HomeMy WebLinkAboutMiscellaneous - 345 BLUE RIDGE ROAD 4/30/20184064 TRAVELERS J�
The Phoenix Insurance Company
P.O. Box 1450
Middleboro, MA 02344-1450
01/07/2016
--a
North Andover Building Inspector
1600 Osgood St Building 20,suite 2035
North Andover MA 01845
Insured: Jonathan Quint
Claim Number: HVX1951
Policy Number: 040928-949026732-633 -1
Date of Loss: 02/22/2015
Loss Location: 345 Blue Ridge Rd North Andover MA
To: Board of Selectmen
Building Commissioner
Inspector of Buildings
Board of Health
A claim has been made involving loss, damage or destruction of the above captioned property
which may either exceed $1,000 or cause Massachusetts General Laws Chapter 143, Section 6
to be applicable. If any notice under Massachusetts General Laws Chapter 139, Section 313 is
appropriate, please direct it to my attention and include a reference to our insured, the policy
number, the claim/file number, the date of loss, and the location.
If you have any questions, please feel free to contact me at (508)946-6482 or email me at
ACOELHO@travelers.com.
Sincerely,
Antonia Coelho
Claim Professional
(508)946-6482 Ext. 6482
Fax: (877)786-5584
Email: ACOELHO@travelers.com
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.
Signature
Date
P0062 F3162C1516008004064 00001 N
Location
q
No. `iG�'
Date
w
NORTof
TOWN OF NORTH ANDOVER
?O',t`•O I.1 ti0
O
R
A
Certificate Occupancy
of $
cwus `�
Building/Frame Permit Fee $
ZZ"
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # =21�- /
171-168
f
/ . Building Inspectof
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER:
DATE ISSUED:
SIGNATURE:
Building Commissionefflaspector of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Properly
i
1.2 Assessors Map and Parcel Number.
Map Number Parcel Number
1.3 Zoning Information:
Zoning District Proposed use
1.4 Property Dimensions:
Lot Area Fronts ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Rapind Provided
RcqWmd Pmvided
t
1.7 Water Supply M.G.L.C.40. 34) 1.3. Flood Zoos iafosmation:
public ❑ Private ❑ Zona Outside Flood Zone ❑
1.8 Sewatap Disposal system
Municipal ❑ On site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
1 '1:7171 1{:i strlct: n r(O
2.1 O of Record r-
L �p
Q
Name nt) Address for Service:
J
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
ns o� �ru,cwtion ups
7 If/ A,' 4 . to-C66E�
Address �( J'�
Sig - I pT
[ Tel
Not Applicable 0
License Number
(2J 11
/� /
Expiration Dat
12 Registered Home Improvement Contractor
Not Applicable 0
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
SECTION 4 - WORKERS COMPENSATION (M.G.L C 152
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building unit.
Sianed affidavit Attached Yes .......0 No ....... 0
I SECTION 5 Descriotion of Proposed Work (check as soaucabk) I
New Construction ❑
Existing Building ❑
Repair(s)
❑
Alterations(s) ❑
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
c�
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed by permit applicant
OFFICIAL USE ONLY
1. Building
(a) Building Permit Fee
Multi lier
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 U ,
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS NT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as er/Authorized Agent of bject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I
I, 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
Print Name
Si ture of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 2"4D 3RD
SPAN
DIMENSIONS OF SILLS
DINIENSIONS OF POSTS
DIMENSIONS OF GIRDERS
FIEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHRANEY
1S BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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The Commonwealth of Massachusetts
Department of Indusbial Accidents
OMCS of Invesdgedons
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
rcv Ian I I of TV all W"n n 11 IylCO.
0 I am a sole proprietor and have no one working in any capacity
U1
Cox. Phone ;
Insurance Co. palsy �
Failure to secure coverage as required under Section 25A or MOL 152 can lead to the Imposition of criminal Penalties d,a Ane up to $1,500.00
anwor one years' Imprisannent.as W@U_as_chill.paualtieslnbelmndAZMP.W. DW.ORIER.and.a.Ans d.($100.W)-R W agehm ms. I
understand that a c jyd-I�b statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I db hereby cer"d9r the ksins and#n�r , # perjury that the information provided above is true and corned.
