HomeMy WebLinkAboutMiscellaneous - 119 SANDRA LANE 4/30/2018 119 SANDRA LANE
/I 210/097.0-0071-0000.0 `
Date.S "a.?.'. 5. S
i�-
4044
<<"OR7: TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
41
, •
CHus�
This certifies that . . . . . . . . . . . . . . . .
has permission to perform . . .. . . . . . . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . .
at. t' . . . . . . .. North Andover, Mass.
Fee. . v :. .Lic. No.. .C: ). . . . . . . . . . . . .�� �._.
LUMBING INSPECTOR
WHITEDUO 08244:53 CANARYMtNingllMt. PINK:Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
,AA Mass. Date 02 19 Permit # 0,(y
Building Location / Owner's Name&/ Az'% ls��&, _'
A9 Type of Occupancy ►v t► r-'1 L_
New ❑ Renovation ❑ Replacement Plans Submitted: Yes ❑ No ❑
FIXTURES
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SUB-BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
Installing Company Name (rMAT Ae Check one: Certificate
Address CAC H mta n) y-r ❑ Corporation
/r E ' Partnership
/Nr. _ nl� AlvYl A ��� ❑ p
Business Telephone_ �� ?-'-117 7 1 2-Aran/Co,
Name of Licensed Plumber _ f'r3,=�?T m 4 Tr4l0r ,
INSURANCE COVERAGE:
I have ayes current jability insoura ce policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
El'
If you have checked Yes, please
/Indicate the type coverage by checking the appropriate box.
A liability insurance policy 1d Other type of Indemnity ❑ 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 ❑ Agent O
I hereby certify that all of the details and information I 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 the permit issue0jor this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum • g Ode and qapterof the oral Laws.
BY 17
�.L
Title re of Ucensed Plumber'
Type of License: Master % Joumeymab❑
Oty/Town
APPROVED OF ICE US ONL License Number 2;3 5
1
}
BELOW FOR OFFICE USE ONLY
FINAL INSPECTIONS SKETCHES_ 1 PROGRESS INSPECTIONS
FEE
NO.
APPLICATION FOR PERMIT TO DO PLUMBING
NAME &TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER
PERMIT GRANTED
DATE 19
I
PLUMBING INSPECTOR
Location
No. Date 1 ? t
ff
„ORTITOWN OF NORTH ANDOVER
Certificate of Occupancy $
fi # Building/Frame Permit Fee $
sus',^° Foundation Permit Fee $
s►cMusE —�—
Other Permit Fee(iaat) $ _
Sewer Connection Fee $
Water Connection Fee $
TOTAL $ Z14—
Building
JBuilding Inspector
9378 Div. Public Works
PERMIT NO. V-1 "7W-S APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1
MAP 440. I LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK ;PAGE —
,ZONE SUB DIV. LOT NO. ��/� C
O ION `m15%W(\A
+ � �1Ail URPOSE ORG �C�Rq+'OWN R'S NAME � /Y�1. NO. OF STORIES SIZE
V WNER'S ADDRE1 `Q), - *16k BASEMENT OR SLAB
ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND '3RD
BUILDER'S NAME SPAN
DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS
DISTANCE FROM STREET POSTS
DISTANCE FROM LOT LINES-SIDES REAR " GIRDERS
AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW SIZE OF FOOTING X
IS BUILDING ADDITION MATERIAL OF CHIMNEY
IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND
--TBUILDING CONFORM TO REQUIREMENTS OF CODE 1 i IS BUILDING CONNECTED TO TOWN WATER
V CL BOARD OF APPEALS ACTION. IF ANY lJ IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS 3 PROPERTY INFORMATION
LAND COST
SEE BOTH SIDES -Cfff.-OLDG. COST 5V V 0�o .�
PAGE 1 FILL OUT SECTIONS 1 - 3
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
PAGE 2 FILL OUT SECTIONS i - 12
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 �` 1J
BUILDING INSPUCTOR
SIGNATURE OF OW ER OR AUTHORIZED AGENT pp
F E E Z, � OWNERTEL.#
PERMIT GRANTED CONTR.TEL.#
19
CONTR.LIC.#
H.I.C.#
q,1-7 8 C3
BUILDING RECORD
1 OCCUPANCY 12 •
SINGLE FAMILY STORIES 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. j
CONSTRUCTION
2 FOUNDATION 8 INTERIOR FINISH
CONCRETE d l 2 13
CONCRETE BIL K. PINE _
DRY WALL
BRICK OR STONE HARDW D
PIERS PLASTER
_ _
UNFIN.
3 BASEMENT
AREA FULL FIN. B'M'TAREA _
y 1/2 1/ FIN. ATTIC AREA _
N_O B M T FIRE PLACES _
HEAD ROOM MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS B 1 2 3
DROP SIDING CONCRETE �_
WOOD SHINGLES EARTH
ASPHALT SIDING HARDI�✓'D _
ASBESTOS SIDING COMMCN
VERT. SIDING ASPH. TILE _
STUCCO ON MASONRY _
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STRS. & FLOOR _
BRICK ON FRAME
CONC. OR CINDER ELK.
STONE ON MASONRY WIRING
STONE ON FRAME _
SUPERIOR I POOR
I
ADEQUATE NONE
5 ROOF 10 PLUMBING
GABLE HIP BATH (3 FIX.) _
GAMBRELMANSARD TOILET RM. (2 FIX.)
FLAT IA SHED WATER CLOSET _
ASPHALT SHINGLES LAVATORY
WOOD SHINGES KITCHEN SINK
SLATE NO PLUMBING
TAR & GRAVEL STALL SHOWER _
ROLL ROOFING MODERN FIXTURES _
TILE FLOOR
TILE DADO
6 FRAMING I 11 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
IL
'M'
BT 2nd _ EOLECTRIC
1st 13rd NO HEATING
WOOD STOVE INSTALL4HON CHECKLIST 110:'
Permit
A building permit is required for the installation of anv solid fuel burning appliance. The building permit and
installation inspection are limited to the stove installation and-not to the stove construction.
:•z Stove ./
A. New ✓ Used B. Type/radiant i tL Circulating
C. Manufacturer ki GAS Nl: Lab.No.
Name/Model No. 1 %ti�'g''� 1 Collar size
Dimensions/Height Length Width �-
Chimney / R`, �� �m
A. New � Existing F/
S. Size(flue area)
C. Other appliances attached to flue(Number and flue size)
D. Prefab(Manufacturerrame and type)
E. Masonry/Lined Flue liner
gyp•b manwauunr►
Unlined
F. Height(refer to diagrams) cap
OVEZ IC T
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Mit( �.Iq 't.ilN•
3
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\` 1 ,u Rd.
1$ 4t1N.
Fiji 51—A 144
a�
HEARTH
CHIMNEY HEIGHT
Hearth(non-combustible)
A. Materials M(-,
B. Sub-floor construction C CA,— " k
C. Minimum dimensions(refer to diagram)
Clearances and Wall Protection I.see stcve installation clearances chart)
A. Type of wall protection provided
B. Clearances(refer to diagrams)
•
i
FIREPLACE CORNER WALLCENTER.
13
'�1;7 d � 4:. .'•rt, .h �' D: 9 5�:` A. ra Iti � �Y � Y.e
26"(660mm)
211/4" 1
25"(640tnm) .; —a� I� (535mm)
r � -
i
o
�53
1 211/4"
(535 mm)
0
Front mew Side mew
V Ihl J7'
Observe these clearances to combustible trim.
�J/ + ' ri s, r
1rE D,J
'Y' B = F,G
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D,J �
I' OU,-t'�•u� E
X C
�Ot/�1✓ Measure side trim
FIREPLACE MINIMUMS FIREPLACE CLEARANCES clearance from here
I
A.Width at face a26"(660 mm.) A. Mantel* 34"(865 mm.) j
B' Width ark=1j2 depth ` 26 060 mm.) _B:"Top7rim* 34°(865 mm.)
C.Depth' 141/2"(370 mm.) C. Side Trim** 201/8"(510 mm.)
D.Height at face 211/2"(540 mm.)
E. Height at 15-1/2"depth 211/2"(540 mm.) *For more details:on mantel and top trim,see Note below.
� . Where side trim extends more than 2 (50 mm)from
the fireplace facing,the side clearance must be no less than
FIREPLACE MAXIMUMS .20 5/8"(525 mm).
H.Lintel depth 9-1/2"(240 mm.)
I. Width' 441/2"(1130 mm.) Measure the side clearance(C)from the exact center of
J. Height' 31"(7 70 mm.) your fireplace opening on the hearth(X). Measure the top
trim(B)and/or mantel clearances(A)from the finished
'The minimum depth must be maintained from the floor of hearth surface.
the fireplace to a height of 21 1/2"(540 mm).
'Though the WinterWarm Small Insert will fit into larger
fireplaces,the decorative optional Vermont Castings
Surround Panels will not completely cover the fireplace
opening s these cions are exceeded. Custom made Approved for installation in "zero-clearance fireplaces"as
trim well as masonryfireplaces.
Sia C24'y,.•3x_;s;• .(. �p3,FF` : i'3fq�er',Y. r .'.:s-Y+:r7fy 4.ti'Cl:',•4 Ytt'4 `t'.f." „"S 1".t.! S
Th@ speciilcations and clearances lnc(udd Irl this Tech Shee 'ar for, rellmtnary pc�rposeso tyc',
q "<k r 4e. s iy v#{� p tyC to t1 r :4.
Before beginning any Installation,consult yourJoc6l authorized Vetmont`Castings eaterk AJ
i
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v�
ft1�� y✓/ ��l t�'t`�I T
£��+�.P.. � � w t.�*�'��f'r.'�a'+ ���3�V {"�'t�'r,'`•M' v '� t{n�.s ��Y-,�c7�. �+..+:+,..��;y^,s' �•-h �J�:
.a' ? -'�a +tq r,��✓ ".r Lei .& - k t ,*`'sJ .°°4 +�: .w 'fi` x ,�,.
lk—
lip
4by 4- 8
M
gq J f
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a,' a e'" .�-a�-•..... � •S^' � 'r�. F 4 �,y�4.�'.'S'a,�+�~ r.
a ,^r" ,1 ,ws,.. J a } '— _^'� r _ i t M �.�'�d.�-"'��{��;..fi� "�`W -:.,s•..
p m
WlnterWarm Small Insert WinterWarm Large Insert GoldenWarnl Gas Insert
FEATURES SPECIFICATIONS FEATURES
■ High efficiency—79%—more heat FOR SMALL MODEL ■ Unique Matrix r° burner delivers the most
()in less wood Log Length: 18 inches realistic flame of any gas appliance
■ Larg c can glass Burn Time: 6.8 hours ■ Elegant Vermont Castings styling
■ Easy ash handling Heating Capacity: 500-1,000 sq.ft. ■ Fuel versatilirv: natural gas or propane
■ High heat output— Maximum Heat Output: 30,000 BTU/hr. ■ Large 24"x 12"fireviewing area
up to 30,000 BTU/hr.with small model and Efficiency Rating: 79% ■ Solid brass trim around glass
up to 50,000 BTU/hr.with large model EPA Emissions Rating: 2.0 grams/hr. ■ Natural air convection,plus standard
■ Twin fans with rheostat for heat circulation Weight: 275 pounds twin 55-cfm tans with rheostat
■ Solid,durable cast iron construction Dimensions: ■ Installation versatility:fits both masonry
I ■ Leg levellers for uneven hearths Visible Front: or factory-built fireplaces
j ■ Thermostatic control for steady,even heat Height: 21" ■ Durable cast-iron front and firebox
LARGE MODEL ONLY Width: 26.1/2" ■ Levellers for uneven hearths
■ Very low smoke emissions—2.1 gran)s/hr. Minimum Fireplace Dimensions for Insert. ■ X11'0 from sl_es to fit larger or smaller
I ■ Only fireplace insert with standard Height: 21' fireplaces.
sparkscreen for open fircviewing Width: 26-10" OPTIONS
■ Brass trim around door Depth: 15" a Remote control
Flue Collar Size: 6 round . Choice of two porcelain enamel colors,
OPTIONS
SPECIFICATIONS Sand and Midnight,plus Classic Black
■ TWO porcelain enamel color choices:
Sand and Midnight
FOR LARGE MODEL SPECIFICATIONS
■ Caat iron surround panels for a finished
Log Length: .24 inches Fuei: Natural gas or LP
appearance Burn Time: Up to 9 hours Maxinwm Heat Input:
■ Outside air adaptors Heating Capacity: 750 1,500sq.ft Natural Gas: 30,000 BTU/hr.
p Maximum Heat Output: 50 000 BTU/hr. �,BTU/hr.
Ma.1 P LP: 30,0.0 BZ U/hl.
LARGE MODEL ONLY n
■ Traditional or Versatile front styles Efficiency Rating: 78.3/o Ignition System: Standing pilot
■ Flexible chimne,connector for easy EPA Emissions Rating: 2.1 gran)s/hr• Fireviewing Area: 24"W x 12"H
' installation 1 y Weight: 475 pounds Dimensions:
Dimensions: Front: Standard Large
Visible Front: Height. 24" 28"
tl: Height. 30" Width: 37" 43"
Width: 41"
Depth: 1" Z"
Minimum Fireplace Dimensions for Insert: = Firebox:
Height: 24" Height: 19.1/2"
rs Width: 34" \\ii 0 28"
' Depth: 19" Depth: 17"
1 Flue Collar Sire: 8"oval
1 I 26•(66a,,,m)
IJJH• 1
21 IR' t11R' �217-
1 69v $W W J?+•
r ( 1 „ ,
�.R r,a,�.J�.;�a.•• Sr rio�i �r JJ
h—ziip'I(3oa�,—.I �iaia' _� ....rT.. is.w;.,., :.•ieia•,.as:,.nd ueh,m,.f
31
. s -
o
Location
No. �S Date
NORTH TOWN OF NORTH ANDOVER
Of4•�.a , ,ti
' Certificate of Occupancy $ _
♦ i #
,SSACMUSBuilding/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $ _
TOTAL $
Check # 1 )3
14 .1- 41 Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE1�,, OR DEyM,OpLISH A ONE OR TWO FAMILY DWELLING
y T['
IM1 E1y�s`
WELDING PERMIT NUMBER. DATE ISSUED:
SIGNATURE:
Building Commissioner/I for of Buildings Date
SECTION 1-SITE INFORMATION O
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
Map Number ( Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning Distrid Proposed Use Lot Areas Frontage 11
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required Provided. ReqWred Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M
2.1 Owner of Record
Name(Print) Address for Service:
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service: O
z
Signature Telephone
SECTION 3-CONSTRUCTION SERVICES 90
3.1 Licensed Construction Supervisor: Not Applicable ❑
�,icensed Construction Supervisor:
License Number
Address
Expiration Date
Signature Telephone �.■.
3.2 Registered Home Improvement Contractor Not Applicable ❑gi
Company N me Z lj/ & 2 *
(>I� wl( Registration Number
O
Ad ss G \ J VU
c)3/3//0 d-
C it U C! vExpiration Date
Signature Telephone V I
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.......0 No.......❑
SECTION 5 Description of Proposed Work check all applicable)
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other Specify
Brief Description of Proposed Work:
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY
Completed by permit applicant
I. Building (a) Building Permit Fee
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction l
3 Plumbing Building Permit fee(a)X (b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5 Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUIILDING PERMIT
1, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZEDAGENT DECLARATION
I, `�2Cr V1 cma//[y�/ 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
Printne�
1n�l�IOU
Si attire of Owner/Aent Date—-.— I — i-— WIMMM
f
NO. OF STORIES SIZE r
BASEMENT OR SLAB S'r ND
SIZE OF FLOOR TIMBERS 1 2 3
SPAN
DIMENSIONS 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
I/IC UUIIIIIIU/IVVUdIIII UI IVldJJdL;IIUJCIIJ
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers'Compensation Insurance Atl
Please Print
Name: VCA
Location: ` 5ct r-�I q-- ii
City iyPhone
am a homeowner performing all work myself.
�I am a sole proprietor and have no one working in any capacity
ETI-am-an providing workers'compensation for my employees working on this job.
Com an name: �- �
Address / f C
City' /�/U Y lJ� fi4 Phone 66 V-0669
Insurance Co. ,CL /'/ Policy,
Company name:
Address
City: Phone#
Insurance Co. Policv#
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00
and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do herby certify under t sins and penalties of perjury that the information provided above is true and correct
Signature
- --Date-
Print
atePrint name Phone#
Official use only do not write in this area to be completed by city or town official' [] Building Dept
[]Check if immediate response is required Building Dept p Licensing Board
p Selectman's Office
Contact person:_ Phone#: F1 Health Department
[] Other
FORM WORKMAN'S COMPENSATION
fy
Town of North Andovert4ORTH
o �t�1Eo ,
O
Building Department o w c
27 Charles Street
North Andover Massachusetts 01845 4Z
C.
y
(978) 688-9545 Fax (978) 688-9542
gcHus����
DEBRIS DISPOSAL FORM
In accordance with the provisions of MGL c 40 s 54, and a condition of
Building permit# the debris resulting from the work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a.
The debris will be disposed of in/at:
Facility location
Signature of Applicant
///100
Date
NOTE: A demolition permit from the Town of North Andover must be obtained for this
project through the Office of the Building Inspector.
INPROVENENT CONTRACTOR s
�t Win: 03/31/ 002
�Re: Private Corporatio
r- Bay State°ho-f irtg,Irtc s i
Sgo Nahoner
44ows T.
tv11NISTRATOWD. READING NA 01064
' 4
NORTH
Town of over
0
�'o = CA o dower, Mass., /mom// DID
.40 COC MICNEWICK V V
%d ADRATED P'P�,`�5
S BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
C)N-b4 -4 /*r
THIS CERTIFIES THAT............................. .......... ..................................
............................................................................. Foundation
A ......
has permission to erect..,S.:. .. .� ..... buildings on �I � � 4100....... Rough
.....
11 � Chimney
tobe occupied as...................................................f........����........./V....�I ..........................ile i.. y
provided that the person accepting this permit shall in every respect conform to thems of the application 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. � � PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permd. Rough
PERMIT EXPIRES IN 6 MONTHS Final
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION ST
ough
W......... .................................................... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required t® Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done
Until Inspected and Approved by the Building Inspector. Burner
FlRE DEPARTMENT
Street No.
SEE REVERSE SIDE Smoke Det.