HomeMy WebLinkAboutBuilding Permit #1135-16 - 80 BRADFORD STREET 4/28/2016 NORTH
BUILDING PERMIT OF�tLeu .b �tio
a 4
yf' 1. ••'•A 6
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TOWN OF NORTH ANDOVER o
APPLICATION FOR PLAN EXAMINATION _
A Date Received No#: ?.
y
/ qSS ICHUs���
Date Issued: YZ ae
IMPORTANT: Applicant must complete all items on this page
LOCATION � ���� k1A
not
PROPERTY OWNER a,•C( � �yC�\ e-9
Print 100 Year Structure yes no
MAP / PARCEL:0-"6
� ZONING DISTRICT: Historic District yes no
Machine Shop Village yes. no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building gOne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
Septic ❑Well ❑ Floodplain. D Wetlands• ❑.'Watershed�Distnct
Y
> .
Ct Water/Sewe r_
DESCRIPTIO OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: Phone:
Address: 0 /U1"
Contractor Name: oohs` ' c�tL� Phone: F�� "�a� 4,/
Email: T-nnLtW 9 a 10A0o ClWkvA
Address' c3 C l c 04 r
Supervisor's Construction License: O��i (2� Exp. Date: . Z
d
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
4
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
n
Total Project Cost: $ oAO< FEE: $ 70,00
Check No.: �� Receipt No.: 30-507
NOTE: Persons contracting with u egistered contractors do not have access to the guaranty fund
Location
No. /�� -/� Date
i
• - TOWN OF NORTH ANDOVER
1
. Certificate of Occupancy $
Building/Frame Permit Fee $V�
Foundation Permit Fee $
Other Permit Fee $
TOTAL $.
Check# C G 73 1
30307
` Building Inspector
i'
Dimension
i 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
NOTES and DATA— (For department use)
it
I
II
'I
® Notified for pickup Call Email
Date Time Contact Name
Doe.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.
I
Roofing, Siding, Interior Rehabilitation Permits
4 Building Permit Application
Workers Comp Affidavit
Photo Copy Of H.I.C. And/Or C.S.L. Licenses
Copy of Contract
Floor Plan Or Proposed Interior Work
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 j
Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan
And
p p
Hydraulic Calculations (If Applicable)
Mass check Energy Compliance Report (If Applicable)
Engineering Affidavits for Engineered products
IN OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
i
4- Building Permit Application
4 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)
i
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
Doc:Building Permit Revised 2014
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped flans ❑
i
F
F SEWERt�.GE DISPOSAL
wer ❑ Tanning/Massage/Body Art ❑ Swimming Pools❑ Tobacco Sales ❑
Food Packaging/Sales ❑ I
Private(septic tank,etc. ❑ Permanent Dwupster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
I
PLANNING & DEVELOPMENT Reviewed On Signature_
i
COMMENTS
- 7
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
I �
i
Conservation Decision: Comments
Water& Sewer Connection/Signature& Date Driveway Permit
DPW Town)Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT
ILocated at.1�24 Main Street��y�•e�m• um iey� n steti, n
z` `
dire De
pa tsignat rNdate . ry a x
71
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d.t.t
t%ORTIi
Town of : _ Andover
' O •'�". `!fir• 0
No. * _
h ver Mass
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o LAKI
coc«ic«ew�cw �1•
p00ATEO
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT ....... �?.�::...... .... ........ ......................................... BUILDING INSPECTOR
has permission to erect .......................... buildings on ............ J�:' /_ ',2d� ................................. Foundation
Rough/F
to be occupied as ............. '. � ;,� .�.5..¢!..:`� ....CJ..... ; ....................................... y
Chimne
provided that the person accepting this permit shall in every res ect 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 d
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 CONSTRUCTION TS Rough
Service
.................. :..... . � ...................... final0�-e
BUILDING INSPECTOR 7 4 �4
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 Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No. ✓JiV�? "�%`
Smoke Det.Y oma/
Enter construction cost for fee cal - North Andover Fee Calculation
Construction Cost
$ 22,500.00 m
$ - $ 270.00
Plumbing Fee $ 33.75
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 33.75
Total fees collected $ 437.50
80 Bradford Street
1135-2016 on 5/3/2016
Garage Repair
NORTFt
Town of, 2 �.. : ndover
O Yr4 . 1
No. * _
4". h ver, Mass,
COCHICHEWICK
U BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
- r
THIS CERTIFIES THAT ....... ).�C C.t� ` .......................... BUILDING INSPECTOR
..... .....................................................................
has permission to erect g S� Foundation
.... buildings �� � ��'
Rough
tobe occupied as .............ZF...........(.. .......... ..:............. ... .......... ........................................... Chimney
provided that the person accepting this permit shall in every respect conform 01 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 CONSTRUCTION TS Rough
Service
.................. ...... .Lr. i� ................
""""""" 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 Wall To Be Done FIRE DEPARTMENT
.Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
WA
Chimneys Residential & Commercial Roofing All Types Of
POINTED-REBUILT-CAPPED
Siding CHIMNEYS Expert Masonry Work
Mass Toll Free I*Roof Leaks Experts� Licensed & Insured
Locally Owned& Operated Sirce 1976 =
1-800-WAIT-4-US ® -� License#034200
(924-8487) IKO Gree warm We work Year Round
o-
Proposal To: Richard Boettcher Date 4/20/2016
Street: 80 Bradford St. 978-807-6460
N.Andover, MA
Garage proposal rboettcher@dddids.com
1. Remove all existing kneewalls and roof structure. Front wall and doors will remain.
2. Frame all new kneewalls to code back to original specs.
3. Frame new support beam and roof structure to code. Beam and roof structure calculated by Jackson
Lumber
4. Install 1/2" CDX Fir sheathing to all kneewalls.
5. Install 3/4"Advantech T&G plywood for entire flat roof. New roof will be framed to have low slope
away from main house.
6. Install Tyvek housewrap to all kneewalls.
7. Install new vinyl clapboard siding and vinyl corners to match main house as close as possible.
8. Install 1/2 insulation board to entire roof. Fastened with plate and screw system.
9. Install all new white heavy gauge perimeter metal to all eaves.
10. Install new fully glued .060 rubber membrane to entire roof.
11. Removal of all work related debris
12. Building permit included.
13.No electrical work included.
14. Contractor workmanship warranty: 10 years
Total cost: 22,500.00
• Payment schedule:
$10,000.00 due on project start date
Final balance including any extras due upon project completion
Thank you!!
Acceptance of Proposal—The above prices, specifications and conditions are satisfactory and are herby
accepted. You are authorized to do the work as specified. Payment will be made as outlined above.
Date of Acceptance: Signature:
1
4-7-16
1:57pm
1of1
I
Data
n: Member Type: Beam Application: Roof
Top Lateral Bracing: Continuous Slope: 0.00/ 12
Bottom Lateral Bracing: Continuous
#/and Load: Moisture Condition: Dry Building Code: IBC/IRC
Load: 50 PLF Deflection Criteria: 0240 live, U180 total 1.000" max. LL
,gad Load: 15 PLF Deck Connection: Nailed Member Weight: 16.6 PLF
X Filename: Beam1
Other Loads
t Type Trib. Other Dead
(Description) Side Begin End Width Start End Start End Category
Additional Uniform(PSF) Top a 0.00" 28' 0.00" 12' 6.00" 55 15 Snow
�— 1400 ® 1400
2800 ®�
Bearings and Reactions
Input Min Gravity Gravity
Location Type Material Length Required Reaction Uplift
1 a 0.000" Wall SPF Plate(425psi) 5.500" 1.642" 4884#
2 14' 0.000" Wall Steel 3.6W, 3.101" 16280#
3 28' 0.000" Wall SPF Plate(425psi) 5.500" 1.642" 4884# --
Maximum Load Case Reactions
used fOrePPIY7ng Point loads(or line loads)to carrying members
Snow Dead
1 3765# 1119#
2 12551# 3729#
3 3765# 1119#
Design spans
13' 7.375" 13' 7.375"
Product: 2,0 RigidLam LVL 1-3/4 x 9-1/2 4 ply PASSES DESIGN CHECKS
Connect members with 2 rows of 1/2"diameter bolts at 24.0"oc
Design assumes continuous lateral bracing along the top chord.
Design assumes continuous lateral bracing along the bottom chord.