Print
,9
Official use only do not write In this area to be completed by city or town dWel'
310j,
# 9 X37
City or Town Parmit/ticensing
❑
❑Check it Immediate response b requMd Building Dept
❑ L kerWrV Board
❑ Selectman's Offtce
Confect person: Phone # ❑ Health Department
❑ Other
C
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11,S150A.
debris wilkbe disposed of in:
(Location of
n tuYe fPerrh it Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
9
I
✓ t � �
Boardd off Bu�'IZg and Standard's ,
HOME IMPROVEMENT CONT A t
Registration: RACTOR t
- 108424r '
Expiration: 8/18/2005
TYPe: DBA
ARCO ROOFING & CONSTRUCTION
Joseph Gys
} 10 MEGHANN LANE
LOWELL, MA 01852
Administrator
Location ? y < < r G
No. d y% Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ 7q, ! d
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL
/ k?,5-
O2/15/t�4 ��
a
C2
Building Inspector
74.00 RAID
Div. Public Works
PE)61:1t1T NO. v
} APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
V40010/1
PAGE 1
MAP'hq0.
LOT NO.
/p-/
2 RECORD OF OWNERSHIP (DATE
BOOK 'PAGE
ZONE
SUB DIV. LOT NO.
�I
LOCATION /
;
PURPOSE OF BUILDING U
OWNER'S NAME i
�yY.�
' /
NO. OF STORIES SIZE W.V�J�, 16
(Cj
OWNER'S ADDRE
V
I
BASEMENT OR SLAB
J
ARCHITECT'S NAM
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME•
a
..
SPAN //� .4G
10
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS'
DISTANCE FROM STREET m
r
POSTS
DISTANCE FROM LOT LINES - SIDES
i REAR
" GIRDERS
AREA OF LOT
FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW Yip t^
V 7
SIZE OF FOOTING X
IS BUILDING ADDITION
MATERIAL OF CHIMNEY v A
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND %-
cl
i00
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ris
i
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION, IF ANY
IS BUILDING CONNECTED TO TOWN SEWER o
IS BUILDING CONNECTED TO NATURAL GAS LINE 010
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 OWNER OR AUTHORIZED AGEN
FEE / T• / 6
PERMIT GRANTED_
19
l/ q v o -�
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST
EST. BLDG. COST PER Se "S36
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
4g
BUILDING INSP[CTOR
OX
OWNER TEL. # 16 �` 7 1
CONTR.TEL.#
CONTR. LIC. # 6-212 7
If
H.I.C.# 116 / 7 V
BUILDING RECORD
1 OCCUPANCY ^ 12
SINGLE FAMILY
MULTI. FAMILY \
APARTMENTS
STORIES
PI
CONSTRUCTION
2 FOUNDATION
INTERIOR FINISH
CONCRETE
PINE
HARDW D
d
1
2 I3
CONCRETE 8L K.
BRICK OR STONE
PIERS
PLASTER
DRY WALL
_
UNFIN.
3 BASEMENT
AREA FULL
1/1 1/2
FIN. B M AREA
FIN. ATTIC AREA
_
_
N_O B M T
FIRE PLACES A_
HEAD ROOM
MODERN KITCHEN
4 WALLS I FLOORS
CLAPBOARDS
DROP SIDING
WOOD SHINGLES
ASPHALT SIDING
ASBESTOS SIDING
ARTA
B 1
2 3
_
_
COMMON
VERT. SIDING
_
ASPH. TILE
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK(5N MASONRY
ATTIC STRS. &
FLOOR
_
BRICK ON FRAME
_
CONC.•OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR POOR _
ADEQUATE NONE
ADEQUATE
5 ROOF
10 PLUMBING
GABLE
HIP
BATH )3 FIX.)
GAMBQELMANSARD
fl
TOILET RM. 12 FIX.)
_
FLAT
SHED
WATER CLOSET
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
TAR 8 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. S COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS
GASOI
L
B'M'T 2nd _
t.t 13rd
ELECTRIC
NO HEATING
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
AUT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
-WAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
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JOYCE BRA5� i'AW
TOWN GLERK
ORTH AlinOVER
" v Town of North Andover
J L o 2 us i u155OFFICE OF
COMMUNITY DEVELOPMENT AND SERVICES
KENNETH R. MAHONY
Director
ANY APPEAL SHALL BE FILED
WITHIN (20) DAYS AFTER THE
DATE OF FILING OF THIS
NOTICE IN THE OFFICE OF
THE TOWN CLERK.
