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Commonwealth of Massachusetts Official Use Oniy
Permit No.�__
a`�-- Department of Fire Services
Occupancy and Fee Checked
7 BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11199] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (Iv1EEC}), 527 CMR 12.00
(PLEASE PR17VT IN TIVK OR TY AL FO ATION) Date: f�✓ / -
City or Town of:
i�( Z'J� To the Inspector of Wires:
By this application the undersigned gives notice f is or her intention o perfoii the ele rical work described below.
Location (Street .& Num erl / Telephone No d
Owner or Tenant
Owner's Address
�
Is this permit in conjunction with a building permit. Yes ❑ No (Check Appropriate Bos)
Purpose of Building Utility Aidthorization No.
Overhead ❑ Undgrd
Existing Service Amps Volts ❑ No. of Meters
New Service Amps
/ Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Installation of Security system
of tho fnllrnvin2 table may be ivctwed by the Inspector ol'Wire!
No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans Transformers ICV A
No. of Lighting Outlets No. of Hot Tubs
Generators KVA
Above In i o. o mergency ig i ing
No. of Lighting Fixtures Swimming Pool urnd. E]grnd. ❑ Battery Units
No. of Oil Burners FIRE ALAR. -NIS No. of Zones
No. of Receptacle Outlets'!i o. o Detection an
No, of Switches No. of Gas Burners Initiating Devices
Total . No. of Alerting Devices
No. of Ranges No. of Air Cond. Tons
Heat Pump Number Tons KW Detection/AlertinanDevices
No. of Waste Disposers Totals: iVlunici al
Local [-] ❑ Other
S ace/Area Heating KW Connection
No. of Dishwashers p Security Systems:
Heating Appliances KW No. of Devices or E uivalen
No. of Dryers
No of No. o Data Wiring:
No. of Water KW Ballasts No. of Devices or E uivalent
Heaters Si ns
Telecommunications Wiring:
No. Hydromassage Bathtubs
No. of Motors Total HP No. of Devices or E uivaient
OTHER:
Attach additional detail i/desired, oras required by the hispcctnr of'Wires.
INSURANCE COVERAGE: Unless waived by the owner, o permit
et it for the
operation"coverage or elitsectrical
a work
e may issue
unless
the licensee provides proof of liability insurance including
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
BOND ❑ OTHER C3 (Specify:)
CHECK ONE: INSURANCE ❑ (Expiration Date)
"�J When required by municipal policy.)
Estimated Value of Electrical Work: (
Work to Start:
Inspections to be requested in accordance with EIEC Rule 10, and upon completion.
certify, under the pains and penalties ofperjury, that the iltformatioti on this application is trite and
t)NO ete.l c 33('
� n
F1RivI NAME: LIC. NO.: 15330
Signature '.1' ` ,1.,�
Licensee: John S . Bassett t Bus. Tel. No.: oda l94 5928
(lf applicable, enter "exempt" in the license number line.) I f Alt. Tel. No.:
Address:
1 OWNER'S INSURANCE WAIVER: i am aware that the Lichsee does not have the liability insu�rnercover<� e�norm1 e t.
ti
required by law. 6y my signature below, I hereby waive this requirement. I am the (check one) ❑
Owner/Agent Telephone No. PERIYIIT FEE: S41(6-,
1 Signature
1
II
Date.,,---,).
TOWN OF NORTH ANDOV
PERMIT FOR PLUI
"SAGMUS�
This certifies that
has permission to perform...-�*�:'� ............ .
plumbing in the buildings of :' .. ................
at. ... �.-- ..t. BJP!..... , North 'Andover, Mass.
t\, X�
Feed? .....
Lie.
o.. �� ff. ~. ! ..............
Cf PLG INSPECTOR
Check
7+670
MASSACHUSETTS UNIFORM APPLICATION FOR.PERMIT TO DO PLUMBING
(Print or Type)
OA/t' ass. Date O 20 Permit # U
Building Lo tion �lS� w er`s ame
l
Type of Occupancy
New 0 Renovation 0 Replacementeol' Plans Submitted: Yes 0 No 0
FIXTURES
B_P_ * -,cFWFR A SFPTfC' #c
I
nstalling Company Name
kddre
iusiness Telephone
lame of Licensed Plumber or Gas Fitter
Check ons: Certificate
0 Corporation
0Partnership
v<rm/Co.
%W 14f/ //h k2)
INSURANCE COVERAGE:
1 have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142.
Yes NO. 0
If you have checked Yesr please indicate the type of coverage by checking the appropriate box.
A liability insurance policy Other type ofindemnity ❑ Bond 0
OWNER'S INSURNACE 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.
Signature of Owner or Owner's Agent
Check one:
Owner 0 Agent 0
hereby certify that all of the details and information I have submitted entered) In above -application are true and accurate to the best of
y Knowledge and that all plumbing work and installations performed nd r the permit fss for this application will be in compliance with
I pertinent provisions of the Massachusetts State Plumbing Code a t 143 lthe a eral Laws.
BY St na ure of Licensed lumber
Title � ��-
City(Town
APPROVED (OFFICE USE ONLY) Type of License: �lt+iaster
License Number
❑Journeyman
e
DRIVES= M
IM
IM
001010=1
MM
IMMIM
MINMI
OffraTIOTIM
001100010101MIM®®
ONO
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nstalling Company Name
kddre
iusiness Telephone
lame of Licensed Plumber or Gas Fitter
Check ons: Certificate
0 Corporation
0Partnership
v<rm/Co.
%W 14f/ //h k2)
INSURANCE COVERAGE:
1 have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142.
Yes NO. 0
If you have checked Yesr please indicate the type of coverage by checking the appropriate box.
A liability insurance policy Other type ofindemnity ❑ Bond 0
OWNER'S INSURNACE 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.
Signature of Owner or Owner's Agent
Check one:
Owner 0 Agent 0
hereby certify that all of the details and information I have submitted entered) In above -application are true and accurate to the best of
y Knowledge and that all plumbing work and installations performed nd r the permit fss for this application will be in compliance with
I pertinent provisions of the Massachusetts State Plumbing Code a t 143 lthe a eral Laws.
BY St na ure of Licensed lumber
Title � ��-
City(Town
APPROVED (OFFICE USE ONLY) Type of License: �lt+iaster
License Number
❑Journeyman
Date. vd .........
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
o4A14o
S,qcmus
This certifies that .........................
has permission to perform
plumbing in the buildings of ...
..................
at., North Andover, Mass.
.............
... �x
PLUMOINGx
INSPECTOR
Check # OGS"fj (J
7724
00
6
MASSACHUSETTS UNIFORM APPLICATION FOR -PERMIT, TO DO PLUMBING
(Pri t or Type
� ,Mass: Date �y
2iiDLEV Permit # "
Bui ding L catio Iwner's am /
Type of Occupancy
New ❑ Renovation 0 ReplacementlB'� Plans Submitted: Yes 0 NOD
FIXTURES
1:1=13
nstalling Company Name _` 619p P141"
Nddress
3usiness Telephone !r�_X yam) A�
Jame of Licensed Plumber or Gas Fitter (1� 4 p/,74
O Check Ong: Certificate
0 Corporation
0 Partnership
n�ourcrirv�.t I.UYtt<AC3C: - -
i have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142.
Yes C� No, 0
If you have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy P1-1-- Other type of indemnity 0 Rnnrl n
OWNER'S INSURNACE 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.
Signature of Owner or Owner's Agent
Check one:
Owner 0 Agent ❑
hereby certify that all of the details and information I have submgrmnednd
entered) In above application are true and accurate to the best of
y knowledge and that all plumbing work and installations perforr the permit iss -for this application will be in compliance with
I pertinent provisions of the Massachusetts State PlumbingCodet 142 of the era( Laws. j6i�
Dy ���Titi=
Si nure of Licensed lumber
Ciry/Tow�n I Type of License: Master
APPROVED (OFFICE USF'ONLY) I ❑Journeyman
License Number
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SUB-BSMT
BASEMEN"FT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
I
I
J
I
nstalling Company Name _` 619p P141"
Nddress
3usiness Telephone !r�_X yam) A�
Jame of Licensed Plumber or Gas Fitter (1� 4 p/,74
O Check Ong: Certificate
0 Corporation
0 Partnership
n�ourcrirv�.t I.UYtt<AC3C: - -
i have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142.
