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Home My WebLink AboutMiscellaneous - 53 LANCASTER ROAD 4/30/2018 / 53 LANCASTER ROAD 210/104.D-0178-0000.0 Date..V.!..f.t!.5..... TOWN OF NORTH ANDOVER ° p PERMIT FOR PLUMBING '7j'•o"; Tom" 0 This certifies thatW-O'"` �� j............................ ..................�............................ has permission to perform......C ...G 5. .! .. ............................................ plumbing in the buildings of......... 17.76'�....................................................... at.... ,,.��.....L -s:. � ........ ........... North Andover, Mass. Fee2.0.1 .....Lic. No. .5'{2Q. ....................................................:............................ PLUMBING INSPECTOR Check# MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY tjo,a& A,,.1&a per- MA DATE 7/62/ PERMIT# ` JOBSITE ADDRESS 45- n&G4�r - !` OWNER'S NAMEM_,.a C.s fen j jr OWNER ADDRESS a. TEL 97P 973 36ot FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[Y PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR BSM 1 2 3 4 5 6 7 B= 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE 1 DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN I FOOD DISPOSER FLOOR!AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: } I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES B--NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ®,-' OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Perh ent provision of the Massachusetts State Plumbing Code and Cha pler 142 of the General Laws. PLUMBER'S NAME I ke—-Sf.rz N �cs•�✓ LICENSE# lf'Wo SIGNATURE MP❑ JP R" CORPORATION❑# PARTNERSHIP❑# LLC❑# 0 COMPANY NAME 642 144 c✓i`,�►„j 1044 ADDRESS J7— CITY STATE ZIP da:,ITSr/ TEL FAX CELI��,,�« a'dca rye� _ EMAIL % >k' T OWN OF ANDOVER MASSACHUSETTS BELOW FOR OFFICE USE ONLY PLUMBING/ GAS PLUMBING/ GAS PLAN REVIEW NOTES INSPECTION NOTES INSPECTION NOTES FEE: $ PERMIT # ROUGH FI ,AL r *:COMMONWEALTH OF MASSACHUSETTS PLUMBFRRAP &F i TTERS t' I SSUES TIDE FOLLOWING L I CENSE a CIlENED AS A JOURNEYMAN PLUMBER �. � �, h THOMAS S FARHAD1AN: `~ �a 415 MAIN HAMPSTEAQ NH 03841 219,4 227439 07:3 .......... :::...::.::: .::.: " - FORM U - LOT RELEASE FORM 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 or requirements. *******************`**********APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT c9 Q 1^0 PHONE LOCATION: Assessor's Map Number L4 J PARCEL 3 SUBDIVISION LOT(S) STREET_ GSA&) CA, ST. NUMBER � ************************************OFFICIAL USE ONLY*********************************** RE MMENDATIONS OF OWN AGENTS: C SERVATION ADMIN TRATOR DATE APPROVED DATE REJECTED '711,ro COMMENTS 5�e_A atfP.c�stl ins _A WeAo_oAs 31 -Frey%, garnet, of ne.e S to 6e, re-)() c�Aart TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED EPTIC INSPECTOR-HEALTH DATE APPROVED L / DATE REJECTED COMMENTS ✓�v,-P—( �, PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm rJ TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED: X SIGNATURE: Building Commissionerfl for of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: �1 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Fromm e ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner f Record Name _� Address for Service: 1 Si na a Tele h ne 2.2 Owner of Record: Name Print Address for Service: o Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction Supervisor: O License Number wn Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name Registration Number r Address _r Expiration Date ^z Signature Telephone Y/ ti SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. -Signed affidavit Attached Yes.......11 No.......0 SECTION 5 Descri tion of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declqre that a statements and i formation on the foregoing application are true and accurate,to the best of my knowledge and belief rin ame J n Si tune of Owner/Agent / W Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST2ND 3 SPAN Dl]v ENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE E K SURVEY INC i HAVERHILL.MA Phone 978.40 .1985#Fax0?8•4E m4ii MORTGAGOR-- DEED REP. PG. PG. ADDRI-SS or PRINCIPLE BUILDING PLAN REF _ 31d1�o�IV rl Ldry ' DA7t OF INSPECTION A.I. /4Wl7Q16ggr AIrE _ SCAt.E: 1"-100f 4 i 1 1 Jib { Lor Ise . 2 - Lof//e *D1eY bno ro S 4Pc tiro. � [ 8 I /Sb,0of JANcA951ree R0*v 1 o T. ' RtJnrt M CERr:I ArloN 1'o. �, 16Et>Y _ frit:ttaao Trus Mo:t I M Plan v� rc are!x ecircau fur per �f y ! location of the prirtaipio structutcls mor 98f?P D p P Y ✓ C15(la to ape pvtpu uns onty uxi A is not inux,de�f«repte9cntee! �OMAI LASS vrlh the local zorfing Wawa in effect whop Lonatrr,ctcAJ P opnrty lune or larvf survey.This plan is+not to be used mrd/or is exempt from violation entorcennent to establish any of the Ptbptxty lines!w any purpose.No adion uAder Moss B.L. Title V11.Chap MA,Sec J responsibility in extended to the land owner or occupant. 0 Subject buiktnd r twit to o vk, j t tasaro Arco RNs witinvdtio:r is bonen tat the loc"ion of survey nmiker 0 Subjurt building is in a Flood Huard Area Of others. Flood Hazard determined from tree rIRM map#_ Dated dorIj Location �-� rim-��►.:- � - No�, Date TOWN OF NORTH ANDOVER A Certificate of Occupancy $ — --- �, Building/Frame Permit Fee $ "-- S00`E�� n Foundatio Permit Fee $ sACNHS Sewer Connection Fee $ AUL Water Connection Fee $ 4 Building Inspector �— C 3271Div. Public Works ,Location Date !�� ,.ORT1y TOWN OF NORTH ANDOVER row,,..° :••;eco ,; f `"�.� F Certificate of Occupancy $ a �. Building/Frame Permit Fee $ 12r Foundation Permit Fee $ s�CNust r Fee $ NORTHAh%%L ection Fee $ Water Connection Fee $ TOTAL $ L f t r�CB G 2 993 Building Inspector / Div. Public Works Location No. Date 1 40RTPI TOWN OF NORTH ANDOVER Certificate of Occupancy $41 r 1 r Building/Frame Permit Fee $ r ss,�C►Nstt Foundation Permit Fee $ Ot rmit Fee $ • SewI�R r fi �LLECTnRJ $ Water Connection FeeLL- TOTAL', $ ' ` 4 1993 Building Inspector t, Div. Public Works Location No. Date 1 NpRT1y, TOWN OF' b ` V ��EA ��1/ER Y �lf�ih'Lell�JZR `•� Certificate of OccupancyLLECTOR i > • : Building/Frame Permit Fee $ ,. cMusEt� Foundation PeBFee 1 Other Permit ee 4 �5�7 Sewer Connection Fee $_ wlE!3p •� ' oy Water Connection Fee $ � TOTAL $ ,?D Jt;, l°r) ! Building Inspector �' Div. Public Works \f I.0 NO, O 3� ' I PAGE 1 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /A f /,K3 7 r/ MAP 4-10. �J . I LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK PAGE — ZONE SUB DIV. LOT NO. LOCATIO PURPOSE OF BUILDING 4 . OWNER'S -WA-ME NO. OF STORIES q SIZE �y OWNER'S ADDRESS r BASEMENT OR SLAB ARCHITECT'S NAME Jr SIZE OF FLOOR TIMBERS 1ST2ND /® 3RD [ al BUILDER'S NAME T SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS --- DISTANCE FROM STREET Lf� POSTSyoe DISTANCE FROM LOT LINES-SIDES! �� REAR " GIRDERS ✓� AREA OF LOT FRONTAGE9.�i HEIGHT OF FOUNDATION / / THICKNESS �U IS BUILDING NEW �i t _,.�y� SIZE OF FOOTING / q X i IS BUILDING ADDITION ! Jy-� MATERIAL OF CHIMNEY IS BUILDING ALTERATION y IS BUILDING ON SOLID OR FILLED LAND 1 WILL BUILDING CONFORM TO REQUIREMENTS OF CODE /� C• IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY �� Y IS BUILDING CONNECTED TO TOWN SEWER ! f IS BUILDING CONNECTED TO NATURAL GAS LINE • INSTRUCTIONS- s PROPERTY INFORMATION LAND COST .1 SEE BOTH SIDES 2m KRMIT m ff vEBT. BLDG. COST CCr VQ jo rU PAGE / FILL OUT SECTIONS 1 - 3 # ,�'Q rn�� 4�g, D EST. BLDG. COST PER SQ. FT. �.� � PAGE 2 FILL OUT SECTIONS 1 - 12 �IF •v�FRpMF FRaRtT t 6 EBT. BLDG. COST PER ROOM SEPTIC�'b /JSEPTIC PERMIT NO. .� ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING O 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR a DATE FIL 1?A3 &V WARD OF HEALTH • 81GNATUR OF O NER OR AUTHORIZED AGENT e FEE 6 - _ PLANNING BOARD PERMIT GRAN,T!ED� OWNER TEL. to CONTR.TEL#��.s�CONTR.LIC.#-G a�� WARD OF SELECTMEN J r — g BUILDINo INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY SiOkIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY oFFICEs LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE B 1 2 13 CONCRETE BL K. PINE _ BRICK OR STONE HARDW D PIERS PLASTER _ DRY YJAII UNFIN. 3 BASEMENT I / AREA FULL FIN. B M'T' AREA _ �� C _ ��. LS-- •- --•- -- - '/ 1/1 1/ FIN. ATTIC AREA _ N_O B MT FIRE PLACES HEAD ROOM MODERN KITCHEN L 4 WALLS I 9 FLOORS G�U ty CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE ✓ __ WOOD SHINGLES EARTH _�_ ASPHALT SIDING HARDW'D _ ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY p� STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR BRICK ON FRAME CONC. OR CINDER BLK. -ii r % STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR / ADEQUATE NONE 1S) 5 ROOF 10 PLUMBING C V GABLE HIP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. (2 FIX.( Y FLAT I SHED WATER CLOSET ASPHALT SHINGLES 417LAVATORY WOOD SHINGES KITCHEN SINK T SLATE NO PLUMBING ca� TAR 8 GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING `U WOOD JOIST ✓ PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 6 COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR -� WOOD RAFTERS y/ AIR CONDITIONING / RADIANT H'T'G � UNIT HEATERS _ 7 NO. OF ROOMS GAS OIL B'M'T 2ndELECTRIC 1st 13rd I NO HEATING FORM U - LOT RELMSE FORM 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. *************/***Applicant fills out this section***************** APPLICANT: va/ -7,4,0 Phone LOCATION: Assessor's Map Number /0 IJ Parcel 7 Subdivision71/G w c f.c 1-la Ya c Lot(s) /3 Street ,4)ig ,V 0�s' y-cg _ � � St. Number �-� 2) ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved A lqlq .T Town Planner Date Rejected Comments MAMAVV l Y Date Approved Health Agent Date Rejected Comments Public Works - sewer/water connections �f �7 - driveway permit t31C� J f/fir/4� Fire Department �" ' <e, