or Tows issuing Authority(circle one): 1 Board of Health 2.Building Department 3.CitylTo`vn Clerk 4.Electrical Inspector 5.Plixmbinglnspeetor 6.other Phone Contact Person: N/F HAROLD PARKER STATE FOREST - 149.23' 9.69' LOT 5 55,369E S.F. �* N/F MAP 1068 n a HAROLD PARKER PARCEL 158 N N STA TE FOREST PROPOSED ADDIMON 5d� h ZONING: R-2 MINIMUM SETBACKS: FRONT - 30' SIDE - 30' 1 30.5 3 .5' q REAR - 30' OWNER OF RECORD: PROPOSED DECK RICHARD W. & / GARAGE UDDER ftOBGN LYNNE 0"NEILL (EXISTING DECK 95 LYONS WAYy N TO BE RAZED) N. ANDOVER, MA 01845 - O ENDRD BK. 6118 PG. 29 LYONS WA Y /y �`OF f✓/gss`ti�a, YY y.CY N\GN`' d: 116.10 C, DOUGLAS E. LEE; No.48094 ` / m burr, `0':�4 MAP 1068 PARCEL 156 B CERTIFY THAT THE STRUCTURE SHOWN ABOVE CONFORMS TO THE ZONING DIMENSIONAL REQUIREMENTS OF THE TOWN OF NORTH ANDOVER AND IS NOT WITHIN THE FLOOD HAZARD AREA AS SHOWN OF THE FEMA FLOOD INSURANCE RATE MAP COMMUNVTY PANEL GRAPHIC SCALE NUMBER 2 �8 0239 F, DATED JULY 3, 2012. -1",t 1 INCH = 40 FT OFESSIONAL LAND SURVEYOR DATE PREPARED FOR PROPOSED PLOT PLAN RICHARD W. OWEILL JOB# 39501 0 0 #95 LYONS WAY PREPARED BY SHEET 1 OF 1 NORTH ANDOVER, MASSACHUSETTS Land Englneer®ng & MAP 106E - LOT 157 Environmental .Services, Inc. 130 Middlesex Road, Tyngsboro, Massachusetts 01879 SCALE 1=40' MARCH 17, 2016 Telephone (978) 649-4642