HomeMy WebLinkAboutBuilding Permit #983-2016 - 95 LYONS WAY 3/21/2016444 At L.�
Permit No#:
Date Issued:
LOCATION
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
ANT: Applicant must complete all items on this
PROPERTY OWNE
Print I 6r Sttucture
MAP' P A P, C E ZONING"DISTRICT: H.'istoric District
hAnrhinp Shon)
IINS
0-001� ORTIJ .1
10
yes
yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
El New Building
9 One family
PlAddition
El Two or more family
0 Industrial
0 Alteration
No. of units:
El Commercial
0 Repair, replacement
0 Assessory Bid
El Others:
0 Demolition
0 Other
08-eptic, OWell"---
01-fibpdplain.
0 Watershed bistric-t
El Water/Sewer
#1
I
OWNER:
DESCRIPTION Of- WUMM I U t5t: 1-r-ml-um'vitu;
I--, I
I
- Please Type or Print Clearly
ke'k�d Phone:qqP qM 0.90-0
Address: q 6 LV6ng- �����WIHZWSZIIMZR
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL EST(MA TED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ 210 606 FEE: $ 3 0on
Check No.: Receipt No.:
NOTE: Persons contrading with unregistered contractors do not have access to the guarantyfund
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
• Building Permit Application
• Workers Comp Affidavit
• Photo Copy Of H.I.C. And/Or C.S.L. Licenses
• Copy of Contract
Li Floor Plan Or Proposed Interior Work
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
• Building Permit Application
• Certified Surveyed Plot Plan
• Workers Comp Affidavit
• Photo Copy of H.I.C. And C.S.L. Licenses
• Copy Of Contract
Ej Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (if Applicable)
• Mass check Energy Compliance Report (If Applicable)
• Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
E, Building Permit Application
Li Certified Proposed Plot Plan
Photo of H.I.C. And C.S.L. Licenses
Workers Comp Affidavit
Li Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (if Applicable)
Copy of Contract
Mass check Energy Compliance Report
Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit
in all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doe: Building Permit Revised 2014
TZ
Plans Submitted [I Plans Waived [I Certified Plot Plan 11 Stamped Plans F1
OF SEWERAGE DISPOSAL
FTYPE
ublic Sewer
P j Sewer
AO
Tanning/1\4assage/Body Art 0
Swimming Pools 11
Well
Tobacco Sales 11
Food Packaging/Sales 0
Private (septic tank, etc. 0
Permanent Dumpster on Site El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
Reviewed On
Signature
Reviewed on. Sian
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decisio
Comments
.Comments
W,ater & Sewer Connection/signature & Date -- Driveway Permit
DPW Town Engineer: Signature:
lmelvox-;r-�A. mvivig- Nttu = ,iT_e mp"pit
u
I
pe:,%.
Miilred—_Dega Mine,
Located 384 Osgood Street
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
Doc.Building Permit Revised 2014
Location
No. 9r 31 —"2
Check# A �,--
30136
Date- 2
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
TOTAL
13Adiin
inspector
t,
Enter construction cost for fee cal -
North Andover Fee Cakulation
Construction Cost
is 2,50,00OLOO)
m
$
$
3,000.00
Plumbing Fee
$
375.00
Gas Fee 100 comm.
$1
TGUGI
Electrical Fee
$
375.00
Total fees collected
$
3,850.00
95 Lyons Way
983-2016 on 3/21/2016
Add Family Room with Master Bedroom Above
Add Garage Bay and Replace Deck
a
U) 0
10 0
CD
0 Z U)
r -IP- 0.0
(D
CL F)"
o
=r
CL a
U)
>to -0
0
0
0 CD
< 0
(D
CL
Cr
CD
-0
CD 0 -N
03 CD
CD 3
a U)
CL CD
0 U)..
S' =
CM CD
U) 0
0 z
CD 0
0
r -OL
0
CD
a
0
(D
Z
:7-7-
C:
z
r,
m
0
0
z
cn
cn
C)
Z
C/)
m
0
0
-0
m
m
x
2R
X
m
cn
z
m
Le.
0
z
cn
�E
P -A
0
CD
N
0
cm
0
to
;a
CD
U)
0.
CL
(D
0 0 -0 =r
0 -1 fu
0 cr U)
< (D -0
a 0 CD 0
M 0 -1 m
o CL 0 3
o =r -0 U)
CD 0
0 0 CL m
h =g
CD 2) CA
0
(D"O
—'- CD m
0.0)
CL 0
to
U)
M= CD
CD
0 o
0 0 U)
—h
Z CD
0 0
= (D Ca
r
o
0
CL
0 CL
CD 0
(D U)
m
M
So
—h
0
0
m M
(A CD
m
C) (A
0
=r
> CD
M "a
0 0
a)
0
CL
000
co
'I
J
p
Ln
3
0
CD
0
(D
(n
1
CD
(D
z
aj
m
a
m
m
z
-n
5.
