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HomeMy WebLinkAboutBuilding Permit #1344-2016 - 18 WILEY COURT 6/28/2016 A40rr- - NORTfy TD L+---) BUILDING PERMIToFst�V,o TOWN OF NORTH ANDOVER � h P� APPLICATION FOR PLAN EXAMINATION 1.; ,m I I l Date Received Permit No#: 5 R,TEo�e��c5 I � 2�1/� A// / CHUS Date Issued: 1 v IM ORTANT:Applicant must complete all items on this page f LOCATION e C7 I Print PROPERTY OWNER PriiA 100 Year Structure yes no MAP OJ075- PARCEL.a/,;� ZONING DISTRICT: Historic District yes no Machine Shop Village jEe� no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family C(Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other eptic Well ❑ Floodplain ❑Wetlands ❑ Watershed District - DAw ESCRIPTION OF WOR TO BE PERFORMED: D Ic'end cation- Please Type or Print Clearly OWNER: Name: 1-Gt.tl._1 n o('©avw Phone: Address: $ t�y �r I f- 4 Contract ,r Name: I'G e c4,1 Phone: I �J�D�i'✓d2.� � - �, 5 9� Em3 4- C, Address: yS e r VX or Supervisor's Construction License: Exp. Date: 7 Home Improvement License: �0 `�� Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.,BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ / Llo o �� _FEE: $ Check No.: (e�-(p 9 Receipt No.: � 6 52,7 NOTE: Persons contracting with unregistered contractor of htaw access to the guaranty fund _ - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/MassageBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ U � COMMENTS CONSERVATION Reviewed on C, , Si nature COMMENTS ` dL HEALTH Reviewed ori Signature COMMENTS 1 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: i FIRE DEPARTMENT r; ,�� - _ �,. � Located 384 Osgood Street x r x ._,'�t L, _.4I ' Tternp Durn`p`s r on sit es ^r `I�_',A,p;--�_-} yam,�r " �Co to at{12, f1/IainfStreet Fire Department signat ru a/d, �� T i7� Y�^ +��r-e1F—� rw�+ •vim.-.swc—aaac ..a�.m••> C_011%IME tt�. �� �r�cr��u�./... 7�, i/,✓c Dimension Number of Stories: ^Total square feet of floor area, based on Exterior dimensions. 700 Total land area, sq. ft.: _q;5� ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: lies No MGL Chapter 166 Section 21A—F and G min.$1oo-$1000 fine NOTES arjdbATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 4� Floor Plan Or Proposed Interior Work iL Engineering Affidavits for Engineered products OTE: 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 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) 4. Building Permit Application 46 Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit , Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 1 V tM. Location ' 1 No.E ;.'H'-i — Z 01 yo Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# t C Building Inspecfor Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 96,400.00 m $ - $ 1,156.80 Plumbing Fee $ 144.60 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 144.60 Total fees collected $ 1,546.00 18 Wiley Court 1344-2016 on 6/28/2016 Addition r -I F NORTH ( W'. 10. _ c . - ver No. y _ h ver, Mass (C2A 1 O ♦^K@ 1 COC KIC K!WKw R4 TE D PPa`��y U BOARD OF HEALTH Food/KitchenPER IT T t LD Septic System .1...... iAOTHIS CERTIFIES THAT ..........P. ..... , ,,,,,, D BUILDING INSPECTOR . . ..ede .. ...... . has permission to erect dui+ Foundation p .......................... buildings on ... ....... ...`�... .................................... to be occupied as ........B�. Jroon ,,, PAA1 � Rough ..... .... ................................ ............................................. 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TIO T Rough Service .. .. . .. ... ....... Final y BUILVlhli�PE OR GAS INSPECTOR Occupancy Permit Occupancy Permit Required to OccupyBuildinzto Occupy Buildinz 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. Smoke Det. pORTH F q1, 0 eo Town of North Andover * Machine Shop Village Neighborhood Conservation District Commission �qS gATFo�P",�<5 1600 Osgood Street North Andover, MA 01845 SAG HUSE Certificate to Alter Date: Z UVI Contact Name&Address: �l ►r1 Y- �Cc,�,Q 1 J G�. �OG C� �I lr1 C.