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Home My WebLink AboutMiscellaneous - 15 LYMAN ROAD 4/30/2018 15 LYMAN ROAD 2101016.0-0023-0000.0 r-y � 1 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCTREP RENOVA OR DEMOLISH A ONE OR TWO FAMILY DWELLING ssx k : x" r r � l�a y y 4' b art ■�®�■ BUII.DING PERMIT NUMBER: c1 17 DATE ISSUED. S a l SIGNATURE: Building Co on r of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parod Number: Map Number .Parol Number 1.3 Zoning Information: 1.4 Property Dimenstow., Zoning District Proposed Use r Lot Area F fl ` 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ReWired Provide ReWired Provided Required Provided 1.5 F1uodZoureiafcumtion: 1.8 S System 1.7 water SapptyM.G.L.CAO. s4) Til Public ❑ Private 0 Zone Outside Flood ZAM 0 Municipal, 0 On Site Disposal System.0. SECTION 2-PROPERTY OWNERSWIAUTHORMEDAGENT Historic.U ;-t: 4' � No 2.1 Owner of Record Al D)O't ' _ N Name(Pri t) Address fd Service: q7S- g r Signature Telephone O 2.2 Owner of Record: Mame Print Address for Service: Sir ature Tele hone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor. Not Applicable ❑ � ' 1 � Licensed tion Supervisor. ` D'q'n License Number "1n�7 6) �> a0 Expiration aft t Telephone rff' 3.2 Registered Home Improvement Contractor Not Applicable ❑ CD i0otla pang Name 1 3 J �g q Registration Number Add ` 'l:!) Expiration bZe t u�at�re T hone SECTION 4-WORKERS COMPENSATION(AiG L.C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the burlAm Pernik Signed affidavit Attached Yes......X No.......0 SECTIONS Description of Proposed Work check a New Construction ;0 Existing Building ❑ Repair(s), 0 Altemtidns(s) '0 Addition: Cl, Accessory Bldg. --0 Demolition 0 Other --0 Specify Brief Description of Proposed Work: i SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be yr OC[ALUSE(31!iL(►' Completed b t applicant "< 1. Building (A) Building Permit Fee r 00 C)o Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building.Permit fee(a)x(b) c= 4 Mechanical HVAC 5 Fire Protection- _ 6 Total 1+2+3+4+5 QQ Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN �� OWNERS AGENT�O/R CONTRACTOR APPLIES FOR BUILDING PERMIT I, IU(VA-VA U f 7�• 1 oll� ,as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to mwk authofikd by this building permit application Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, m as Owner/Authorized Agent of subject property Hereby declare.that the statements and information on the foregoing application are true and accurate,to the best of my knowledge t and belief ill Print N e Mi of Owned ent Dat illiallil�ll III-- NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS l 2 ND 3 RD SPAN DIMENSIONS OF SII LS DMU NSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY ' IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE •v i • y � .111 1 1 11 :1 1 : 1:! • tl 1 ' 1 11 1 :« 1'' 77!I I 1 1'1 :It•-/ ■ .111 "1 ,1j�1 1 � • :11 1 I 1 1 •1 � / 111 11 1 1 ■ :1 1 I ' 1 11 1 {1 !1' 11 � 1 :!11 / 1 1 • 1 11 ' / `! ►11 1:1'✓ 1.'! 1 11 :I I / t - 11 .� 1 111 1 /1 ■■ `.o ®�►,i III I ® i � � � . It 1 � 1 // F ., 1 I 1 I 1 I , 11 , .. , , 1 / 1 1 :1 t - •i 1 « 1 :1 1 - • 1 • 1 11 If; 1� I 1 II : . t III 11 i 1 1 1 /„ 1 11 , 1 II , II .1 • f77 i7j r fil e oV 51 1 r - i — Information and jostructtons Massachusetts:General Laws chapter-152:sechon 25 requires all employer$to provide-workers' compensation for their. employees:..As quoted from the"law",-an employee is defined'-as every person in the service of another under any contract of him express or implied,oral or written. artners association,corporation other legal entity,or any two An employer is defined as_an.mdividual,.p hip, ton ' or or more o£ the foregoing engaged in a joint enterprise, and including 1the legal representatives of a deceased employer,or'the receiver or trustee of an individual;partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apart and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,`construction or repair work on such dwelling house of on the grounds or budding appurtenant thereto shall not because of such employrrtent be deenned.to be an employer: MGL chapter 152 section 25 also states that everystate or local licensing agency shallwithhold the issuance,or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of coMVHance with the insurance coverage required. Additionally,neither,the commonwealth nor any of its political subdivisions shall egter into air contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority.. Applicants s . Please fill in the workers',compensation affidavit completely,by checking the box that applies to your situation, Please Supply company nom,address and phone numbers along with a certificate of insurance as all affidavits maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage....Also be sure,to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being -requested,not the Department of Industrial Accidents. Should you Have any questions regarding the"law.-.or if-you are required to obtain a workers' compensation policy,:please call flu.Department at the number listed below. City or Towns Please be sure that the affidavit iscomplete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant: Please be sure to fill.in the permitl icense-number which will be used:as a reference number, The affidavits may be returned to the Department by mail or FAX unless other arrangements.have been made. The Office of Investigations would lice to thank you in advance for you cooperation and-should you have any questions; please do not hesitate togiveus a call 1011 The Department's address,telephone.and..fax number; w The Commonwealth Of Massachusetts Department of Industrial Accidents 600 Washington Street Boston,Ma. 02111 -.fax#:4(617)721-7749 phone#:..(617)7274900 east 406 North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: r (Location of Fac' ty) / Signature of Permit App icant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector ,f°'� ✓dee 1 amama�uuea��o ✓[�aaiae�euaet� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 085086 Birthdate: 07/23/1979 Expires:07123J2007 Tr.no: 85086 F Restricted: 00 STEPHEN H OBRIEN _ 56 FITCHBURG RD#531 TOWNSEND, MA 01469 Administrator X.�omvteeon�vea o�✓lilaGvaclutGel�6 - - Board of Building Regulati ns and Standards License or registration valid for individul use only r= =_ �,=�' HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: a Registration: 133895 Board of Building Regulations and Standards tt One Ashburton Place Ren 1301 Expiration: 8122/2005 Boston,Ma.02108 _ Type: Public Corporation MC CONTRACTING INC. LEONARD MARTELL JR.. 62 CONSTANTINE DR. z:—', 11Y ., TYNGSBORO,MA 01879 Administrator Not valid without signatur__ x.10RTH oVVn of _ Andover AAA No. &?7 � - - =o� dover, Mass. Sma"491' D T O -C LAKE ' COCMIC ME WICK V ORATED P'Pa`-`C BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT �!charcl AeBUILDING pINSPECTOR ..................................................... ..........................I. ........................................................ Foundation has permission to erect..S fly.1.60.............. buildings on ....I... . *!O ti ..�........ Rough .............. ..................................... ,� s ate. ti to be occupied as '� rr Chimney ......................... ...................... ..... ................................................................................................................ provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes andBy- ws relating to the Inspection, Alteration and Construction of Buildings in the.Town of North Andover. /1P �� PLUMBING INSPECTOR -Y 's 0 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ........... .0 /......... ............ Service ................ BUILDING;INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and.Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Location �� 1 `� `N A a No. Date 1 NORTH TOWN OF NORTH ANDOVER 41 ` Certificate of Occupancy $ �Ss+cMusEt Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ � C Check # ' >8 71 L 17305 r ---- Building Inspector