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HomeMy WebLinkAboutMiscellaneous - 108 ROSEMONT DRIVE 4/30/2018 / 108 ROSEMONT DRIVE 210/098.8-0031-0000.0 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTINGV (Print or Type) 1 C NORTH ANDOVER Mass. Date . building Location f ,fe{ Permit / 7J0S Owners Name Q S �� �j�� ? New Renovation D Replacement El Plans Submitted D lit` FIXTUR=S N � W N N 0 0 Z � a h e m Q o o w ~ a z o F• u d t2] y 1' W y�j o 0 , O W I- Q y a w d z Z " sn tr > 4 o w w LU to w z a x a W w a w t- W h x c� is W w a o > u. h � .rtu 2 q W .4 r Q >. d 0 = 0 Z Ld O N T. Q to > E W 2 a x O t, 5 tt. x a C7 V y Q a U, o SUR-13SWIT. BASEMENT 1ST FLOOR ` 2ND FLOOR 3110 FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOREl (Print or Type) Check one: Certificate Installing Company NameL 6 61f P Corp. Address 7 A1417/Zt"4y -Y, Partner. 4 KO t:`'��/�_ �fS Olr�� Firm/Co. Business Telephone: Name of Licensed Plumber or Gas Fitter .6e.6 e *e_t ee•U Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0 Other type of indemnity 0 Bond Insurance Waiver: I , the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner L__J Agent M 1 hereby certify that all of the details and information 1 have submitted (or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under Permit iuced for this application will-be In compliance with all pertinent provisions of the Massachusetts State Gas Code and tlupter 142 of the General Laws. By TYPE LICENSE: Plumber Title Gasfitter- Signature of Licensed City/Town: Master Plumber or Gasfitter Journeyman J©S"-O 2— APPROVED APPROVED OFFICE USE ONLY) License Number BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME& TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE 19 GASINSPECTOR l• At Date.. . . .. . ... . .. . .. ..... i r I d MpRTM TOWN OF NORTH ANDOVER �! FOr a� ,a Lp , PERMIT FOR GAS INSTALLATION °�•.e°�.rr'�qh S'q uSEt I 1 i This certifies that . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . has permission for gas.installation . . . . . .. . . . . . . . . . . . . . . . . . . . : . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . . . North Andover, Mass. Fee.. . ?. . Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,GAS INSPECTOR ' WHITE:Applicant CANARY: Building Dept. PINK:Treasurer -'GOLD:File NORTH f '� E 0 of �� xAndover A No. 270 " dower, Mass. 2O COC NIC Chi 1 1 1 S K f BOARD.OF HEALTH Food/Kitchen PERMIT. . T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...... Foundation i..... ..t:..... ... .., ..l.. I .. has permission to erect. . uildings on ./O...ifAIDA11).it.00 �M004 Ar9 Rough � �`.1 �� to be occupied as S'N•�A��. .�>/.....y .... .... ......... .. .. .. ��� Chimney ' e provided that the person accepting this permit shall in every respect conform to the terms of the applica n on file in Final 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. to SC A PEPLUMBING INSPECTOR FEW=�llNDiAT10N ONLY VIOLATION of the Zoning or Building Regulations Voids this Permit. RF.GIA,ATE IN MK UM L& Rough PERMIT EXPIRES IN 6 MONTHSFinal y - �addci UNLESS CONSTRUCTIONS �o p�— ELECTRICAL INSPECTOR PERMIT FOR FRAME/BUILDING Rough 4W..,G =1- -*%.....i... ................................. Service DME fl-V FM PAID:- '0 0 BUILDING INSPECTOR Final Occupancy Permit Required t0 Occupy Building GAS INSPECTOR Display in a Conspicuous, Place on the Premises — Do Not Remove Rough P Y P Final No Lathing or Dry Wall To Be Done Until Inspected and Approved• by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL d&,63312"1 CONSERVATION FINAL Street No. (ZMAIPR /IAInTI=R FINAI 4 °23 f DRIVEWAY ENTRY PERMIT Smoke Det. 4R ' CERTIFICATE OF USE & OCCUPANCY Town Of North Andover Building Permit Number 2 Date r THIS CERTIFIES THAT r; r THE BUILDING LOCATED ON J 0 6 ,f'�� o, MAY BE OCCUPIED AS IN ACCORDANCE WITH THE PROVISIONS OF THE MAS ACHUSETTS STATE BUILDING CODE AND =; SUCH OTHER REGULATIONS AS MAY APPLY. A. j CERTIFICATE ISSUED TO ADDRESS st 1CMU Building Inspector NORTFi��. Town ofover� \ , (In Vrt t a A � over, Mass., SVA V 19 coc.c BOARD OF HEALTH low PERMIT. T D Food/Kitchen Septic System •. THIS CERTIFIES THAT ...... ..... tryew...01).. F undation BUILDING INSPECTOR has permission to erect. ". uildings on .�Q �I ,�. � )� i l�9 Rough A tjC �a—� 3 53 ........... to be occupied .� � Chimney provided that the person accepting this permit shall in every respect conform to the terms of the applicaif6n on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final �t �/L Buildings in the Town of North Andover. torC x PLUMBING INSPECTOR PERMIT OILY VIOLATION of the Zoning or Building Regulations Voids this Permit. RMULM BY p in" K Rough PERMIT EXPIRES IN 6 MONTHSB r U FIXP �D ELECThICAL INSPECTOR UNLESS CONSTRUCTION M5441!) , D PERMIT FOR FRAME/BUILDING Rough �cl A.- ..... .... ................................................. Service DATE: � � FEE PJUD: X61 v_ BUILDING INSPECTOR Fina Occupancy Permit Required to OccupyBuilding p g GAS INSPECTOR Display in a Conspicuous"Place on the Premises — Do Not Remove Rough 3 na No Lathing or_ Dry Wall To Be Done Until Inspected and Approved• by the Building Inspector. FIRE D P RTME T Burner 33�z 3l . >�a PLANNING 3)l4INAL (4>#5 7 CONSERVATIO `� Street No. SEWER/WATER­-,zr&d z-,7;R-f4 FINAL G °�3 DRIVEWAY ENTRY PERMIT'_O&) Z-ZO-1a Smoke Det. �/ - -- Date. �/I .I�. .... . . . . NORTH TOWN OF NORTH ANDOVER f i D ' PERMIT FOR GAS INSTALLATION ,SS^CHUSE� This certifies that . . . . . . . . . . . . . . . . . . . � . . . . . . . . . . . . . . has permission for gas installation . .' . . l !e . . . . . . . . . in the buildings of�!�!. ... . . . SYS=. . . . . . . . . . . . . . . . . . at/,4. �-. 9�!�✓�? !!?7 ' + ., North Andover, Mass. Fee. . . . . Lic. No?�4. .�.�. . . . . . . . . . . . . . . . .fir. . . . GAS INSPECTOR Check# 6132 MASSACHUSETTS UNEFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) Date �� /�j, Q NORTH ANDOVER,i e MASSACHUSETTS( Building Locations i Ta, o 0 lnf� 6�,Z Permit# 1 OFM�CII�Q,� Owner's Name rj Amount$ New Renovation Replacement Plans Submitted � a w H a Gw w v, � � `� ae a w H x a z w a �" &n CQ z o �" w '' F w z o m x .da o a° > o a° F o SU B-BASEM ENT BASEM ENT 1ST. FLOOR 2N D. FLOG R 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or typ `/ Check one: Certificate Installing Company Name f 1D FY {FfJo'I6!3 4-R7.0"K-Q p �� �yy � /� 11 Corp Address 3 S1"M �0 KtG!'( i(a- �f �1ro Partner. usmess Telephone - f 2 2-q inn/Co. Name of Licensed Plumber or Gas Fitter >/V4 K y INSURANCE COVERAGE Check one: I have a current liability Insurance,policy or it's substantial equivalent. Yes 13 NoO If you have checked Les,please in ' ate the type coverage by checking the appropriate box. Liability insurance policy13 Other type of indemnity D Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 13 Agent 13 I hereby certify that all of the details and inform ve submitted(or entered)in above ap ation are true and accurate to the best of my knowledge and that all plumbing work and I tai a'IEW s performed under Permit Iss d for this application will be in compliance with all pertinent provisions of the M achus s fatas Code an Chapter 14 of the General Laws. By: Licensed Plumber Or Gas Fitter Title Plumber ��' City/Town 0 Gas Fitter (cense um er 10 Master APPROVED(OFFICE USE ONLY) ffrourneyman MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING �► IPrint or Typel al NORTH ANDOVER, , Masa. Date l U �J Building �T / PermN tr M(�) O ,, mo Locatio 'US. Owner's `p Name New Renovation ❑ Replacement p Plana Submitted: Yes❑ No ❑ FIXTURES 3-0 rs .. « s � • M >t J «44 s « el « H t s « � = a s ILr e u ; o Y Is � � ofo ` � s IL K ee11 ar $ r r 0 {� < t < s s s s < O < .1 < at «< < O < �. M L' 0 0 0 it s • o atr!—!lMT. BAeRMNNT ISTFLOOR i I IN0FLOOR X110 FLOOR ITN FLOOR aTM FLOOR •T114 FLOOR, 1TNFLOOR lTNFLOOR - Check one: Certificate Installing Company Name TV(?1r,-r7 Pr( W. (3 Corp. Address R iw � 0 Partnership SS o e -,To 0 Firm/Co. Business Telephone J Name of licensed Plumber INSURANCE COVERAGE: ec one 1 have a current Ilabllty Insurance policy or Its substantial equhratent. Yes S� No ❑ If you have checked y", please Indicate the type coverage by checking the appropriate box. A liability Insurance policy 17 Other type of Indemnity 0 Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the 11censee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement., Check one: Owner ❑ Agent ❑ Signstuts o er a UNmH t en I hereby certify that all of the detalls and information I have submitted W entered)In above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under thepermit I for this applicatlon will be h compliance with all pertinent provisions of a Massachusetts State Plumbing Cade end Chapter 112 of the as Law . ey - na ute of Licensed Pkknber TitN License Number f V A.Cb Z Ctty/Town Type of Plumbing License: Master APPF WED(OFFICE USE ONLY) Journeyman ❑ ,AORT#1 ot + TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING SS�CHUS This certifies that . . . . . . . . . . . .... . ... . . . . has permission to perform . . . . . . .... . . . . . . . . . . . . .. . . . . . . . . . . . . . . . plumbing in the buildings of . . . . .. . . . . . . . . . . . I. . . . . . . . . . ... . . . . . . at. . . . . . . . . . . . . . . . ... . ... ... . . . ... . . . . . . . . ... North Andover, Mass. Fee. . . . . Lic. No.. . . . . . . . . . . .... ... . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File MORT11 Ofe ° `�bC 1- y A NORTH ANDOVER BUILDING DEPARTMENT '1''° ro✓*` * 400 Osgood Street �SSACHU561 Tel: 978-688-9545 Fax: 978-688-9542 BUSINESS FORM FOR TOWN CLERK DATE: ' r =' © L) NAME: ADDRESS: 0 ;" it" n AJ % ZONING DISTRICT: TYPE OF BUSINESS: BUILDING LAYOUT PROVIDED: YES O 1 AVAILABLE PARKING SPACES: ZONING BY LAW USAGE: YES. NO BUILDING INSPECTOR SIGNATURE r RevbW 11.5.04 BUSINESS FORM FOR TOWN CLERK Lo cation1 / Off' No. Date ZZ- M N,&D TOWN OF NORTH ANDOVER f . op Certificate of Occupancy $ ; Building/Frame Permit Fee $ roe Foundation Permit Fee $ s•►CHust Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ o Building Inspector 9 515 Div. Public Works PER31IT NO. « APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 _- MAP +40. �® LOT NO. ©3 2 RECORD OF OWNERSHIP IDATE BOOK "PAGE — ZONE SUB DIV. LOT NO. LOCATION I w w r_I T` PURPOSE OF BUILDING lJi 4 R-6,6, l�'4 OWNER'S NAME NO. OF STORIES SIZE ��D OWNER'S ADDRESS ..A BASEMENT OR SLAB 9[�A /� t ARCHITECT'S NAME )C�,e SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME J-1v� 11 `�� SPAN DISTANCE TO NEAREST BUILDING t P!/V DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS 31/, .( l� I y c"I DISTANCE FROM LOT LINES-SIDES( ��'7'1 1 REAR " GIRDERS l l l Iv qL AREA OF LOT I AG�LJ�•�l/ FRONTAGE HEIGHT OF FOUNDATION r-1 THICKNESS to 'I IS BUILDING NEW I` 1,., J� SIZE OF FOOTING b 1 . X I IS BUILDING ADDITIONI\•�.ly '� MATERIAL OF CHIMNEY IS BUILDING ALTERATION N l I e IS BUILDING ON SOLID OR FILLED LAND 1 WILL BUILDING CONFORM TO REQUIREMENTS OF CODE / IS BUILDING CONNECTED TO TOWN WATER 1 •l/� 5 BOARD OF APPEALS ACTION. IF ANY ).l 1 IS BUILDING CONNECTED TO TOWN SEWER u`'( ��+Cl IS BUILDING CONNECTED TO NATURAL GAS LINE t::;' S INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST a 0 SEE BOTH SIDES EST. BLDG. COST "-1[>> v PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS i - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED l ( ( l DUILDING INSP[cTOR • SIGNAT OF WNE RI ED GE T Q F E E OWNER TEL.# 68 (z,` L't PERMIT GRANTED -7 CONTR.TEL.# l.X✓�-S •�� v� 19 / CONTR.LIC.# r-Is � �zl H.I.C.# �< a l Ra a BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY I RIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION _I 8 INTERIOR FINISH CONCRETE 3_ 1 2 13 —� CONCRETE BL'K. PINE U_ LJ �. BRICK OR STONE HARDW-D __ �f_ �G`�f �� PIERS PLASTER V L \` +—I _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. BM'TAREA FIN. ATTIC AREA _ NO B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN L 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDIN D _ ASBESTOS SIDING COMI,ACN _ VERT. SIDING ASPH. TILE STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE IF BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING I MODERN FIXTURES TILE FLOOR TILE DADO 6 FRAMING i l HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &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 B'M'T 2nd ELECTRIC 1st 13rd INO HEATING 40 NORTFI ONNM Of - over 0 0 �. �o rdower, Mass., / 19 � � COCMCMEWICK \ ORATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septicsystem BUILDING INSPNCTOR THIS CERTIFIES THAT..................... .... .... ........... .....................�. ....................................................... ' Foundation has permission to on .........../..a.z........... Rough tobe occupied as..................1.. ... . .... .....`..... ................ . ....................................................................,........... Chimney provided that the person accepting this per shall in every respect conform to the terms of the application 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, PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STA S ELECTRICAL INSPECTOR Rough ...................................... .......... ..... ..... . .. .. ................................. Service / U DI G INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. � Sa\ �/�r' �O77�rrnirrnr•rr�/� r/'• ��rJ.lrrr�ri.lr//d` 1i:i it-� '• �j DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR R LICENSE Nusher: Expires: Birthdate CS 053099 06/29/1991 06/291,961 Restricted To: OO 169I80NFORORSTY N ANDOVER, MA 01845 I I-- I ! .� J'•'!' 1/'/�fN)!/n)IIINy1III I� I/l14111i•Ili l!'IIl I NOME IMPROVEMENT CONTRACTOR 3 Registration 101814 TYPO - INDIVIDUAL Expiration 06/29/96 Kevin Murphy Kevin W. Murphy Ll�•1.��� r; r 1¢9,8oxford St �DMINISIRA]UR �•Andover MA 01845 v -offs f 7L (--1 r�6-C` �(A ( G �3v w„��G� �6 `V Location No. ,,,?2D Date N°0 , � Of TOWN OF NORTH ANDOVER ao p Certificate of Occupancy $ 'i, Building/Frame Permit Fee $ �/I `�,7 J CMUS C" t Foundation Permit Fee $ sA Other Permit Fee $ SevJo onnection Fee $ 'f� Water Connection Fee $ f • 7.1-f TOTAL $ Building Inspector f1 Div. Public Works 1 Location /,4 tr „ No. Date NORTH TOWN OF NORTH ANDOVER S Certificate of Occupancy $ (i- J �� +# Building/Frame Permit Fee $ J '� ACMFoun t_//�n�ermit Fee $ s sus Oth r Permit Fee $ @Wer Connection Fee $ - Water Connection Fee $ -- TOTAL Building Inspector .c r' - Div. Public Works Location No. Date Ot N°oT;,ti 1 TbWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ $ E Foundation Permit Fee sACNlls t , erA e""'-' $ ,rj wer Connection Fee $ Dater Connection Fee $ TOTAL $ '. I luilding I ector �f / ti /" Div. Public Works � �itJilT NO. �D ,�� " APPLICATION FOR PERMIT TO BUILD — NORTH ANDOYERrMASS. PAGE 1 MAIC K40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK PAGE ZONE SUB DIV. LOT NO. — I LOCATION PURPOSE OF BUILDING OWNER'S NAME vV 1 NO. OF STORIES /mac SIZE~„ OWNER'S ADDRESS 1r{,h BASEMENT OR SLAB e ......� ARCHITECT'S NAME �. SIZE OF FLOOR TIMBERS 19T2 k juf�2ND 2 y (� 3RD BUILDER'S NAME ( A_ ` �we SPAN /` (` DISTANCE TO NEAREST BUILDING t DIMENSIONS OF SILLS( DISTANCE FROM STREET CS�Jh�} POSTS W1. 4 O DISTANCE FROM LOT LINES -SIDES�6 4 20 REAR l _ GIRDERS IAS p_ V^ I C AREA OF LOT �,/, ' 1 FRONTAGE HEIGHT OF FOUNDATION -JXVr V`( /�,/�1 THICKNESS /Q ll IS BUILDING NEW ( G7 i Y L /` SIZE OF FOOTING IS BUILDING ADDITION /alb MATERIAL OF CHIMNEY woo ` IS BUILDING ALTERATION Ll o IS BUILDING ON SOLID OR FILLED LAND �a I 1•` WILL BUILDING CONFORM TO REQUIREMENTS OF CODEIle,C2IS BUILDING CONNECTED TO TOWN WATER yi 5 BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER !-, IS BUILDING CONNECTED TO NATURAL GAS LINE Lt 7 INSTRUCTIONS 3 PROPERTY INFORMATION • SEE BOTH SIDES FEW p LAND COST 00 I - � EST. BLDG. COST no Mau PAGE 1 FILL OUT SECTIONS 1 - 3 L—_ A Fm �/' DQ�v 0 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 � / DUE FRAME PERMIT$ 4or 6 0 0 EST. BLDG. COST PER ROOM � SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED f SIGNATURE OF OWNCER OR !5.WTHOR12NDAG T BOARD OF HEALTH F E E D PERMIT GRANTED .i�t1'IPdER TEL. ���-36G 118 PLANNING BOARD / XNTR. TEL. 19 OtJTR. Li%.# BOARD OF SELECTMEN BUILDING RECORD 1 OCCU ANCY 12 SINGLE FAMILY V S�ORIEs I THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _ 3 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B M'TAREA _ FIN. ATTIC AREA NO BMT FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS C CLAPBOARDS B 1 2 3 _ DROP SIDING CONCRETE WOOD SHINGLES EARTH t ASPHALT SIDING HARMU'D _ ASBESTOS SIDING COMMC:N _ VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY + STUCCO ON FRAME I BRICK ON MASONRY ATTIC STRS. & FLOOR I_ ,••,, 'a r,+� BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 SOOF 10 PLUMBING GABLE HIP Vt BATH (3 FIX.) GAMBQEL MANSARD TOILET RM. (2 FIX.) T FLAT SHED WATER CLOSET ASPHALT SHINGLE 60oo LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING f TAR & 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. &COLS. STEAM STEEL BMS. S COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G F UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd ELECTRIC r �— Isl 13rd NO HEATING FORM U - LOT RELEASE FORM ' 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: Z2r, 4 S -►►� Phon LOCATION: Assessor's Map Number Parcel Subdivision �6z�� � qz c� � �5 Lots) �1 Street < CS�4 �Ou.1�1� JQz a S_ St. Number _ C — ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved? Conservation Administrator Date Rejected Comments tA.4 6x- AILYNIUA Date Approved Town Planner Date Rejected Comments _,:t_A- Date Approved Food Inspect6r-Health Date Rejected Date Approved 4 -9 Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connect ionsr1MbPJS'l r - driveway permit S Z Fire Department Received by Building Inspector Date