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HomeMy WebLinkAboutMiscellaneous - 247 BRIDGES LANE 4/30/2018Date � �.14 ............... TOWN OF NORTH ANDOVER PERMIT FOR WIRING /DP, -A - This certifies that\jA....LCt..5.� ... ... ........ . ... .... has permission to perform .... 1 . ......................................................... wiring in the building of . ...................................................................... ........ at .2-4!x..... ....... 5!!�Jy.s ....... L.....rA.k ......................... North Andover, Mass. Fee ..... ....... 3.5 . 7 ......... Lic. N ECI .-C 4CALTIG;��Oif Check # (,ccoarrewo of c/1//auca�c�ueef�a Offi,ciallUUse Only .,C) �uviers Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 527 12.00 (PLEASE PRINT RV IlVK OR TYPE ALL BVFORMATIOA9 Date: - [ 24/117 City or Town of: I, oiz . A %2scw e.R .. To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Q%%'% 43 R -Am Qs - Owner or Tenant fZe cticz F Telephone NoA $.Qy L - 9 -7 Owner's Address Same as ve Is this permit in conjunction with a building permit? Yes ❑ No . Q (Check Appropriate Bog) Purpose of Building Dwelling Utility Authorization No. Existing Service Amps / its Overhead ❑ Undgrd ❑ New Service Amps / olts . Overhead ❑ Undgrd ❑ Number of Feeders and Ampacky Location and Nature of Proposed Electrical Work: No. of Meters No. of Meters ho wniVAd hV t6 IMSMC1Or Of mires. No. of Recessed Luminaires ddle No. of CeiL-Sgyp• .( �) Fans TOM T o. of Transformers K KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires In Swimming Pool Abodve ❑ -grad, ❑Butte o. o me Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. oeng D and InitiatiDevices.- No. of Ranges. No. of Air Cond. Tom No. of Alerting Devices No. of Waste Disposers eat p Tom• um r Tons o. ofSelf-Contained Detection/Ale Devices No. of Dishwashers 1 Space/Area Heating KW focal ❑ Connection ❑Other No.. of Dryers Heating Appliances KW.Sec" s: Na of ices or Eguivalent No. of Water , Heaters. o. of No. of S• Data Wiring: No. of Devices or uivalent No. Hydromassage Bathtubs No. of Motors Total HP W. Te No. of Devicesso orr ommnmcotE nival �r� Naleat OTHER _;-4 .. nc r iwil by thv Inmentor of wires. Estimated Value of Electrical Work: $650.00 (When required by municipal policy) Work to Start -1 2 `4 fl 4 Inspections to be requested m 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. Cf1ECK On' INSURANCE ❑] BOND ❑ OTHER ❑ (Specify:) I �fy, under the pains and penalties of erjuty, that the mformadon on dds application is true and cwmplete FIRM NAME: Northeast Electrical Services INC. LIC. NO.: 20782A Licensee: Daniel B. Kobus Signature C. NO.: (7fapp�M, enter ..mom., in the license mmi er line.) ABCTel. No.. 508-966-7467 Address: 40 N Main Street. P O Box 361 Bellingham MA 02019 Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License. Lic. No. OWNER'S.INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law.. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owder/Agent Telephone No. PERMT FEE: $ Signafare . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 Pr�rtt Forrn , `f www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Northeast Electrical Services Address:40 N. Main Street, P.0 Box 361 /State/Zip: Bellingham, MA 02019 Phone #:508-966-7467 x307 Are you an employer:' Check the appropriate box: ❑✓ I am a employer with 24 4. 0 I am a general contractor and I employees (full and/or part-time).* . 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] T have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.= 5. ❑✓ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑✓ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑✓ Electrical repairs or additions 1 l.