;a
0
C
aq
tA
M
m
0
-n
5'
w
Ln
(D
I
(D
;o
0
c
m
r-
m
M
m
0
V
r,
c
m
0
=r
-
j
(D
<
0
C
m
=r
0
r-
0
w
2
z
LA
"a
m
0
Ln
(D
'a
ct
n
Ln
(D
3
-n
0
0
CL
--
=r
(D
:3
0
0
m
>
Gerald A. Brown
Inspector of Buildings
Please pri
DATE:
JOB LOCATION:
TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
1600 Osgood Street, Building 20, Suite 2035
North Andover, Massachusetts 0 1845
HOMEOWNER LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Number S66et Address
Name Home Phone
PRESENT MAILING ADDRESS
Telephone (978) 688-9545
Fax (978) 688-9542
Work Phone
City Town State ii�p_ �;_de
The current exemption for "homeowners" 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, provide
that the owner acts as gMervisor.
DEFINITION OF HONMOWNER
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 I I O.R5.1.2)
The undersigned "homeowner" assumes responsibility for compliance with State Building Code and other applicable
codes, by-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 SIGNATUI
APPROVAL OF BUILDING
Revised 8.2015
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
jhe commonwealth ofHassachusetts
Department ofindustrialAeeldents
I Congress Street, S�ite 100
Boston, MA 02114-2017
www.mass.gov1dia actorsxio�triciansffllwbers-
WorkeTs�, Compensation Insurance Affidavit: Builder5lContr,
To 33F, FILF,)D WITH THE PFMTbXG AUThCORIV. Ledbly
Please Print
Name
Address: Li J
, �44
A
Phone#:
City/State/Zip- 1-14 L11
'e
-Areyouanemp!07� &-ekt], appropriatebox:
r? P.
J.[] I am a emploYer vvith__�1410yees (f"11 and/or part-time
2.F] I am a sole proprietor or partnership and hay', no employees working for me in
any capacity. [No workers, comp. insurance requirod.]
3.E] I am a homeowner doing all -work rnys-1Z (No workers' comp. insurance required]
4,Rl am a homeowner and will be hiring contractors to conduct all work on my property. I will
-P workers' compensation insurance Or are sole
'nsure that all contract6is either hav
, �' JA� I kl:t 'V�A -
proprietors with �10.effiPPYW�-
Itractor , a-hd I Apye hired the sub -contractors listed on the attached sheet.
S. am a general cor , � _._ ,� e ,
hive' e#loyees and have workers' comp. insurance.t
These sub-con"q
6.nweareac(
152, §1(4).
-A,y applicant that
t Homeowners who
tContrar,tors that cb
emblovees. Ifthe sl
I its of:dc6rs have exerciped theirright of -exemption per MGL 0.
Pploy&, comp.
. [No w,kers, in�orance required -1
2
xt'. ;
Type ofproje�i (Vequi - ri
7. E] Nd-Wd6nstr�d n
8. El P�omo
9. 0 Demolition
10 Vuilding addition
rl ElecVi�aYjpp*s or additiggs
repagrs or dildiRons
13i [!] ko6f re�airj
14.
. E10ther
I . . W
gl t the section below showing their workers' compensation Policy 9rmat'olr"
��1' nfu�t 0
U Dating such.
affi�a�jt indib�ting they are doing all work audthe, hire outside contractors must submit a new affidavit indil
must at . tached im additknal sheet showing the . name of the sub -contractors and S,49 whe�ther q pot thos.ekpntigq� have
,— I---- -_',1P.q Aw'Must orovido their workers' comP. Policy number -
lam a . ... plyer that isproV1din9_W0TkerS'eo�','Pens
information.
Insurance Company Name*
Policy # or Self-im. LiG.
insurancefor MY eflTlbyees. helow is thuollcY and)ob slt�
Expiration D4te,
City/State/Zip'.
job Site Address' WQ ompensation policy declaration page (showing the Policy number and expY. ation. date).
Attach a copy of the Tkers' c al violation punishable by a fbib up to $1 1 500.00
Failure to secure coverage as required under MGL c. 152, §25A is a crimin 6RDER and a fine of up to V50.0 0 a
andlor one-year imprisonment, as well as civil penalties in the form of a STOP WORK
day against the violator. A copy of this Statement may be forwarded to the Office Of lilvestigdtlons of the D'A forinsurance
coverage verification.. - is true and correct
pidedabove
-------------------
derthepains andpenaldes ofperjurY t iat the information pro
I do hereby cerq(Yu� 7 A A I
in this area, to he completed by cily or tOVU Official
official use on[Y. DOnOt_wTita
permit/License
City or Town:
issuing Authority (circle One): i ctrical Inspector 5. Plumbing Inspector
1. Board of Health ?,. Building)Department 3. City/ToWn Clerk 4. Fle
6. Other
Phone
ContactPersOn-
t",
Information and Instructions
Massachusetts General Laws chapter 152 requires' �dl empl6yqs to provide workers' compensation for their p4ftdy, I si�.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contra'Ot oil'
express or implied, oral or written."
An employer iEf deffi6d as "an in1viduat, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in ajoint enf&pdse, and including the legal representatives of a deceased employer, or the
receivbt'05r'. tra0d.6 dan individual, partnership, association or other legal entity, employing emplbypes'. - However the
owner of a dwelling house having not more than three apartments and who resides therch or the occ ulp�At 6f 16
dwelling house of another who employs persons to do maintcri�mcb,-construotion or r9fiairwork on such dWe 4ouse
or on the grounds or building appurtenant thereto shall not be'ca0lie-' of such eifipfbj�ic�f t6 deemed to' be an employer."
MG-rL c i hapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to opdrate a business or to construct buildings in the commonwealth for any
applicant-wh6j hasu t produced -acceptable evidence of compliance with the ins
" '*I "Q urance coverage i�4qred."
Additionally, MG� q44pjqr 152, §25C(l) states "Neither the commonwealth nor any of its political subdivisions shall
enter intp any contract for the performance ofp-ablic work until acce p*table evidence of compliance with the insurance
requirements of th i s chapter have been.presented to the contracting authority."
Applicants
�leasb fill out the.workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
neceisary, supply s.ub, :co.ut.ractor(s) name(s), address(es) and phone number(s) along with their certfflcate�s) bf
insurance. Liniiied-iiability dompanie's (LLC) or Limited Liability Partnerships (LLP) withu.o employees , oler than the,
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP do' Cis have
employees, a policy is required. be advised that this affidavit may be submitted to the Department of fudustrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The Affid0vit should
be, retained to the city or town that the application for the permit or license is being requ�steq, not the De lartment of
ludustrialAccidenis. §hould you have any' questions regarding the law or if you are req*ed to obtain a W�`o'r-kers'
compensatioii'poiicy, pime call the Department at the number listed below. Self-insured companies sl�6&enter their
selftisuram�e license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to 0 Out in the event the Office ofInvestigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. la addition, an hpplicant
thai must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy 106imation (ifnecessary) and under "Job Site Address" the applicant should -write %U locations in _(city or
town)." A copy Qfio affidavit that has been officially stamped or marked by the city or town may be lirovided to the
applicant as proof that a valid affidavit is on fila for future permits or licenses. Anew affidavit must befilled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to buria leaves etc.) said person is NOT requited to complete this affidavit.
The Department's address, telephone and:ffix number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 02-23-15 www.mass.gov/dia
Nlf -
HA ROL D PA RKER 5 TA 7F FORES T
MA P 106B
PARCEt 158
PROPOSED
ADDITION
ZONING: R-2
MINIMUM
SETBACKS:
FRONT
- 30'
SIDE
30'
REAR
30'
OWNER OF RECORD:
RICHARD W. &
ROBIN LYNNE O'NEILL
95 LYONS WAY
N. ANDOVER, MA 01845
ENDRD BK. 6118 PG. 29
LYONS
VA OF 414SS
DOU LASE.
LEES C"
No.48094
MA P 1068
PARCf -L 156
I 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 COMMUNITY PANEL
NUMBER 2,5^8 0239 F, DATED JULY 3, 2012.
DATE
NIF
HA ROL D PA RKER
S TA TE FOREST
PROPOSED DECK
GARAGE UNDER
(EXISTING DECK
TO BE RAZED)
GRAPHIC SCALE
0 20 40 so
I INCH 40 FT
PREPARED FOR
PROPOSED PLOT PLAN RICIIARD W. OVZU
JOB# 39501
1 #95 LYONS WAY PREPARED BY
SHEET 1 OF 1 NORTH ANDOVER, MASSACHUSETTS Lan� Englneerlqg &
MAP 106B - LOT 157 Enwronmental S�prvlces, Inc.
130 Middlesex Road, Tyngsboro, Massachusetts 01879
SCALE 1 =40' MARCH 17, 2016 Telephone (978) 649-4642