HomeMy WebLinkAboutMiscellaneous - 106 WEYLAND CIRCLE 4/30/2018.t r
Date.!�.....�......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .......... .... ......�1 -- -.... t�.� .................`.............
has permission to perform ...........�......®`v.......r?\.!'«..........................
wiring in the building of,,.,.. c.._ G c
............................................................I........
at ........ `'�....6.!. ....� '...C-t�.... ............ ... . North Andover, Mass.
.............. Lic. No........ Z
ELECTRICAL INSPECTOR
Check #
2y� �
Ilep It
1'
( om.monwea& of Maajachaietti
2epartment of ire Seruicei
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No.
Occupancy and Fee Checked
[Rev. 1/07] (leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 8/26/15
City or Town of. North Andover , MA To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) 106 Weyland Cir.
Owner or Tenant Sohil Thakkar Telephone No. 781336
Owner's Address 106 Weyland Cir. North Andover, MA 01845
Is this permit in conjunction with a building permit? Yes ✓❑ No ❑ (Check Appropriate Box)
Purpose of Building PV Solar System Utility Authorization No.
Existing Service 200 Amps 200/ 240 Volts Overhead ❑ Undgrd ✓❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
WORK
Location and Nature of Proposed Electrical Work: Installation of a safe and code compliant grid tied
PV solar system on an existing residential rooftop - 34 Panels
Completion of the following table may be waived by the Insnector of Wires.
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑In- Elo.
rnd. rnd.
o Emergency Lighting
BatterX Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
g
No. of Waste Disposers
Heat Pum
Numr
be"""'
""T"""""'ons """""""
KW
....................
No. of Self -Contained
Totals
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances Kir
Security Systems:*
No. of Devices or Equivalent
No. of Water KW
No. of No. of
Data Wiring:
Heaters
Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs
—Signs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
$23,000 Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work.(When required by municipal policy.)
o Work to Start: 9/26/15 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑✓ BOND ❑ OTHER ❑ (Specify:)
1 certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: Skyline Solar LLC _ LIC. NO.: 21667A
Licensee: James Leavitt Signature I LIC. NO.: 12572B
(If applicable, enter "exempt" in the license number line.)Bus. Tel. No.- 732-354-3111
Address: 124 Turnpike t. Suite 10 West Bridgewater, MA 023 Alt. Tel. No.:
*Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's age
Owner/Agent
Signature Telephone No. PERMIT FEE. $ Id
The Commonwealth of Massachusetts
Department of Industrial Accidents
n
Office of Investigations
I Congress Street, Suite 100
4
Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Skyline Solar LLC
Name (Business/Organization/Individual):
Address: 124 Turnpike Street Suite 10
:West Bridgewater, MA 02379 phone #: 732-354-3111
Are you an employer? Check the appropriate box:
1.9 I am a employer with 60 4. 0 I am a general contractor and I
employees (full and/or part-time).*
2.0 I am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.] 5.
3.0 I am a homeowner doing all work
myself [No workers' comp.
insurance required.] t
have hired the sub -contractors
listed on the attached sheet.
These sub -contractors have
employees and have workers'
comp. insurance.1
We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. 0 New construction
7. 0 Remodeling
8. 0 Demolition
9. 0 Building addition
10.0 Electrical repairs or additions
11.0 Plumbing repairs or additions
12.0 Roof re airs
13.® Other SOlar
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
lContractors 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 policy and job site
information.
Insurance Company Name: A.I.M. Mutual Insurance Company
Policy # or Self -ins. Lic. #: VWC-100-6018336-2015A
Job Site Address: 106 Weyland Cir. North Andover, MA 01845
Expiration Date: 3/8/2016
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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
1 do hereby cttfy ndr theins andpenalties of perjury that the information provided above is true and correct.
f 8/26/15
#:/07-35 111
Official 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):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #•
mueoSuaeo Aq pauuuoS
�WI
■=1
2909
Date .... .,/.
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that
L eR rq l?�+5 + Cv; ry1 1/-11 .
......................................................................................
has permission to perform .....:5. e...0 `......... P.Z......................
whin in the building of .......... ...............
8 S
at ....<:. .... l.. ..14 orth Andover, Mms.
Fee ... ..1��'.(�� Lic. No.../..�t.� ... ............/1...`...........
.... . .. .... ......... .. .. .
CTRICAL INSPECTOR
K 33 W1
03/14/96 12:09 35.04 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
t
k5, 1.
I� 'N j
0
lJlir UUIIIIl1llptURUltI� tit tHuslii djugett.0
Uel)(jamertt r f /'uhlic Safety
BOARD OF FIRE PREVENTION RKAJI.ATIONS 527 CMR 12:00
J
Offire Use Only}'70-
Permil No. (t
Occupancy & Fee Checked
APPLICATION FOR PERMIT _l_O PERFOfZlv1"90 Ileaveblankl
ELECTRICAL WORK Y!
