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HomeMy WebLinkAboutMiscellaneous - 172 APPLETON STREET 4/30/2018 (2)1 1 9 5 1 Date... !......pCl. N-0 4 NORT►, °`' °:•�"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that !J 1-1G{ `� .. C r� ' ........................................................................................... has permission to perform .......:. ............!...�v..................................... wiring in the building of .....0 �............................................. Pfd at .. l.......... .. {.. ......?...... .. f ..................... . North Andover, Mass. Fee ..:�:J .... Lic. No. // cc��pp� ELECTRICAL INSPECTOR G (� o��e : a:.ao p WHITEApplicant CANARY: Building Dept. �jFINK: Treasurer Rough Service 1 Final ty 014t GDII1iI onwralt4 of fii»ssur4ustus Office Use Only Department of Public Safety Permit No. BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy d Fee Checked 3/90 lleave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Oat ?, City or Town of ' lag -1 '/ To the Inspector of Wires) The undersigned• applies for a permit to perform the electrical work described below. Location (Street & Number) /7z4�CTd�/ S� Owner or Tenant 45k11E-4 OCy'yyE''� Owner's Address Is this permit in conjunction with a building permit: Yes L=T No If (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service New Service Number of Feeders and Ampacity Amps / Volts Amps / Volts Location and Nature of Proposed Electrical Work Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. of same to this office. YES 0 NO LJ If you have checkedl,Y55, please indicate the type of coverage by checking the appropriate box. INSURANCE BOND ❑ OTHER❑ (Please Specify) Estimated Value of Electrical Work $ 0 Work to Start -?- 07 -5? Inspection Date Requested: Signed under the penalties of perjury: FIRM NAME &611f,> YES 0 NO 0 1 have submitted valid proof Rough 7- Z 7' q -d Final LIC. NO. (Expiration Date) Licensee_*r��/f77y�� Signature _ .1, V LIC. NO. Address 17,: � Si � "� �" Bus. Tel. No. 01'rZ_626`Z— Alt. Tel. No. 32V'7295' OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) TOTAL No. of Lighting Outlets No. of Hot Tubs No. ransformers KVA Above In - No. of Lighting Fixtures Swimming Pool gmd. ❑ gi nd. Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Ba"ery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and To No. of Ranges No. of Air Conditioners Tons Initiating Devices No. of Sounding Devices. Heat I otal I otal No. of Disposals No. of Pumps Tons KW No. of Self Contained Detection/Sounding Devices No. of Dishwashers Space/Area HeatingKW municipal Municipal m ci ❑Other Local❑. Connection No. of Dryers Hearin Devices KW No. o No. ot Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. of same to this office. YES 0 NO LJ If you have checkedl,Y55, please indicate the type of coverage by checking the appropriate box. INSURANCE BOND ❑ OTHER❑ (Please Specify) Estimated Value of Electrical Work $ 0 Work to Start -?- 07 -5? Inspection Date Requested: Signed under the penalties of perjury: FIRM NAME &611f,> YES 0 NO 0 1 have submitted valid proof Rough 7- Z 7' q -d Final LIC. NO. (Expiration Date) Licensee_*r��/f77y�� Signature _ .1, V LIC. NO. Address 17,: � Si � "� �" Bus. Tel. No. 01'rZ_626`Z— Alt. Tel. No. 32V'7295' OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) Date... — 4% .. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION .. This certifies that ............ has permission for gas installation,,%. -4.—.< ...... in the buildings of. ............. at ;....,Aorth Andover, Mass, Fee* . Lic. No......... .......... GAS INS R Check # 1-1,PA/IP (?.in; cr Tr.-�1 `Vor-Th "u.-ecr.,,a:;, Dare Ta�'-0al. ,y Pyr-ic � 6u:iCinc� Loca.;on1-7d-�1-7d-ODir-r,.,) S,—_ Ow'ner's Ns:^eGdn �� 6 /' .*-Uh'iUF• Type c Occk-:Pzncy S.' -'t Mt.. y -t „T FLGGn ��� FL00� I l i l l i i I l l i i i i I i� I ► I I I 4TH. FL00n I! I I I I I I I I I I I! I f I I I I I I STH FL00;; 7TH F L 0 0 F 88TH, FLOOF. I I I I I I !ns'.a!ing Cempa.ny Na: e TOWNSEND OIL CO2LANY, INC. Chec4 ene: Cerjrz`e F.��ress 75 WEST MAIN STREET Corpera'ior, GEORGETOWN, MA 01833 Pa- ners`,ip Business Telephone 978-352-8711 N2rne of Ucensed Piumbe, cr Gas Fl e' .TnRN RAEATTME INSURANCE COVER.A GE: ! r'.3'!e c CLi rrel-'�i I'w-'i i'.;/ InS- __ p{�; Gr i.s $J`iS`.3:".�.C., ey'_r/3. Y;,`il_„ i;i?_:5 i��e (eti� (?"�_ ,`.5 C'` �.{.�.._ Cr. .-7. j Yes N's ` - ! c :-1 e C .'<' �_5 . r' =-a a _ I r.� :.,.... _ i ,-i _ �; C = : j C li _ 2 - _ : z.. - r _ e c_,=-a_e r_ C."i �:e �:? G` t:'e Mass. G2. _ ra. (c 2 ( 5 _ Gi t, :� F/'• -T:: 2�, N3 i r.- cr, ec'e yy, 2: f8 C• C --2Cr DC7-.ne1•5 1e a" c, `;e Gle:_i5 2 -.3:. I � a,e 5_., .,...cJ �;:� 2'.o c_ 2:.i? - 2'e is .9 2'.. 2= "L'_ ,.:e :? C: _ / . -''� C Z.I;, ir.s;?, a':c-' ;,?-.:r7.ztyL-�a' -e ^5.i_.: -a a :C' r'. :•2 ,'-, ';:;�'r'. _ �� _ G _ L-? ,til �.� y?.s S;�.a G>, Cc•.' 2-C^G 3�'e' 1'' c Iv'Q`l0'h !O-rIC� USc O'._YI Location / T+ No. / Date TOWN OF NORTH ANDOVER .oma a Certificate of Occupancy $ Building/Frame Permit Fee $ ��s'•••° • Eta sACMus Foundation Permit Fee $ G1# Ter- Permit Fee $ �— T6Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector e: U 5 `{7ro1/98 12;54 50. 00 PAID Div. Public Works Location r I `�01 No. i,- ti Date Nom,. TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ oAreo �sswcHusE< Foundation Permit Fee $ I Other Permit Fee $ 50 ASewer Connection Fee $ Water Connection Fee $ ` TOTAL $ % Building Inspector 07l0119a 12:54 5n_ ► P07D Div. Public Works '4 C4 v z U r m w IIS A 4 x o x 0 L z 3 J L. z 3 Q x FFr.w a _ � z C -a z z w O oLLI L � z U a �, Z m N W epi a �n v°"i G a d � O O O OJvn `6 C O L hLL�l r > ej ej ¢ z z z O m c m '4 C4 v z U r m LU J x ¢ J z � h /\ m z o O p Lzj r L LU LL) LLJ C4 X055 pC z O z z z ¢ z w z x ¢ L 3 J L. z 3 x � z c 1 m O Z d � F- O O OJvn `6 C uJ' L > ¢ z z z O m c m e �jC tJy OU J tsJ LLl la) N `7 LL U UO 0 0� J z z z z z m < m LU J x ¢ J z � h /\ m z o O p Lzj r L LU LL) LLJ C4 X055 pC z O z z z ¢ z 4' , FORM U - LOT RELEASE FO INSTRUCTIONS: This form is used to verify that all nec, Boards and !I-',partments having jurisdiction have been of the applicant and/or landowner from compliance with any '"APPLICANT FILLS OUT THIS APPLICANT I X�,V14 0(,,01&dW LOCATION: Assessor's Map Number O SUBDIVISION-EL-n4h k U_ STREET --- *"OFFICIAL USE ONLY A1LAENDATIONS OF TOWN AGENTS: t A a 4 iGlvWe CONSERVATION ADMINISTRATOR 'ovals/permits from 0 dW99 relieve or requirements.% PHONE PARCEL LOT (S) _ ST. NUMBER_12Y DATE APPROVED `'S/c� % DATE R€JECTED TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER(WATER CONNECTIONS ` DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE 66, L -0 -T -7- e) O 0T7- 80 .o a ExISTIk i 0 E a' c - 85.00' .�&•PPLUMU STQ.EET i. ExISTIk i 0 E a' c - 85.00' .�&•PPLUMU STQ.EET ��- ODD ' ,� Town of North Andover N°RTil .eW S V3 V,e OFFICE OF 3a °,.'"