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HomeMy WebLinkAboutMiscellaneous - 12 HIDDEN COURT 4/30/2018 12 HIDDEN COURT I 210/065.0-0179-0000.0 ' r i Insurance Adjustment Service, Inc. 352 Warren Ave Unit 11 Portland, ME 04103 (207) 878-8020 Fax (207) 878-8041 UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 139,SECTION 3B Date: February 25,2011 TO: Board of Health/Building Inspector RE: Insured: Denise Canale Property Address: 12 Hidden Court No Andover MA 01845 Date of Loss: 2/5/2011. RECEIVED Policy Number: BDCTTV MAR — 2 2011 TOWN OF NORTH ANDOVER Type of Loss: HEALTH DEPARTMENT File or Claim Number: 67346 Claim has been made involving loss,damage or destruction of the above captioned property,which may either exceed$1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6,to be applicable. If any notice under Mass.Gen.Laws,Ch. 139,Sec.38 is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured,locations,policy number,date of loss and claim or file number. Thank you for your cooperation. Very Truly yours, George S Long Adjuster F,xt. 139 9959 Date...... ........ -� NORTH - 3?° `' TOWN OF NORTH ANDOVER PERMIT FOR WIRING SSACMUS� This certifies that ............... ..... ....... .. ...... has permission to perform .......... ............................................................... wiring in the building of......... ........................................... at ./ it?.v....�1 T .A,North Andover Mass. Fee...�� o" Lic.No.�. .6�? .. �,. ....... , ....... ...... ..... . ELECTRICAL INSP�CTO/ 3 Check # ao pz !. Commonwealth of Massachusetts Official Use Only Department of F!,re Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked t [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT ININK OR TYPEALL INFOBJW TION) Date: 2— City --City or Town of: r To the Inspector of Wires: By this application the undersi ed gives not' e of his or her intention to perform the electrical work described below. Location(Street&Number) Id $- Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes 5RO No ❑ BLDG PERMIT# Purpose of Building Utility Authorization No. Existing Service® AmpsZd Volts Overhead ET' Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)FansNo. of Total. Transformers KVA, No. of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency ig Ing rnd. rnd. Batte 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. Tonsl No.of Alerting Devices No. of Waste Disposers Heat Pump Number .Tons KW No.of Self-Contained Totals: """' Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW LocalMunicipal ❑ ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Water No.of No.of Devices or Equivalent No.of Heaters KW Si ns Ballasts Data Wiring: No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with NEC 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:) I certt&,under the pains and penalties of perjury,that the information on this application is trace and complete, FIRM NAME: ��c vj9�-� LIC.NO.: Licensee: �Yr) Signature Call LIC.NO.: / ��- (If applicable, enter "exempg zit the e n b r line) Address: / 65 a," _ A Bus.Tel.No.: S���5/1'/-#ij2e Alt.Tel.No.: *Per M.G.L. c.147,s.57-61,security wor requires Dep e of Public Safety"S"Licen 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 agent. Owner/Agent Signature Telephone No. [P7EiRMIT7FEE. $ t ELECTRICAL PERMIT NO. INSPECTION REPORT: � ELECTRICAL INSPECTOR-DOUG SMALL i F PECTION: Failed—[ ] Re-inspection required($50.00)-[ ] ments: (Inspectors'Signature-no initials) Date 2.FINAL INSPECTION: Passed—° Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: (Inspectors'Si ature-no initials) Date 3.UNDER GROUND INSPECTION: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: c (Inspectors'Signature-no initials) Date 4.INSPECTION—SERVICE: DATE CALLED NATIONAL GRID: NAME: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date I 5.INSPECTION-OTHER: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF$50.00 IS TO BE CHARGED. The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston,MA 02111 UV vww.