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HomeMy WebLinkAboutMiscellaneous - 18 PHILLIPS COMMON 4/30/2018I ilk D t, //- c� -,f), Y,-" - a.. ....... ........ TOWN -OF NORTH ANDOVER PERMIT FOR GAS INsTALLATION This certifies that ................. has permission for gas installation .... ... ........ in the buildings')of l: ...................................... ... at ... North Andover, Mass. ......... Sd " Fe&_3s9; ...... Lic'. NO'. . . .. 7 _'G "C' T - R Check # 7046 MASSACHUSETTS UNIFORM APPLICATON FOR PERMrr TO DO GAS FITTING (Type or print) Date l �^ a d '� C( NORTH ANDOVER, MASSACHUSETTS /' Building Locations .� l/�lr tl (� �0 S C6 !'t ^ aou Permit # ©'T� Amount $ e h u ti WA f Al -t /r Owner's Name New Renovation Replacement Plans Submitted (Print or tYD4 Name V_/o'A-C /<<a `►'1� �� Address 6, New Q Q N Business Telep one // Az , 171 tr — Q C Name of Licensed Plumber or Gas Fitter k -4 ,xv c- Ti' c,-.� Check one: Certificate Installing Company Corp. Partner. Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. YesIn No If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity Bond a 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 13 Agent 0 ---j ..,,.—y ... au V «M; ucuulb auu 1111Unnauon i nave suomir[eo (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 compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter 10— Plumber PL _ 1,57'4 7 9'� Gas Fitter License umber Master Journeyman v fid, u m x w v� x M w o y x\ Gw w z M H x w w o z c a z a o C) H zWQ H w U F Q z w F- F� F W C� p > W H V U U5 W o a x z 3 z o z� o w c° a>° F o SUB-BASEM ENT BASEM ENT 1ST. FLOOR ' 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR STH. FLOOR (Print or tYD4 Name V_/o'A-C /<<a `►'1� �� Address 6, New Q Q N Business Telep one // Az , 171 tr — Q C Name of Licensed Plumber or Gas Fitter k -4 ,xv c- Ti' c,-.� Check one: Certificate Installing Company Corp. Partner. Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. YesIn No If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity Bond a 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 13 Agent 0 ---j ..,,.—y ... au V «M; ucuulb auu 1111Unnauon i nave suomir[eo (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 compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter 10— Plumber PL _ 1,57'4 7 9'� Gas Fitter License umber Master Journeyman v fid, u yfThe Commonwealth of Massachusetts E Department of Industrial Accidents Ojpce of Investigations 600 Washington Street Boston, M. 4 02111 www-mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electric'lans/Plumbers Applicant Information Please Print Leffibly Name (Business/Organization/Individual): Address: City/State/Zip: New Nf'( 3 d Phone #: Are you an employer? Check the appropriate bog: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2.F I am a sole proprietor or partner- listed on the attached sheet. $ ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5• ❑ We are a corporation and its required.] 3. ❑ I am'a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. c. 152, §.1(4), and we have no insurance required.] t -employees. [No workers' _r• COMP. insurance required.]. Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. 0 Building addition 10.❑ Electrical repairs or additions 11-❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other - ubmit --J -rr-._ --• �-•� ;;� ��� > A .....�� biiu ., om we secuon below showing their workers' compensation policy information. - f Homeowners who sthis affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors 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 is providing workers' compensation insurance for my employees: Below is the informmiinrL policy and job site 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. I do hereby certify under the�d penalties of perjury that the information provided above is true and correct - - - Date: /(-90-09 Phone #: 6 d 3 - S a s- U1 a-7 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/'I own Clerk 4, Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions � Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity; or any two or more of the foregoing engaged. in a joint enterprise, and including the legal representatives of.a deceased employer, or the . receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability.Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have ' employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit..The affidavit should j be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. _ City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at .the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, . please do not hesitate to give us�a call. The Department's address, telephone and fax number. The Commonweala of Massachusetts Department of industrial Accidents Office of Investigations 600 Washington Street Roston, N4A 0:21.11 Tel. # 617-7274900 ext 406 or 1-977-MAS.SAFE Fax # 617-72.7-7749 Revised 5-26-05 NAr"rw.mass.gov/dia Date . 12 -.. 7 0/41 .......... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACHUSe- This certifies that ..... has permission to perform :--7-3... - ! ...... plumbing *n-t,he buildings of .................................. at ...... I ........... ...... .. ....... I North Andover, Mass. Z Fe5...... Lic. No .......... ... ............. PLUM XINSPECTOR Check # 6'.8.6 8 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Location g 1� 1 l tP C()jj iA htj Owners Name M e Ca A 10 t(AMPCC Permit # n Amount Type of Occupancy 1✓W e i' n.1 ry New Renovation Replacement ©C Plans Submitted Yes. -1:1 No �- . F1 (Printor type) Check one: Certificate Installft Company Name T, N A L L o ,'C A-j"J p f H D Corp. Address P` 0 1� G x 57), D Partner. ` Z w2 .vice V-1 V4 ori Z Business Telephone Cl 7 2f. 25 5— y 5-0 y Ymn/Co. Name of Licensed.Plumber: 7-7-k M v4 S Insurance CoveiaQe: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity El Bond Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance ignature Owner D 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 compliance with all pertinent provisions of the Massachusetts State Pjppbing Code and Chapter 142 of the General Laws. `7—�� Title City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License �Y03 icense Number er Master Journeyman El • Date ... .... ........ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..... /4, e.z..o ('-- .. ............................... has permission for gas installation .... 1,!, . ............... in the buildings of .... ........................ at ... / C— North Andover, Mass. Fee. Lic. No..1 ..... �GAS INSPECTOR Check # J 5479 I MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTIlVG (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations PHP 116 P3 Cn m m e ate! Ar441'j w4ftfK New ❑ Renovation ❑ Date 3-&—o6 Plans Submitted ❑ Permit # Amount $ (Pint or type)one: Certificate Installing Company Name -7- J14 L L O fq .,✓ la4 f/ Corp Address /0 d /3 d X S 702 ❑ Partner. e,4w4 evv « 14 og aid' SQL Business Telephone 97 Z b'5 ' 9 5'0 `!� ❑ Firm/CO. Name of Licensed Plumber or Gas Fitter 7L/vrr ,q s W%9 //y eq v✓ INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. YesEJ No[] If you have checked M please indicate the type coverage by checking the appropriate box. Liability insurance policy ® 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 ❑ I nereby cermy that au of the aetails and mtormatton 1 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 compliance with all pertinent provisions of the Massachusetts State Gas Code anfl Chapter 142 of the General Laws. OVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ® Plumber ;( Y � 33 ❑ Gas Fitter License Number ❑ Master ® Journeyman • • (Pint or type)one: Certificate Installing Company Name -7- J14 L L O fq .,✓ la4 f/ Corp Address /0 d /3 d X S 702 ❑ Partner. e,4w4 evv « 14 og aid' SQL Business Telephone 97 Z b'5 ' 9 5'0 `!� ❑ Firm/CO. Name of Licensed Plumber or Gas Fitter 7L/vrr ,q s W%9 //y eq v✓ INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. YesEJ No[] If you have checked M please indicate the type coverage by checking the appropriate box. Liability insurance policy ® 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 ❑ I nereby cermy that au of the aetails and mtormatton 1 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 compliance with all pertinent provisions of the Massachusetts State Gas Code anfl Chapter 142 of the General Laws. OVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ® Plumber ;( Y � 33 ❑ Gas Fitter License Number ❑ Master ® Journeyman Date../..- i� ..C.... . ON° 4248 ,J "OR':,ho. TOWN OF NORTH ANDOVER : •� ` �°c ° a PERMIT FOR PLUMBING This certifies that./. ' . -. .: -gy m^ � ``": '' • ............. • • • has permission to perform ............ • • • • plumbing in the buildings of..��......�...... ..... • .. • • • ... • • • . at/r ..�._: !:—�- ? . r.<,- ; North Andover, Mass. Fee. v ..... Lic. N o. 7_:3.3.... `..... ;, /Y�a.., �r�,. c,.� ........... PLU ING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING z .� (Print or Type) Mass. Date ) 2a 19_jj Permit # Building Location /C A ) I I / , j �p�n-n� ���J Owner's Name 1V 2 fLMA, S 140Ae6! L.-4 /U Arj)-)a ! e -r,2-, /11 14 O ( J Type of Occupancy i + -DE I i t: __ New ❑ Renovation ❑ Replacement t)d Plans Submitted: es ❑ No ❑ FIXTURES r Installing Company Name I1TAe-0 Check one: Certificate Address �� f^ �L /-} C ti n1 r3 n) f- PJ ❑ Corporation �Y1 E/ +4 0 &:---A) Al t•y r NLI ❑ Partnership Business Telephone Z -5 -7 -7 1 9-A'r�/Co, Name of Licensed Plumbed r3 r;i_' T til r, A n�ryl,Q rKll� INSURANCE COVERAGE: I.have a current 1�'ability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ It you have checked Yes. please /indicate the type coverage by checking the appropriate box. A liability insurance policy ld' 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:- Sionatura of raunnr nr rn., ,'. A...,... Owner ❑ Agent ❑ nereoy cerury tnat an 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 yormed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum ' g e and apter of the eral Laws. By Title vmmre of Licensed—Plumber City/Town Type of License: Master % Joumeymah ❑ APPROVED OFFICE US ONL License Number y33 5 • Y • • • Sol .. ISSMSENEEMENEENNER 00010011000 Installing Company Name I1TAe-0 Check one: Certificate Address �� f^ �L /-} C ti n1 r3 n) f- PJ ❑ Corporation �Y1 E/ +4 0 &:---A) Al t•y r NLI ❑ Partnership Business Telephone Z -5 -7 -7 1 9-A'r�/Co, Name of Licensed Plumbed r3 r;i_' T til r, A n�ryl,Q rKll� INSURANCE COVERAGE: I.have a current 1�'ability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ It you have checked Yes. please /indicate the type coverage by checking the appropriate box. A liability insurance policy ld' 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:- Sionatura of raunnr nr rn., ,'. A...,... Owner ❑ Agent ❑ nereoy cerury tnat an 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 yormed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum ' g e and apter of the eral Laws. By Title vmmre of Licensed—Plumber City/Town Type of License: Master % Joumeymah ❑ APPROVED OFFICE US ONL License Number y33 5 �I If v r c 9 v m s o m m m f- 0 O m 0 0 m A m c N m 0 z r c °jEocation Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ fjj- — l� Building/Frame Permit Fee $ �> 1 Foundation Permit Fee $ Y.z Other Permit F_ee $ MMA- c 1 n Fee $�J ! `. ' y -ice roll we Water Connection Fee ?TO -AL! i t3-6 jj �rYY�y }� �is �yse�l Building'lnspector Div. Public Works Z - Location No. Daib 4PPAl' ii 0 �v TOWN, OF NORTH ANDOVER Certificate of Occupancy $ 41 �) Building/Frame Permit r 6e $ F?4Wdi.aM,,' Permit Fee d • "I -a tq"#n $ Other Permit Fee $ 4 Sge"Wer connection Fee $ Water Connection Fee $ -------- TMA 1� $ -x� Building InspeZtor Div. Public Works Location No. X Date TOWN OF NORTH ANDOVER.---, Certificate of, Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ 0 her Peimit Fee $ heer ConnectlUn FW- $ Water fq�m nn%et!p e $ 00 TOTAL $ 20, , No. Aneovei Ulwor ./I(*Ildlngjlnspect .0 ry .1>76 i Div. Public Works ']AmiT NO.• ' % APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. %% �j� D� /PAGE�1 MAP KJO.I LOT NO. 2 RECORD OF OWNERSHIP "DATE BOOK "PAGE ZONE f SUB DIV. LOT NO. LOCATION V PURPOSE OF BUILDING OWNER'S NAME s. C J - NO. OF STORIES 2 SIZE2 OWNER'S ADDRESS B SEMENT SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST �C A 2ND !J 3RD BUILDER'S NAME / „ � n - � SPAN DISTANCE TO NEAREST BUILDINGN/) ��(�f- DIMENSIONS OF SILLS ' DISTANCE FROM STREET /)I POSTS --- DISTANCE FROM LOT LINES - SIDES ;20 ( REAR c"] - GIRDERS(J - x � r7 ` AREA OF LOT / SfJ� a FRONTAGE I/1 HEIGHT OF FOUNDATION C�_ / THICKNESS IS BUILDING NEW 1 i /�� IA G SIZE OF FOOTING �2� Z21X 10 IS BUILDING ADDITION O MATERIAL OF CHIMNEY IS BUILDING ALTERATION /� IS BUILDING O SOLID R FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE �%� IS BUILDING CONNECTED TO TOWN WATER / iif s BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER i�ElS - IS BUILDING CONNECTED TO NATURAL GAS LIN INSTRUCTIONS j x �Q nom ONLY SEE BOTH SIDES sy rm JI �^ r {jr PAGE 1 FILL OUT SECTIONS .1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF 11R�' c� ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED r7l JX J �. 1 y SIGNATURE OF OWNER OR AUTHORIZED n OWNER TEL. # �k_�ly 1 11 A PERMIT GRANTED CONTR. TEL. #('� 19 CONTR. LIC. # Ima go= i FAR Fm Fm CK FWE MM. IT Q7 1�i� 3 PROPERTY INFORMATION LAND COST o, l EST. BLDG. COST EST. BLDG. COST PER SQ. FT. J U EST. BLDG. COST PER ROOM 4?4 ocz) SEPTIC PERMIT PERMIT NOAJ�. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN PERMIT FOR ERAMEAUILDING ; DATE::: P 2 -EEE PAID2�'�LL—rla BUILDING INSPECTOR J ,, BU-ILDING RECORD 1 OCCUPANCY 12_ a SINGLE FAMILY srORIEs. TH•ks SECTION MUST SHOW EXACT "DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY — oFFiCEs, LOT LINES.. -AND EXACT"DiMENSIONt OF•kUILDIiNGS.- WITH 'PORCHES. GA - APARTMENTS RAGES, ETC. SUPERIMPOSttD.'THIS'-REOLACES PLOT PLAN. CONSTRUCTION F 2 FOUNDATION 8 INTERIOR FINISH \ CONCRETE _ B 1 2 .I3 ' CONCRETE BL'K. I PINE BRICK OR STONE HARDW D PIERS PLASTER ' .,• _.� DRY WALL UNFIN. 1 �"• ` 3 BASEMENT, I , AREA FULL FIN. B'M'T' AREA '/ '/, °/, FIN. ATTIC AREA NO BMT FIRE PLACES-; HEAD ROOM _ MODERN KITCHEN 4 WALLS 9•. ;. FLOORS t CLAPBOARDS+. B 1 2 3 DROP SIDING CONCRETE . WOOD SHINGLES `r EARTH �_ I ASPHALT SIDING HARDII✓'D X _ ASBESTOS SIDING _ COMI,ACN VERT. SIDING ASPH. TILE STUCCO STUCCO O ,MASONRY.\� N M AME � .l BRICK ON MASONRY - ?.° ATTIC STRS. 8 FLOOR _ *MAS YS t.` r •+ BRICK ON FRAME, 'm CONC. OR CINDER BLK. STONE.0 ASON Y', WIRING STONE- 'FRAME !: SUPERIORPOOR ADEQUATE I NONE �'• '.� ,.._ `, ,;l..` 5 ROOF 10 PLUMBING - GABLE HIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES >LG LAVATORY — WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ h TILE FLOOR TILE DADO - 6 FRAMING II 11 HEATING WOOD JOIST TIMBER BMS. & COLS. STEEL BMS. & COLS. 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EX/STI �/G PELoPp 9, 6/6 A�t/ODYE�P, /Yl,4SS,41////SETTS O/8/O I tA W 3 N L � R=z.�co /3� or:*Z6 /Z,"o.sF 1� -=a OF 7 Ac. 200,0.4.11 i ti r G'OmmOA/ S //EPEL3Y CE PT/FY TO TyE TITLE /.�/SUPO P ANO O T /cL /Y N TO TNEBAN.(' T.S�gT T//E OwELG/.tiG /S COCATEO O.</ Tf/E GOT AS/S,yairy A�vO T//AT/T OOES Ol/FOPiY! /N ,kY/Ts/ Tf/E / OLdN OF NO, 4A1AOKOIe 20111/,VG .PEGA,QD/NG SETBACA'S F-ZO ff ST-PEETS "r /'Ur>//EP CEPTiF �4T Tif/S O�rELL/�Y6 /S NOT f S LnG4TEo /N T.s'E %�L000 ffA2.4.P0 ,o.PEf►, o,P�i�r/V FO,P �.1//LG/�S CA/yJ/I�ON �E✓ELOP/y/�ivT -"`250098 GYJOSB Ca2P oma' JEFFR�, Ti%/S PLAN/ FO,� ��D�TGgGE' ?!/,POSES ' if/OT FD,P BO!/,vO,Py oETE,P�iugriov_ eo�,vo.yes� ir/Fo.P.y!- �E.P.P/iYl.9C.� �,�/GitiEE,P�!/G SE•P!�/lEs AT/O t/ TA �E.S/ FPO�Y! EX/STI �/G PELoPp 9, 6/6 A�t/ODYE�P, /Yl,4SS,41////SETTS O/8/O I FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments Navin have been obtained. 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