► ' ° 1 do L . OMMUNITY DEVELOPMENT AND SERVICES 146 Main Street } WII,LIAM J. SCOTT North Andover, Massachusetts 01845 SACH Director Director SWI14MING POOL REGULATIONS NOTE: PERMIT CARD SHALL BE POSTED IN A VISIBLE AND ACCESSIBLE LOCATION FOR OBTAINING THE VARIOUS INSPECTORS' SIGNATURES. ALL SWIMMING POOLS IN EXCESS OF 2 FEET IN DEPTH ARE REQUIRED TO HAVE A BUILDING PERMIT AND CONFORM TO THE FOLLOWING REGULATIONS: 1. ELECTRIC: An electrical permit must be obtained prior to an application for a Building Permit to install a pool. 2. ZONING: Pools shall be located to the rear of the front building line of the house and no closer than 10 feet to the side or rear lot line. 3. HEALTH: a. Location from subsurface disposal system must be approved by the Board of Health. b. Semi-public and public pools must have plans approved by the Board of Health prior to construction and must also have an annual operating permit from the Board of Health. 4. SAFETY: Pools .must be enclosed by a suitable wall and fence, at least 4 feet in height with self-closing and. -latching gate that meets the approval of the Building Inspector.* No water allowed in pool until fence is erected. Pool cannot be used until inspected and approved by the Electrical Inspector and Building Inspector. *Fencing on corner lots must be erected 20 ft. inside lot line. FEES: ELECTRICAL PERMIT - $35.00 BUILDING PERMIT - 6.50 per thousand on estimated cost; 35.00 minimum permit fee D. Robert Nicetta, Building Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 C c c m c ts CD : C N � O O : f c� •d W. A N m C c a m o ts J= I o y E oiQ E c QO :mac 1 * * a E N N .mm H = .m CoCc W O �O+ N W `Norm GC =CD o cm :coco Q acz m 0 C, H O O Z ' C O C a m mt3 N y uiW p �'' C w •� LL m o •N •� A C Z W E CD 0.CM o C.7 a g 7 _ �_ 1� O O N O H Z co i O co Z O C y co .y CL co C� C O CD CA O O h C O V cc C cc Q. co) O s co d y C a a a a u v N T o V, b v x a cG iz, a r_G r w o w c ii ua w G co z b cn o E cn C c c m c ts CD : C N � O O : f c� •d W. A N m C c a m o ts J= I o y E oiQ E c QO :mac 1 * * a E N N .mm H = .m CoCc W O �O+ N W `Norm GC =CD o cm :coco Q acz m 0 C, H O O Z ' C O C a m mt3 N y uiW p �'' C w •� LL m o •N •� A C Z W E CD 0.CM o C.7 a g 7 _ �_ 1� O O N O H Z co i O co Z O C y co .y CL co C� C O CD CA O O h C O V cc C cc Q. co) O s co d y C { Location Z 2,)- /_i Date ,.01t71y• TOWN OF NORTH ANDOVER # s Certificate of Occupancy $ " Building/Frame Permit Fee $ +ssufiUSEt Foundation Permit :ee $ Other Pe mit Fee $ `/. v tJ t - Sewer Connection Fee $' ►A kr Connection Fee $ P TOTAL $ �_ 5 ` . c" Building Inspector 1 6 6326 Div. Public Works APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. I/PAGE 1 MAP d-40. LOT NO. I 2 RECORD OF OWNERSHIP (DATE BOOK PAGE .' ZONE SUB DIV. LOT NO. LOCATION 1 ,7- s PURPOSE OF BUILDING 84 4:, , _ 5 ,3 OWNER'S NAME 'j o " Q 'CO Nti10/Z C NO. OF STORIES �x 5 � SI E x/ OWNER'S ADDRESS I Wle, fty-S 21, A I7 7/ '_1 f 1 !O BASEMENT OR SLAB ARCHITECT'S NAME �' SIZE OF FLOOR TIMBERS IST 2ND 3RD -,,a C� BUILDER'S NAME IS 1E SPAN DISTANCE TO NEAREST BUILDING /%D V DIMENSIONS OF SILLS DISTANCE FROM STREET / POSTS DISTANCE FROM LOT LINES - SIDES /,(� Sri REAR / �O / CCJJ GIRDERS AREA OF LOT /�_ /1 FRONTAGE /y / !iC HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW /C- ' o 7,7 2c/ J SIZE OF FOOTING X IS BUILDING ADDITION e,4 zl&-) G, MATERIAL OF CHIMNEY IS BUILDING ALTERATION ye S IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Y„e5` ! 