Yes C� No, 0
If you have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy P1-1-- Other type of indemnity 0 Rnnrl n
OWNER'S INSURNACE 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.
Signature of Owner or Owner's Agent
Check one:
Owner 0 Agent ❑
hereby certify that all of the details and information I have submgrmnednd
entered) In above application are true and accurate to the best of
y knowledge and that all plumbing work and installations perforr the permit iss -for this application will be in compliance with
I pertinent provisions of the Massachusetts State PlumbingCodet 142 of the era( Laws. j6i�
Dy ���Titi=
Si nure of Licensed lumber
Ciry/Tow�n I Type of License: Master
APPROVED (OFFICE USF'ONLY) I ❑Journeyman
License Number
N
6142
Date.
ooe-,LO K TH
0
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that.z.-,-�---� .......................................................................
...........
has permission to perfWrm ... ..............
wiring in the building of .............. . .... ........................................
............. .. . . ............. . North Andover, Mass.
FeeAA ...... . ..... (/Lic. NoAale- ...... 4 .......
ELECTRIC AL INSPECTO
Check #
R
Commonwealth of Massachusetts Official Use only
Department of Fire Services Permit No.
Occupancy and Fee Checked
3 BOARD OF FIRE PREVENTION REGU IONS [Rev. 11/991 leaveblank)
APPLICATION FOR PERMIT TOP RFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK ORTY AL FO ATION) Date: / O — �p
City or Town of: iTo the Inspector of Wires:
By this application the undersigned gives notice 9f his or her intention to
pe rf the ele rical work described below.
Location (Street & N m erg
Owner or Tenant Telephone No 02
Owner's Address
Is this permit in conjunction with a building permit?
Purpose of Building
Existing Service Amps / Volts
New Service Amps / Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Installation of Security system
Yes. ❑ No
Utility
Overhead ❑
Overhead ❑
(Check Appropriate Box)
tion No.
Undgrd
Undgrd ❑
No. of Meters
No. of Meters
Comnletion of the following table may be waived by the Inspector of Wires.
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
of Lighting Fixtures
Above ❑In- ❑
SwimmingPool arnd. grrn
i o. o Emergency Lighting
Battea Units
No. of Receptacle Outlets,
No. of Oil Burners
FIRE ALARMS
I No. of Zones
No. of Switches
No. of Gas Burners
o. o Detection and
Initiating Devices
No. of Ranges
g
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
p
Heat Pump
Totals:
Number
Tons
KW
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances Kit
Security Systems:.44
No. of Devices or E uivalen
No. of Water KW
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
Hydromassage Bathtubs
No. H Y b
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or E uivaient
OTHER:
. Attach adaumnat aetatl y aesirea, or as requirea o_v the inspector oj rr fres.
INSURANCE COVERAGE: 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
46 `1 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:)
(Expiration Date)
Estimated Value of Electrical Work: �� (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
1 certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: ^ LIC. NO.:
Licensee: John S. Bassett - Signature `' t LIC. NO.: 1533C
(If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 603 594 5928
Address: Alt. Tel. No.:
OWNER'S INSURANCE WAIVER: I am aware that the Lic'ghsee 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.
Owner/Agent
Signature Telephone No. r PERMIT FEE: $�,
FJ
A
Location
f
0 V11,31
s_ �►
`No.
Date
S
j.
1
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
a
Building/Frame Permit Fee $
c `�• Foundation Permit Fee $
us
Other Permit Fe�t�"" $
Sewer Connection Fee $
—ter
Water Connection Fee $_
`TOTAL
r..
Building
Inspector
g a'1
-'. ,. Div. Public Works
q4
Location' We_-L1 4Cj0 Ca
. No. ZZ-S Date
,, I TOWN OF `NORTH ANDOVER
p Certificate of Occupancy $
Building/Frame Permit Fee $ 4 1,-1;z
�ss�cMuSE`
Foundation Permit Fee $
Other Petmit Fee $ "
S6Wer Fee $
Water-Connection Fee $ ....
TOTAL $
4
v
t1 Building Inspector
11:54 1,141.50 PAID
vt�2
Div. Public Works
8292
Location � ' `4e -y(- %NC� Ce
Dvo Z 3 3 Date
TOWN OF NORTH ANDOVER
C rt ficate of Occupancy $ S�
Building/Frame Permit Fee /$,
.Foundation Permit Fee i110
.' $ too
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $ �.50
r Building'Inspectoi
!� ? .00 PAID
/95 14:45 150�. .,
Tp
82.91"
9 1 Div. Public Works
C7
�,� a.-4+ .��.�r+s�►,er.�_+^.--.-,:: tees- .:W-�.�+.�'°"L:.:..^ � --ki` -'•.c .'c^'"'..'`S�&,"�' _'''3``"r'S'fi3f"�^�.�'�•...
Z' e!
Location
No. v
Date
.,. MpllTq
Opt..•°
TOWN OF NORTH ANDOVEPg
:+.•�ti0
Occupancy
p
Certificate of
s
�> ; •
•.
Building/Frame Permit Fee
F=�SSACHUSEt
Foundation Permit -Fee $
Other Permit Fee $
x;
Sewer Connection Fee. , $
/
tv
Water Connection Fee $ ZQZL
f
TOTAL ' $ Zol -)t s
Idin , Ins ector
Div.{ic Works
1
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
PAGE 1
MAP KVO.
ZONE
/
LOT NO.
SUB DIV. LOT NO. !�
7
2 RECORD OF OWNERSHIP IDATE
BOOK iPAGE
LOCATION 1021
0/
PURPOSE OF BUILDING
,SIZE
OWNER'S NAME O
�`-ta C
�
NO. OF STORIES l
���
Onevin
WNER'S ADDRESS 1� 33
/�iJ
•^ �, 2�
K/ J�
BASEMENT OR SLAB
QLJ
ARCHITECT'S NAME
%
SIZE OF FLOOR TIMBERS 1ST 2ND 3RD
•BUILDER'S NAME
Joh C���t�
-
Al,
SPAN fC
DISTANCE TO NEAREST BUILDING]
if..m /
DIMENSIONS OF SILLS Ll�
POSTS
'DISTANCE FROM STREET f� �P'`"
DISTANCE FROM LOT LINES - SIDES
�� REAR /
GIRDERSoev
AREA OF LOT 1'1
d
FRONTAGE ��
HEIGHT OF FOUNDATION Q THICKNESS lb
Lee.
IS BUILDING NEW 'V.e
/
X
SIZE OF FOOTING ZZ)
V
IS BUILDING ADDITION
MATERIAL OF CHIMNEYof
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND C� %
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
IS BUILDING CONNECTED TO TOWN WATER T
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER Yee _v
IS BUILDING CONNECTED TO NATURAL GAS LINE ie S
INSTRUCTIONS
SEE BOTH SIDES , _ PERMIT FOR FOUNDATION ONLY
REGULATED BY PARA. 114.8•S. B.C.
PAGE 1 FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 - 12 DATE _(el 0cC_ FEE PAID .-.-
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE LED AND APPROVED BY BUILDING INSPECTOR
DATE FILEDV/
,-SIGNATURE OF OWNER OR AUTHORIZED,AG
-(
F E -E Z
PERMIT GRANTED
®o cla PERMIT FOR FRAME/BUILDING
DATE: FEE PAID -
3 PROPERTY INFORMATION
LAND COST 7 i ft -0
EST. BLDG. COST (I Coe,
EST. BLDG. COST PER SQ. FT. 0
EST. BLDG. COST PER ROOM/
Ir
SEPTIC PERMIT NO.
4 APPROVED BY
OWNER TEL. N > ~ //p d
CONTR. TEL. N �>�11'fr)
CONTR. LIC. #. 6P2_ 'T 9
H.I.C. N
R 311; F•7' 11 W �►
BUILDING RECORD ,
1 OCCUPANCY' 12
SINGLE FAMILY S-ORIES THIS SECTION MUST SHOW EXACT, DIMENSIONS OF LOT AND DISTANCE FROM' L
MULTI. FAMILY OFFICES LOT LINES AND EXACT DJMENSIONS,OF BUILDINGS,..WITH PORCHES. GA -
APARTMENTS - 1, RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.'`.
1
CONSTRUCTION ,
2 FOUNDATION 8 INTERIOR FINISH
CONCRETE 8 1 2 .I3_,
CONCRETE BL'K. PINE
BRICK OR STONE HARDW-D
PIERS PLASTER
DRY VJALL
UNFIN.
3 BASEMENT I '�
AREA FULL FIN. 8 M AREA
V, 1/2 '/, FIN. ATTIC AREA T
NO 8 M T - FIRE PLACES L
HEAD ROOM MODERN KITCHEN
4 WALLS I 9 FLOORS ~
CLAPBOARDS B 1 22 f 3
DROP SIDING CONCRETE I_
WOOD SHINGLES EARTH
ASPHALT SIDING HARD"JD _
ASBESTOS SIDING _ COMMCN
VERT. SIDINGASPH. TILE _`�•'�71�'J'�'} +t
STUCCO ON MASONRY �� ` - `� `t� �, •,�'IR
STUCCO ON FRAMEt�•y, •G" Vis+ - .�'..+ ! 1..�T � ^• T'�
BRICK ON MASONRY ATTIC STRS. & FLOOR
BRICK ON FRAME
CONC. OR CINDER BILK.
„ STONE ON MASONRY- WIRING _-
STONE ON FRAME _ .'- _ , 1 ..,{ •.—.-`--•--�..., Y f {J
SUPERIOR I� POOR
ADEQUATE NONE
5 ROOF 10 PLUMBING
GABLE HIP BATH 13 FIX.)
GAMBREL MANSARD 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
FRAMING 11 HEATING "*Alf' 'd, '`^'
WOOD JOIST ` PIPELESS FURNACE �• "` L, t+�';J•'1
FORCED HOT AIR FURN.
TIMBER BMS.,&:COLS. STEAM
STEEL BMS. & COLS." _ 'HOT W'T'R OR VAPOR 1.+
WOOD RAFTERS _ AIR CONDITIONING '"'"` �"''� �'�'�''` '' -? ; w �z...:. �..i
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS OIL
B'M'T 2nd _ ELECTRIC fj T
1st f.� 13rd I NO HEATING �f.F ifi331 9
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FORM II - IAT RELZME FORK
INSTRUCTIONS: ''his 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.
*******************'Applicant fills out this section***********x*****
APPLICANT: /.c1 Phone�i-1���
LOCATION: Assessor's Map Number Parcel
Subdivision f 12 2C Gvc�. C) Lots) y y
Street ULP2 t�,Ol CfrC f V-- St. Number fn
********************�****Official Use only******************xx****
RECOMMENDA I S T AGENTS:
5�
Date Aocroved S
Ccnsa r:aLion Ad.— nistraLor Date Re; ectad
Cc-, entre
Date Approved
Town Planner Daze Resected
Coro;en:__
Fced _nspec cr- e?lth
Daze Approved
Date Resected
Date Approved
Date Rejected
Wcrt:s - sewer/water ccnnectlons _ —77W 5-10--`75
- drivewav permit -r-T-L'O5 ^li)
Fire Denartne.n,:
Received by Building Inspector Date
o� #41
Os / s f-.
oll
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S 11"66Y C'E.crlfY TO TyE
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N.ASON I S TELEPHONE -41Zo, - s 3 �4
MATERIAL OF CHIMNE'_' G
INTERIOR C3Ii4NEY c _
EXTERIOR CHIMNEY �/�'' L
.- n
NUMBER AND SIZE CF :.ETES d' 1-7,
THIC:{�`IESS OF HE3RTH
�' chi�m,ey or' f_rec .ca con`.,__.. �o recu4 e. is of the code and
have rules an rec;:T_atio:.s be received:
T� e
-11
DAL
SIGNATURE T TRE OF MASON ' CONTR . LIC. = oma✓
..
EST. CONSTRUCTION COST; CO,:T AC'-' PRICE �J zoU
PER,MIET GRANTEDl-SFE-
ROBERT NICETT_
A, Bi:I:jD;_�G .:S= _C--
INSPECTED
REMARKS
cCrID BRICX REQUIRED
THIS PERMIT iI S T 'BE DISPLAYED ON THE PREMISES
04 cL
�8 $o4Z
KAREN H.P. NELSON
�' '- '
:
_�
-Town of
120 Main Street. 01845
oim�o,
�!�!►
NORTI3 ANDOVER
a
cs s) 682-64x3
BUILDING
CONSERVATION
•'""",►
_
nmslo4 of -
HEALTH
PLANNING
& COINBIUNITY DEVELOPMENT
PLANNING
CHIMNEY APPLICATION AND PERMIT
DATE
PERMIT 14!X33
LOCATIO
d�G
OWNER'S
NAME
'
BUILDER'S
NAMELkj�
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�
MASON'S
NAME
(�i�/ 1/i // //
MASON'S
ADDRESS
-.2l,�� •� i"./
N.ASON I S TELEPHONE -41Zo, - s 3 �4
MATERIAL OF CHIMNE'_' G
INTERIOR C3Ii4NEY c _
EXTERIOR CHIMNEY �/�'' L
.- n
NUMBER AND SIZE CF :.ETES d' 1-7,
THIC:{�`IESS OF HE3RTH
�' chi�m,ey or' f_rec .ca con`.,__.. �o recu4 e. is of the code and
have rules an rec;:T_atio:.s be received:
T� e
-11
DAL
SIGNATURE T TRE OF MASON ' CONTR . LIC. = oma✓
..
EST. CONSTRUCTION COST; CO,:T AC'-' PRICE �J zoU
PER,MIET GRANTEDl-SFE-
ROBERT NICETT_
A, Bi:I:jD;_�G .:S= _C--
INSPECTED
REMARKS
cCrID BRICX REQUIRED
THIS PERMIT iI S T 'BE DISPLAYED ON THE PREMISES
04 cL
�8 $o4Z
`- -�— The Commonwealth ofyfassachuserts
_ - Department of Ind:tmial Accidents
L AWL dla�stltos
-�` 600 Washington Street
; Boston, Mass. 03111
Workers' Compensation Insurance Affidavit
Failure to secure coverage as required under Section :4A of>IGL 15Z can iead m the imposition of enminal penalties of a fine up to 51.:00.00 and/or
one years' imprisonment as Well as Civil penalties in the form of s STOP WORK ORDER and a riot ofS100.00 a day against tne. I understand that a
copy of this statement may be forwarded to the Office of Investigations of tbe D[-% for coverage verification_
I do hereav cerrifv under the 'ns and p allies of,
P; int name
tit= rhe infornrauon provided above is true=corr ot
Date 611
�S
aiTicial use only do not write in this area to be completed by city or tows aaicil
city or town: permi6ticenx x "Building Department
CLicensing Board
❑ check if immediate response is required CJ'electmen's Ofrice
C:Heaitb Department
contact person- peooe s; r`Otber
(Trod V" PIA)
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CERTIFICATE£tzOF�USE &��OCCUPANC,
.'-1'�':..
v �Townof Nort -An over
Building Permit Number Date �suTmgFiR 19,1995
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 28 Weyland Circle (Foxwood Lot #44)
MAY BE OCCUPIED AS Single Family Dwelling w/2 Car IN ACCORDANCE
Garage (Type III)
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTTER REGULATIONS AS MAY APPLY.
°I,•".°t':ACERTIFICATE ISSUED TO Foxwood Realty Trust
•'` °� 3 Turnpike S t .
ADDRE S
cNusE
Builcrihg Inspector