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HomeMy WebLinkAboutMiscellaneous - 24 COLGATE DRIVE 4/30/2018Date .......6.. 4.Ir TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION his certifies that .Q... ...................................... has permission for gas installation 40 ... ; ..... ...... 0 .— 0.we,,,.ov. t inthe buildiqgs o ....................................................................................... .. . .. ........ ...... b. . . . ................... North Andaver, Mass. Fee ....................... Lic. No. ............. e ........... ..... Check# 10" � i 11 � YX", MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE PERMIT# -G JOBSITEADDRESS --OWNERSNAMEJ . OWNER ADDRESS FAX.- TYPE OR PRINT O.CCUPANCYTYPE COMMERCIAL]. EDUCATIONAL RESIDENTIAL„ ;d . CLEARLY Nom.© -[--] RENOVA71 O-N:E1 REPLAcEmENT.- PLANS SUBMITTED: YES® NOE] APPLIANCES I FLOORS- BSM 1 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE: FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER - LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM /.SPACE HEATER ROOF TOP UNIT TES--T UNIT HEATER LINVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE have a current IlablI41 insurance Policy or its substantial equivalent which meets the requirements of MG . L Ch. 142 YES @NO E] I IF YOU CHECKM YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHEMNG THE APPROPRIATE BOX BELOW LIABILITY INSURANCEPOLICY OTHER TYPE INDEMN'rTy E] BOND OWNER'S INSURANCE WAIVER:-1 am aware that the licensee does not have the Insurance coverage requ ired by Chapter 142 of the Massachusetts General laws, and that my signature on this permit application waives this requirement SIGNATURE OP OWNER OR AGENT CHECK ONE ONLY: OWNER 0 AGENT I hereby certify that an of the detaft and information I have submitted or entered regarding this application ar-e true and accurate tD the best -- Of my knowledge and that all plumbing work and lbstallations-perlbanad under the Permit issued for this application will be in ODMP"Wfth an P provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Lam. PLUMBER-GASFITTER NAME LICENSE SIGNATURE MID LE MGF Ej JP [] JGFE] LPG.I CORPORATION [A# PARTNERSHIP [j#= LLC []# COMPANY NAME���_ V��,�s - ADDRESS CITY{—STATE ZIP ]TELJ_ YX", Location : 6, & G ,,- A2e- i No. :Z1- q ` // Date Check # 2 ? 2 7 24 , �-- 4 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL ";, 101 Building Inspector BUILDING -PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 7- Date Received Date Issued: r IMPORTANT Applicant must complete all items on this DESCRIPTION OF WORK TO BE PREFORMED. rr mow, CAt's Lo- 0,- mv. v 30IA_s ntification P ase Type or Print Clearly) OWNER: Name: U 4,5 9V Phnna -3%S D �� ARCHITECT/ENGINEER ' Address: FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE Total Project Cost: $ ' Check No.: NOTE: Persons contracting w' unr e contri Phone: IReg. No. ESTIMATED COST BASED ON $125.00 PER S.F. FEE: $ 1091!t4 _Receipt No.:/cT rs do not have access to aranty fund I D O b a X �¢tuv O Chi U b u 0 W A "aa+or. ai b .0 c in0 0 a a in wa°' U a v W u cR w W: eo a°' M w A GWS ra V)cn v 44. 6 0 O O ai • L O Z o. O ca D E I � G ca 'O y O O co m CL ~ =•+ 0 CDL m o a CL vM a Ca o -Wc cc � c v ca c Z � V y O c c C _cc CL .y O W W It W uj lz LUW ww ,, Y/ c c t5 o ` C y O C 'r O CJ U C C ea cc C y y � EQ CO o co <\. o a y C c o 0 �cmme E ..Cam m .mm a H a 3 Of m y cm Co O c O v .W y wpm :+ m � m _ 0 cm y :.dCt m ` O O .L \ CJ H O CJ Z G ' r cc cm H m - h m C �C Q � CD �t 3 0 H O W0O LL.•N �E � y o LU c'S n o CO3 co o� � y •� J O 2 ami 44. 6 0 O O ai • L O Z o. O ca D E I � G ca 'O y O O co m CL ~ =•+ 0 CDL m o a CL vM a Ca o -Wc cc � c v ca c Z � V y O c c C _cc CL .y O W W It W uj lz LUW ww ,, Y/ Workers' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia sensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (BusinessIOrganization/Individual): Address: - -33 Ci /State/Zi ` `E'- `v�� S S Are you n employer? Check the appropriate box: Phone #: 1. a employer with 5— _4. F1I am a general contractor and I employees (full and/or part-time). * have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' compo insurance required.] ❑ I am a homeowner doing all work myself. [No workers' compo insurance required.] or I have hired the contractor listed on the attached compo insurance, t 5. We area corporation and its officers have exercised their right of exemption per MGL e. 152, § 1(4), and we have no employees. [No workers' Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. oofrepairs 13.DOther sheet compo insurance required. i * Any applicant that checks box #1 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. iContractors 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' compo 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: 4, ��!% eww (--�J Policy # or Self -ins. Lie: / (J i— �C% G' Expiration Date: 440� Job Site Address:d City/State/Zip: AIN e4AZ V 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 certifYu der thepains and penalties ofperjury that the information provided above is true and correct. Signatu Date: Phone: lias.sacbusetts - Department of Public Safcn Board of Building Regulations and Standards Construction Supervisor Specially license License: CS SL 9959 Restricted to: RF ERIC TEEL 33 HAMMOND STREET ROWLEY, MA 01969 ,.,f� .Expiration: B►Z3t20'11 ('..mm6,At-3n0r Tr#: am i Oboe of '"'ons=er amain and usiness Regulation t�- 10 plank Pi g. suite. 5170 Boston,1 ss uSe s 0211 Home ReQistration: 16W52 Type: DBA &xpi—flon: 413/2012 Tr4 293914 ERIC A TEES ERIC TEFL PO O?; ERIC A. TEEL ROOFING Commercial and Residential • Fully Insured 978-479-7420 A Yl d lei ROOFING ESTIMATE ESTIMATE SUBMITTED TO:JOB t' " � IL NAME JOB # j� ADDRESS JOB LOCATION n I, CITY/STATE/zIPr 'Ve ` DATE ,f , �� PHONE # d FAX # CELL 'WE HEREBY AGREE TO SUPPLY THE MATERIALS AND LABOR AS SPECIFIED IN THE MARKED BOXES BELOW... NOTE: ONLY THE MARKED BOXES / PERTAIN TO YOUR ESTIMATE. WE AGREE TO: 1. COMPLETELY STRIP THE ENTIRE OF THE EXISTING LAYERS OF SHINGLES. ❑ 2. INSTALL A NEW LAYER OF EXISTING ONE LAYER OF SHINGLES ON ❑ 3. INSTALL A NEW RUBBER ROOF(S), USING ALL NEW RUBBER ROOFING MATERIALS ON THE ROOF(S) SHINGLES OVER THE ROOFS. INSTALL NEW ICE & WATER SHIELD ON ROOF(Sk ROOFS EDGE, RAKES, VALLEYS, DORMERS, SKYLIGHTS, CHIMNEYS, & FLAT ROOF AREAS. INSTALL NEW LB. ASPHALT FELT ROOFING PAPER ON THE ENTIRE ROOF OF THE C 6. ' INSTALL NEW 81NCH ALUMINUM DRIP EDGE ON THE ETI4RI s COULD OCCUR BEYOND OUR CONTROL... NOTE: (IF) MORE LAYERS OF ROOFING MATERIALS ARE FOUND THAN INDICATED ABOVE, AN EXTRA CHARGE WILL BE ADDED FOR THE (LABOR & THE REMOVAL OF DEBRIS) OVER AND ABOVE THE PRICE OF THE ESTIMATE We propose hereby to furnish material and labor — complete in