� W . o s� Project Address: Project Description (attach additional pages,if needed): "a-d fl 0'yI W10dowS tU -a(IcIlb"I , GWchufecturaj (e y, l 1 M b M OGI/1 n -Pyl tD Ise wk&,+C- zPJ4::—' rl,�'ct 1 vlo\�o Commission Vote: Voted LL to b to grant/deny Certificate to Alter on YL ! p Comments (attach additional pages,if needed): Signed: ne Shonn - Mach Village Neighborhood Conservation District Commission MSV NCDC Page Page No. of Pages CLASSIC CONST UTCrIO CO. BOXFORD,li&A 978-382-4500 0 PROPOSAL SUBMITTED PHONE _ D� STREET J06NAME CITY,STATE and IP CODE f' JOB LOCATION AFIC7HITECT " DA E OF PLANS 7Pr f We hereby submit specifications and estimates for: -- j •4 �--.....,-raze 4:., 5_t , ._ -- � 1 .,,9G�.g.._ ,,FIG� _. _ "_ -%r`JI a_7.....lev; ...._: !_ ..f cwt._4_x4_ AP, A- G . ............ --: � .f,�.11.L:���_v,t�v'��;'1.L.�.L.-6g�:���.,��-�,�`f--.)r..-�r�•--=z,')L<'.;�[:�_".�.t I�:�.....�_�11_f-�f'��=T—�L-�:�LLI,>._.I_y/f�__L._�L._-�'-•-/at`']1�. Hit proPUSP hereby to furnish material and labor—complete in accordance with above specifications,for the sum of: - dollars($ 'ei�) ). Payment to be made as foliows: Z' � 1 t s ! All material is guaranteed to be as specked.All work to be completed in a workmanlike ,f – r manner according to standard practices.Any alteration or deviation from above specifications Authorized involving extra costs will be executed only upon written orders,and will become an extra Signature. charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control.Owner to carry fire,tomado and other necessary insurance. Note:This proposal maybe Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. Arreptaure of proposal.—The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature (�s� to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature L��4& lnspecctorl, �o��� PIN Meech lcc� of-PrWertY: Avl over j i MOTE- Rightof Wacf not; 5howh. VVIlte Streer---- 46.or 94.as�deec Ford garage vto. 18 t ' r M r Zot f5 2 stortf dwelling lot 11 �. 45.75' f Lot configuration is Cot I'7 lot. �8 based on assessor's information and may S not be e%,-�, L red 304910 3 �ood pan¢�; 250098 OOD3 G ,tiood zorLe: ��,11A OF"�s,, �o PAUL' ye .��j�heref6y certify�theLtt�us mortgage inspeefn"on was pt ,�ared�-fb GROVER 4 OrGie 6 Santos Car.Amerkan Wesiae11t1�11, a No 313 It glu dweWrig stwwty M-em does not faU im a speck a FEA-)k 41ood hazar& arca wfdv am eRctwe date o f s�,>�+ the dweILilu does "rifm-r ,rry ffu local,toning 6y-taws imef Fejt . xttht ttmw oFconst.truction wi respeato horizontal. dimmsfbt' cc Scale: 1" _ �0 setback. iVequ irements or is exen4 r from vtotahi ym ea-Foreert+t, me Date: 3.9.94 vz om under Mv-55. &nera.Llaws Chrxptw4o2.•5ectL'0rv7. File No. t 16594 PLEASE NOTE: The structures as shown on this plot plan are approximate only. An actual survey is necessary for a precise determination of the building location and encroachments, if any exist, either wad- across property lines. This plan must not be used for recording purposes or for use in preparing deed descriptions and must not be used for variance or building plan purposes. This plan must not be used to locate property lines. Verification of building locations, property line dimensions, fences or lot configuration can only be accomplished by an accurate instrument survey which may reflect different information than what is shown hereon. Please note that this is "NOT A BOUNDARY SURVEY" and is "FOR MORTGAGE PURPOSES ONLY". COLONIAL LAND SURVEYING COMPANY, INC. 269 Hanover Street • Hanover, Mass. 02339 - Phone: 617-826-7186 • Fax: 617-826-4823 SPILLER'S 568207 The Commonwealth of Massachusetts z Department of IndustryalAccldents 1 Congress Street,Suite 100 '~ Boston,MA 02114-2017 www.mmass.gov1d1a Workers'Compensation Insurance Affidavit:Builders/Contractors/Elee.tricians/Plumbers. TO BE FILED WITH THE JPERAdITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization&dividual): Address: 'qS g C-ucm City/State/Zip: Phone#: y�y t:� 6? U Areyou an employer?Checktfie apQropriate box: Type of project()pquired): l.