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HomeMy WebLinkAboutMiscellaneous - 20 MOUNT VERNON STREET 4/30/2018N iv � o O � O V Z O � o m o M z o 0 CD Z o co o � o m m 6A cA CJ T— c_ r19 ' J ppy O � ■ N m x m m x m m .O d CO2 Cl) CD n Z y r � � c CL CA CD o p CDCL cr o rF CCD O CCD 0o w a. C� CD CO) CD CLO CO) CD CO) O CD Z CD O � rF 0 CD je; 0'/ O CD O Itt �JJ r� V J n O z C 0 C G C y O C y= dp S m CO) = = t ®O m ccAn� m Z" o rt c 70 �,64— =Crn rr, CD o � �m m S > > m H ; m t0 0 O "� O O ZS.cag -' p LA C2 �t W ac m =r 151 a o C2 CL U2 o _? CD ZD HMEN CD cc CL .d-► H CO) C. G =r: Q' CL o CA m mcli V J C CA O O m mm � .dam H 3 �o O A O CD O z 0 C3 m :d CDSr Vl = m 'd CL 14 ^• r 1 dcC2 Vf CA o=' o c� CD. En ccn o � , " cn 9j 04 m Z 0x S a G CoOp;- cn FW;n .0 M CL a rA tz [D E� ° W x o �z n i O M C Date ...��.. �. �.G�.�........ TOWN OF NORTH ANDOVER p PERMIT FOR WIRING i This certifiesthatu-. �./.......: ............................................................. has permission to perform .:..:............ ............. ....� .. ...... . �....................... wiring in the building of ..............:................................................ at .,. .................................... .......... n............. .......... .North Andover; Mass. Fee ...................... Lic. No�� ..........7 ............. �� ... ..... ..... .. .. ELECTRICAL INSPE R Check # 6 3 to 8692 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. e C/ /011 Occupancy and Fee Checked [Rev. 1/07] np.nxiP hl�"Ll APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical CodeW(MEC),1 CMR 12.00 (PLEA SE PRINTWINKORTYPEALL�ORvMTION) Date:City or Town of: NORTH ANDOVER To the InspWires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) ) '0f4V0w7— t,�A�,4, Owner or Tenant P_ Owner's Owner's Address _0,41-L1 C . Telephone No. 22,62 P36 4 Is this permit in conjunctio with a building permit? Yes No P g �(� cL ❑ (Check Appropriate Boz) Purpose of Building •e,� Utility Authorization No. Existing Service c950 Amps /r?WVolts Overhead � Und rd g ❑ No. of Meters _ New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and. Ampacity Location and Nature of Proposed Electrical Work: 1�1";G_;ZWe C o No. of Recessed Luminaires No. of Luminaire Outlets C,omle ono the followin No. of Ceil: Susp. (Pad e) Fans No. of Hot Tubs table may be waived by the Inspector No. of Total Transformers KVA Generators KVA No. of Luminaires No. of Receptacle Outlets Swimming Pool Above ❑ in ❑ d, rnd. No. of Oil Burners o. o mergency Lighting Bette Units Fly ALARM SNo. of Zones No. of Switches No. of Ranges No. of Gas Burners No. of Air Cond. TonsTotal No..of Detection and Initiatin Devices No. of Alerting Devices No. of Waste Disposers No. of Dishwashers Heat Pump Number Tons KW _ Totals: "" Space/Area Heating KyV No. of Self Contained Detection/Alertin Devices Local ❑ Mumelial Connection_ El Other No. of Dryers No. of Water Heaters KW No. Hydromassage Bathtubs Heating Appliances KW No. of No. of Si s Ballasts No. of Motors Total HP Security Systems:* No.. of Devices or Equivalent Data Wiring: No. of Devices or Equivalent Telecommunications Wiring: No. of Devices or Equivalent OTHER: Wires. AAttach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: ®0Q_ (When required by municipal policy.) Work to Start: < 2�� 7 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE CO RAGE: 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 andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: Licensee: LIC. NO.: r,��/' f' � Signature (If applicable, enter "exempt " in the license number line.) LIC. NO.: ` (? Address: Bus. Tel. No.: *Per M.G. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Alt L cl. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signatur elow, I hereby waive this requirement. I am the (check one) ❑ owner ❑owner's agent Owner/Agent _ Signature Telephone No. 9-1�aJS-?