accordance with the above $ / C with payments to be made as follows: Any alteration or deviation from the above specifications involving extra costs Respectfully will be executed only upon written order, and will become an extra charge over submitted and above the estimate. All agreements contingent upon strikes, accidents, or delays beyond our control. Note — this prop may b� dehd Mcceptance of Propooai The above prices, specifications and conditions are satisfactory and are hereby Signature accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance 6cations for the sum of: Dollars by useaccepted ,frhiri� _days a ©�PER'17`[T NO, APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP NO. I LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK !PAGE ZONE SUB DIV. LOT NO. � LOCATION 'a% PURPOSE OF BUILDING p ` u co n o o OWNER'S NAME n ^ NO. OF STORIES SIZE OWNER'S ADDRESS L` BIS 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 MATER:AL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METERS 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 SIGNATURE OF WNER OR FEE PERMIT GRANTED 19 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST d EST. BLDG. COST PER SQ. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTM j summima INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY SiOR1ES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR d PINE HARDW D PLASTER DRY WALL UNFIN. FINISH 1 2 13 CONCRETE CONCRETE BL'K. BRICK OR STONE PIERS 3 BASEMENT AREA FULL FIN. B'M'T' AREA FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B _ 1 2 �_ 3 _ _ DROP SIDING CONCRETE EARTH WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ HARDV!l D COMMON 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- I POOR ADEQUATE 1 NONE 5 ROOF 10 PLUMBING GABLE GAMBREL FLAT HIP BATH (3BATH PIXY MANSARD TOILET RM. 12 FIX.) 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. & COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ 1st 13rd I 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. + _ WOOD STOVE INSTALLATION CHECKLIST pMMZT NO: �- J 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 t { S' Circulating i C. Manufacturer, 110 Aj ,1— C/1 5 f G Lab. No. Name/Model No. 09 61 A 87- 9n Collar size Dimensionsi Height ength r / 5 -IR- —Widthal Chimney A. New J12 S�� Existing ' B. Size (flue area) . if C. Otherappliances attached to flue (Number and flue size) NO A L . D. Prefab (Manufacturer—name and type) E. Masonry/Lined 'fes s Flue liner Unlined (type & manufacturer) F. Height (refer to diagrams) cap OVER lot 2;vtIN1 3, MIK o CHIMNEY HEIGHT Hearth (non-combustible) A. Materials C B. Sub -floor construction C. Minimum dimensions (referto diagram) Clearances and Wall Protection (see stove installation clearances chart) A. Type of wall protection provided 13 Q B. Clearances (refer to diagrams)---� FIREPLACE CORNER 12'( MIN. I2" ,MIN. 1 [n MIN. .Qcc�sS yl HEARTH WALL/CENTER 13 I r `• cap factory -built chimney C i roof support 1 support bracket B connector pipe non-combustible wall protection A _ connector overlap A A u 'i i woodburning stove ,ry � non-combustible floor protection „y 12" 1'/2" • 12". Figure 2109.4 Figure 2109.4 STOVE INSTALLATION CLEARANCES Combustible 1/2 "Asbestos Millbo?rq Concrete: Masonry Spaced Out 1 " Stove Components Material Spaced Out 1 '. 