�amaemployerwith •1_ t employees(Mand/or part-time).° 7. ❑New construction 2,E]I am a sole proprietor or partnership and have no employees working for me in 8. E]Remo delitig any capacity.[No workers'comp.insurance required.] I❑I am a homeowner doing all work myself:[No workers'comp.insurance required.]t 9. F1 Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 [wilding addition ensure that all contractors either have workers'compensation insurance or are sole I L E]Electrical repairs or additions proprietors with no employees. 12.FJ Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 1. .[]Roof repairs These sub-contractors have employees and have workers'comp,insurance.l 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we haveno.employees.[No workers'comp.insurance required.] m . . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit#his affidavit indicating they are doing all work and then hire outside contractors riiust submit a new affidavit indicating such. tContractors that check this box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have -eraployees. Ifthe sub-contractors Piave employees,they must provide their vwoA&s'comp.policy number.• 14m an employer that is providiing workers'compensation insurance for my employees.'Below is the policy an Yoh site information. Insurance Company Name: Policy#or Self-ins,Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or 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 Office of Investigations of the DIA,for insurance coverage verification. X do hereby cert' unde ae and penalties ofpei ry that the information provided above is true and correct. 011 Si aforez/zc �kDate: Phone#• a6r��� Official use only. Do not write in this area,to he completed by city oi-town official. City or Town: Permit/License# Issuing Authority(circle one): ; 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: , Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. 1 Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. Howdver the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,constriction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commdnwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any 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 Please fill-out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractoi(s)name(s),address(es)and-phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Depattment of Industrial Accidents foi•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 the Department at the number listed below. Self-insured companies should'enter-their self-insurance licens o 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 fill out in the event the Office of Investigations 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. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided'to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 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 CLASS-1 OP ID: MI CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD1YYYY) 06/0212016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE; OF INSURANCE; DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED ' `RESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. h..PORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies) must be endorsed, If SUBROGATION 13 WANED,subject to the terms and conditions of the policy,certain`policles may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsemen s - Chas. E Hartshorne N�Ar CONT CT Chas. F. Hartshorne&Son,Inc 3 Chestnut St. PNoNEAx ac ,781-245-4300 ac No:?81-246-5810 Wakefield,MA 01880 ADDRESS. Chas.F.Hartshorne&Son,Inc INSURERIS)AFFORDING COVERAGE NAIL q INSURERA:NGM Insurance Company 14788 INSURED Classic Construction Co Inc INSURER 8:Associated