® 713' PERMIT FEE: $ Z/ — 17 - 0 e� Se;�,e �� c c : www.nwsss.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers DD.licant Tnfnrn.nf;.... Nairie (Business/0r9mization/individual): Address: City/State/Zip:__ Ut�2 T / Phone #:. . - -?.3 % Are you an employer? Check the appropriate box: The Commonwealth of Massachusetts 111 >l '! ! Department of Industrial Accidents Office of Investigations have hired the sub -contractors 2.0 I am.a.sole proprietor or partner- °,f U 600 Washington Street These sub -contractors have Boston, MA 02111 c : www.nwsss.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers DD.licant Tnfnrn.nf;.... Nairie (Business/0r9mization/individual): Address: City/State/Zip:__ Ut�2 T / Phone #:. . - -?.3 % Are you an employer? Check the appropriate box: 1. ❑ i am a employer with 4. ❑ I Mn a general contractor and I employees (full and/or pail -time).* have hired the sub -contractors 2.0 I am.a.sole proprietor or partner- listed on the attached sheet. _ ship and have no employees These sub -contractors have working for mein' any capacity. [No workers' comp, insurance workers' comp. insurance. 5. ❑ We are a corporation and its dINuired.] officers have exercised their aim a homeowner doing all work right of exemption per MGL myself. [No -workers' comp. c. 1,52, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 4. ❑ Building addition 10.❑ Electrical repairs or additions 11 .7 Plumbing repairs or additions 12.❑ Roof repairs 13.❑.Other "'' ' siso nu out me section below showing their workers' compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hila outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheer showing the frame of the sub -contractors and their werk••s' comp. you infornation. 1 ant an employer that is providing:workers' compensation insurance for my. employees: Below is the information. policy and job site Insurance Company Name: Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip. Attach a copy of the workers' coatpensafion 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 pains and penalties of perjury that the information provided alcove is true and correct Signature: Date: Officiat 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- ,f, 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. 'iiowever the owner of a dweiling 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 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 .question's regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the numberlisted 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 i. . 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 ffidavit 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA €12111 Tel. # 617-727-4900 sxt 406 or 1-11.77-MASSAFE Fax # 617-727-774 Revised 5-26-05 www.mass.gov/dia Location l No. 31-l/ Date / 1-C2 q's p'6 Tq TOWN OF NORTH ANDOVER 9 1 Certificate of Occupancy $ 1 .wows. t. • MUs <� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # S� 18742 42 'Building Inspectvrr I .1 Property Historic District: Yes No 1.2 Assessors Map and Parcel Number: c)67-c)-<3053--o0o0.c0 Map Number Parcel Number _ Name (Print) Address for Service ZZ z— C7' 1.3 Zoning Information:. Zoning District PrUse Signatu Telephone 1.4 Property Dimensions: -7dd6 �© LA Area Frontage ft 1.6 BUILDING SETBACKS fit Front Yard Side Yard Rear Yard Required. Provide Required Provided Required Provided 0 - 30 1.7 Water S�rply M.G.I,.C. 34) 1.3. Zone Information: Public ❑ private , "t j,Zone Outside Flood Zane ❑ 1.8 Sewerage Disposal System Municipal ❑ On Site Disposal System ❑ ams-r<ivrn L - rxvrzm i rvrrf4zics w/AuT13VRI ED AGENT Historic District: Yes No 2.1 Owner of Record Name (Print) Address for Service ZZ z— C7' Signatu Telephone r vY� 2.2 er of Record: I s Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable rt Licensed Construction Supervisor. License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 00 