2. Foundation Wall 4" Brick Veneer Radiant Stove(1. -Front 36" — — - Circuiating Stove6l.) 24" - — - -rront A. Radiant Stove 3. 36.. 18" 6" 18" —Side! 3ackiTop A. Circulating Stove 12„ 6" 6" 6 —Side! 3acki Too B. Single Wall 64. 18., 12" 6., $ Connector Pipe B. Insulated 2" 2„ 2 2" Connector Pipe C. Chimney Heignt Three (3) feet above adjacent roof and (Metal or Masonry) two (2) feet above any roof ridge within 10 feet. 0. Oamper If a damper is not included in the stove construction, it m.ust.be installed.in the connector pipe. 1. Front. Fuel or ash access side. 2. Non-comoustible spacers required. '3. Clearances on each side of a radiant stove with a heat shield shall be measured as if a circulating type. Note: Clearances shall be measured perpendicular to stove body. Laboratory verified test clearances permitted. 4. Thimble required for passage through combustible construction. - 1.2 ; f ,, f F Location_�- No., Z Date 1 -2e --z ' y� 0 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $_ Water Connection Fee $ TOTAL A/ :Building Inspector 01/30/96 16:46 45.50 PAID 9536 Div. Public Works PERMIT NO. -o Z5 f APPLICATION FOR PERMIT TO BUILD - NORTH AND12 OVER, MASS. '/ i v PAGE 1 MAP KBO. 091 LOT NO I 2 RECORD OF OWNERSHIP (DATE BOOK, "PAGE ZONE SUB DIV. LOT NO. I LOCATION PURPOSE OF BUILDING k. OWNER'S NAME l NO. OF STORIES SIZE OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3R6 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 i IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER { BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 INSTRUCTIONS r 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 OF OWNER OR AUTHORIZED AGENT FEE PERMIT GRANTED 19�_ 36- 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST7,0 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSP[CTOI! OWNER TEL. # (� CONTR. TEL. # CONTR. LIC. # J-1 L H.I.C.# 1033 17' BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE PINE a I 2 I3 CONCRETE BL K. BRICK OR STONE HARDW D PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ 1/1 1/1 °/. FIN. ATTIC AREA _ N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WAILS I 9 FLOORS CLAPBOARDS DROP SIDING WOOD SHINGLES B _ 1 2 3 �_ _ _ CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING HARDW D COMMON VERT. SIDING _ 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 I POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) GAMBRELMANSARD A TOILET RM. 12 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. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL ELECTRIC B'M'T 2nd _ to 13rd 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. R H .a o v CO c ° u a 0. U � O Z4 ca cn v� ccO % Z —twwto� w ..ate w :ac w Q G csa z �n q cn LLJ 0CL z W O E L 0 o v Z o O y D C� CIO ©� CO —i Mco E m m i O GC co C >., CO coCL L �Q V2 O � O• CJ J �O. O ." C Z cC2 0� V y CI !d CO) I o CO :�ci oma C N O ` ccO U L) ..ate :ac CZ o • �CD CO) :Ea �m ,.. co CL y C CO m E :mm a y w.+ y m y C co 9 L C CO) y ec C O _ m E y r.L m : m y m m o C= cm :rm r CO2 ac= � � m cS m Z o` cc :coo cs c m C �C S A p N am m CIO rm+ y m .2H L m C r •Vf CD Z W V W C m C4 a _ m C C42 cc C� . �.