HomeMy WebLinkAboutMiscellaneous - 88 MIFFLIN DRIVE 4/30/2018Date .%/zs l ......
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TOWN OF NORTH ANDOVER
,
PERMIT FOR GAS INSTALLATION
This certifies that.W. ! AYP1— PMJ.-I
has permission for gas installation
in the buildings of/ ...................
at .. 196. J
q/1 ........?1x*1X.k,2Aa--:,)4---9 ,North Andov ,Mass.
Fee. 20. Lic. No./. -�. .. .
GAS INSPECTOR
Check # p /
7 IS 5 7
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{Typearl?�)
790RTHAM0VIXM&%ACRWXM
BuffancrLoca€ions
Date /0-/ k // -
PteIt
=
Amount$
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SUB-BASEM ENT-
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BASENEINT
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FL.O0RTH_ FLOOR -
IS
TH. FLOORTH.
FLOOR
MAat ortyPe) Ch a= Ce�mcate tr
Iiame 7 4 L l r� _f:'A . �i 6411 C� �mCOY
Address -- '- d- !.3 o X S-7 S a
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Business Telephone y Cel/ - rej -q!5-097 n TMWCa
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Nannie o£iicerssed -Plumber or Gasntter f.vrt
IlUMMANCE COV RAGE Checkone:
Ihzvea thabil tybsmaacepolmyarrrs snnbstantW e4md� Fes No
if_vauhavechecked gleaseiaclic�tetheWe=°`ebycherlogtheapar bo
Vabiii�y iasmauce policy Otbertppe ofindemaity � - Band
Ow s IaSarance'4�aiver. l mn awaretbat the licensee does not have the bsnrance cavenageriWred by Chapter 14? ofthe
Mass. General Laws., and that my sgtna#am oatbis permit application waives this regoi?emeaL
Check one:
.SignatureofOwner ar Owner's Aga Owner 11 Agent
t hereby certifythat Q oftbe detanns
(or entered) in -Jvwn mmurcrAr. Z— ---+— .,.7—
best ofmyknowledgea{nd1bataIlnlambkgworkandinstatt on,, puffirmed underPeanitISSurzd f�tbisanrolicatianwdibeis v
compliance with all pertiae prrnnsioas of theMassachusetts State Gas Cade anal Chapter 142 ofthe General Laws.
Signature of -Licensed Plumber Or GasFier
Plumber ' V 4 33
�wrn Gas Fitter ricMeD,tumber
�Amster
LOVED (mlm am oNLT) Journeyman
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTHAIMOVM MASSACHUSETTS
��% iDate
Building �/amemYmne R/1
pefmit
— Type of 0a�panay
Amount
New 0 Renovation Replacement M Plans Submitted Yes ❑ No E]
FIXTURES
(Print or type) I
Inswiing CopmpanyNeme
Address SOX
Business Telephahe- ,
This certifies that
OF NORTH ANDOVER
PERMIT FOR PLUMBING
1��� 11,qZ197/-5
.. .......
has permission to perform
d //
plumbing in the bui)dings of . �I. qr<? I "���t • • • • • • • •
Name ofLiceasedPhimber: I.. 411 . , North Andover, Mass.
Insurance Coverage: Indic ae theta at .. <.�.. // • . � . f / r
Liab�ity insurance policyFee �' c;J . Lic. N o. � y � � /� f. .....
PLUMBING INSPECTOR
Insurmceawl- r: L the undersigned, h* Check #
three insurance I
signs= I
I herby =tify that an afthe Beta s and infanmatiaa I have submitted (or entered) is above applirafinn aro true and acctat to the
best of my Iamwledge. and that ail plumbing work and moons pabxned under Permit bld for this apphcadon. will be in
compliance with all pertinent provisions ofthe Massachusetts State Plumbing Cio
.w �e sad Chapter 142 aithe General isws.
s
A/ • 4 4 11wI 11"i •
TyyppeoofPluumbingLicense
e um er Master n Jonmeymaa
Location
No. Date J ��
TOWN OF NORTH ANDOVER
p
Certificate of Occupancy
$
b ; :
Building/Frame Permit Fee
$
cnust
Foundation Permit Fee
$
Other Permit Fee
$
Sewer Connection Fee
$
Water Connection Fee
$
TOTAL
'f Building
Inspector,
J
Div.
Public Works
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Licensed & Insured &
• Roof Leak Experts •
(978) 794-3883 • 1-800-WAIT-4-US
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Phone% _ / Date
/ 33 ! ( / Z
Proposal Submitted To /f/{
r-f �I �/` C /�
Street h
Job Name
City, State & Zip Code
Job Location
Job Phone
We Propose hereby to furnish and labor in accordance with specifications below, for the sum of:
Dollars ($
1VA7�Wv sr,.i11�c cr -�'76j Q cfv
All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized
manner according to standard practices. Any alteration or deviation from specifications be- Signature:
low involving extra costs will be executed only upon written orders, and will become an
extra charge over and above the estimate. All agreements contingent upon strikes, accidents NOTE: This proposal may be
or delays beyond our control, Owner to carry fire, tornado and other necessary insurance.
Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days.
We hereby submit specifications and estimates for: . ,,.
10
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7-6 14 61Y
/ i L ��/l...T .7��''' _ � � �t �s //lam !✓/.r Cv a acl�'l�y. �iYs.�ir'� s �
Acceptance of Proposal - The above prices, specifications
and conditions are satisfactory and are hereby accepted.