Industries of MA Michael Robidoux 45B Glenda) Rd INSURER C: Boxford, MA 01921 INSUREq D; INSURER E: INSURER F., COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OP ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE APFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INTR TYPE OF INSURANCE IND POLICY NUMBER MMIDOWYY MI-410 Y LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,001 CLAIMS MADE FKOCCUR MPJ41041 061251.2015 06/25/2016 pAMISES Ea oTrM7 w $ 500,001 X Business Owners MPJ41041 06/2612016 06/25/2017 MED EXP(Any one person) $ 10,001 PERSONAL 8 ADV INJURY t 1,000,001 GEN'LAGGREGATE PRO-LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,001 POLICY E]JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,001 OTHER: $ AUTOMOBILE LIABILITY OMB1 ED SINGLE LIMIT S W accident ANI'AUTO BODILY INJURY(Per pereon) S ALL OWNED 8CHEDULED AUTOS AUTOS BODILY INJURY(Per ecclaenl) $ HIRED AUTOS NOWOWNED PROPERTY AUTOS "Pr accldent $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATIONPER AND EMPLOYERS'LIABILITY YIN 87ATUTE I I ER B ANY PROPRIETORIPARTNERIEXECUTIVE AWC700705001202 09/1712015 09/17/2016 E,I„EACH ACCIDENT $ 100,00( OFFICERIMEMBER EXCLUDED? El N 1 A (Mandatory In NN) E.L.DISEASE-EA EMPLOYEE $ 100,00( If cs d RIPTION OF OPERAMN8 below esglbP folder E.L.DISEASE-POLICY LIMIT $ 600,00( D SGI DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarka Schedule,maybe attached if more spaco Is mqulrod) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Andover ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Chas.F. Hartshorne&Son,Inc ®1988-2014 ACORD CORPORATION. All rights reserved. I ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD � I Massachusetts -Department of Public Safety Board of Buiiding Regulations and Standards �uTiiiauCiiCiii Supervisor 1 M r411"lV 'g� �� License: CSFA-050193 y\.i.1:N i MICHAEL R ROBO ` 45B Glendale Road $ Boxford MA 01911 Expiration Commissioner 01/04/2017 �_. ,Gelaaaas.�apan LZ6L0`dW OHOdXOg i b MA IIIN SNAVI3 HLZ xnoplgoH iaeyolw 00 NOtionHISNOO OISSVID V90 -9102/L/8 `:uo.4w dx € :actA1 5£8L01 uol; Is sr - ; U01.3"INOOIN3W3AOMdW13WO - uogs n2a ssa pn slle �amnsuo o aai 1 2I S 78 3)d �1 !JO :s acn javrcn���a��Jnamtoaacc�uo aYxP NpRT�{ Town of North Andover O A o Machine Shop Village Neighborhood Conservation District Commission 1600 Os good Street North Andover MA 01845�•',� g CH Application For Certificate to Alter Instructions: Fill out the form below and submit to the Machine Shop Village NCD Commission Chairperson(contact info below). The goal of this application is to provide a clear understanding of the proposed alterations,and how they vary from the existing conditions. Your application must include photos or plans of the existing conditions,and plans or drawings of the proposed changes. Include product&material descriptions for both existing and proposed conditions. Discussions with the Building Dept. or MSV NCD Commission are not a substitute for filing an applicationIq S- Date: Contact Name&Address: ►-; n o L 0-4 xnIq e) ZIT Project Address: A Jl IZ elow Project Description (attach additional ages,if needed): -1 lu le Information Provided: ✓IPhoto/Drawing of Existing Conditions t hoto/Drawing of Proposed Conditions Description of Existing Materials Description/Catalog Cuts of Proposed Materials to be used Other Information(describe): MSV NCDC Current Chair:Liz Fennessy,77 Elm Street,lizettafenness@yahoo.cotn 0&90_I9e- .qi OD ' -'9(V4J -Dj9S I'i ----- 1 d.5 OT WVr "f g ��.xxxeecyexumrswucas.. . . - r '�nrw•�,arwn'raunwa:a,.�- - ��� - i �nQc�+�►a'J f i u A t 1 - bYM 14HIAi IN�YU4iR1�M4lL 'FM1R� _. .IT�iC i ' diWY�CGi�i'iSI3YdWiWi'�MII 'AK - - - FFBWI�il!d6.'SG7m9 �. ..!�918�`P2iL031lIM�}pgyAi61Ytlh3MY�ARIMi' _ .. - "...N�uucw'M'lrX�gnMYw �LTwI PMP1�fw�aill�C'�wLaf� _ _ Fools - 2 x l z RA sps O.C. i Roof R-AMVOG - T71 I 177 -7 102 .95O ��- d 17 —Z IA .. 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