Allowable Stress Design
Actual Allowable Capacity Location Loading
Positive Moment 124124 334964 37% 22.85' Total Load D+S
Negative Moment 22164.# 33496.# 66% 14' Total Load D+S
Shear 73834 14785.# 49% 14.01' Total Load D+S
Max.Reaction 162804 203444 80% 14' Total Load D+S
TL Deflection 0.3066" 0.9076" 0532 22AT Total Load D+S
LL Deflection 0.2364" 0.6807" U691 22.17' Total Load S
Control: Max.Reaction
DOLs: Live=100% Snow=1150/o Roof=1250/o Wind=160%
Design assumes a repetftive member use Increase in bending stress: 4%
All product names am trademarks of their espective owners - ..
COPydght(C)2013 by Simpson Strong-Tle Company Inc.ALL RIGHTS RESERVED.
"Passing Isdefined as when Ne member Ooorjoist,beam orglmet shown on Nis drawing meets applicable design Made forloads,Loading Conditions,and spans listed on this sheet.
The design must be reviewed by a Qualified designer or design professional as required for approval.Thlsdeslgn assumes product Installation according to the manufacturer's
cifhcations.
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Ur-,
I Congress Street,Suite 100
Boston,MA 02114-2017
www.massgov/dia
orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leeibly
Name (Business/Organization/lndividual): C uV1Q elq 0V
Address: �5z,
City/State/Zip: /K -c Ik J "1 I� 4fJ Phone#: �' 3 /
Are you an empioyer't Check the appropriate box: Type of project(required):
Ia employer with _employees(full and/or part-time).* 7. ❑New construction
2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. remodeling
any capacity.[No workers'comp.insurance required.]
3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 1 El Demolition
10❑Building addition
4.[]l am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sok 11.❑Electrical repairs or additions
Proprietors with no employees.
12.E]Plumbing repairs or additions
5C]1 am a general contractor and I have hired the sub-contractors listed on the attached shat.
ibese subcontractors have employees and have workers'comp.insurance_= 13.E]Roof repairs
6.❑We arc a corporation and its offices have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4)�and we have no employees.[No workers'comp.insurance required.]
'Any applicant that checks box NI must also fill out the section below showing their workers'compensation polity information.
t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such_
'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the po/icy and job site
information.
Insurance Company Name: /•7 K-V1 nm u l-i-r i / r
Policy#or Self-ins.Lic.#: /Jui c ' °� a ° �l 2 0/S"Expiration Date:—/ II I asI t�
Job Site Address: JS J �l�� lk 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 S 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.
I do hereby certify unk7pl and penalties of perjury that the information provided above is but and correct
Signature: Date:
Phone#:
OffWial use only. Do not write in this area,to be completed by city or town official,
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.Cityrrown 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.
Pursuant-to this statute,an en ployee is defined as"...every person in the service of another under-any contract of hire,
exiMess 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. However the
owner of a dwelling house having not more than three apartments and who resides therein,or tire-occupantof the
dwelling house of another who employs persons to do maintenance,construction 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 rnnstruct buildings in the commonwealtb 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-contractors)name(s),address(es)and phone numbers)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 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 the Department at the number listed below. Self-insured companies should enter their
self-insurance 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 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.#617-7274900 ext.7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
i
WORKERS COMPENSATION AND EMPLOY RS LIABILITY INSURANCE POLICY
INFORMATION PAGE
A.I.M. Mutual insulare Company
54 Third Avenue
Burlington, M ssachusEtts 01803-0974
(800) 876-2 65
NCCI NO 26158
POLICY NO, AV�1C-400-7009484-201.5A
PRIOR NO, gj��400_7009464-2014A
ITEM
1. The Insured: All Under One Roof
DBA:
Mailing address: C/O John Lanzefame
30 Temple Drive FEIN:**-***8251
Methuen,MA 01844
Legal Entity Type: Sole Proprietor
Other workplaces not shown above: See Location
2. The policy period is from 11/09/2015 to 11/09/2016 12:01 a.m,standard time at the insured's mailing address.
3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the
states listed here: MA
B. Employers'Liability Insurance: Part Two of the policy applills to work in each state listed in item 3.A.
The limits of liability under Part Two are: Bodily Injury by Accident $
Bodily Injury by Disease $ -- - 100,000 each accident
Bodily Injur by Disease $ '""---• --500,000 policy limit
each employee
C Other States Insurance: Coverage Replaced by Endorse ent WC 20 03 06 B
100,000
D. This Policy Includes these Endorsements and Schedules: EE SCHEDULE
4. The premium for this policy will be determined by our Manuals f Rules,Classifications,Rates and RatingPians.
All information required below is subject to verification and cha ge by audit.
Classifications '�'-
_.__ _.. .. __... Premtu Basis
Code Estimat d Perslo0
No, Total Annual Of Estimated
— ---- ••- Remuneration Remuneration Annual
Premium
INTRA 174355
t
INTER
SEE!.CLASS CODE SCHEDULE
._....,._--�,._
Minimum Premium + - ""----------- _
"—G-O--V-- To[al Estimated Annual Premium ,
STATE CLASS De osit Premium >
VA--54W S# to Assessments/Surcharges
$1 .00 x 5 7500%
This policy,including all endorsements, is hereby countersigned by `• -
Authorized Signature 10/05/2015
Date
Service Office:
54 Third Avenue P rry Insurance Agency LLC
Burlington MA 01803 5�2 Chickering Rd, Rt 125
N rth Andover,MA 01845
WC 00 00 01 A(7-11)
includes copyrighted material of the National council on compensation insurance,
used with Its permission.
Massachusetts - i.eCpa tl-nent of
: J' gliding `:^,`gg Aiaa'.iC;':i
License: C8469120
JOHN W LANZAFAME
30 TEMPLE DR
METHUEN MA 81844 ,
CaF'nmissions,r 04/03/2017
• r-mob_ .� .:„
Click on the registration number to view complaint history. You can also view arbitfatiyn and Guaranty Fund
history.
The list is current as of Wednesday, October 8, 2014,
Search Results
REGISTRANT RESPONSH E REGASTRATCON ADI SS EXPIRATION STATUS
NAME INDIVIDUAL NUME ER DATE
ALL UMER OME RGOF LANZAl AA,1E. 137057 166 A MERRIMACK ST 10/02/2016 Current
JOHN METHEUN, MA 01844 -- _ _--- --- _
@ 2012 Commonwealth of Massachusetts.
Mass.GovG is a registered service mark of the CommonweWth'of Massachusetts.
MORTGAGE INSPECTION
Appleton
Land Surveying, Inc.
SURVEYING • ENGINEERING • LAND PLANNING
234 ESSEX STREET LAWRENCE. MASSACHUSETTS 01840
(308)886-424 (508)888-7488
MORTGAGOR oCrtfi'c H t 2-
ADDRESS OF�VIPRINCIPAL BUILDING
SHED V 0 3(\A V FV D ::5TIZEE-r
Nc >r.T 4 ANDovc r
NOTE: THIS MORTGAGE MSPECTION was prepared
` apeaficxdly for mortgage purposes and is not to
be r6Ged upon as a survey. A.L.S.I accepts no
responsity for damages resulting from said reliance
by anyone other than the said mortgagee and its
N oasigria in connection with its proposed mortgage
finonc:ing to said mortgagor.
LOT"'/b The information on this mortgage inspection is the
exclusive property of A.LS.L Unauthorized use,
reproduction or modification of bib material is strictly
V " ` prod, and may be subject to legal action unless
prior wrbeti conserrt from A.L.S.I. is obtained.
CUMFICATION TO:
��F.�tzj7 L A1.JT2�NGE SAVINGS 3�►�E!
DD vL�e. F3 This mortgage Inspection was prepared in accordance
7 5-Ty with the Technical Standards for Mortgoge loan In—
speed=
n—
LvD F� DN o aoud Surveyo adopted as and�Civil Engineersthe usetta Association
of l
�. Zy•ti `� I STATE THAT IN MY PROFESSIONAL OPINION
d the prinapcl structure/s and accessory structure/s
with the dinermonal setback requirements of the
zoning ordinances. and that there are no encroachments
of major Improvements either way across property lines
- 7i G 3 ' _ except as shown.
w
190- syr l7 w 7197
�p
0
9.
0& Nater
2-711
Dwelling is not located within a Flood Hazard Zone
❑ Dwelling is located within Flood Hazard Zone
❑ Information is insufficient to determine Flood Hazard
Flood Hazard determined from F.E.MA Flood Insurance
rate map. WN
Deed Reference: Bk. 3 5 8 Pg. S�o
Scale: /! = 36 I �`
Cert. No. Date of Inspection: -i " 9
Plan
P Reference: PI. No. 8-c X09.�G e Date of Plan: 6 " -y-7
U
o- R
o,e s7c�3