❑ Plumbing repairs or additions 12. ❑ Roof repairs 11 ❑ Other "Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. ' Homeowners who submit this 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 state whether or not those entities have employees. If the sub -contractors have employees; they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Automatic Data Processing Insurance Agency, Inc. Policy # or Self -ins. Lic. #:NOW428117 Expiration Date:7/29/14 Job Site Address: L 0 ?jU= Ln City/State/Zip:No • � jIyv t l� 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 1-ne up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine If 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 above is true and correct T 7467 x 307 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector 6. Other Contact Person: _ Phone #: PC% AMERICAN CLAIMS SERVICE SMULTI-LINE ADJUSTERS BUILDING COMMISSIONER OR INSPECTOR OF BUILDINGS 1600 Osgood Street North Andover, MA 01845 RE: INSURED: PROPERTY ADDRESS: POLICY NUMBER: LOSS OF: FILE/CLAIM NUMBER BOARD OF HEALTH OR BOARD OF SELECTMAN Gerald and McGrath Jr. 247 Bridges Street, North Andover PH0O100751404 3/31/13; Retaining Wall Collapsed 30398 PD Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim file number. Craig Gillespie Claims Representative On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Unless we hear from you within the next 10 days, we will not be obligated to pay any portion of this claim to you. Date 4/2/13 7 KIMBALL LANE, BUILDING C, LYNNFIELD, MASSACHUSETTS 01940 TELEPHONE (78,1)245-9516 • FAX: (781) 245-1077 DateA c2,1 - e46 .................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........................................................................ ne has permission to perform .................................................. wiring in the building of .................................................. .. ......... ...... .......... . ...... -7............ . North Andover, Mass. Fee ................. L i c. N o—.. . . ......... ELECTRICAL INSPE Check # 6 7 Llk 6 ThEC0AM0NffE4+ LTH0FAMSSACMS`V7S Office Use only DEPARTME7VTOFPUBLICS4FM Permit No. G�4/Co BOARD OF FNEPRE[�MONRECUL9TIONS 527Cb1R 12:1x0 UOccupancy & Fees Checked, A PPUCATION FOR PERMIT TO PERFORM aE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACI USSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) L2 y -\e No. a ►'\(-1C VP T` VC)a 0A, L�,, Owner or Tenant L cA-4 �\e f 1 "e d C9e i a-� d y1r1 c 4y-a-vL-) Owner's Address Clc P S Z Y -\e Z"ov`e r hoz O gels Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building �OOyf C0 Y a U r � (6 d t_ Utility Authorization No. Existing Service Amps Volts Overhead ED Underground Q No. of Meters New Service Amps �� Volts Overhead [= Underground Q No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 14 V No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA and 1Z ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets _ No. of Gas Burners No. of Ranges No. of Air Cond. Total FIRE ALARMS No. of Zones Tons No. of Disposals No. of Heat Total Total No. of Detection and Pumps Tons KW Initiating Devices No. of Dishwashers Space Area Heating KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local Municipal Other' Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP , �.- OTHER haa=ComRmatt9at4retepwxrdSdN�xtlsGalaa!Latus Iba%eawiertlmb7ldyh&==Pbl yidL&gCrnTi* C ovwgecritssdsbrtWe:givalat YES NO ED 1finesr>fxnftdvandpoofofsarne1o1heO>Ii= YES F1 NO F-1 Ifjcuhned>aJWYES,I kmmk ether peofoo'umpbydredrgtl>e-# e-4 t1tVX )1`R ANCE '� BOND OTEIER Q ftweSpedfy) " 1 ©��c�/�� FStirl Va11XdEhl Wak $ WotktoSw RL I 2 . 7�4,1(o Fmal 5- SigrWunJTMPa�rltiaofpajWy, / e) FIRMNAME &� ZI Ic3' 4 QOIL47YM- ( fay, UnWNo V J1� t , LIoflseNox&10 .— amxssTe].Na OWNER'S IN5LIRANaNVAMM,lam awaretb the Limsetdmnotha�theirtsraacreoo�aageabssr alegrtna)etasrecgmedbyMassadttseUsGaiaalIarns and6�rrrysigrrafirrernttasparttkappTlcatiatwm�es this r�t>gsrta�t. (Please check one) Owner Agent Q Telephone No. PERMIT FEE $ j' z Q 2 LL O D cc O m = Lai v a+ Y \ o LL U a (n °C W In Z Z 1 > m C O + � > LCL L > K T v C E U LL O U to Z Z > d L °�° [C LL O in Z u W W L °�° Q' u Z N m LL O u a CAa Z 4A L °�° CC LL z W a: W 0 25 Li E CO Z a+ v L a D O Y O N O w CL v �a 0 0 N V E Q. LN �0.. C �r .0 0 0 E O.s O � (� L - V N 3 'C Q J L m CD a: ' L O 'O N O N — 0 "O CD O a N Ewa as H Z t 'y O C LOM H CL 4) C. r N a) V O c c i L m :5 - Q. d H p N O 2 ca W -a- O O LL 'y EL d & N C � N +�+ �=. W •E V . d 0-0 0CL 0 co N m O t w `c. o 0 0 2 z O G co z COW w LLIa I.: CD y No 2 7 9 3 Date ..... a/��1....� TOWN OF NORTH ANDOVER PERMIT FOR WIRING <, This certifies that ............................LA.......fi.......�.6..................................... has permission to perform `� 1 �� ............................................................................... wiring in the building of M C G` I? (A at........r�..`...��.......r/..r.�.:."'.���.....�� .......... ,�orthAndov...'... Fee .3.5 .:. 0 ... Lic. No. "� .....�n. ......... .........I ................ ..•LECTRICAL INSPECTOR Check #� WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 1 ne (_,ornmonweciim ui 1.1u>�u��,��� �U 7 F - /1 r.reit ta. V Dc;>cr:mcnt of Public SaIcrY acvy,Mr L ret C1ee1e4 i BOARD OF FIRE PREYc.?4TION REGUlAnONS S27 CMR 12th 3/90 APPLICATION FOR' PERMI T .TO PERFORM ELECTRICAL WORK Al wmrk to be pc-" .+ed !n accordance With the Maecachusers Uev.rical Code. 527 CMR 12:00 (pLFvS PP.T'tr Z'Z ih� OD T°J ALL INFORzi.4.TI0H) Date City 0 = T0c--a Of (/Vr )o o'c ✓R To the Lspec=r. of Wires: The undersigned applies for + ^ a pit to per -`o= t`e elect-'_eal work described bele. Location (Street: & Nti✓ber()�_ 4 L/y I-' R r D 6 �S LAO E- C-ner or Te:ant n F—K Ii L_ � /vl C 'g �TN C%.ner's Address Is this pe =it in conjunction vita a building pe =`r -t: `_'es � No [go' (Check Appropriate Box) ?-jr-Pose of Build_ng� /�%?IL// i-�/' U:ilicf dutto:i= tics ti0. Existing Ser ict Ow Asps / G Vol:� C:er`.ead ❑ UndgrdCi� No. o`_ New Ser -ice !-ps / Vols Gti-_stead ❑ Undgrd ❑ No. of y<ter H=ber of Feeders and }=paci:} Location and Nature of ?roposed B!ectrical Work VL//i\ T (Jig No. of Lighting Cutlets No. of Lighting Fixtures No. of Receptacle Outlets No. of Switch Cutlets No. of Ranges No. of Disposals H No. of Dishwashers No. of Dryers No. of Sate: Beaters No. Eydro Fassage Tubs No. of lioc Tubs IAbove i 1' ❑ S-i—irg ?ool gid, L_! g -td. No. of Oil Bursters �No. of Gas Bu:-ers Total INo. of Ai. Cond. cons =oca1 10 -call I No. of ?eatp�.�s Tons 1C.r (Space/Asea Heating IFeating Devices ' Ho, of No. o: Sins Ballasts INo. of yDtors Total F? Iota No. of Transfo-Hers TVA Generators rlk INo. of--ergency Lighting Batte-Y•'Units �ilR: AL�I�"S -No. of Zones No. of Detection and Init'_ati^.g Devices No, of Sounding Devices No. of Sel_` Contained Detection/Sounding Devices "'-nicioal Other Local ❑ Connection❑ Low voltage INSMkNC- ?u --swan: to the requrrenents o! Xassachusetts General La -s ! , I have a c_ -rent Liability insurance ?oiicy including Cep c:eted 07erations ca-.erage or its su s;ant_s_ equivalent. Y=S Q NO C] 1 have submitted valid proof of sa=e to this office. YES C] NO [] If you have cI eked YES, please indicate the type o: cover:3t by checking the a;propr£ace box. INSUFLANCE OND ❑ O=r U (?lease Specify) /- /�� / k.Zxp ration Date) Esci^ated value of Electrical Work S Work to Start Inspection Dact Requested: Rough(,//j_L CAI____ Final Signed under the penalties of perjury: IrZ`i NA2r h U ID izTl Licensee (C /9 Cr V Signature Address O'.WER'S 7ltS'u' .tiC WAIY 11= aware that the License? ttantial equivalent as required by F-assachusetts General application waives this rcquire=ent. Owner Agent Telephone No. Signature of Owner or Agent) .LIC. NO. A S8 6 V c IC. NO.� Bus. el_ No. 7 Alt. Tel. No. es�o � have the i"ur ance coverage or its sub' aws, and that ay signature on this pe::tit (?lease check one) .....,...::??:!�i;�}:.::::::h::•::4::+•:j;i?:::}::::{i{'rw:'r ..... :: ... .: ?{:??.::; ;::;: n,.;.; ::::••.:v:{{:.}ii:'.::'{•}:•^ •:.?:: '.y::.; :;•..;ii:' .. .: •: .....h. {:.{•:�{::::::::::::::5.'•:�'�•r.<���:�rz4??;: DATE lMM/DD/YYI ACORE PRODUCER 978-458-1865 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Fred C. Church, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR One Merrimack Plaza ALTER THE COVERAGE AFFORDED BY THE' POLICIES BELOW, P.O. Box 1865 COMPANIES AFFORDING COVERAGE Lowell, MA 01853-1865 COMPANY A Travelers Property Casualty INSURED COMPANY Richard W Gaudette B 8 Kiberd Drive COMPANY N Chelmsford MA 01863 C COMPANY D ... .1r.:..........................................................................................::y......•...................................r.:....:...:...•....:.:..•..:...:...:.:.....:..:....:...:..:....:...:...:.........:.:.....:...:...........:.............:..............:................r........................................................................... ..;�...•...w........:..f...wl.......:....:....:......:.:......:....v......:....:....r....:....:....:......;..;.......:.....;..:.....:....................... . ...v... .:.:.: . .•.n..,•::.v.... ,.::....•.«.....nvY..,.{•.:.. ... «+ •/n.r+{.•.:.n_. .}.,:..:.:.::..::..?:..?:..::..::..':..?:..l:. .i:.r:....:n: n:.•:...�.:...:.:r .n :v.:...:....r..{.: Yi•.?:i{�'y.Y4�{�r{•'!•:{:v?,¢r.. 'r:Y•.. .. ..... .;.?...? ..r: '• .iv.i.:i.:!:?'C{•r{. h.^1{.{:.v.:h.'•.:}.{\.:{:.•v.:%:_: �.::..:^r::C.r{.:•. %rr:.:♦.:4:::.v,.:::,+:,::n:::•�n':vh....•'{:.rh:.:.:;.$.:v.h;«':h.`.•:}r.ri .J?'}' f?.Yi. \•ti: rh.:..:.r••i�.?�':•.i<'v.`v. }:%$\ ' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. c0POLICY LTR TYPE OF INSURANCE POLICY NUMBER EFFECTIVE DATE IMM/DD/YYI POLICY EXPIRATION DATE IMM/DD/YYI LIMITS A GENERAL LIABILITY 359K4390 1/14/00 1/14101 GENERAL AGGREGATE $ 2000000 x COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $ 2000000 PERSONAL &ADV INJUR If 1000000 CLAIMS MADE a OCCUR EACH OCCURRENCE $ 1000000 OWNER'S & CONTRACTOR'S PROT FIRE DAMAGE (Any one fire) $ 300000 MED EXP (Any one person) $ 5000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 8 ANY AUTO BODILY INJURY 6 (Per person) ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT e OTHER THAN AUTO ONLY: ANY AUTO EACH ACCIDENT AGGREGATE t EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ UMBRELLA FORM S OTHER THAN UMBRELLA FORM WC STATU- OTH- WORKERS COMPENSATION AND.DRYLIM I ER EL EACH ACCIDENT $ EMPLOYERS' LIABILITY EL DISEASE - POLICY LIMIT 8 THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE OFFICERS ARE: R EXCL EL DISEASE - EA EMPLOYEE $ OTHER DESCRIPTION OF UPERATION51LOCA71UNSf VtMIGLt5/ArtUAL I I tma electric wiring within buildings SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF . ANY KIND UPON THE CQMPANYn ITS /AGENTS OR REPRESENTATIVES. Date................................. ; TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........................................ ............. ..... ........................ ..... ... has permission to perform ...................................... I ............... wiring in the building of ................................................................................... at.............................................................. I ................ .North Andover, Mass -r"! Fee.....:...,......'""Lic. No . .............. A.3 .......................................................... ELECTRICAL INSPECTOR Ill 47 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File uhe Tommonwolth of ffiassar4usttts Mepartment of Public to ttll UBOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only z 24. Permit No. Occupancy ,& Fee Checked 21(249_ 3/90 (leave 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 City or Town of NORTH ANDOVER To the Inspector of Wi es: The udersigned applies for a permit to Location (Street & Number) Owner or Tenant Owner's Address /V i= work described below. Is this permit in conjunction with a building permit: Yes l _! No ❑ (Check Appropriate Box) Purpose of Building^� Utility Authorization No. Existing Service - _ Amps2�Volts Overhead ❑ Undgrnd PD No. of Meters I New Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity (� Location and Nature of Proposed Electrical Works No. of Lighting Outlets No. of Hot Tubs No. of Transformers ToKVA No. of Lighting Fixtures Swimming Pool Above In- gmd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Bumers Battery Units No. of Switch Outlets 2 No. of Gas Bumers FIRE ALARMS No. of Zones No. of Detection and Total No. of. Ranges No. of Air Cond. tons Initiating Devices No. of Sounding Devices No. of Self Contained No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Local Municipal ❑ Other ❑ No. of Dryers Heating Devic ' KW es Connection No. of No. of 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 Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES & NO C I have submitted valid proof of same to the Office. YES P NO C: if you have checked YES, please indicate the type of coverage by checking thea opriate box. INSURANCE Fi BOND C OTHER C (Please Specify) (Expiration Date) Estimated Value of lectri I Work $ Work to Start ' Inspection Date Requested: Rough Final Signed under the FIRM NAME LIC. NO.A! �`��L Licensee / (,J / S;�n ature ` , / ut: NU. Address '! �f��G�T /may % �/y�76' Bus. Tel. No. Alt. Tel. 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 General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) (Signature of Owner ar Agent) a Telephone No. PERMIT FEE $ x-6565 Location 21-1 LAmF- No. = s� Date TOWN OF NORTH ANDOVEO ' - p ' Certificate of Occupancy Building/Frame Permit Fee $ $ • C 1SSA�MUSEt�' Foundation Permit Fee $ Other Permit Feeh30.i 1 $ Sewer Connection Fee $� Water Connection Fee $ TOTAL $ ... 82'04 �1 Building Inspector Div. Public Works PERMIT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP KJO. LOT NO. 2,5- I 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE ZONE SUB DIV. LOT NO. �I LOCATION 86c6e� 1-4n� PURPOSE OF BUILDING OWNER'S NAMEr ` NO. OF STORIES f SIZE G �7 OWNER'S ADDRESS 2.�'7 / ; 6 d aS n BASEMENT OR SLAB ARaHITECT'S NAME SI SIZE OF FLOOR TIMBERS IST '��/�O 2ND 3RD t1 BUILDER'S NAME &_Ac4T1 c4� a ,c-/ '/ CA SPAN )1/ DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING �'Z �� X IS BUILDING ADDITION MATERIAL 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 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 SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE �oc� PERMIT GRANTED 19 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST 121 ZCXC� EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY NUILDING OWNER TEL. # J aC CONTR. TEL. # �4 CONTR. LIC. # o,,!5 -?&P7 H.I.C. # l ! ` I BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE PINE HARDW D B 1 2 13 CONCRETE BL'K. BRICK OR STONE PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA 1/4 1/7 1/1 FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 _ 3 _ DROP SIDING JK CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ HARDW D COMMCN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME _ BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR _ CONC. OR CINDER BILK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I�POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GAB GAMBREL HIP MANSARD BATH 13 FIX.) 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 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 D AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL ELECTRIC NO HEATING B'M'T 2nd _ t t 13rd 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. : �--a 4S &I,Ll 477-,,f-�ka 6 ON v 0 b rA rA co W • � o :Ix c w w o O y ti 0 .'CJ C ea Q :oCD m CD C43 lec is �ca a z C� �.C3 v � o cm �O :mc CL= `m CD a O y 3 y z y x w c 7 W-0 d dV i m vJ P w w w OEn u4 V) -w a o ; v OO w t o a W 3 V n is W cu � �, o LE cn w° ��' U u='. u. cn w � w ~w COD q cn vEi W • � o :Ix c w w o O y ti 0 .'CJ C ea Q :oCD m CD C43 lec is �ca a z C� �.C3 v � o cm �O CD O O O o v Q O y D C i CD cm CD o� LA O �r= mLm m co 0 CD CL ~ ♦_-+ Z R � co 0 0 _O Cl, �Q O Cqu Cc cl co 1 � J m + O CL V C . Co. _ c * �Q z Q W cn Z O U :mc CL= `m CD a O y 3 y CA � cm Och y c 7 W-0 dV i m vJ yCD O w cm r' OO t V: �• v Z W O V - CD C ~w COD �m�~ L O m W . C. O +L+ C : C. CC Q.WCLu CJ ca. m m O:._ O . g ..... 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Date, _,e u1 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Per it Fee $ Other Pefmi ee �� $ Sewer Connection Fee $" Water Connection Fee $ TOTAL $ � BuildingInspector Div. Public Works r � :cation Date Y—X -!9 v &ORTII TOWN OF NORTH ANDOVER � • o o ? ------. — ,, p Certificate of Occupancy $ Building/Frame Permit Fee $ �s Et Founda�wn,Per. �,Fe s�cMus Other Permit Fee $ 45' 0 # Sewer Connection Fee $ Water Connection Fee $ / TOTAL $ Building Inspector - `1 04/05/94 20:41 15.00 PAID �°_ 7104 �` Div. Public Works c2 Ioc� t�No. kr/y Date rR 1 N' TOWN OF NORTH ANDOVER 0' «.0 t�e ,6,�0 •.. RR 0 C? AsidjalfQ&p Certificate of Occupancy $ Building/Frame Permit Fee $ ,ry°•'t�' i s�CHuse Foundation P mit Fee $ �^ R Other Permit Fee $ a Sewer Connection Fee $ Water Connection Fee $ TOTAL $'� , �} Building Inspector 02/61/44 48.59 25.00 RAID yp�Q �W 7028 Div. Public Works r%S ` Location147 No. . /, Date 41, G roRTM TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ Building/Frame Permit Fee $ 4CHUS `� Foundation Permit Fee $ f — Other Permit Fee $ f Sewer Connection Fee $ Q Water Connection Fee $ TOTAL $ (� (Building Inspector f• _ ! 6311" 8 Div. Public Works 9 Location i rlc�. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ FottaroPermit Fee $ Othe0brmit Fee $ Sewer Con,rjpction Fee $` Water Connetn Fee " $ TOTAL �J'' $ .� Building Inspector Div. Public Works Location Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Feo, Other Permit Fee C-) $ Sewer Connection Fee ' Water Connection Fee $„ i TOTAL i TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Feo, Other Permit Fee C-) $ Sewer Connection Fee ' Water Connection Fee $„ i TOTAL $ Building Inspector ` Div. Public Works E Ja,No. a / APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER MASS. PAGE 1 MAP'+40. LOT NO. 2 RECORD OF OWNERSHIP DATE 'PAGE ZONE DIV. LOT NO. (BOOK — LOCATION I Q URPOSE OF BUILDING SNS, p�ylA ll � 7-/Izs/ OWNER'S NAME NO. OF STORIES SSIIZIE OWNER'S ADDRESS ✓ BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2,,ely 2ND �i ✓�Q 8RD/o BUILDER'S NAME //ZIL SPAN DISTANCE TO NEAREST BUILDING / DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS 7 /" , �//(l DISTANCE FROM LOT LINES - SIDES REAR GIRDERS ,_� ✓, / AREA OF LOT 31,//09 FRONTAGE / --7. V HEIGHT OF FOUNDATION �` THICKNESS Nle) 1Q I IS BUILDING NEW i L/ x SIZE OF FOOTING /1 0 x iS BUILDING ADDITION MATERIAL OF CHIMNEY .S BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND 6�-Z' WILL BUILDING CONFORM TO REQUIREMENTS OF CODE yds IS BUILDING CONNECTED TO TOWN WATER -o1 BOARD OF APPEALS ACTION. IF ANY A aV U IS BUILDING CONNECTED TO TOWN SEWER /�/ t% IS BUILDING CONNECTED TO NATURAL GAS LINE Y,05 INSTRUCTIONS SEE BOTH SIDES uwu.IrLLp $P /�/} LM FDA ff; / V r V /1/ � PAGE i FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS I - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS r PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED F 64� ez. — /c _ 4-15,U�RI D SIGNATURE OF OWNER OR AAGENT ' FEE �� PERMIT GRANTED'/ OWNER TEL. # G4y � CONTR. TEL. #��) 3 �- 19 CONTR. L,c. • • SOV ^ 2 I9,q,9 r s PROPERTY INFORMATION LAND COST d J EST. BLDG. COST EST. BLDG. COST PER SQ. FT./ EST. BLDG. COST PER ROOM 9k/�-27a SEPTIC PERMIT NO. 4 APPROVED BY s BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN FOIZK U - LOT MUZUE FORK 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. ****************JIApplicant fills out this section****************' - APPLICANT: Co lo,v l •C V L . Lo Phone 61 - 5 `/% LOCATION: Assessor's Map Number /0 y Parcel % Z Subdivision Lot (s) Street �Rr P� G St. Numbed' ************************Official Use Only************************ REC0MIENDATIONS OF TOWN AGENTS:. Date Approved l (, r l Conservation Administrator Data Rejected • Comments C & Date Approved d Town Planne Date Rejected Comments Health Agent Comments Public Works - /water connections Date Approved Date Rejected - driveway permit 1�>119��> G� /k/, . Fire Department Received by Building Inspector Date KW 2 �� cd ,Ha W o A oc v ° w E u a cn lz � rw z z A Gq -° w° to C2 vOC ° E x U c x ;4O 0 z a x_ °�° a°' `° w G4 w -� u ,�� W °�° Q� u 4' J) c w' Cd U z x °�° 04 c w w A 94 W v E = z cin Q v ° C� ui • • c� cd o CL o � c C.7 = v C : 0 a co C.3 $ v 3� CMS= w m c E c.:r r � �` m a M cf m y m ca J y O O s Em y 4! m � cm 3�mor m Q V•FZ O y.+ C O` C Ci Q i �N m C •O G Cs co COD 4D CD LJJ C2 .O �'•� .c .r 'CA MDA CL O C Z CC: •uj E Ci = v .y O CM C.3 m p CO C COD a m c cCA .o CD f- z 2c.�m 1 o J z E CD L O ~ Z 0 LU �. O C CD c �- W I O CD 0 y m m cn > CD O CD p CL = O � O i � O O OO Q CL rma y C -o C Q C.3 .� O J LL. CO2 Z CD z_ v CO)CL W CA C3 0 z \ Z z � W Ilk 111.1)ING (.ON 1 it (VATION IWAIAII NORTH ANI�OVEIt $11I1 �;IItit„I.I. •'••:.':.: � t:I�I;;�:�i1 tllra•Il•:t►Ifi•1!; 111VIN111N I ili!, -I <<i 1'1.i1NN1N(;. KA tl :I. 1 I.P. NI :l .ti( )N. 1 )II t1:(:'I ()It CHIMNEY APPLICATION ANO I'E13111' ATE PLNHi'I'. # )CATION LINER'S NAME: j/ri �.�� acv �•r� 1ILDER'S NAME:�"'o�,y�,�G ISON' S NAME: %SON'S ADDRESS: ISDN'S TELEPHONE: JERIAL OF CHIMNEY:��c,� IrERIOR ClIIh1NEY: EXI LR1OR CHIMNEY: IMBER AND SIZE OF FLUES: II CKNESS OF HEARTH: y" :.Q,I'. chbi,tey oa (jiaepCace eon(jaitin .to .11te acqu.ii(emell.t:s u( the cu11e (1)111 have :tuce.6 curls .gutatiou been neeebed: 1�5 .TE: .GNATURE OF MASON= :RMIT GRANTED: / d — FEL 'BERT NICETTA ILDING INSPECTOR SPECTEU: 'MARKS: SOLID BLUCK RLQUIIt1:1) d� THIS PERMIT IJUSF UC: UISPLAYLU 014 111E 1'IZ MISIS . _, 3 PE&aSYT Nfj . APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. v tl- i/ PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK 'PAGE ZOyHE �1 SUB DIV. LOT NO. 15 /9 F I OCATION _ 2�Loll PURPOSE OF BUILDING N NE R'S NAME 4Ye NO. OF STORIES SIZE OWNER'S ADDRESS O _ % Qin l/ /e _ / �S /✓ BASEMENT OR SLAB ' ARG ECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD ILDER'S NAME "4619;2/S ,y��� SPAN DISTANCE TO NEAREST BUILDING G -- DIMENSIONS OF SILLS POSTS DISTANCE FROM STREET 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 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 INSTRUCTIONS 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 FILED SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE o J!kPERMIT GRANTED 'OWNER TEL. # CONTR. TEL. # 19 �� CONTR. LIC. # 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST ,ECT' COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING INSPECTOR 1 OCCUPANCY SINGLE FAMILY STORIES I— MULTI. FAMILY OFFICES _ APARTMENTS CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH CONCRETE 13 11 12 13 PIERS 3 BASEMENT AREA FULL '/ 1/] '/ NO BMT HEAD ROOM 4 WALLS CLAPBOARDS DROP SIDING WOOD SHINGLES STUCCO ON FRAME BRICK ON MASONR BRICK ON FRAMF ON 5 ROOF GABLE HIP GAMBREL MANSARD FLAT I SHED ASPHALT SHINGLES WOOD SHINGES SLATE TAR 8 GRAVEL A WIRING 10 PLUMBING BATH (3 FIX.) TOILET RM. 12 FIX.) WATER CLOSET LAVATORY KITCHEN SINK NO PLUMBING . • y UNFIN.^� ote _ WOOD JOIST �• PIPELESS FURNACE IN. 0'M'TAREA FORCED HOT AIR FURN. FIN. ATTIC AREA _ FIRE PLACES _ STEEL BMS. & COLS. MODERN KITCHEN _ WOOD RAFTERS _ 71 9 FLOORS B _ 1 2 �_ 3 _ CONCRETE _ EARTH HARDW D COMMON A WIRING 10 PLUMBING BATH (3 FIX.) TOILET RM. 12 FIX.) WATER CLOSET LAVATORY KITCHEN SINK NO PLUMBING . • y I ote _ WOOD JOIST �• 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 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 -13rdNO ELECTRIC HEATING 71ftp (7) m • P, x q 0 CG v u aG o w° v > cn A cin z Q G 0 ca w° °�° 9:4 v U ro w z R. °'° � m w w z U W W n7n H cn w o W z d ao 7 04 ro w w w A W W C w coy v v cn p .x O co ui om c� o Ni i � N wV CLC CU 4 ,o o L . N +r ECDCLQ CF s Ik �C N v •� os v m c CO2 co O N ma N C_ 4 CD N -o I .o m -C=! *t N _ • y cc C c E o o -vi m N co > r z o CD "�'o c c cc" Q o'co m � co �cc-., o moo CM c o � � H m�N m COD z WARcc C* c •N 1== C Z ''m •N LU •� V V C. m p m !E .= H a m-5 o-0 = A J2 o = C� CD 0 E co O o � Z CD Q O CA C C CO C CM co y 0 � M E m m i O GD O i co CD 0 Q Cd O Q a- �a ca C o cc CC O Q O -co C Z co V C �C — C c CLH J z LL z O a W Un z 0 U J z PERMIT NO. ' APPLICATION FOR PERMIT TO BUILD —NORTH ANDOVER, MASS. PAGE 1 MAP hQO.I LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK ;PAGE 'ZONE SUB DIV. LOT NO. F- i LOCATION "1 L/� /Ln. �S / �_ J� pG /c/Vu L.T�- PURPOSE OF BUILDING �¢ ae� �Z�/� DQcC t ?'<2 OWNER'S NAME /f_ /O I /,` /! L l� <( NO. OF STORIES SIZE OWNER'S ADDRESS R A�, // C✓ .- ads BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST - 2ND 3RD BUILDER'S NAME /��/ SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS POSTS " DISTANCE FROM STREET 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 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 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 EILED "Y/6 SIGNATURE OF IZED AGENT FEE 4y/ / 0 PERMIT GRANTED ONINER TEL. —�.�- 6 CONTR. TEL, gd4eis l/� CONTR. LIC. # al0e�po'�- ;Wt 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. CJ EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD i BOARD OF SELECTMEN 1 OCCUPANCY SINGLE FAMILY GABLE I HIP GAMBRELMANSARD FLAT I SHED STORIES BATH 13 FIX.) MULTI. FAMILY PIPELESS FURNACE OfFICFS _ APARTMENTS FORCED HOT AIR FURN. LAVATORY _ CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE B 1 2 I, _ CONCRETE BIL K. PINE BRICK OR STONE HARDW D PIERS J PLASTER _ DRY VJAII UNFIN 3 BASEMENT AREA FULL _ FIN. B M T AREA HOT W'T'R OR VAPOR V. 1/2 s/. WOOD RAFTERS FIN. ATTIC AREA _ NO BMT _ FIRE PLACES _ HEAD ROOM _ MODERN KITCHEN _ OIL B'M'T 2nd _ 1st 13rd ELECTRIC 4 WALLS II 9 FLOORS CLAPBOARDS B _ 1 ��_ 2 3 DROP SIDING WOOD SHINGLES CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING _ HARDVJ D COMtACN 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 5 ROOF II 10 PLUMBING GABLE I HIP GAMBRELMANSARD FLAT I SHED BATH 13 FIX.) PIPELESS FURNACE TOILET RM. (2 FIX.) WATER CLOSET _ _ _ ASPHALT SHINGLES FORCED HOT AIR FURN. LAVATORY TIMBER BMS. & COLS. WOOD SHINGES STEAM KITCHEN SINK _ SLATE HOT W'T'R OR VAPOR NO PLUMBING WOOD RAFTERS TAR & GRAVEL AIR CONDITIONING 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 FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ 7 NO. OF ROOMS RADIANT H'T'G UNIT HEATERS GAS OIL B'M'T 2nd _ 1st 13rd ELECTRIC NO HEATING C W 0 m Vt- It. w� k 4 � v d -- 11 I s c J � � Q � Qw � (7s a F44,-5 tin'y Nolle �3 4 rL 11 I s c a CN .a w o Q o (� 0 o w v cn U a C/)w C4 U z z ►� m s m -n o r o cG , C ^c U m c iz O U z zU W o as m c Lr. O ww z u W W W °A � > V) m GL w V z C no c z w a W ? 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