146 Main Street
North Andover, Massachusetts 01845
(508) 688-9533
BOARD OF APPEALS
NOTICE OF DECISION
Property: 345 Blue Ridge Road
i� :o C0r,iy that twent,� (20) ��
elapsed from date of d
a�ujout fil Q( OcUot1 filed
Robert Vandette
Date: 9-13-95
345 Blue Ridge Road
Petition# :043 -95
North Andover, MA 01845
Date of Hearing: 9-12-95
The Board of Appeals held a regular meeting on Tuesday evening, September 12, 1995
upon the application of Robert Vandette requesting a Variance under Section 7, Paragraph
7.3 and Table 2 of the Zoning Bylaw so as to permit relief from the side setback
requirement of 30 feet to construct a shed.
The following members were present and voting: William Sullivan, Raymond Vivenzio,
Walter Soule, Robert Ford and John Pallone.
The hearing was advertised in the North Andover Citizen on 8.23.95 and 8.30.95 and all
abutters were notified by regular mail.
Upon a motion by Walter Soule and seconded by Raymond Vivenzio, the Board voted
unanimously to GRANT relief of 4.1 feet from the side setback requirement of 30 feet.
Voting in favor: William Sullivan, Raymond Vivenzio, Walter Soule, Robert Ford and
John Pallone.
The Board finds that the petitioner has satisfied the provisions of Section 10, Paragraph
10.4 of the Zoning Bylaw and that the granting of this variance will not adversely affect
the neighborhood or derogate from the intent and purpose of the Zoning Bylaw.
BOARD OF APPEALS,
William Sullivan, Chairman
Raymond Vivenzio
John Pallone
Walter Soule
A_.TTES^: Robert Ford
A 7i ue Copy
7bwn Clea-;
r
BOARD OF APPEALS 688-9541 BULDING 688-9545 CONSERVATION 688-9530
Julie Parrino D. Robert Nicetta Michael Howard
W
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C*�
HEALTH 688-9540 PLANNING 688-9535
Sandra Starr Kathleen Bradley Colwell
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CHIMNEY APPLICAVION ANO PERMIT
DATE �,�' C,' PERNI'T #
LOCATION
OWNER'S NAME:
BUILDER'S NAME: ,
MASON'S NAME:
MASON'S ADDRESS:
MASON'S TELEPHONE:
MATERIAL OF CHIMNEY:
INTERIOR CHIMNEY: ,, EXI ERIOR CHIMNEY:
III NUMBER AND SIZE OF FLUES:,��.
THICKNESS OF HEARTH:
Witt chbiIney on. 6-Aepeace eon(onut to 4he ne.quw)(eme►I,t.5 v() .the code cued have Aute and
Aegulat,�om been rceeetved:
DATE: r%%/.��G S'i
SIGNATURE OF MASON:
PERMIT GRANTED: 6 _:L R� 9�
ROBERT NICETTA
'BUILDING INSPECTOR
INSPECTED:
REMARKS:
rN
SOLID BLOCK REQUIRED
FEE U•. OP
THIS PERMIT MUST BE OISPLAYEO ON 1IIE PREMISES
X&
Town of
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KAI'W .N I I.P. NI:I ..9 )N, I Jl l tl a : l OI t
CHIMNEY APPLICAVION ANO PERMIT
DATE �,�' C,' PERNI'T #
LOCATION
OWNER'S NAME:
BUILDER'S NAME: ,
MASON'S NAME:
MASON'S ADDRESS:
MASON'S TELEPHONE:
MATERIAL OF CHIMNEY:
INTERIOR CHIMNEY: ,, EXI ERIOR CHIMNEY:
III NUMBER AND SIZE OF FLUES:,��.
THICKNESS OF HEARTH:
Witt chbiIney on. 6-Aepeace eon(onut to 4he ne.quw)(eme►I,t.5 v() .the code cued have Aute and
Aegulat,�om been rceeetved:
DATE: r%%/.��G S'i
SIGNATURE OF MASON:
PERMIT GRANTED: 6 _:L R� 9�
ROBERT NICETTA
'BUILDING INSPECTOR
INSPECTED:
REMARKS:
rN
SOLID BLOCK REQUIRED
FEE U•. OP
THIS PERMIT MUST BE OISPLAYEO ON 1IIE PREMISES
r
' Location..
2 Date
No. K
NOR7M
TOWN OF NORTH ANDOVER
,
•.
'1
o?a,,..o
Certificate of Occupancy
$
��
Building/Frame Permit Fee $
s
S�cHust � y
tier Plermit ee
$
s w�G LOAn n Fee
Conn Eti F e
T,
No. tEtIMIr Loll!
$
,;.
TOTAL
$
5C)
Building inspector
Div. Public Works
Location
O v,
No. Date
"Oft oT;�4, TOWN OF NORTH ANDOVER
Certificate of Occupancy
� 4
:";r Building/Frame Permit Fee
Foundation Permit Fee
ve onnection Fee
P, O VV
Watery CSS ction Fee
C,
Building Inspector
Public
Location 3 ��LU �-� tJG
No. Date 41 to k §c—
d� �-g 354
U39
(�D_
Building Inspector
Div. Public Works
TOWN OF NORTH
ANDOVER
p
Certificate of Occupancy
$
Building/Frame Permit Fee
$
SACMUS
Foundation Permit Fee
$
�
Other Permit Fee?0l
$
N
Sewer Connection Fee
$
Water Connection Fee
$
TOTAL
$
!�
d� �-g 354
U39
(�D_
Building Inspector
Div. Public Works
PERMIT NO
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
PAGE 1 I
MAP
4-40.
I
LOT NO.
2 RECORD OF OWNERSHIP IDATE
BOOK i PAGE
ZONE
SUB DIV. LOT NO.
r
LOCATION 3 6,
PURPOSE OF BUILDING
OWNER'S NAME R Ae�� A ���
��l/!J
NO. OF STORIES SIZE 2-e,I%(`�
/` 7
OWNER'S ADDRESS
BASEMENT OR SLAB
ARCHITECT'S NAME ^ --R,y _{.'
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME CLOS-IZN6.
SPAN
DISTANCE TO NEAREST BUILDING tQ (
DIMENSIONS OF SILLS
POSTS
l:�
4DISTANCE
DISTANCE FROM STREET l
FROM LOT LINES - SIDIS. �� , �f REAR
JFRONTAGE
--
" " GIRDERS
/
AREA OF LOT S%45O� o
!
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW yins
SIZE OF FOOTING X
IS BUILDING ADDITION Jl �/MiC�C �OG
{
MATERIAL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE fi! �s
t•/
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
B INSTRUCTIONS gF
SEE OTH 61DE5
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
i �Y /
SIGNATURE OF OWNER OR AUTHORIZED AGENT
A
kEE
PERMIT GRANTED
411 19_
3 PROPERTY INFORMATION
LAND COST f`
EST. BLDG. COST At
EST. BLDG. COST PER SQ. FT. L
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
9 D
BUILDING INSPECTOR
OWNER TEL. #
CONTR. TEL. #
CONTRAICJ
# Lc
H.I.C. # Las-oF--)
c 1 (21 rui
, �-- 90C - 4-
BUILDING RECORD
n
1 OCCUPANCY 12
SINGLE FAMILY
S--ORIES
MULTI. FAMILY
OFFICES
APARTMENTS
__
CONSTRUCTION
2 FOUNDATION
8 INTERIOR FINISH
3 1 2 13
PINE
CONCRETE
CONCRETE BL'K.
BRICK OR STONE
HARDW D
_
PIERS
PLASTER
DRY WALL
_
UNFIN.
3 BASEMENT
AREA FULL
FIN. B M AREA
_
1/1 1/2 1/1
FIN. ATTIC AREA
_
NO B M T
HEAD ROOM
FIRE PLACES
MODERN KITCHEN
_
4 WALLS I 9 FLOORS
CLAPBOARDS
B
1
2
3
DROP SIDING
WOOD SHINGLES
CONCRETE
EARTH
HARDrJ'0
COMMCN
ASPH. TILE
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
_
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY
ATTIC STRS. & FLOOR
BRICK ON FRAME
I_
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
_
STONE ON FRAME
SUPERIOR I-1 POOR
ADEQUATE NONE
5 ROOF
10 PLUMBING
GABLE
I
HIP
BATH (3 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
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
OI l
B'M'T 2nd _
1.t 13rd
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.
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FORK U - IAT RELEASE FORM
INSTRUCTIONS: This fora -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*****************
''APPLICANT: Phone
.LOCATION: Assessor's Map Number Parcel
Subdivision Lot(s)
Street�JG1211;061Z `Z� . St. Number
************************Official Use Only************************
RECOMMENDAYION,p OF GENTS: q
Date Approved �< S
` Conserv tion Administrator Date Rejected
Comments
6E Date Approved
Town Planner Date Rejected
Comments
Foo�In ector-Health
,S'eis' c nspector-Health
Comments _ z) 15 el'u e f
Public Works - sewer/water connections
- driveway permit
Fire Department
Date Approved
Date Rejected
Date Approved
Date Rejected
Received by Building Inspector Date
P, I
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Of
JONN S. yGs
sLAURETANI
# 34311 H
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9,y SURNF'�
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Scale: ( " : (z,Q
I JOHN S. LAUR5TAN)
A PROFESSIONAL LAND SURVEYOR, 01111111111111
DO HEREBY CERTIFY THAT THE AMERICAN SURVEYING COMPANY
ABOVE MORTGAGE INSPECTION 77 Rumford Avenue, Waltham, MA 02154 (617) 893=6477
PLAN WAS PREPARED FOR
iC Fn> /y/Ai i3�c� 1�1 r p IN
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JOHN
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# 34311
l Agorrs Si���� Q'
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Scale: ( ° - (-,Q
I ,JOHN S. LAURSTAN)
A PROFESSIONAL LAND SURVEYOR,
DO HEREBY CERTIFY THAT THE AMERICAN SURVEYING COMPANY
ABOVE MORTGAGE INSPECTION 77 Rumford Avenue, Waltham, MA 02154 (617) 89316477
PLAN WAS PREPARgD FOR
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HOME IMPROVEMENT CONTRACTORS REGISTRATION
Board of Building Regulations and Standards
One Ashburton Place — Room 1301 I
Boston, Massachusetts 02108 i
I
HOME IMPROVEMENT CONTRACTOR L----- -------------------------- ..
Registration 105084 Expiration 07/16/96
Type — PRIVATE CORPORATION
I
HOME IMPROVEMENT CONTRACTOR
Registration 105084
Custom duality Pools Inc. I Type - PRIVATE CORPORATION
Robert A. Bent Expiration 01/16/96
16 Wyman Road
Billerica MA 01821 I Custom Quality Pools Inc
COMMONWEALTH
OF
MASSACHUSETTS
EXPIRATION DATE
01/10/1997
RESTRICTIONS
NONE
a v _iI. Aw
SS 4 023-44-1646
FEE:
100.00
HEIGHT:
DOB:
01/10/1953
THIS DOCUMENT MUST BE
CARRIED ON THE PERSON OF
THE HOLDER WHEN EN-
GAGED IN THIS OCCUPATION.
0
r
P
0
m
DEPARTMENT OF PUBLIC SAFETY
ONE ASHBORTON PLACE
BOSTON, MA 02108
LICENSE
CONSTR. SUPERVISOP
EFFECTIVE DATE LIC -N0.
06/30/1994 040192
ROBERT .A BENT
16 WYMEN RD
BILLERICA MA 01P21
NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY
STAMPED - OR - SIGNATURE OF THE COMMISSIONER
'/&6v ,/t�v
SIGNATURE OF LICENSEE
_ Robert A. Bent
jG�Q o &7�t41i6 Wyman Road
ADMINISTRATOR Billerica MA 01821
0
0
M
m
Failure to p oRR^f>A a oorreaf
/lAIRR9tt+FAPff"i'C "`: dt^ u:•P,p�`~�AQ
Caof x p8 SAW080on
FOR PROTECTION AGAINST
THEFT, PUT RIGHT THUMB
PRINT IN APPROPRIATE
BOX ON LICENSE.
;!.',BLASTNGOPER rs RS:~'
y lMUSTlINdLUDE PKTO.
MAY 1
t
r
1z 1994
SIGN NAME IN FULL AO 91GtJA�UgliVE