rn X Z O rn z rn go O mn ic 0 ra rn rM z G) SECTION 4 - WORKERS COMPENSATION (M:G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will resultN, in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 4 • `�'�. Addition ❑ , Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify ' Brief Description of Proposed Work: e.uj c/ �St�ih1 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant (3FFiCIAL 4., `,1 USE ONLY ' ..s 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR FOR BUILDING PERT 7 PERMIT;- /APPLI I, ;- 244.) cr s �(` S17`C1�" , as Owner/Authorized Agent of subject property Hereby authorize "Cc. mow/ ct2i o to act on My behalf, " all matters r tive to work authorized by this building permit application. —Signature X Owner Date SECTI 7b OWNER/AUTHORIZED AGENT DECLARATION r J 4 ,�Sf7f C19- ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief � NGS Print Name Signature of er/A ent NO. OF STORIES Date SIZE 30Z SO Fr BASEMENT OR SLAB eYu SIZE OF FLOOR TIlvMERS 1 2ND DL 3RD -Z-1K1 O SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIIVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE I1 I �v 0.' w O O H �ruiLUom cc c O O c L y O cc ' r.+ O w v eav cc me Cc r o 0 Ea a 4m. c CD �L v S d Ce E5 o� H CR O G a:v 0 3 y � cm 0.3 c, c, m o �v -0 dJ W CO) mo lo LZ MOJ Q o c I-- S h • S � COD W .y D A r+ 1— H .aOS � .y ti .CL • p 'o t Saw m CD O U W r-� O v CD E CDO Z °D CL. O y Q� CD I C C O■— C Q A O O '� m m 0 CD LM CL Z O � O Q O m O a CQ cc c�vp ev .V J 'O CD c Z 03 0 CL C.3 y m C _R d CO2 Ck W ,,o vI y �C W W N AG °o w v cn o w o w :c U G w w°' '� w W a°' w w cn o J) .m cn 0.' w O O H �ruiLUom cc c O O c L y O cc ' r.+ O w v eav cc me Cc r o 0 Ea a 4m. c CD �L v S d Ce E5 o� H CR O G a:v 0 3 y � cm 0.3 c, c, m o �v -0 dJ W CO) mo lo LZ MOJ Q o c I-- S h • S � COD W .y D A r+ 1— H .aOS � .y ti .CL • p 'o t Saw m CD O U W r-� O v CD E CDO Z °D CL. O y Q� CD I C C O■— C Q A O O '� m m 0 CD LM CL Z O � O Q O m O a CQ cc c�vp ev .V J 'O CD c Z 03 0 CL C.3 y m C _R d CO2 Ck W ,,o vI y �C W W N , b(0RT- TOWN OF NORTH ANDOVER OFFICE OF 4 `* BUILDING DEPARTMENT 400 Osgood Street y`SP 4Yk0 2�,4 North Andover, Massachusetts 01845 Gerald A. Brown Inspector of Buildings HOMEOWNER LICENSE EXEMPTION Please Lnnt DATE: ,IOy -a Telephone (978) 688-9545 Fax (978)688-9542 JOB LOCATION:__ o;6 AfT 1/'�6w Number / Street Address Map/Lot HOMEOWNER_ .9.dz�s �C \5 - a 4' 0 �j X017 3� Name Home Phone Work Phone PRESENT MAILING ADDRESS cX /1/7 �t� O v iz � City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other Applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will c� ly with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption .4 �� Office Use Onty 044 C90mInDIIIUPalth of 013tt Uutts Permit No. Erpartment of Public 2TIttg Occupancy & Fee Checked �a IML BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 g0 geave 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) Date �� or Town of NORTH ANDOVER ' To the I spector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) e-915— Owner or Tenant ��iijc� r Owner's Address Is this permit in conjunction with a building permit: / Yes � No El (Check Appropriate Box) Purpose of Building �� PO �/J� /:6- -/Pp L b Utility Authorization No. Existing Service Amps _J Voits New Service Amps _I Voits Number of Feeders and Ampacity Location and Nature of Proposed I Overhead ❑ Undgrnd ❑ Overhead ❑ Undgrnd ❑ No. of Meters No. of Meters No. of Lighting Outlets I No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Abov ln- grnd. ;ZN1 gmd. ❑ I Generators KVA No. of Emergency Lighting No. of Receotacie Outlets No. of Cit Burners ( Battery Units No. of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Totai No. of Ran Ranges g No. of Air Cond. tons Initiating Devices Heat Total No. of Disposals No.of Total Pumps Tons 1CW No. of Sounding Devices No. Self Contained I No. of Dishwashers � Space/Area Heating KW ction/Sounding Devices Detection/Sounding Localj I Municipal r Other Connection I._. No. of Dryers I Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors 1 Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massacnuserts general Laws I have a current Liability Insurance Policy including Comoieted Ooerations Coverage or its substantial equivalent. YES = NO = ! have suomitted valid proof of same to the Office. YES = NO = If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specity) Estimated Value of Electrical Work $ 17eo �— Work to Start Inspection Date Recuested: Rough Signed under the P, nasties of perjury: Final (Expiration Date) FIRM NAME_. – Z --- LIC. NO. Licensee ti LIC. NO. Bus. Tel. No. j Address n� - `w Alt. Tet. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts GeneralLaws, a d that my signature on this permit application waives this requirement. Owne Agent (Please check one) Teleonone No. a PERMIT FEE S (Signatu a of ZTwner or Agent) x 5565 DEPARIIOI Of PUBLIC SAFELY } r CONSIRUCIION SUPERVISOR LICENSE Birthdate 1� Wber. Wires. 12/30/M3 f� p47061 12!30/1998 Restricted Io. 00 fRANCIS l SHEA r r 20 NI VERNON 51 '.'r� N ANDOVER . NA 01845 Date'r7/ .. zip TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �9SSACHUSEt ' t4l This certifies that .... ? ..... ., *✓'...... has permission for gas installation :-+�" t% ................. in the buildings of .... }% .. ....................... at North Andover, Mass. �v Fee .'' .. Lic. No..1�.... GAS INSPEOR Check # r � LL 62-46 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NORTH ANDOVER Mass. Date 11/28 Building Location 20 MT VERNON ST Owner Tel# 978 258 3099 - 978 475 4000 2007 Permit # Owner's Name FRANK SHEA Type of Occupancy RESIDENTIAL New W1 Renovation❑ Replacement Plan Submitted: Yet No[—] FIXTURES Installing Company Name Eastern Propane & Oil, Inc Address 131 Water Street Danvers, MA 01923 Business Telephone # 800-322-6628 Name of Licensed Plumber or Gas Fitter Scott CnhPn Check one: ZCorporation Partnership Firm/Co. INSURANCE COVERAGE: I have a cures liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ✓ I No ❑ If you have c ecked ries, please indicate the type coverage by checking the appropriate box. A liability insurance policy R✓ Other type of indemnity ❑ Bond ❑ Certificate 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: Owner, ❑ Agent ❑ ISignature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in abov knowledge and that all plumbing work and installations performed under the permit issued pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Generz By. Title City/Town APPROVED (OFFICE USE ONLY) pplidation apO que and accurate to the best of my thief aPpliOtioo will be in compliance with all Type of License: t/" U lumber Signature �f Licensed KmberZrGas Fitter &AGas fitter • -Master License Number ik 4199 • -Journeyman MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) C NORTH ANDOVER Mass. Date kuilding Location'VV Owners Name_ New 'Y Renovation D Replacement Plans Submitted D FIXTUgrc r f l _ _ _ — _ _ T _ _ _ Check one: Certificate le ----Corp. K Partner. Firm/Co. Business Telephone: Name of Licensed Plumber or Gas Fitter Insurance Covera e: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 21 Other type of indemnity Q 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 coverages. Signature of owner/agent of property Owner 17 Agent 11 I hcrcby certify that all of the details and information 1 have submitted (or entered) in above application are Ale and accurate to the best of my knowtcdge and that aa plumbing work and tnstxliations performed under Permit issued fo: this application wijtrbe in compliance with all pettla5nt provisions of the Massachusetts State Gas Code and Chapter 14: of the General Laws. d By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE: Plumber asfitter- aster Journeyman A gignatureo•• f Licensed Plumber License Number h L z =- o t- us d Q m 0 W H a W w Q°' ,, al' Q Wus y a __ 07 t— a y t4 o F- z. t f- z t. W F- w O O? IL y U W -4 Fo- 2 <, < t:t W > C < W O .-. 2 Q }. t► 0 4 < O o O = w 0:,. Q W N cc s o u. A c7 .1 V Q > C2 tl t— O SUR—BSNIT. I BASEMENT IST FLOOR / 2NO FLOOR 1 3RD FLOOR 4THFLOOR I 5TH FLOOR 6TH FLOOR TTK FLOOR 6TH FLOOR r f l _ _ _ — _ _ T _ _ _ Check one: Certificate le ----Corp. K Partner. Firm/Co. Business Telephone: Name of Licensed Plumber or Gas Fitter Insurance Covera e: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 21 Other type of indemnity Q 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 coverages. Signature of owner/agent of property Owner 17 Agent 11 I hcrcby certify that all of the details and information 1 have submitted (or entered) in above application are Ale and accurate to the best of my knowtcdge and that aa plumbing work and tnstxliations performed under Permit issued fo: this application wijtrbe in compliance with all pettla5nt provisions of the Massachusetts State Gas Code and Chapter 14: of the General Laws. d By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE: Plumber asfitter- aster Journeyman A gignatureo•• f Licensed Plumber License Number IIS 1� TO 2-15 8 This certifies that . . . . . . . . . . . has permission for gas installation .... in the buildings of * 2. at ... fjAJ. . 41 v Nor CU North A**n*d*o*ver, Ma'. Fee—F.5. . Lic. N OP8 1 ( GAS INSPECTOR W 4 WHITE: Applicant — CAARY: Building Dept. PINK: Treasurer GOLD: File., Date..�I. 4.. 4 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION Location ��0 J No. _ Datecr �, t M Q CA. C {�- zzz �` 2 f ��.,8213 TOWN OF NORTH ANDOVER Certificate of Occupancy $ "' Building/Frame Permit Fee $ Foundation Permit Fee $ _ o Other Permit Fe O6� $ z 1Qi N Sewer Connection Fee $ 0 Water Connection Fee $ o TOTAL 6&! Building Inspector Div. Public Works PERMIT NO. e m L- " -I, f+I, APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP iqO. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE ZONE SUB DIV. LOT NO.I LOCATION Q-0 )blr� aplxjo)j &l1 ee7- �/S RPOSE!l�BB D�F6 a)Er R&tse. &Rooyd-scuomn�ia(a,�eu OWNER'S NAME FgAP t4 SHEA -r J` h f`7 NO. OF STORIES SIZE WNER'S ADDRESS MT ✓P�NON _�ee7 _ BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME�I,��I -� I ` r�/1 j- J SPAN DISTANCE TO NEAREST BUILDING --- DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS -61STANCE FROM LOT LINES - SIDES PT REAR ]o OI�J GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS S BUILDING NEW pie SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND ILL BUILDING CONFORM TO REQUIREMENTS OF CODE �/® `7GJ C� IS BUILDING CONNECTED TO TOWN WATERY /.o C`. Qt3 .BEARD OF APPEALS ACTION. IF ANY f� IS BUILDING CONNECTED TO TOWN SEWER P Q `+✓IV 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 ANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR + DATED v Sl"ATURE OF WNER ORAUTHORIZED AGENT l J FEE,, G U PERMIT GRANTED . 19 0 13 3 PROPERTY INFORMATION LAND COST .Wf-BLDG. COST '3666 �gCJ EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM ISEPTIC PERMIT NO. 4 APPROVED BY OWNER TEL. # CONTR. TEL. # CONTR. LIC. # H.I.C. # BUILDING BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY- _ SiOkIES 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. f L CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH 3 I 2 13 PINE CONCRETE CONCRETE BL'K. BRICK OR STONE —{ HARDW D— PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL '/. 1/7 FIN. B'M'TAREA FIN. ATTIC AREA _ _ N_O B MT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B _ l 22 J 3 _ _ DROP SIDING CONCRETE EARTH WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING STUCCO ON MASONRY _ HARDY✓'D COMMCN ASPH. TILE STUCCO ON FRAME _ 11 BRICK ON MASONRY ATTIC STRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR J POOR _ ADEQUATE 1 NONE 5 ROOF 10 PLUMBING GABLE I I HIP BATH 13 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 I 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 NO. OF ROOMS GAS OIL B'M'T 2nd _ t.t 13rd ELECTRIC NO HEATING f L r ..- a Ti i CD. . �go a om M ZZZ w•�— "� .= :.._ �. ?CL�a .m -jo -- 10 o o� O d To Z-ccs j T y . C7 -. o G -L/ C13 0 CD Ott. T O O �. j m C r..... . Z C. FS C c o r O C C/)m m c7�' C 'Zj o. o C.� y c � 4� . OJ tinRD � o o, - rr .CL C-)Zo� EL CD a CD m CS C .-• . v, o C. Cf0 m ,cr d C) coo 0 o _ is al m CD co) O H 3 D Q v y DOCD m D CD CD _ � C O 10 CD CD CD �► : /.f m m J �i C7'• ti d O CSD C-) A r CD c o Cn Cn Cb y17 OC� S? p �O O ^' R w 7 G c O 0d,r dZ �• 4 C Cn x w n 0 � o c x Ht-' H y oft as f1p. On. 0 0 c JotumyWeLssmuffer T)ools The Safari I v INSTALLATION AND POOL CARE INSTRUCTION MANUAL Johnny Weissmuller Pools, Inc. 8600 River Road Delair, New Jersey 08110 IMPORTANT: GIVE THIS MANUAL TO THE HOME OWNER UPON COMPLETION OF INSTALLATION. T1811 -49A N Y -p �n O IL � lD l0 m m C.7 r i m ti W Me f' p O O O O O O S j W W z N Y -p �n O IL � lD l0 m m C.7 W W Me f' Z v- r j W W z � / d W !moi ['L W 0 �'O J o Z J a o 0 0 0 0 0 C-1 J O O On U-1 Ln un "-I d U' T l0 T un C" �. Ln W Z un r- O T r- n N t_n O O - I.a.. tn ~ o 3 ! u o o Qf W w 7 C=) N J Q i O O S S ! lJ'1 m r'�J cu r1./ ti C%i N LA.- W O ^ ►--r R C -. C2- O W O S 1--1 V1 C2- W = W r" --c c-) W O l!� 1 -M Z ]1 C2. d U W T IL O v 65 T f\ C.7 W Me Z Z v- r j W W �1 � / d W !moi ['L W 65 T f\ C.7 W Me v- r j W W �1 cr d W !moi ['L W v �'O J o Z WL... cn r -I C-1 cx C N cx C=3 �--� LAJ _ V .. OC �. --c C= W O O _ C= W Ln L m t_n O - I.a.. tn S o 65 T f\ v- r j W !moi ['L W v �'O O o Z WL... cn r -I C-1 cx N cx W w d _ V .. OC �. Q- W O S S Ln L m t_n O - tn o 3 u o Qf W w 7 C=) N J Q i 65 T f\ I' J O CL LLO w 0 Ln Ln a 1.-.1 Ix Ln W cx L.n I .1 LL 0 to cr J u C_J Ln �- U O Ll- lJ Z O Z W PU u, 4 CJ IZ LA- 1 X J m l.0 Z 0-- 1 I W w Z CD LLI cxCD LLJ CN J Z CL W 1--J 3 W O I \\ Sell . Ln �7 3 3 3 L 3 W P c2z m L" O W CiJ Z 1 1--1 P U Q w 0 ~ ! / / I . C=) FIGURE 13A 33 I .1 LL to cr Ln u C_J i O Ll- lJ O u, 4 CJ IZ LA- T Ln -j U m l.0 Z 0-- 1 O w Z CD LLI cxCD LLJ CN J Z CL W 1--J J J J Ln W O J J0-4 Ln a 3 3 3 v- C-) v~i CD J i O I O' J1 J —J J J LL O 3 3 L 3 W P c2z m L" O W CiJ Z 1 1--1 P U Q w 0 ~ ! / / I . C=) FIGURE 13A 33 I +i , Ln li-. F - z 0 z 57 J onv a• c Vtip` T T Ar.j. THP r 4-17F'IF A r,; WARNING: DO NOT EXCEED THE FOLLCt"JI,lG VALUES FG NOTE:U FASTEINERS : 1/4-20 S.S. FASTENER 75 (11N.LBS.) 3/8-16 S.S. FASTENERS 236 (IN.LBS.) 3/8-16 ALUMINUM FASTENERS 143 (IN.LBS.) C A U T 10 N : AFTER COMPLETION OF YOUR POOL. THE POOL MUST NEVE i BE DRAINED TO A CONDITION LESS THAN 1/2 FULL, OTHERWISE, DAMAGE THE STRUCTURE AND/OR LINER MAY RESULT. THE FILTRATION SYSTEM INSTALLATION INSTRUCTIONS ARE SUPPLIED WITH THE FILTER. IF A FILTER, OR ANY OTHER ELECTRICAL DEVICE IS ADDED TO THIS POOL, IT IS ...c RESPONSIBILITY OF THE PURCHASER TO TAKE ALL NECESSARY PRECAUTIONS AS SET FORTH IN THE NATIONAL ELECTRICAL CODE OR LOCAL ELECTRICAL CODES. FAILURE TO COMPLY WITH THIS REQUIREMENT MAY RESULT IN A DANGEROUS CR HAZARDOUS CONDITION AND WILL VOID THE WARRANTY. W A R NIN G :BY NATIONAL SWIMMING POOL INSTITUTE STANDARDS, TH�� POOL, EVEN IF SUPPLIED WITH A DEEP END, CONFORMS WITH N.S.P.I. STANDARDS FOR A TYPE 0, NON -DIVING POOL. DIVING OR JUMPING INTO THE POOL MAY CAUSE PERMANENT INJURY OR DEATH AND DOING SO IS SOLELY AT THE RISK OF THE POOL USER. POOL SIZE 15' 18' 21' 24' 24' HOPPER 27' 27' HOPPER PERATIONAL GALLONAGE CHART GALLONS POOL SIZE 4,600 12'x8' 6,700 12'x21' 91000 15'x24' 11,800 15'x30' 15,800 15'x30' HOPPER 15,000 18'x33' 20,280 18'x33' HOPPER 59 GALLONS 4,800 5,800 8,200 10,500 14,075 13,750 18,525 "As Klan 0 Land /n TH AND OVER, MASS. showing Built Foundation Location " Sco%:1 "=20' 28 Mt. Vernon St. Prepared For Fr c7n k Shea Date: December 17, 1993 Zoning District: R-4 Residence 4 District Note: Property Line Data Token From A Plan By Amherst Survey Associates, Inc. Doted April 7, 1983. In My Opinion, This Foundation /s Not /n A Flood Hazard Zone As Shown On The U. S.D.H. U0 Flood Hazard Boundary Mops. l Hereby Certify That The Foundation On This Property is Located As Shown On Plans And Complies With The Zoning Requirements Of The To f N o 'er, Mass. ''1 . F 1p Myrtle 1. Moyer � ...... 140.58' Area 0.32 AC 149058 S.F. 17.6' Existing o 52.9' o ----- ----- Concrete o Foundation o o Q; 1.. 17.6' Top Of Found. =132.26' 140.58' MT. VERNON (Private - *s' wide) STREET Location am -4 `1 No. � Date 9 9 ,.ORTp TOWN OF NORTH ANDOVER r Certificate of Occupancy $ A • �; Building/Frame Permit Fee $ 59S 3 0 �. 4 O� •eswws4 ; sAc„ S Foundation Permit Fee $ ---------- --� Other Permit Fee $ Sewer Connection Fee $ CM Water Connection Fee $Mr- _ TOTAL $ O / 7 Building Inspector i 9523 Div. 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Ul I I ' 4'0� N (m n•) ► I 6'8" Top of wndow and door rough openings 70 x� O O 0-0 CO A A C) n C) O co ;0 ---A o \ c- J.00, CORPORATIONo x ; � �" � ��WFRANK x rTl N x SHEA 0 o c) O o -n Z a®mac � a' ' P ��a 0 _ co WITH 6' 0" FARMERS PORCH r n � cl 8 00 o rn ' o C7 0 g� r- a Z t O C) d Z nCD ► m C o C O Z O z 00 0 (n Vc) N)Vmo�) O 21:' o vC o OO oN p5 CO -on D a o x D CO Z%,. rp < a; = mCD O � Z53 O n Q Z x r c� a S t� Ln OR. - o CDZ N 70 x� O O 0-0 CO A A C) n C) O co ;0 ---A o i g :> c- J.00, CORPORATIONo ; � �" � ��WFRANK SHEA 0 28 X 38 COLONIAL � a' ' P ��a 0 _ WITH 6' 0" FARMERS PORCH � i g .. ■ o=co s �^ U ai a U916 o 19 1NOUVWdd00 H080d S�AVJI\,�0�9 H1M ]VIN0100 82 X 8Z V3HS ANV�J",,o 00,r U,i to 1' .. 105 , 2-1 O U, O � O `— - - — x ® N O G1 x - � N -- uO LL 0 E N O co E 00 a o- v 0 m to Con t, (V CU O p z co Z � a O x a ca N p O_ L C° x N (U E II x y y = o Q \ aEi I E m a \ E v m N 0 0 0 m .s� o OM i— N s O D co N I s Q x o 6, Z5 m aad J x r I Dc� a� O y F x\ 0 - CDbx o 0 C 7W, (D C-) N N xx Z 0 rn O szsM 0 x - i x x p 0 —• I N 41 0 14- 0 77 \ 0 U X, D O a - O� N W ; fD x > OD b• a - p .--. p a D 0 O W O Q Z I I x\ s O N N p Ln N CSD N d x x �_ m! x ? 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CORPORATION D 0 �� FRANK SHEA ocn 28 X 38 COLONIAL cr ��`n0 ; 00 WITH 60- FARMERS PORCH o = co a Als 31 VI'd ON108vog � 300 a C�/ anis 03sn A 31 V1 d ONInnj ON Ili 3) jo NOIJV)ol /83liva , \ s � �313b� - � d� s� 830 V3H P8noa Q1 A*C jl� ` I anis ' � �3WW I al T3 ignoo olxr 4.1SOd 83N803 d3lJVd dMdOa 4 Location �%ifefioZ �Jf. �b ae� 37 Zo Zo No. { Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ -7 /,..1 Other Perrbit e, $ 'kSewer Connection Fee $ ill Water Connection Fee $ i.� .�� WD ll�.7 0 TOTAL $ wilding Inspeptor Di /PubYc Works 1%Pcation 'No. �rY 2 Date .!/-/9'93 .a r1ORTOWN OF NORTH ANDOVER L r Of �r.o •�1'% O . oA Certificate of Occupancy $ d'5 •yy } : Building/Frame Permit Fee $ ,SSACMUSFoundation Permit Fee $ 1,2 0 Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ c ,q TOTAL $ f v U / 3 BuildingInspector P I +y�16:07 0.00 PAID 6�1 Div. Public Works Location 2ll���/rrn�/�%I No. Date "ORT" TOWN OF NORTH ANDOVER O Certificate of Occupancy $ L ; Building/Frame Permit Fee $ c►,usEt Foundation Permit Fee Other Permit Fee $ Sewer Connection Fee Water Connection Fee TOTAL Mt1l /i Building Inspector (1 0 12/24/93 16.16 849.00 p41D -686 �a ! ti 6 8 6 9 Div. Public Works PO o n o 0 m H Oil Gd :E, �.j r o zo d� Cl)"n d� M 20 H v� O yz �vl0 BIW z 0 PO o n o v as CD 0 m -I Gd :E, �.j r o zo c� Cl)"n M 20 o n yz o z 0 0 o r� � y o � W r Ln z W y c� Po � o oLo � z � d r� v as CD 0 m -I F' :. :E, �.j Mm o Cl)"n M 20 o n o z 0 ..... .� ra�6,at.asa in. �:1:LL'll!'e..��K63.i1..✓W.a.sS..J..: L.Y'1..L:iw�b :fir .'\ W 1 3 m D m � z z C� C z cn m -,kj 7 _ 'ss, I y T � CD T r- �� 0 CCD O M C D a m CO. z o CO)Do ` CCD m C-) A6 D _s O CD O y n' O y CD O �F CD CD CO) CD CO) 0 0 CCD O W s: 3b 5 s `D N 0 C CR a c•?.00 d =_ CA O CCA a c CD 10 to �.0C ® v H � a Cy .df�S CO cc.* T W awn o m CD CO) o y o� co, C 0 C') 0 O H C7 W =r H" ft a =r CO CD H O C9 4 a CD ilk �1 y a� �• d CCD W H �C OCD co CD ca o 0cl) OR zo 0 CD v o C-) � o a; � CD CD w� - =w w CD v MMI C/) cn I'Dn eb -rD s Z rr1 w CT7 CD a- Crr7 G r p� G C w d p a cn y Q0`� V J 1 i � 1 �;: z x owl 0 0 c / FORK U - IAT RELEASE FOME INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Depa*'tmemts 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. ****************Applicant fills out this section***************** APPLICANT: �Z9�U/� "F 0&,? Phone SOP 6 *3 ?S el LOCATION: Assessor's Map Number &Y7 Parcel / S Subdivision eUTA Lot (s) 2S- 3 (p -3 Street AOA --T �fC2.t vt! �S ce�� St. Number , ************************Official use Only************************ RECOMMMMA N OF TOWN AGENTS: Conserv- Date Approveda Zon Administrator Date Rejected Comments Comments Data Approved Data Rejected Date Approved Health Agent Date Rejected Comments Public Works - sewer/water connectio nz - driveway pe=it Fire Department �f7�' Received by Building Inspector Date x!1$19 ' r 7 e ° 1 • . t In .... as .h t .45 +•t eh .,. ti• a � I n 0 t APPLICATION FOR PERMIT TO BUILD - NORTH . ANDOVER, MASS. 115�l `fw �/�� �� WAGE 1 /Ad.40 ��p1�0 LOT NO. _ ZONE I SUB DIV. LOT NO. LOCATION ��•''` b ,� 2 RECORD OF OWNERSHIP iDATE IBOOK 'PAGE f % _ 0 PURPOSE OF BUILDING OWNER'S NAME Vis) •� MD r� NO. OF STORIES SIZE 7 OWNER'S ADDRE(SSa�vh BASEMENT OR SLAB ARCHITECT'S NAME S / � �fiQq_r�,./� C4 SIZE OF FLOOR TIMBERS 1STaJlo 2ND 9 �A 3RD 1� //�, �G V BUILDER'S NAME s y�vja SPAN t k DISTANCE TO NEAREST BUILDING % DIMENSIONS CfF SILLS _ ix� r' DISTANCE FROM STREET sJ� • �( --- POSTS ' F4 DISTANCE FROM LOT LINES -SIDES /P/ `1 Jp- ,V REAR 1 J / GIRDERS AREA OF LOT /I aspg. FRONTAGE 1L�J� /"' I7V HEIGHT OF FOUNDATION THICKNESS O • IS BUILDING NEW yle �! r F�JQ SIZE OF FOOTING -` �j X )1 IS BUILDING ADDITION MATERIAL OF CHIMNEY •� IS BUILDING ALTERATION 000 IS BUILDING ON SOLID OR FILLED LAND • . WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 1 p y�J IS BUILDING CONNECTED TO TOWN WATER Yes. Y BOARD OF APPEALS ACTION. IF ANY i /�/1 IS BUILDING CONNECTED TO TOWN SEWER Q"¢ !e+ 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 rR %PMWff 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 FILED j SIGNATURE OFOWN OR AUTHORIZED 4 NT - 3 FEE A U G� OWNER TEL. PERMIT GRANTED CONTR. TEL. CONTR. LIC. # 3 PROPERTY INFORMATION 'LAND COST ' • '-.> '� , EST. BLDG. COST /7l / 1 EST. BLDG. COST P R SQ. FT 1"'7 • y0 EST. BLDG. COST PER ROOM �Y! SEPTIC PERMIT NO. ` ��/, 4 'APPROVED BY 'v �3 BOARD OF HEALTH PLANNING BOARD F - BOARD OF SELECTMEN a NUILDING INSPECTOR 1-7` 6 ` ,OCCU.PANCY SINGLE FAMILY '0 RIES. MULTI. FAMILY _ 'OFFICES _ APARTMENTS CONSTRUCTION 2 IFCUNDATION _ 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D' _ PIERS PLASTER _ DRY WALL UNFIN. ` 3 BASEMENT AREA FULL FI�. B'M'T' AREA«B'M'T' 1/1 1/2 1/1 fll�. ATTIC AREA ` NO B M FIRE4,ACES T HEAD ROOM _ 'MODERN KITCHEN Ix 4 WALLS I 9" FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDIU D _ ASBESTOS SIDING _ COMMCN VERT. SIDING WH TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. S FLOOR BRICK ON FRAME CONC.'OR CINDER $LK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIORPOOR _ ADEQUATE NONE 5 ROOF 11 10 PLUMBING GABLE I HIP BATH 3 FIX. GAMBREL MANSARD TOILET RM. (2TOILET RM. (2 FIX) FLAT I SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK / SLATE NO PLUMBING _ TAR A GRAVEL STALL SHOWER X 66 FRAMING HEATING 11 HEATING WOOD JOIST PIPELESS FURNACE r FORCED HOT AIR FUF TIMBER BMS. 6 COLS. STEAM STEEL BMS. 6 COLS. HOT W'T'R OR VAPO WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS GAS 7 NO. OF ROOMS OIL B'M'T 2nd 1stt 3rd ELECTRIC NO HEATING S BUILQING RECORD: -""-L,' 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA - ETC. SUPERIMPOSED. THIS REPLACES PLOT,PLAN. • to - .. . t e F, 4 r e F,