You are authorized to do the work as specified. Payment Signature:
will be made as outlined above.
Date of Acceptance: Signature:
BUILDING DEPARTMENT
DEBRIS DISPOSAL FORM
In accordance with.the provisions of MGL. c 40 S 54, a condition of Building Permit Number
Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as
defined by MGL c 11, S 150A
The debris will be disposed of in:
Location of Facility
Signature of Per 't Applicant
�'•y I 1 i
i Date
NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of
the Building Inspector
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1 Location n rr =:-4
No. hof Date
NORTN TOWN OF NORTH ANDOVER
, 9
•
Certificate of Occupancy $
�'�s' ••' Ern Building/Frame Permit Fee $
s�cMus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # So 7.5 --
Building Inspegq
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
-
BUILDING PERMIT NUMBER:�� DATE ISSUED: 4`
SIGNATURE: AaW �`✓�
Building Commissioner/Inspector of Buildings Date
SECTION 1 -SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
1.3 Zoning Information:
Zoning DiAiic—t Proposed Use
1.4 Property Dimensions:
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Rapired Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
Public 0 Private ❑ Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System ❑
SECTION 2- PROPERTY OWNERSHENAUTHORIZEDAGENT
Historic District: Yes No
2.1 Owner of Record
o ry 7
Name (Print Address for Service,: ' % n
�� �// q2F 6(Q ! - S�tl
Sipe�ure Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature Telephone
Not Applicable
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
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SECTION 4 - WORKERS COMPENSATION (M.G.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 building permit.
Signed affidavit Attached Yes .......❑ No ....... ❑
SECTION 5 Descri tion of Proposed Work check all applicable)
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
of Proposed Work:
'De., cut
I SECTION 6 - FSTIMATF.n rONCTRUrTION rncTc I
Item
Estimated Cost (Dollar) to be
Completed b permit applicant
OFFICIAL USE ONLY
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) X (b)
�6
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
—0-6
Check Number
aV,%- iivuN is Uw,PfKAUI UKiL.AHV1N lU DE CUMYLEUD WHN;N
OWNERS AG T R C TRACTO IES FOR BUILDING PERMIT
A7-klo07 Ra 1.4
I, as Owner/Authorized Agent of subject property
Hereby an a to act on
My beh , in 11 in ers rola dto k authorized by this building permit application.
)'-ho 0
Si ature t Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, 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
and belief
Print Name
of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TINMERS 1 2 ND3 RD
SPAN
DDAENSIONS OF SILLS
DIMENSIONS 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
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978-688-9545
978-688-9542 Fax
ItORTIj
Of4,..ae °'yG
F
i •
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER MA 01845
HOMEOWNER LICENSE EXEMPTION
Please print
DATE b d f #I,
JOB LOCATION
HOMEOWNER
Number
Name
Street Address
Phone
PRESENT MAILING ADDRESS
T 7 Yx-1
Map/Lot
Work Phone
a I 1?q C
City/Town State Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings of
two units or less and to allow such homeowners to engage an individual for hire who does not possess a
license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1.)
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, one or two family dwelling, attached or detached structures 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.
The undersigned "homeowner" assumes responsibility for compliance with the 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 an uiremen and that he/she will comply with said
procedures and requirements.
HOMEWOWNER'S SIGNATURE
APROVAL OF BUILDING OFFICIAL
MORT GAGE INSPECTION PLAN
AT
88 MIFFLIN DR/VE
NORTH ANDOVER, MA.
NO. ESSEX REGISTRY OF DEEDS.' % T6,91
PLAN.'
CERTIFIED 70.' LAWRENCE SAV/NGS BANK .
SCALE.' 1 "=40' DATE. -MAY 15, 200/
/52.67'
`f\l,\SrORY,,,
WOAD
o LOT /2 - �A�iE\
c ' /4 550 s.f. • • °
. OWELZIN �
W00\FIF
DECK
/67.95'
NOTES:
/)Do NOT USE OFFSETS TO ESTABLISH PROPERTY LINES
OR TO ERECT ANY STRUCTURE.
2lPROPERTY LINE'S ARE DETERMINED FROM COMP/LED
INFORMATION TO BE USED FOR MORTGAGE PURPOSES ONLY.
CERT/F/CAT/ONS.'
BASED ON MY KNOWLEDGE, INFORMATION AND BELIEF, /
HEREBY CERT/FY THAT THE PERMANENT STRUCTURES INDICATED
ARE LOCATED ON THE GRCUND APPROXIMATELY AS SHOWN AND ARE
CONFORMING TO THE ZONING SETBACK AFaI/REMENTS OF THE TOWN OF
M2 ANDOVER WHEN CONSTRUCTED ANO THAT THE STRUCTURE SHOWN /S NOT
LOCATED /N A FLOOD HAZARD ZONE AS PER F. E.M.A. MAP,
COMMON/TY N0. 250098 3C EFFECT/VE DATE.' 06- 02-93 ZONE.' X
� ••7
PG 259
JOHN ABAG/S B ASSOCIATES, PROFESSIONAL LAND SURVEYORS
137 CHANDLER ROAD, A ND OVER, MA. (508)688-4699
AF t/CANT.'• TRO/A NO. 4799
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
at: �? 441 - r Lt.0 "t)✓- is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
cIt, S150A.
Also, note Permits are required under Fire Prevention laws Chapter 148 Section
10A.
The debris will be disposed of in:
of
C
Fire Department Sign off: �-
Dumpster Permit
of Permit Applicant
Date