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Home My WebLink AboutMiscellaneous - 124 MIFFLIN DRIVE 4/30/2018 124 MIFFLIN DRIVE 210/032._ 0-0002-0000.0 JAN-15-2007 10: 14 PM LARRY OGDEN 978 352 2858 P. 02 �C.�.V i nJ :M JP..P R Io m?.o ? $1gnno �e,,k 0-1 SwPIPO T"'S 111 USS k tri 4.W1. s 2gvD Z�pdJ�pso Ns Qo:sr f ue. 8 . Ne�P•�S �fi� t3 �. GNrc-k�.� 14-6�0Cvc.E. Iv'oAT4 Avvi)ou&k t.-A CoQ, I-r-ufv MVF-P14ul A SN OFFAw -to M LAWRENCE `370 - 6 $ 3 - 7Zo7 1 NA.40 ! '0y 27163 p H • 'UNHL EN�'� 7 Date..... ......�U... ..!..... • NORTM °f<"`° '•�"� TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING ,SSACNUSE� This certifies that r C J „! �� ';/� ��/ .. ........-� has permission to perform . .." - wiringin the building of...... ........................................................................... at.............................................. �1 .:�....,r v{r'";North Andover,Mass. r Fee..f ..r..'... Lic. ...........I.�✓ �.•:"�.- /sir........ TR ELECICAL INSPEC`T'OR 7 Check # = r r a Commonwealth of Massachusetts Official Use Only Department of Fire Services permit No.- _/9 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] 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 IN INK OR TYPE ALL INFORMATIOA9 Date: i I q17-7 City or Town of: )VO�k /4 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) r r IVNA/I y i 7 ti Owner or Tenant J1�;/ ;'►Q r �,?/�v Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ 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-followingtable maybe waived by the Inspector of Wires. No.of Recessed Luminaires r No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA p No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- E3o.o Emergency Lighting rnd. rnd. Batten Units No.of Receptacle Outlets p No.of Oil Burners FIRE ALARMS I No.of Zones No.of SwitchesNo.of Gas Burners No.of Detection and �7 Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: " " Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local El Connection El Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: 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 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:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete- , FIRM NAME: />l Gt. ; t- LSC -, .- LIC.NO.: /,a ' Licensee: Pic P hew_+hd / Signature z f '(7 LIC.NO.: (If applicable,enter "exempt"in the license number line) Bus.Tel.No.: Address: r-�, + r. '4i Alt.Tel.No.: G *Security System Contractor License required for this work';if applicable,enter the license number here: 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 PERMIT FEE: $ j}�S Signature Telephone No. JAN-08-2007 06 :48 PM LARRY OGDEN 978 352 2858 P. 01 Not . gosl- f aa. a e4M s o a E_ 1' iv o'r i'z OR... 1 Dt r eu O k L ty a Of'0'�s LA•WIRENC� 3 7t, -- 68 3 � 2a7 Nalco + .. R� 1� 7 27768 �Or1Al- Date., .' / ��/ . 7 . . � MORTM of 4, TOWN OF NORTH ANDOVER 0 o PERMIT FOR PLUMBING Is 4P SSAMUS� 1 This certifies that . . .�. . . . ... . . . . . .!!. . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . e+. . . . . . . . . . . . . . . . . . . . . . . . . . . f" + cl plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . North Andover, Mass. Fee. . Lic. No.f- : .'. . . : . . . . . . . . . .t... . . . .�. . ..\. . . . . . . . . . PLUMBING INSPECTOR Check # -7 r r.I .' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS '7 ` ��J Owners Name "� f!�e.. �G� Date �✓ Z ^� •l Building Location O' /'�i Permit#7L 31 Amount '3 v Type of Occupancy New Renovation Replacement [] Plans Submitted Yes a No FIXTURES n v sialeavllc R4SEWW M HOat M RLR �t FLOat 47tH ROM SII FI1Xlt say Haat 7IH Flat M FUM (Print or type) f Check one: Certificate M Installing Company Name j/! {? 1:1 Corp. Address Partner. Business Telephone aFirnt/Co. Name of Licensed Plumber. Insurance Coverage: Indicatp1he type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond Insurance Waiver I,the undersigned,have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner Agent 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 Permit Issued for this application will be in il compliance with all pertinent provisions of the Mass 'Mp State&lqmbi��142 of the General Laws. By: Sigrialure oi-Licensea Flumoer Type of Plumbing License Title City/Town License um r Master Journeyman n � APPROVED(OFFICE USE ONLY L.Li� (Print orr Type) TS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING ype)) •, NORTH ANDOVER , Mass. Dale r I Building Permit ✓� Location_ Owner's - Name UA New► 0 Renovalion O Replacement Eq Plans Submitted: Yes 0 No El f M q Vh s C IC 11- O 2 M x h 99 o 41 u H x N i o a: W 1< 14 _ = o. H a a r' o H IK %i wF N W O O 16 j W 0 O O �h1 ! 'S O J 00 sue—esa1T. . SAIRMENT 1!T FLOOR IND FLOOR I ,RD FLOOR Fr ITN FLOOR STN FLOOR } SIN FLOOR ` TIN FLOOR I SINPLOOR Check one: CertNicale Installing Company Name-,- d fF7 Corp. Address 3 Cn,,4 a rNn 4— d Partnership f C 1 Firm/Co. Business Telephone — G II Name of Licensed plumber or Gas Fitter P r 6CV�c; INSURANCE COVERAGE: Check one I have a current liability Insurance policy or Its substantial equivalent. Yes (A No O If you have checked yes, please Indicate the type coverage by checking the appropriate box. A(lability Insurance policy ( Other type of Indemnity O ' Bond O 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: Signatute of Owner or Owner's Agent Owner O Agent O I hereby certify that all of the details and Information I have submitted(of entered)In above application are true and accurate to the best of my knowledge and that an plumbing work and installations performed under the permit Issued for this application will be In compliance with all pertlnent provisions of the Massachusetts State Gas Code and Chapter 112 of therva. ey Type of License: , 'l �7 Plumber ure na of LkensedPlumb-of or aas er Title Gasntter N Master License Number CftyRo'n Q Joumeyman 11PPFI0NE0(OFFICE USE ONLY) BELOW FOR OFFICE USE ONLY , 'iNAI INSPECTION SKETCHES ' FEE PROGRESS INSPECTION NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC NO. _ PERMIT GRANTED DATE 19 GAS INSPECTOR "` N Date. . . . . . . . . . . . . . . . . . . . . NORTH TOWN OF NORTH ANDOVER Qft �E� iy gtiO o CEIVEDN'M .EOR GAS INSTALLATION . 09 _ �._ . e • S pACAH US OCT<y 2 21991 �9SEt No, Andover Collector This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. . . . . . . . . Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GASINSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File Location Z o2 .�f r �� ' 12 No. (- O ` Date NQRTM TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ -7� 9- _ JAtMUSE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # r Building Inspector PERMIT NO. APPLICATION FOR PERMIT TO BUILD********NORTII ANDOVER, IIIA MAP NO. LOT NO. 62, 2. RECORDOFO\L'NE IIP DATE BOOK PAGE ZONE 012- Sllll DIY. LO'T NO. _ r LOCATION 12 C{ � Ff / w �� PURPOSE OF 6JADING OWNER'S NAME 1J ch, V►1 S ti NO.OF STORIES /Gv SIZE OWNER'S ADDRESS iM BASEMENT ORSLAB ARCIITTECT'S NAME /1 SIZE OF FLOOR TIMBER! Isl 2 3 1 1 I111ILDER'S NAMEcCJ/ 1 n SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET DIMENSIONS OF POSTS DISTANCE FROM LOT LINES-SIDES REAR DIAIENSIONSOFGIRDERS AREA OF LOT FRONTAGE IIEIGIITOF FOUNDATION TIIICKNESS IS BUILDING NEW SIZE OF FOOTING x IS BUILDING ADDITION AIATERIALOFCiUhINEY 1S BUILDING ALTERATION IS BUILDING ON SOLID Oil FILLED LAND WILL BUII.DING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTS TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER i IS BUILDING CONNECTED TO NATURAL GAS LINE INSTUCTIONS 3. PILOI'ERTY INFOIWATION LAND COST EST.BLDG.COST 6 a PAGE l FILL OUT SECTIONS 1-3 EST.BLDG.COST PER SQ. FT. EST. BLDG.COST PER ROOM ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERM If NO. ATTACHED GARAGES MUST CONFORM TO STAII-�FIRE REGULATIONS 4. APPROVED IIV' �// PLANS MUST BE FILED AND APPROVED B\'BUILDING INSPECTOR BUILDING INSPECTOR DATE FILED OWNERS TEL/I CONTR.TELH CONTR.LICH D6 d SIGNATURE OF-O\VNER OR AUTHORIZED AGENT // FEE $ 1-3lqr PERhIff GRANTED //3 D� Q Revised 5/5/99 JAI Pape of Free Estimates 105 Haverhill Street Fully Insured Methuen, MA 01844 THOMPSON'S ROOFING (978) 691-1355 Shingles-Tar and Gravel-Slate Rubber Roof-Single Ply-Copper Work PROPOSAL SUBMITTED TO PHONE DATE Jane Glen 9-16-99 STREET JOB NAME 124 Mifflin Drive CITY,STATE and ZIP CODE JOB LOCATION North andover MA 01845 ARCHITECT DATE OF PLANS JOB PHONE We hereby submit estimates for. Strip off all roof shingles on house and garage Renail all loose boards Install aluminum drip edge around roof line Apply rubber ice adn water shield 3 ft. up all along edges and in valleys Apply 15 lb. felt paper on rest of roof area Reshingle with a 25 year shingle your choice of color Install new flange around soil pipe Waterproof chimney flashing Cutin a ridge vent on house only w ; 1 ( 6-e rC ryi o,) Remove all work related debris 25 year warranty on material 10 year guarantee on labor Construction lic. #060112 Improvement #128612 1 " We PrOpOSe hereby to furnish material and labor—complete in accordance with above specifications,for the sum of: dollars(s 6 2 0 0 . 0 0 Payment to be made as follows: $2 ,000 .00 start of job $4 ,200 .00 on completion Six thousand two hundred dollars All material is guaranteed to be as specifled.All work to be completed In a Workmanlike manner according to standard practices. Any alteration or Authorized deviation from above specifications involving extra costs will be executed Signature only upon written orders,and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire, tomado and other necessary insurance. NOTE This proposal may be Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us If not accepted within days. a AAi r� d PrOW — The above prices, • specifica ions and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment Signatu will be made as outlin Bove. Date of Acceptan e: `� Signature CERT I F I CA TE OF L IAB I L I T Y I N S U R A N C E DATE 07/30/99 (MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER PELHAM INSURANCE SVCS INC THE COVERAGE AFFORDED BY THE POLICIES BELOW. 122 BRIDGE STREET PELHAM NH 03076- INSURERS AFFORDING COVERAGE INSURER A: Liberty Mutual INSURED INSURER B: The Maryland Thomas Doyle DBA INSURER C: Thompsons Construction & Roofing 8 West St. INSURER D: Salem NH 03079 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN• THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 B [X] COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 300,000 [ ] [ ] CLAIMS MADE [X] OCCUR SCP 34865353 04/15/99 04/15/00 MED EXP (Any one person) $ 10,000 [ ] PERSONAL & ADV INJURY $1,000,000 [ ] GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $2,000,000 [ ]POLICY [ ]PROJECT [ ]LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT [ ] ANY AUTO (Each accident) $ [ ] ALL OWNED AUTOS BODILY INJURY [ ] SCHEDULED AUTOS (Per person) $ [ HIRED AUTOS BODILY INJURY [ NON-OWNED AUTOS (Per accident) $ [ ] PROPERTY DAMAGE [ ] (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ [ ] ANY AUTO OTHER THAN EA ACC $ [ ] AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ [ ] OCCUR [ ] CLAIMS MADE AGGREGATE $ $ [ ] DEDUCTIBLE $ [ ] RETENTION $ $ WORKER'S COMPENSATION AND [ ] WC STATUTORY [ ] OTHER A EMPLOYER'S LIABILITY WC2-31S-314995-019 04/21/99 04/21/00 E.L. EACH ACCIDENT $100,000 E.L. DISEASE-EA EMPLOYEE $100,000 E.L. DISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Garage Repair at 82 No. Policy St. Salem. NH CERTIFICATE HOLDER [ ]ADDITIONAL INSURED: INSURED LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR Anthony Mottolo TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED PO Box 504 TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Andover= MA 01810 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE rj (7/97) Page 1 of 2 w _ DEPART ENT RUBLIC-SAFETI� CONSTRUCTION SUPERVISOR IICEMSE Muaher--_ _ _ Expires' Birthdate CS c� - 411 X8/04/2000 08/04/1956 r.-g_: F- J 1) �1. TN T; BBYIE" SALEM,yw�tH 03079 HOME IMRROVEMEMT CONTRACTOR ' ` c Regittration 128612 • i" {, Tyke'=.SBA' • . . ExPiration 04/28/01 1 THOMPSON'S ROOFING ; THOMAS T. DOYLE .o t*wST ST t ADW*SrATOR. SALEM NH 03079 BUILDING DEPARTMENtT DEBRIS DISPOSAL FORM In accordance with the provisions of.MGL c 40 S 54,a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: Location of Facility L�u�ll S� 4- CJ Signature of Permit Applicant i Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector i 1 NORTH Town of R over yo00 T �0 - - LA a dover, Mass., a COC KICMEWICK sRATED PPS 1 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System uvw� BUILDING INSPECTOR THIS CERTIFIES THAT...... ... .�r ....... .. ........... .Y..4W. .. ...............;&A..4....... ................................ Foundation has permission to erect.g.S41Rl p .... buildings on �� I... �� V i.......... Rough ......................... ..... ............ ....... ... ............ . ... to be occupied as Chimney ...R. . • .... provided that the person accepting this permit shall in every respect conform to the terms 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 Permit. Rough Final 403 111IR PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS 000 Rough y/ . ................................ ... ................. ..... Service BUILDING INSPECTOR Final Occupancy Permit Required to 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. VIT J, AORTy _ �. OWn ! �� f 2230 �� i� �. . � a (ED t Fs APRIL7V! k moi'. I85S ��,�•� d®ver, Mass., �~ c-_r 19 ID I'D SANITARY ENGINEER �' HIS CERTIFIES THAT . . . . . '.taw . .�f . . . � (.�,�. .f��16 . . . . . . . . . . . . . . . . . . . . . . . . . BUILDING INSPECTOR has permission to erect to be occupied as �. .d ,s . . . . I. . . . . . . . . . . . PLUMBING INSPECTOR provided that the person accepting this permit shall in every re 1f. ,,?to the the application on file I in this office, and to the provisions of the Statutes and By-Laws a the .Tn �_ti Alteration and Con- struction of Buildings in the Town of North Andover. ELECTRICAL INSPECTOR VIOLATION of the Zoning or Building Regulations Voids th': armi V / r ` L ` /I�� -- Q' Gv r U /�1/ G�./. . .G^/ . . . �. . . . . . G 6. C.fi C . . . !� //11 GAS INSPECTOR BUILDING INSPECTOR To Occupy Building,Apply at Building Inspector's Office, Town Hall. This Card Must be Displayed in a Conspicuous Place on the Premises \ P and Not Torn Down or Removed (� No Lathing to Be Done Until Permission is Issued by Building Inspector DKKIAI TV I=nn nrft �nwiKio TRIC f-%Ar)n A� PER111T NO. 4�:1-3� __ APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP NO. LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK PAGE ZONE I SUB DIV,LOT NO. �- LOCATION ) '� %//J /� Jj� PURPOSE OF BUILDING OWNER'S NAME NAME NO. OF STORIES SIZE '7 OWNER'S ADDRES BASEMENT OR SLAB J !L ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET /f( '" "' POSTS DISTANCE FROM LOT LINESyS -SIDES 7- Ii0kAR J�j, " GIRDERS AREA OF LOT FRONTAGE JC7 HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW / SIZE OF FOOTING X l i 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 3 PROPERTY INFORMATION INSTRUCTIONS LAND COST SEE BOTH SIDES EST. BLDG. COST �Sf� PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 ,v.T*&-PERMIT NO. /-3 -5-3 ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING I' 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FSLED BOARD OF HEALTH ATURE OF OW ER OR A T OR ED AGENT F E E PLANNING BOARD PERMIT GRANTED �/-110-25/ 19 BOARD OF SELECTMEN BUILDING INSPECTOR 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 3 l 2 13 CONCRETE BUK. _PINE _—i— BRICK i_BRICK OR STONE HARDW'D PIERS PLASTER DRY WALL _— _— UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA 14 1/2 '/ FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS II 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE I� - WOOD SHINGLES EARTH _ ASPHALT SIDING HARD"✓D ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE STUCCO ON MASONRY � STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR BRICK ON FRAME i CONC. OR CINDER BLK. _ STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIORII POOR _ ADEQUATE I NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13BATH FIXE _ 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 MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING II 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 OIL B'M'T 2nd ELECTRIC 1st 13rd NO HEATING r