� as m W O E L 0 o v Z o O y D C� CIO ©� CO —i Mco E m m i O GC co C >., CO coCL L �Q V2 O � O• CJ J �O. O ." C Z cC2 0� V y CI !d CO) I Ldcation No. Date et "O�T�. TOWN OF NORTH ANDOVER Certificate of Occupancy $ • # Building/Frame Permit Fee $ �6. s411,� Foundation Permit Fee $ CHU Other Permit Fee $ Sewer Connection Fee $ REC4W0&a 'dM&t Fee $ AU�Tg`8 199x_ $ No. Andover Collector Building Inspector Div. Public Works PE&Alm NO, . v APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP d40. LOT NO. 2 RECORD OF OWNERSHIP JDATE BOOK `PAGE -NE p- SUB DIV. LOT NO. I —I LOCATION r1 j�/ eOL�' �rL� PURPOSE OIr4HM4tl0MfG r 6 f O�YI/NER'S NAME A L yj t' 2 ,T !vc/ NO. OF STORIES SIZE OWNER'S ADDRESS �� BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD /r Of3UILDER'S NAME /� � yl /Z / SPAN DISTANCE TO NEAREST BUILDING / �� --- DIMENSIONS OF SILLS DISTANCE FROM STREET ISD STANCE FROM LOT LINES — SIDES r1 REAR , 1 d M� -- — POSTS I GIRDERS I AREA OF LOT t� G� �, FRONTAGE O� HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY AS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND 2—N ILL BUILDING CONFORM TO REQUIREMENTS OF CODE i/Jf' 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 I 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 FILED SI NATURE OF OWNER OR AUTHORIZED AGENT F E E ,50 PERMIT GRANTED OWNER TEL. # CONTR. TEL. #- 19 CONTR. LIC. # 3 PROPERTY INFORMATION LAND COST oe EST. BLDG. COST 9161 GG EST. BLDG. COST PER SO FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4,. APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN - w�w�nr �Aa!-6fr1VK I OCCUPANCY SINGLE FAMILY Si OPIES _ MULTI. FAMILY OFFICES _ APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _ 3 2 13 CONCRETE BL K* —{ PINE BRICK OR STONE H — _ — — PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ 1/. 1/7 1/1 FIN. ATTIC AREA _ NO B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS JB 1 22 J 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING — HARD\J — ASBESTOS SIDING COMLACN VERT. SIDING STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME CONC. OR CINDER BLK. WIRING 5 ROOF II 10 PLUMBING GABLE I HIP GAMBRELMANSARD FLAT I SHED BATH 13 FIX.) TOILET RM. (2 FIX.) WATER CLOSET _ _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK STEAM SLATE STEEL BMS. & COLS. NO PLUMBING _ TAR & GRAVEL WOOD RAFTERS STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ BUILDING RECORD 12 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. 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE TIMBER BMS. & COLS. FORCED HOT AIR FURN. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ Ist 13rd I ELECTRIC NO HEATING s s I N IV i Ye 1 11 � I � .-" I I 1% kvi -?Vll NCT A i;.Iqn F,73M ?mrl'a7'nA QUOM'd It$ -'AR, LC T I N IV i Ye 1 11 � I � .-" I I 1% kvi -?Vll NCT A i;.Iqn F,73M ?mrl'a7'nA QUOM'd It$ -'AR, 't -v" vttllutl4l. aNl uo f"!E C4 r,- lK r es; 01) On 4 7:r 0, 1 1v u;; 1 "4 0 t3iAI TA q'M pft'.;rV' r v 4%"A Q,- TK= v;4 Z LY, t it '2- �v Af ' I D MT� ed �i L PI u A N C, L S, LL"a fATE -D e 'TIO BF 'G, FO; I T (i A,�� E: z F 3 f t Y 4j7 1% kvi -?Vll NCT A i;.Iqn F,73M ?mrl'a7'nA QUOM'd It$ -'AR, 't -v" vttllutl4l. aNl uo f"!E C4 r,- lK r es; On 4 7:r 0, 1 1v u;; 1 "4 0 t3iAI TA q'M pft'.;rV' r v 4%"A Q,- TK= v;4 Z LY, t it '2- �v Af ' I D MT� ed �i L PI u A N C, L S, LL"a fATE -D e 'TIO BF 'G, FO; I T (i A,�� E: z F 3 f t Y 4j7 r� LSC a-' m w IL LU am L.L a .z V Z E :.J Lf) W J M .CC yr CI D, ori-. .c CL .� W O �I � � W W W O _ Z v d Z Z W d c O Z ZLu Q Z CID cc L C L J L V L m Y E c °' �' c W` c0 o c I C U LL cc LL cc co LL Q LL m CO) LU am L.L a .z V Z E :.J Lf) W J M .CC yr CI D, ori-. .c CL .� W