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/lElectriicians/Plumbers Applicant information )Please Print Legibly Na1ue(B.usiaess/Organization/Individual): Addxess: / City/State/Zip: y� Il�7'V, ()3&96()3&96 Mona#: �(��-- J �` �15 2d —U Are you an employer?Check the appropriate box: Type ofproject(required): 1.❑ I am a employer with. 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part part-time) have hired the sub-contractors 2.[VJ I am a sole proprietor or partner- listed on the attached sheet.? 7. ❑Remodeling . ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.El Electrical repairs or additions required.] officers have exercised their 3.❑.I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c.152,§1(4),and we have no 12.❑Roof repairs insurance required.] employees. o workers q 1 p [N comp.insurance required.] 1311 other ?Any applicant that checks box#1 must also fiII out the section below showing their workers'compensation policy information. '►Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees Below is the policy and job site information. Insurance Com an Name: P Y Policy#or Self-ins.Lic.#: Expiration Date: Sob Site Address: City/State/Zip: i 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 maybe forwarded to the Office of Investigations of the DLA_for insurance coverage verification. X do hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct. Signature• �y""' 5 ✓�-' Date: Phone#: 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Location C7 No. QYy Date 312s19 2- TOWN OF NORTH ANDOVER p Certificate of Occupancy $ O BWiding/Frame Permit Fee $ /O 2- Foundation Foundation Permit Fee $ s�caus Qther FeIi + Fee $ �.� Sewer Connection Fee $ Water Connection Fee $ Ltt � TOTALone 4 , , Building Inspector �l Div. Public Works _/f4--7 Location /�2 /-1/D©C--W C? / No. 6V Date 3h/s.z °"T" TOWN OF NORTH ANDOVER 3?°i t"`D-,••°MOL jaia6mMilik p Certificate of Occupancy $ "� ... Building/Frame Permit Fee $ f sEta Foundation Permit Fee $ /00, 0-0 es Other Permit Fee $ e 4% ection Fee $ AMP � Water Connection Fee $ T �T&91- $ f 6 d. oLo Building Inspector 5 Q 1 3 Div. Public Works Location No. Date 31,0,314?2 pC11Tq TOWN OF NORTH ANDOVER n �ft n Certificate of Occupancy $ +& Building/Frame Permit Fee $ s'� CHUS ' Foundation Permit Fee $ s�cHus � . ng rmit Fee. $ w ?ion Fee :: $ ��- k9?w!ger Connection Fee $ - $ TOTAL .s o 5�` y ``' '�i Tiding Inspector A biv. Public Works IPER-stIl,� NO. tOT O APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. s,! PAGE 1 M5P +46. /�. LOT NO. , 7 2 RECORD OF OWNERSHIP DATE BOOK PAGE y ZONE I SUB DIV. LOT NO. �7 LoCATJW `' nn PURPOSE OF BUILDING 0- %-fj - l�.f7YTL,�� OWNER'S NAME 11ti � �� le NO. OF STORIES t; SIZE fQ s* OWNER'S ADDRESS C ' l BASEMENT OR SLAB ARCHITECT'S NAME s- SIZE OF FLOOR TIMBERS IST9ey,,6, 2ND qi� 3RD �• BUILDER'S NAME y�_. (�.,[ �/� � .�,pj SPAN ZJ O'- fr' L � DISTANCE TO NEAREST BUILDING �+�- �' DIMENSIONS OF SILLS ev. ;/ --- DISTANCE FROM STREET POSTS Lt/�f DISTANCE FROM LOT LINES—SIDES x'7:1 ' REAR � i�m GIRDERS AREA OF LOT / ' `y� fi4J FRONTAGE 7� J HEIGHT OF FOUNDATION < d/l0 THICKNESS w / ✓ t IS BUILDING NEW t SIZE OF FOOTING X IS BUILDING ADDITION dj MATERIAL OF CHIMNEY 16 f- J i IS BUILDING ALTERATION [ IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE �� j- IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY � 0 IS BUILDING CONNECTED TO TOWN SEWER �` C IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES PERMIT FOR FRAME/BUILDING EST. BLDG. COST 2tS� OOD• ,PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT.,o.dv PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM DATE. .FEE PAID. SEPTIC PERMIT NO. ^Y6,A_.C�6- 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 DAT ILED M BOARD OF HEALTH IGNATU E O O NER OR AUTHORIZED AGENT n OWNER TEL.# 7 7'� FEE ��a S,D VGUNIH. ItLff CONTR.LIC.# 'W32), PLANNING BOARD PERMIT GRANTED PERMIT FEE' ,1 �J� BOARD OF SELECTMEN LESS FDA FEE . �-o PERMIT FOR FOUNDATION ONLY n_ d_t�FRe Mr O% �0z ov REGULATED,BY PARA: 112.7 S.B.C, j� BUI INSPECTOR LATE: 3 � S31 EE PAID:_�— 3 S ilPt�d`= .<�sWnA�Wwk%i• `tea �...r: ...�, .,_;. . ,.. ....' +a•` ' 'BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY oof StoRIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINTS-AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC.-SUPERIMP„OSED:-THPS'•REPL'.ACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH CONCRETE d 11 12 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B.M'TAREA _ '/ '/p l/, FIN. ATTIC AREA _ NO B M FIREPLACES HEAD ROOM.. _ MODERN KITCHEN 4 WALLS II 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDINd CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW'D _ ASBESTOS SIDING COMtACN VERT. SIDINGASPH. TILE _ STUCCO ON MASONRY CY_ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR (- BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) / FLAT SHED WATER CLOSET _ ASPHALT SHINGLES7 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 —01 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 I NO HEATING d � � 1 P FORM U j TOWN OF NORTH ANDOVER s LOT RELEASE FO1k1 i SUBDIVISION ��11 i �'/T�/ ASSESSORS MAP SUBDIVISION LOT(S) 7 7, PERMANENT ADDRESS (ASSIGNED BY D.P.W. STREET APPLICANT i�L S'�� � / PHONE 3 3 .? i DATE OF APPLICATION TOWN USE BELOW THIS LINE PLANNING BOARD DATE APPROVED s TOWN LAMNER DA'T'E REJECTED CONSE VATION COMH41 SSION DATE APPROVED ao• 4 CONSURM'TION At ftlN. DATE REJECTED 'BOA4 OF HEALTH AM '241A DATE APPROVED HEALTH SANITARIAN DATE REJECTED. DEPARTMENT OF PUBLIC WORKS �Q DRIVEWAY PER1,1IT p"74A)-QtAS24 (�:h_4 SEWER/WATER CONNECTIONS � . FIRE DEPT. t RECEIVED BY BUILDING INSPECTION t� DATE EM 2 U1t.,D1N AR DEP %Ei�T This form shall be signed by the agents of tide �P�anning and Health Boards, the Conservation Commission prior to the issuance of any building permits for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. GE�r I f=*1 4C:> F4=)U U CNN -rt C)u 4r L.oGAT!✓t� 1 U 1��ve_T'l-{ �r.1 C�off/�TZ. Nfq S S I`to2Tt-t A ��ovErt�. � M ASS. 13'lvo� � 1 G• � ts`o J I P 3� r "ti 120.0 J z N � _ N , (n -- Q •` L=3G.�5 �,=2 S.00 - i So.00- . t4AR 91992 ^i o L�IJJLDMG DEPARTMENT GE.iZT11=y THA c�FSE�TS ilcw�.1 A2.� X02. THEOf 'Tt-IE, c�F-r1=SE""C'S 1�5E cot T4-Ftc.. f3 cJ t c...�t:�..i C� 'S�+5�.�'t� �y►� � i W rT-f+ THE.Zol.t►u Cs CJE`t"E.t2.t.-A t w.i AT l o f�i 40, 0.13972 Sy l_.Ak.t S �� C o u F'o2iM T�/ 02.. Uo►.,.1 -Cows F'o 2r1•�I TY per` ,p p +� �,c.t N�.►..f C:o",.err 1.lo.AEp�,MA tiiNALS L?IN E' -/ N S E H V AT U W-------- �AORT N�llj�11 Ai L T 6 0 own of ri Over 0 No. 040 ji° VLWAN-4f EV-4TRY PERMIT A E Oer, Mass#V, tk 1 .? J1? BOARD OF HEALTH PERMIT T ILD THIS CERTIFIES THA4AI&...W..0&Aff- VE W. .. ... 09-160... AlIfttAlligMALP A I BUILDING INSPECTOR has permission to ereft W. -V.or.Awrow dings on M.10j:11W.....CTR.......... Rough to be occupied as.%5AACALIF....P*W1&y.P ... ............ Chimney Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file In PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. PERMIT FOR FRAME/BUILDING Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES I IONTP�JE: FEE PAI D-/D 0 11 ELECTRICAL INSPECTOR Rough UNLESS CONST UC N STARTS Service PERMIT FOR FOUNDATION ONLY Final 'ONT11 U 7CT N STARTS .. . REGULATED BY PARA: 112.7 S.B.C. ... . ...... ... .... BUILDING INSP GAS INSPECTOR DATE.1/ 3jUL_FEE PAID:A4212__!L Occupancy Permit Required to Occupy BudkK PERMIT FEES.__./Lz�L' Rough LASS FDA FEE - /0' Final Display in a Conspicuous Place on the P&YkRM PERMIT$--4 0 L-S""o FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector tl �' 'ivi ToWM of 0 n over No. 040 ° n. jjVj VEVVAY ENTRY PERMIT = � er, Mass. 1 C H H CK .4 OR ?� SS BOARD OF HEALTH PERMI THIS CERTIFIES THA .. .W.. . .... .. .:. ...I..COOP... Vwx has permission to er i�y dingson ..,� L... . -I.ODA& .V.... .......... L�p'1�0 ` Sgal to be occupied as Lem ;......pwmmyp ....1(/R do f�&..........i� IK 492—,, provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Ll�M6�lV` , PECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection;Alteration and Construction of ou Buildings in the Town of North Andover. PERMIT FOR FRAME/BUILDING ,n VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES I 10 N T�rgE• s z FEE PAID'/01-'200._.. ELECTR AL INSPECTO x Rough i c UNLESS CONST UC N STARTS Service ' PERMIT FOR FOUNDATION ONLY Final © REGU TED BY PARA: 112.7 S.B.C. DATE3,Q��FEE PAID:1 BUILDING 1NSP G 7!7 Occupancy Permit Required to Occupy Buil� PERMIT•FEE u � LESS FDA PERMIT� a zs aO Display in a Conspicuous Place on the P& MFS IRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector I 1yP_ 0 • CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 40 Date JUNE 4 , 1 9 9 2 THIS CERTIFIES THAT THE BUILDING LOCATED ON 12 HIDDEN COURT ( LOT #7 ) MAY BE OCCUPIED AS S I N G L E E A M I L V DWELLING IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. OF No oTH •9•Y 02 .t a CERTIFICATE ISSUED TO A n d o v e r Const. 9 D e v . C.o a p. ° ADDRESS 66 Sp2ing Hitt Rd. No h Andover , M SSAG Hl15 to ec or kocation !�f•r.�JJ No. `� y� Date A* - .�r'2 — i I o<r°oT;�tio TOWN OF NORTH ANDOVER p Certificate of Occupancy , $ s Building/Frame Permit Fee $ C" SES Foundation Permit Fee $ Other Pe"y Fee $ Sewer ConnWk�Fee $ Water Cordon 4; $ ! , oil, Building Inspector Div. Public Works ; PE&JiIT NO; 40 f 49APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP h40. LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK '.PAGE ZONE I SUB DIV. LOT NO. / �I LOCATION (• _/ 12 Q PURPOSE OF BUILDING OWNER'S NAME G� � NO. OF STORIES SIZE OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD •�(!�� BUILDER'S NAME SPAN ,�•, (� DISTANCE TO NEAREST BUILDING DIMENSIONS OF SAILLS DISTANCE FROM STREET C POSTS DISTANCE FROM LOT LINES—SIDES /0,ot REAR p�`JQ f— '� GIRDERS AREA OF LOT S FRONTAGE Ise 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 WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH BIDES EST. BLDG. COST • PAGE 1 FILL OUT SECTIONS i - 3 EST. BLDG. COST PER OQ. FT. f �® PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. l 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 BOARD OF HEALTH SIGN TORE OF OWNER OR AUTHORIZED AGENT 'to EE � fO rO OWNER TEL.#-�73- ��39' PLANNING BOARD PERMIT GRANTED CONTR.TEL.# j 19 _ CONTR.LIC.# BOARD OF SELECTMEN NSPECTOR BUILDING I t 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. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER - _ DRY WALL _ UNFIN. 3 BASEMENT 11 AREA FULL FIN. B M'TAREA _ FIN. ATTIC AREA _ N_O 8 M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARD"✓'D _ ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. a STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR _ ADEQUATE NONE S 5 ROOF 10 PLUMBING GABLE I 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 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO 6 FRAMING 11 HEATING J WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. _ a TIMBER BMS. &COLS. STEAM STEEL BMS. d. 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 I NO HEATING ✓! ' d F L A I'l 1-1111 U V A 'I All A L ;:�LWVLO I W A L o yo , own of 6 0 naover 0 No. V.. r �/ )RIVEWAY ENTRY PERNAIT A ' 9ver, Mass... 1'C -_ qH,W,CK S13A BOARD OF HEALTH P ERMIT TCrBOILD THIS CERTIFIES THAT. AAA.r�....................................... BUILDING INSPECTOR has permission to erect oAwdidingson f.*.rl �IObWr.r. Rough Chimney to be occupied as.... "- -40A-yy--A9&AArA-&.1A0-49 ... Final provided that the person accepting this permit shall in every respect conform to the terms of the application on rile in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. Final VAOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Rough UNLESS CONSTRUC:TIO, il STARTS Service Final . . ................. iUilf, I�NG�INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove . Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector