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HomeMy WebLinkAboutMiscellaneous - 143 LIBERTY STREET 4/30/2018 (3) j 3 i��6ER y STREET .......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING �,SSACHUSES This certifies that ........... ........................... has permission to perform ... -'A ................................. wiring in the building of ..................................................... at2Y-?..... ............... . .. ,North Andover,Mass. -a ..... Lic.No�.). . . . .Fee...... ...... ............. ........... . ELECTRICAL IN PE R Check 9081 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 9p ! Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]/071 (leaveblank) "" APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Ali work to be performed in accordance with the Massachusetts Electrical Code(MEC 527 MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: A6 Z-2/6,9 City or Town oh NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or he intention to perform the electrical work described below. Location(Street&Number) f Owner or Tenant La © Telephone No. 8- 78T Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building 1>co�l�,�,� 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 thefollowing table may be waived by the Inspector of Wires. of No.of Recessed Luminaires No.of Ceil: TransSusp.(Paddle)Fans Total Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency Lighting rnd. rnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons 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❑ Municipal ❑ 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 z:ccommiunicat:o-^s`A/icing:No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value ofE ectr'cal Work: 4�, ,00 (When required by municipal policy.) Work to Start: /c,Y�, 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 cover ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Rr BOND ❑ OTHER ❑ (Specify:) I certify,under the pain nd penalties perju that the information on this applic is true and complete. FIRM NAME: �'w IC.NO.: 1?30 Licensee: Signature , IC.NO.: (If applicable enter- mp "in the 'ce se num er line.) S.Tel.No. ?�/-7,/- �>f Address: ��.+, a s4+©5f Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security wor 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 agent. Owner/Agent PERMIT FEE: Signature Telephone No. t � The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'b Name(Business/Organization/Indivi dual): a/i/ Address: c3o� ��•�"1`e,A ��Y City/State/Zip: elw 6 QD Phone#: ?il— 7�/ Are you an employer?Che the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I i employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.Q am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition ' working forme in any capacity. employees and have workers9. ❑Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.[?Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.,[No workers' 13.❑ Other comp:insurance required.] *Any applicant that checks box#I 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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 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. Ido hereby certify u der the pains and pe ialties of p Wy that the information provided above is tru and correct 9 Signature - -; Date: D D t Phone#: Z? 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#: 1 S r � .r r f ' ^ s r s 1 , t ,f ,Si .liU°C[' C t .Sr'.i. '`!rl t _ta ') ii'ar,,.26 r.'r�", its'c;. 0?:z3 nft . f L AA Town' of Nonn ndover . ,q-,". No. 2 6 A' L, _ z O- GJNorth Andover, Mass., J01vd J —1971 WY k, BOARD OF HEALTH .SLY 0 P ERM IT To BUILD THIS CERTIFIES THAT................ 0.................................... . BUI IN N5P T Thas permission to erectWP 02:t.lk;C buildings on /-Pt.�3.Q.'H).4r1.k3.Lz&T ....ia)X44. .... Rou9 5 Chimney . to be occupied as5j.M 6-.QZXAm.i). ...Dw.aLiLj.w&. Fina4dp, provided that the person accepting this permit shall in every respect conform to the terms of the application on rile in PLUMBINGINSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough0 I C,/) /V Buildings in the Town of North Andover.. PERMIT FOR FOUNDATION ONLY VIOLATION of the Zoning or Building.-Regulations Voids this Permit. REGULATED DY PARA: 114. 8-S. B.C. DATE: FEE PAID: ELECTRICAL INSPECTOR FERM!T FOR FRAME/BUILDINGRough Service Final DATE: FEE PAID' .............................................................. R BUILDING INSPECTOR. GAS INSPECTOR Rough Final Display in -a Conspicuous Place on the Premises- FIRE DEPT.Do NBurner t)blot Remove/ ,',— 1 1) 4-4-- , p- M . Lathing ' to Be Done Until Inspected and Approved by SmS"oke DNOet. Building Inspector '' Location .�h`//_3 No. �'�"�� Date �� Z �aRTM TOWN OF NORTH ANDOVER Otte•n v,'�'O „ Certificate of Occupancy $ + Building/Frame Permit Fee $ S',"' tFoundation Permit Fee $ �M�st C�/JIAIl./ RECE W, FM MST $ 25' =�--- Sewer Connection Fee $ `''--- ( tQ doQtion Fee $ TOTAL $ 2� No. Andover C01lector Building Inspector Div. Public Works Location No. Date „ORTh TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �'�s ^°''►<�' Foundation Permit Fee $ s�CHust Other Permit Fee $ Sewer,Connection Fee $ Water Connection Fee $ AUG 619?0TAL $ ! �• ---�ia>i.i f`"� } ' Building Inspector Div. Public Works Location�"7,341t-3) No. Date NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ °> Building/Frame Permit Fee $ �+seth ACHU Foundation Permit Fee $ "� J Other Permit Fee $ Sewer Connection Fee $ h' Water Connection Fee $ 1J�� TOTAL BuiIding41nsprc—tor Div. Public Works PERMIT NO. 0804'* APPLICATION FOR PERMIT TO BUILD NORTH ANDOVER, MASS. + �/ � J- Gr i c MAP +40.90 8L—I LOT NO. 2 RECORD OF OWNERSHIP jDATE BOOK !PAGE V yZONE SUB DIV. LOT NO. LOCATION/y.)? Allerjz 17'1' PURPOSE OF BUILDING OWNER'S NAME Ri6varNO. OF STORIES a SIZE OWNER'S ADDRESS / n BASEMENT OR SLAB nQ � ARCHITECT'S NAME Sg/ yct roj-( . �vO/ ,d SIZE OF FLOOR TIMBERSJ 1ST x la 2ND a3RD BUILDER'S NAME �An�/ !` f�/7 SPAN DISTANCE TO NEAREST BUILDING 3c� Fr DIMENSIONS OF SILLS o�Cb DISTANCE FROM STREET y POSTS DISTANCE FROM LOT LINES-� SIDES 6-d- �/_ REAR q� � 'sr-'" GIRDERS E-0,oD0 AREA OF LOT l7 FRONTAGEO4 r�p HEIGHT OF FOUNDATION (� THICKNESS :� O S «l IS BUILDING NEW 'yes SIZE OF FOOTING dF-1- X IS BUILDING ADDITION rl C MATERIAL OF CHIMNEY Or�C IS BUILDING ALTERATION no IS BUILDING ON SOLID OR FILLED LAND 561 WILL BUILDING CONFORM TO REQUIREMENTS OF CODE YeS IS BUILDING CONNECTED TO TOWN WATER h D BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER rJ 6 IS BUILDING CONNECTED TO NATURAL GAS LINE 176 INSTRUCTIONS 3 PROPERTY INFORMATION !` ERMIT FOR FOUNDATION ONLY LAND COST &,3,,OCo ,/- SEE BOTH SIDES do Q�� Bot EST. BLDG. COST ' Sz2 3¢0 REGULATED BY PARA: 114. YAW EST. BLDG. COST PER SQ. FT. f- PAGE 1 FILL OUT SECTIONS 1 - 3nT y /. PAGE 2 FILL OUT SECTIONS 1 - 12 DA 1 E. �'� FEE PAID EST. BLDG. COST PER ROOM ���j SEPTIC PERMIT NO. yyy I i ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS I PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR ° I f DA FILED 211- 91 e BOARD OF HEALTH SIGNATURE OF OWNER OR AU HORIZED AGENT - � OWNER TEL.#-697.-01-2/ CONTR.TEL.N CONTR.LiC. /3 (o PLANNING BOARD PERMIT GRANTED �o �,¢ �• 0, So o-o 19 �— 6oG°Pox 0 s PERMIT FOR FRAME/BUILDING LESS FSA tiD� n �� BOARD OP SELECTMEN �l vo DUE FE� S 6� DATE FEE PAID•., BUILDING INSPECTOR l BUILDING RECORD 1 OCCUPANCY ti •i1-� •r �.. r . .. k2,SINGLE FAMILY rOl'F ulES T SECT-ION N�'U *II; Q�;Alrs, T DIM�I�5OF LOT'AND DISTANCE FROM MULTI. FAMILY ICES LLINES,AND.,EXACT I�,1 �_l .N�'-^��.,-Q�" DINGS. WITH PORCHES. GA- APARTMENTS C'TtY1•'! "" i •. RAGES. ETC Sa.e,PE,R11�1�OSED. .r'lIS FP LAN. it 1 �► CONSTRUCTION n s /a^ 5t 'l 6 2 FOUNDATION I 8 INTERIOR FINISH CONCRETEX- 3 1 2 13 CONCRETE BL K. PINE AL y— BRICK OR STONE HARDW D _k_ - PIERS PLASTER X, DRY WALL - UNFIN. / /♦ � I - I 3k BASEMENT I AREA FULL FIN. B'M'TAREA _ --- --� '-^ /��P 'Q�� FIN. ATTIC AREAN / tp / ! NO '%M'T FIRE PLACES - HEAD ROOM ' MODERN KITCHEN v� \ �• /Q 4 WALLS I 9 FLOORS ^-.� •'�'\�` /����/ //// / / �,,,8� / CLAPBOARDS )l B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ �_ r \ ASPHALT SIDING HARD!/'D ASBESTOS SIDING _ COMMON VERT. SIDING ASPH. TILE •l�O0 1 1 STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR BRICK ON FRAME , ( 1' / f CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME ./S 751-ic a a k' SUPERIOR POO I T:�/S"�/ ADEQUATE I NONE11 5 ROOF 11 10 PLUMBING GABLE I HIP BATH 13 FIX.) _ •_; ( 1 0 1� /r GAMBREL MANSARD TOILET RM. (2 FIX.). _ \ 1 �1 6 g9 i \ 96.91 FLAT I SHED WATER CLOSET _ 1 ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER X _ 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. ZC 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 Hyl .S 13rd I NO HEATING RI S - - E —S o d ._/4 C L_-►clv ir-�i2 o,�s C �' , EZcz_T-r�,._��.Ci3 _,�,<✓.A�,� _2�0 --? -l-( _J- _- R-vcc� r 71� Z-2x7- rJ s .-- -- - --- ------ - - --- - - - -6 L- ------- - ham,� �-,�------ - - -�- -- p NN�i t _ _ �F ------ - - ----------- ------- - - - --- 2,�-b � -- - ----- ���;7� X,per) �e 1 - � •J� �ivy �y, -�1 F ', {� 9 �i.� PUBLIC SAFETY ONEY ORDER pEPARTMENT OF ` CHECK OR M - - 1010 COMMONWEALTH AVE• ' ENCLOSE ED FEE, COMMONWEALTH BOSTON, MASS.02215 FOVA!Am, OF DpBLE TO c r !"1�UapEl•'JMA MASSACHUSETTS i LIC SAFETY" �0��(�. ION R'oF'PU ��� LIC-NO. COMMIiSS. o � i 1,;•, , �* CASH) DATE �t l +�°x** I EFFECTIVE DATE lDO NOT SEND EXPIRATION o o 13 8 6 4 Q613011 X91 o 0613011 9prp p It9CES RESTRICTIONS f,m ��51�;� � 73 CW-11N1 988 .273 v 1 , 24-6 + L SS r)zy.. FEE: By LICENSEE PND OFFICIALLY. PR ONLVI +�� E THE COMMISSIONER LINE v4L per` PHOTO(BLASTING O ,n NOT VALID UNTIL SIS GNATURE O 1 VE SIGNATURE w F..,a 1J' STAMPED OR .' IN FULL-ABO fes. SIGN NAME HEIGHT•• ENSEE �.�.-•,! ►3 DOB: - SIGNATURE 1 Lu , t�h102/1933 MMISSIONER MUST BE '�/j/y �f 1H15 DO,N IHE PERSON AGF {/(Cl - P WHEN E I z OARRIED NG HOLDERTION O a ED IN THIS OCUPP s� OTHERS-RIGHT LHUMB PRINT ,.�---•, - "' '200M2B7-81429 FORM U TOWN OF NORTH ANDOVER LOT RELEASE FORM SUBDIVISION ASSESSORS MAP io , SUBDIVISION LOT(S) C PERMANENT ADDRESS (ASSIGNED BY D.P.W. ) J STREET 4p 7- APPLICANT PHONE <-Z/ DATE OF APPLICATION � ')�- a�S- 9/ TOWN USE BELOW THIS LINE PLANN G OARD DATE APPROVED TOWi LANNER ji�Fl -tV -& 9-1 IytODATE REJECTED CONS RVATION COMMISSION DATE OVED CONSE VATION ADMIN. D EJECTED t BOARD OF,HEA llA'1'E APPROVED ''H �.1 NZ1 RIAN DATE REJECTED DEPARTMENT OF PUBLIC WORKS * vtl)�" DRIVEWAY PERMIT a 4MWeC'lfi�SEWER/WATER CONNECTIONS Nd '�Pw'%r- 6 FIRE DEPT.t(YZP- S I QS �� r a4 P 7� RECEIVED BY BUILDING INSPECTION DATE This form shall be signed by the agents of the Planning 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.. BOARD OF III.At III *~ Town of North Andover ,l•tass - . . r lla t e /G 192/— APPLICATION 92APPLICATION I-Olt WELL & I'UHI' I'ERI•II"I' _ - I:ation is hereby made for permit to drill a well (X ) . Application i„s :o install ( ) a pump system. .on : Address 7' 7 - Lot �{ dd Aress 9.S/ A, 1c1 . 253 Sr �al � L f'�%��i� I'cl . �S� � ,ontractorAddress o (9133 :ontractor Address :ONTRACTOR ( To be completed at time of pump test ) )f Well Well used for -er of Well Size of Casing II,! of Bed Rock Depth casing into Bed Rock al Tested? Yes (_) No (—) Date of TeSti.nR of '•1e=1 — Well Ended in What. Llaterial to Water_ Delivers Cals . i'er Min . for It hours )wn feet after pumping --hours. at GPH J61 �f Completion -- ---_ __ - _ SignaLurc hell (;oi�Cractor INSTALLER (To be'- f-illed i.n' before i �i:�tt� l. Lati.on ) iName Pump - - ------ - —-— I'ump 'I'ypc Used Pump Delivers CPM Size of Tallk__ •laterial Used in Well : Cast iron ( _) Gnivonized ( _) I'I,-' stic ( _1 ?it ( _) or I'itless Adapter ( _) leeve used to protect pipe? Yes (_) NU (r) 'l'yPe or Name Well Seal h�4�4�r���'rt�Ci��'c���ti►4���4��t4�4t4t'c�r�4�Y�ry4i4ti4�4�'rt�r�4t'riY�'��4�'tti'rti'tirti't�'r,':�!:4t;�;��i��;i��r��.�:I)L,��,U� ����CZ�ydr�rfr�r�� Mater analysi_*s repor-t 'submitted to Board of Ilcalth_ release given (D owner of record & 13].19 . Insp IlealLh Inspector F own " nd Of _ 6 ` OLover N.O. 264 (, i er Mass., 1911 C /y BOARD OF HEALTH fra_ Y THIS CERTIFIES THAT............... �.�. :2.�..1? y "s BUILDING INSPECTOR has permission to erect�?oo� T3/2/C,��.. buildings on �?'�' .�143�. Rough A Chimney to be occupied as ./NK. .. RAM LT.bwt W. .7.e^4. >�..A. .. r'�Q 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 FOUNDATION ONLY Final VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA: 114. 8'S. B.C. PERMIT EXPIRES IN 6 MONTME: ,-5��11 FEE PAID: ELECTRICAL INSPECTOR Rough FRt.4!T FOR FRAME/BIUNWS CONSTRUCTION S ARTS Service Final FEE PAI .,,..,.4� ..... . .. .... .. . . .. BUILDING 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 Lathingto Be Done Until Ins ected and Approved b MEMO. P PP Y Smoke Det. Building Inspector F CERTIFIED FOMDAT/ON LOCATION �o PLAN LOCATED /N. N 2 T!I . . . /� n/ 1�© ✓��P 5C.4LE: /N = +0 DOTE: �.cC7 CHR/ST/ANSEN 4' SERGI, INC. IGO SUMMER ST. HAVERN/LL, MA. 0/830 Q CL/ENT. g l TH/S CERTIFICATION /S MADE AND LIMI TED TO TME ABOVE CL/ENT. I CERTIFY THAT THE STRUCTURE SHOWN CONFORMS TO TRE D/MENS/OVAL REOU/REMENTS OF THE ZONING BY-LAWS OF THE . . 7�.L✓. Al . . . . . . . . . . . ' n OF !l0..: K/HEN CONSTRUCTED. OFFSETS SHOWN ARE FOR_ZONING DETERMINATION Q Q ONLY AND ARE NOT 70- HE USED TO ESTABLISP /-o 73 PROPERTY LINES OR TO DETERMINE LOCATIONS OF BUL DI/1IG ADDITIONS. `. 97Jtzo �= S . `� TO THE BEST OF MY KNOWLEDGE AND BELIEF THE PRIMARY STRUCTURE SHOWN ON TRIS PLAN c o ,C ��► �� /S NOT LOCATED WITHIN A FLOOD HAZARD ZONE AS S/IOWN ON DEPARTMEmr H.LID. FEDER.4L_ /NSURANCE ADMINISTRATION M.4F5. COMMUNITY NUMBER .2, .-5.O D q QDlS DATE. J V AH OF MMAJEL E � CAN G- a 7 Z A2by 1 CERTIFIED FOUNDAT/ON LOCAT101V _o - PLAN LOCATED //Y: N o /Z 7-// An/4-') SCALE= P = +0 DOTE. CHRISTIANSEN 4' SERG/, INC. /60 SUMMER ST. HAVERN/LL, MA. 0/830 CL/ENT. �.�.'` ��b. . . '= �f. . .. . . . . TH/S CERTIFICATION /S M-4DE .4ND LIMITED TO THE ABOVE CLIENT. I CERTIFY THAT THE STRUCTURE SHOWN CONFORMS TO 71-IE DIMENSIONAL REQUIREMENTS OF THE ZONING BY-LAWS. OF THE . . . -�!! . . . . . . . . . . n OF M0- .�N ✓.E I"'-::> WHEN CONSTRUCTED. l CS U I OFFSETS SHOWN ARE FOR ZONING DETERMIN.4T/ON Q ONLY AND ARE NOT TO BE USED TO E.STABLISI1 �o 3 Q PROPERTY LINES OR TO DETERMINE LOCATIONS OF BUILDING ADDITIONS. TO THE BEST OF MY KNOWLEDGE AND BELIEF THE PR/MARY STRUCTURE SHOWN ON TN/S PLAN /S NOT LOCATED WIT7I/N A FLOOD HAZARD ZONE AS SHOW ON DEP.4RTMENT H.LID. FEDER.4L INSURANCE ADM/N/STRATION M.41:5. 43 ;. COMMUNITY NUMBER: .2- 5 0 0 C7.8. .oo�s g �k 1 � H OF _70J. A. � 'Q-' SEM y _ Na 3319f �Q ° Lar Tow I1 of j. IWILi)wO :,,.3�::a-'. NUn UNr Llt C:ONtiI.I t V/\'PION 1 11 VV;P ,N �l ��lt. t,l ,•I - I 1'i \NNIN(; PLANNING & t,O!11l►(l!N1'1'1' DI. N'1sLOPAI1 NT i OI t CHIMNEY APPL1CAf1014 ANO ITKA111- VAl E PERM].' i'L'. :;LOCATION /y3 /rmy- y S ,�o✓ 3 OWNER'S NAME: IC *Q tL �ZSo ,.,GUILDER'S NAME: . AASON'S NAME: pg-JASON'S ADDRESS=- ;2 6 r .e • rr n JASON'S TELEPHONE: ✓�$-- '� 33 IATERIAL OF CHIMNEY: lG �.;NFERIOR CHIMNEY: BI ERIOR CHIMNEY: (/ IUMI3ER ANP SIZE OF FLUES: �� .-HI CKNESS OF HEARTH: -- " �u c6LUlrney an. 6a.ePeace coft()onm to Vie u() the cure and have -a(Ce.5 alid .egutatiow been nece.t.ved: 'ATE: � � ----------- � . a AGNATURE OF hIASON: ' 'ERMIT GRANTED: l LL�25 C OVERT NICETTA �. .UILVING INSPECTOR INSPECTEU: EMARKS: SOLID BLOCK� IZ[�(1Ulltl?U , r THIS PERMIT MUSE UE UISPLAYED 014 111E PUMISLS CERTIFICATE OF USE & OCCUPANCY Building Permit Number 3- Date THIS CERTIFIES THAT THE BUILDING LOCATED ON y MAYBE OCCUPIED AS _ IN ACCORDANCE WITH THE PROVISIONS OF THE SACHU TTS STATE B DING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO ` ADDRESS Building Inspector 1 I