All work to be performed in acumlam a with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INF RMATION)
A� Date o2
City or down of
'!L- r
The undersigned applies for a Per to perform the electrical work described below.
-- To the Inspector of Wires?
Location (Street &Number)
Owner or Tenant__
�7�� • A
Owner's Address
Is this permit in conjunction with a building permit: - --
Yes No Lt)j_- - (Check Appropriate Box)
Purpose of Building
Existing Service
— AmpsAuthorization No. --------/------
New Service Vulls
Overhead 11 Undgrd ❑
(� ❑
Voits Overhead U
Undgrd
Number of feeders end Ampacity
location and Nature of Proposed Electrical Work
No. of Meters
No. of Meters
FIRE ALARMS No. of Zones____.___
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Self Contained
Delection/Sounding Devices
Municipal
local❑ Connection ❑Other
INSURANCE COVERAGE: Pursuant to the requirements of Massac:husttes General Laws
have a current Liability Insurance Policy including Completed Operalions Coverage or its substantial equivalent. YES ❑ NO [A I have submitted valid proof
of same to this office. YES I7 NO I.I
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE ❑ BOND ❑ OTHER❑ (Please Specify)
Estimated Value of Electrical Work $
Work to Start Inspection Date Requested:
Signed under the penalties
Of per, �i /�!
FIRM NAME
ZS
'17
G // //.7
FIRM
Licensee
Address
Signature
(Expiration Date)
Rough -- final
_ LIC. NO. T �C
_ LIC. NO. s�3
Tel. No.
o.
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not hove the insurance coverage or its substantial equAri(valent as required by Mass husetts
General Laws, and that my signature on this permit application waives this reqI uirenrrnOwner Agent t. OI K (Please check one)
(Signature of Owner or Agent) Telephone No.._.____ PERMIT FEE $
� 3
2778
NORTH
SS U
Date.JA
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
C.
'? W'**'� le Oe 6/ e
This certifies that .... / ...................... ....... . ............ C ......................... P!
has permission to perform ..... A) -.e .... . ......... ...... ........,
wiring in the building of ... E.1) Y. c 1 zt 0. �'d jd.f.ty/ ..... 6elll ..................
�4 CU
........ !/Qk ....... .............. . North Andover, Mass.
Fee ..!-.4!''.... Lic. No../I`G//O .............................................................. E CTR ICAL INSP ECTOR
C � I ( �( �
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
_'Office Use On
01 4t L9IImmanWMft4_if Ii-siol efts Permit No: i ^
Occupancy & Fee checked I� (��U
Begmtni >n of Vublu ;3ddq - I cY "
/ BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3190 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
or Town of NORTH ANDOVER - To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) nn
Owner or Tenant
Owner's Address / _1> _1� I (.- i z f� '7-0 1 6 -f ' -
Is this permit in conjunction with a building
>permit: Yes No C (Check Appropriate Box)c�,
Purpose of Building /�7/✓�Wf.��/��r�1 Utility Authorization No.
Existing Service Amps Volts Overhead ❑ Undgrnd ❑ No. of Meters
New Service rte— Amps Volts Overhead u Undgrnd F-�- No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total
IIII KVA
No.
of Lighting Fixtures I
Swimming Pool Above—
grnd. _
In- i
grrd. _ ,
Generators KVA
No. of Emergency Lighting
No.
of Receotacie Outlets
No. of Oil Burners
I
Battery Units
No.
of Switch Outlets I
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Total
No.
of Ranges
9
No. of Air Cond.
tons
Initiating Devices
No. of Sounding Devices
No. of Self Contained
No. of Disposals No.of Heat Total Total
Pumps Tons KW
f lo.
of Dishwashers
I SoacetArea Heating
KW
Detection/Sounding Devices
Local ^ Municipal r Other
�. Connection I_
No. of Dryers I Heating Devices KW
No. of No. of
Low Voltage
No.
of Water Heaters KW
I Signs Ballasts
I Wiring
No. Hydro Massaqe Tubs I No. of Motors Total HP I I
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of M, sachusens general Laws
I have a current Liability Insurance Policy including Cc mo ed Operations Coverage or its substantial equivalent. YES NO = I
have suomittedXvafid'.,roof of same to the Office. YE5 NO Z: If you have checked YES. please indicate the type of coverage by
checking the ate box.
INSURANCEND - OTHER :: (Please Specify)
(Expiration Datel
Estimated value of lectric W� f k S
Work to Start
Signed under tile Penalties of perjurer:
FIRM NAME I Auld l�
Inspection Date Recuested:
Rough Gh- r Final
f � L _4U,
LIC. NO. 11 -f q 7h
Licensee C ar` f signature —,C-- - - - -/
r� Bus. Tel. No. b
Address <A d-l� ' Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re-
quired by Massachusetts General Laws. and that my signature on this permit application waives this requirement. Owner Agent
I'll
(Please check one) dD
Telephone No. PERMIT FEE 5
(Signature of Owner or Agent) x-6565
Location_
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy
$
Building/Frame Permit Fee
$ (8J�
Foundation Permit Fee
$
Other Permit Fee
$
Sewer Connection Fee
$
Water Connection Fee
$
TOTAL $
2-c LA
� wilding Inspector
12/29/95- 1,850.00 PAID
9415 Div. Public Works
k
ocation, 0(0 WGU �AW (aL
allo. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy
$
Building/Frame Permit Fee
$
Foundation Permit Fee
$; --
Other Permit Fee
$
Sewer Connection Fee
$,
Water Connection Fee
$
TOTAL
(1)
$
Building Inspector
_ 9M
Div. Public Works
Location'
No. d Date
E5
TOWN OF NORTH
ANDOVER --a
0.
Certificate of Occupancy
If7
$
I�
Building/Frame Permit Fee
$
�� °'^•'�°''°t�
Foundation Permit Fee
$
#
SSAC14USE
} o
Other Permit Fee
$
N 95�
Sewer Connection Fee
$ ••
e
50%
Water Connection Fee
$ • 411-19
•f
TOTAL
$ 26-) • a'�?=
F
B '
Ins ct r
.J= 8938
Div.
lic Works
7 1r
Location
No. o Date >-'
f
N°RTM TOWN OF NORTH ANDOVER
O�it�o r�,ti
Certificate of Occupancy $
*� # Building/Frame Permit Fee $
sAC
"�<Foundation Permit Fee $
1 St
r--O#4w Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
r TOTAL
xl?--- C/ &----
b 09/96 12:47
65 6
uilding Inspector
25.00 PAID
Div. Public Works
PER31IT Nb. to V
F
APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
V PAGE 1
MAP KBO.
I LOT NO.- 30
� 1)
2 RECORD OF OWNERSHIP IDATE
BOOK ;PAGE —
ZONE
SUB DIV. LOT NO.
LOCATION 6(
c`
PURPOSE OF BUILDING
L•SIZE "
OWNER'S NAME / 07 wc)cJ &14 y4
OWNER'S ADDRESS -7� —I,_ r -n 10 /� I
�e
1�
'2 5,*
NO. OF STORIES '�
BASEMENT OR SLAB
�5-�� �
ARCHITECT'S NAME % /1 ^` \
�J 1
SIZE OF FLOOR TIMBERS
1SCTl2 `O 2ND 2 )0 3RD
BUILDER'S NAME A„ rl'k/ p PA f/ I 1
A<,
SPAN 1 4 I
DISTANCE TO NEAREST BBjU'ILDIINNG �(�
DIMENSIONS OF SILLS
x�
DISTANCE FROM STREETZ ij
POSTS
✓44'
DISTANCE FROM LOT LINES - SIDES 2. �J
REAR a C"�
" GIRDERS
X`l
AREA OF LOT 12 I °C7 1 Z FRONTAGE 7J,C-
J
3-e
HEIGHT OF FOUNDATION
1 THICKNESS �� 1
IS BUILDING NEW s
Y
iMATERIAL
SIZE OF FOOTING
"x 1 f
IS BUILDING ADDITION
//l. U
OF CHIMNEY
f .nom ✓`
IS BUILDING ALTERATION e% -.o
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE �/� c
! J
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY .e�/�
IS BUILDING CONNECTED TO TOWN SEWER Y -40e
IS BUILDING CONNECTED TO NATURAL GAS LINE QS
INSTRUCTIONS a PROPERTY INFORMATION
SEE BOTH SIDES
PERMIT FOR FOUNDATIONONLY LAND COST
REGULATED BY PARA. 114.8"S. B.C. EST. BLDG. COST p 3C�1cab
A
EST. BLDG. COST PER SQ. FT. .y�L te.
PAGE 1 FILL OUT SECTIONS t - 3 `y
PAGE 2 FILL OUT SECTIONS 1 - 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING DATE FEE PAID (.00-
4.v -
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPEVERMIT FOR FRAME/BUILDING
DATE FILED
. SIGNATURE & (§rolr1ER OR AUTHORIZED AGENT
F E
&M
PERMIT GRANTED
19 c�
BLDG. PERMIT FEE ��.,..�r....,..
NIov 2 2 I� �� LESS FM FEE____
DIX FRAME PERMIT $
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
OWNER TEL. #
CONTR. TEL. #
697 //2-9
CONTR. LIC. #
H.I.C. #
9o,3,b �za1).a
;BOILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY
S DRIES,
MULTI. FAMILY
ELECTRIC
OFFICES
APARTMENTS
_
CONSTRUCTION,
2 FOUNDATION - I
CONCRETE_
CONCRETE BL'K.
BRICK OR STONE
PIERS
_
8 INTERIOR
3
PINE
PLASTER _
DRY WALL .>C
UNFIN.
FINISH
I
2 13
_
3 BASEMENT
AREA FULL
FIN. B'M'TAREA
_
1/1 1/2 %
-FIN.. ATTIC AREA
_
NO BMT
FIRE PLACES
L
HEAD ROOM
MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS
CONCRETE
EARTH
HARD\!J'D
COMbAC;N
B
_
1
2
�_
X
3
_
DROP SIDING
WOOD SHINGLES
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
ASPH. TILE
STUCCO ON MASONRY
STUCCO ON FRAME
_
BRICK ON MASONRY
BRICK ON FRAME
ATTIC STRS. & FLOOR I_
CONC. OR CINDER ELK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR POOR _
ADEQUATE � NONE
5 ROOF
10 PLUMBING
GABLE
HIP
BATH (3 FIX.)
GAMBREL
MANSARD
TOILET RM. (2 FIX.)
_
FLAT
SHED
WATER CLOSET
_
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
_
TAR 6 GRAVEL
STALL SHOWER
_
ROLL ROOFING
MODERN FIXTURES
TILE FLOOR
TILE DADO
6 FRAMING
11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. 3 COLS.
STEAM
STEEL BMS. & COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
_
AIR CONDITIONING
_
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS
GAS
OIL
y
THIS SECTION MUST SHOW EXACT DIMENSIONS OF -LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
i
B'M'T
2nd
_
I
ELECTRIC
1f1
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3rd
NO HEATING
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FORM U - LOT RR ME FOS
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: 9 W <>Ct1 24d Cz2Phone 0? -7- 11-2-8
LOCATION: Assessor's Man Number
Sucd i vis ion ?c Wcac�
rt
Street
Parcel
Lots) Jr `J 3 -
St.
St. Nu -icer IQCe-
************************Offic4-al Use Only*******************w****
RECOMME2tDA 4ONS OF TOWN AGE ITTS :
Con Ar•: anion administrator
Cc,:- e?
Town Planner
Co=—er.:s
Fcod Inspector- ealth
4_�
Co =-n :-
Date Approved
Date Resected
Date Approved
Date Re;ecte^
Date Approved
Date Re-iec:ed
Date Apprcved; C�
Date Re;ec���
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KAREN H.P. NELSON
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CONSERVATION
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NORTH_ ANDOVER
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PLANNING & CONi MUNITY DEVELOPMENT
LOCATION
OWNER'S NAME
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CHIMNEY APPLICATION AND PERMIT
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BUILDER'S NAME /
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/JGMASON'S NAME r�ZZ, L "/�D1'C Il �
120 Main Street. 6iW
(508) 682-6483
PERMIT #1�
MASON'S ADDRESS
MASON I S TELEPHONE e:,0"4 (e-7
MATERIAL OF CHIMNE-
INTERIOR CHIMNEY EXTERIOR CHIMNEY
NUMBER AND SIZE OF FLUES
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THIC_CTESS OF HEART:
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have rules and recu' atic:.s
conform reauirerent Of
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the code and
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SIGNATURE OF MASON
/CONTIRJ.� LIC.
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EST. CONSTRUCTION COST/ CONTR.�C=
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PER;-1I7" GRANTED
ROBERT NICETTA, BUILD;:+O
INSPECTED
REMARKS
FEE
c^ 10 a7TCK REQU RED
THIS PERMIT IMIUST BE DISPLAYED ON THE PREMISES
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APPLICATION FOR CERTIFICATE OF OCCUPANCY /INSPECTION
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DATE REQUEST FILED/RF..ADY FOR INSPEC'T'ION: � o�
CLOSING DATE ON PROPERTY: v1
FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS RECUT D.
ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME.
A RE -INSPECTION FEE OF TWENTY DOLLARS ($20.00) WILL BE CHARGED IF
THE STRUCTURE DOES NOT. MEET ALL APPLICABLE CODES.
SIGNED:
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APPLICATION FOR CERTIFICATE OF OCCUPANCY /INSPECTION
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LoT? �Q x wood
DATE REQUEST FILED/RF..ADY FOR INSPEC'T'ION: � o�
CLOSING DATE ON PROPERTY: v1
FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS RECUT D.
ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME.
A RE -INSPECTION FEE OF TWENTY DOLLARS ($20.00) WILL BE CHARGED IF
THE STRUCTURE DOES NOT. MEET ALL APPLICABLE CODES.
SIGNED:
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