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 SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVE BUILDING INSPECTOR DATE FILED SIGNATURE -C OWNER OR'ALTTHORIZED AGENT FEE OWNER TEL. # 6&P 966,6 PERMIT GRANTED CONTR. TEL. #_;�}.f� 19 C�O�N�T�R�.`LIC. # OD 6s:5 3 PROPERTY INFORMATION LAND COST ps EST. BLDG. COST EST. /) EST. BLDG. COST PER SQ. FT. v EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY Si ORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE PINE B 1 2 13 CONCRETE BL K. BRICK OR STONE HARDW D PIERS PIASTER DRY WALL _ _ UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA '/ 1/1 '/ FIN. ATTIC AREA _ NO BMT FIRE PLACES _ _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS DROP SIDING WOOD SHINGLES B _ 1 2 3 _ _ _ CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ HARDIA✓'D COM/,nCN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 10 PLUMBING 5 ROOF 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 & 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. & COILS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS GAS 7 NO. OF ROOMS OIL B'M'T 2nd _ 10 13rd ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 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. ****************Applican t fills out this section***************** APPLICANT: 1ANIEL k0(l Phone 01J LOCATION: Assessor's Map Number Parcel i Subdivision Lots) J Street e�� St. Number ). ************************Official Use Only************************ RECOI*EEN T O OF TOWN AG S : Date Approved 7�a� Conse tion Administrator Date Rejected Comments 66, kmj kA Date Approved_ Town Plannerr Date Rejected Comments nrA&)6m cos, Date Approved Food Inspector -Health Date Rejected Date Approved Septic Inspector -Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date m LLJ 0 LLJ LLJ ir LL N ca 0 < uj 00 Uj a: Gi Ld o U = it 0� (A Z LLJ (1) U- < z 0 LLJ m LU Aj CO CL a U- 0 co O LU LU 0 0 < uj (L I" 9 Lu LU ir LLJ wca = 0 0 z all ''w L) cr < 0 LU LL 0 < U zYlI-- ui Q.LU da 0 tz z cc 0 T) Im 50 0 0 0 L) Cl) z C) 00 < A' CD z 0 u LLJ W C2 M= 0 ui co P XG. j C,4 w M 6.4 0 < M V)OCJ Z z 0 LU a w uj 114% vc =Z z 0 0 zzcc 0 CA cn , A > I f3all Aj Us 4z - cu A,n6l , - KPIL C) Q, ul CD UJ (n WA . lll—�� – . _4 C V,66 D hoz io co C: 'o M ru U09. 000 x ui LL LLJ 0 0. OC U)pn LL. 0 Z Z, Iz 0 0 loo40 U) w 2 • Z, z %%0 0 0 0 4c ck W Zr< cc 4W OR X CO of w cr 0 Us 4z - cu A,n6l , - KPIL rA vi tv E� w° cn OF w° w�' v U `� ii CD a°' w O U W U W Z cn w a � a°' w F" Z w ca o v cn D o cn D J O.L CD 1�� c— J z ss. S ' d C CSC CD H Fc Z C.3 c3 •CL. O Q � CD O.L CD 1�� a C i c— J z ' d C CSC CD H Fc Z C.3 c3 •CL. C O ed CD c :om CC CAcov z z W I O > _� Q y •� r0.. C. N 0 D W z > L-+ O 0 0 CD c E U) cc a a L C N y m 3 z r.+ . V � m � N 0. O CL 'd m O • y C ea C IS o .mo c= c cv ev nv CJ y O m .0 O "� C: Cf z rr -cc O •ate+ J c � Q CO2 Z C O a C L �� m V �� C! N O � Z O cm •O ~ O � N C m C = dam" N cc LL LL rr C rr OL, P_•.N� W C.= w= -�y OZ � _ PoC .0`y'o O a�mzip a C i J z o E CD Fc Z QLUCL CD c CC CM z z W I O > _� Q y •� m m W z > L-+ O CLCD 0 CD Q > . V 0. O CL CL �a C.0 C c= c cv ev CJ J 'a z .Q O •ate+ J LL CO2 Z C z_ V CO)Q CL C C cc LL LL 0. F- G V2 C7 23 z z a LL C LL � V. • •PLOT . .. PLw46�43 Lja6wp • i M ®tZT H WPB V E IZ m *4& 0 t2 I C F -i Ate- P F. V_ v,f.�iTV-5 WC1 til o -r 1-4 Low t 180'. 0 c.) i 1 1 � � 1 � I Lo J 1 � 1 in .:.jay I � EXISTIUG FOL)WD s i l t�c2a i a.i A.GE EA4Z E: 1 \ t2oa� I MP;zovemal co moi" ' • �''` 5.00 � " "� ate.. • • _ --t2 �1-S 8 .. PP L. ETO u STPIEET No.: lel S - kLar Date T; TOWN -OF NORTH ANDOVER amok p - 2 '�PJfLDING DEPARTMENT A r Building/Frame Permit Fee $ SACNUS� s Foundation Permit Fee $ Other Permit Fee $�as,00 W ac�, Building PERMIT NO.," k) 9 Ail APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. CPAGE 1 MAP h40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK PAGE - ZONE SUB DIV. LOT NO. I LOCATION PURPOSE OF BUILDING OWNER'S NAME 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 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 WILj. BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BC \RD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER J IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE -F11 -ED / A_ SM'FATURE OF OWNER OR AUTHORIZED AG FEE PERMIT GRANTED 19 �_ J ti 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY WHITE: Building Dept. CREAM: Assessors CANARY: Treasurer BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING INSPECTOR 'NV7d 101d S33V1d3M SIHl 'C350dW12l3df1S 'Ot3 'S3ovu -V9 'S3H:)UOd H11M 'SEMM-11(18 d0 SNOISN3WIC 1OVX3 CNV S3NM 107 WOMA 3ONVISIC CNV 10-1 dOSNOISN3WIC 1OVX3 MOHSisnW NOLUMS SIHl ZL I , AONVdf1000 I a3033a JNiaiin9 EJNIIV3H ON _I Pic I +`1 P"Z I.W.9 D18ID313 110 SWOOM 40 SV0 SS31V3H 11NI1 0.1.H INVIOVS ONINOIIIONOJ SIV NOdVA SO 8.1.M IOH WV31S 'NSnl NIV IOH O3JS03 3JVNNn3 SS313d1d _ sb3ljV4 OOOM 'S10J ? 'SW9 13315 'S10J 8 'SW9 839W11 1SIOf OOOM ONIMH L L I ONIMad 9 OOVO 3111 MJ013 3111 _ S38n1XN N8300W `JNIJOON 1105 _ 83MOHS ll V1S 13AVaO V SV1 _ `JN19Wnld ON 31V1S NNIS N3HJ11N S30NIHS DOOM ANOIVAVI S310NIHS 11VHdSV 13SO1J N31VM 03HS IV13 1X13 LI ON VSNdIH 13WVO 35 XNaE) H1V9 19VO 'JNI9Wflld OL dOOH 1 - S �) 3NOII?l3dns NOOd 1 ONIMIM 3WVS3 NO 3NO1S kdNOSVW NO 3NO1S 'N19 N30NIJ SO 'JNOJ 3WVN3 NO NJIS9 _I SOol3 8 'SS1S JI11V ANNOSVW NO NJIS9 —� _I E j 9 3111 'HdSV NOVVWOJ 3WVN3 NO on1S ASNOSVW NO OmJJn1S ONIOIS 'ISM ONIOIS IIIS311V ONMIS 11VHdSV O,tA(JSVH HldV3 S310NIHS DOOM 313NJNOJ SONV109dONO VlD SHOOld 6 �� snvM b N3HJ11N N83OOW S3JVld 3NIJ V3NV JI11V 'Nil V3SV .1.W13 N13 WOOS OV3H 1.W 9 ON '/r °/, 7, lln3 V3NV ' I 1N3W3SVI £ _ E L l E NIdNn 11VM ANO N31SVld SN31d 3NO1S NO NJIN9 f 'N.19 3138JNOJ 3134JNOJ NOIIVGNnOl Z O.MaNVI 3NId HSINI! IIOIV31NI 8 NOIlOnl:fISNOO S1NMIMV S3JIjjo—_ Aliwv3 'lllnw $3IS0!S AlJWV3 316NIS ZL I , AONVdf1000 I a3033a JNiaiin9 WOOD STOVE INSTALLATION CHECKLIST Permit A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. Stove A. New Used _ B. Type/radiant 'z'�� Circulating C. Manufacturer -r� © _Lab. No.,67 _�:Z Name/Model No. <-- Collar size Dimensions/ Height Length © Width Chimney / A. Newv Existing B. Size (flue area) C. Other appliances attached to flue (Number and flue size) D. Prefab (Manufacturer—na and type) E. Masonry/Lined = Flue liner Unlined stype as manuttoturer) F. Height (refer to diagrams) cap O VER'I 3'MIN. 1. j i------ �47,t CHIMNEY HEIGHT Hearth (non-combustsb� le)G 1 A. Materials - B. Sub -floor construction C :: X ti C. Minimum dimensions (refer to diagram) Clearances and Wail Protection (see stove instal A. Type of wall protection provided �!C B. Clearances (refer to diagrams) FIREPLACE 12'� MIN. 12" ,. MIN 2 1$" MIN. (FUEL;�Si QLGE55 yl HEARTH clearances CORNER -91r WALUCENTER 13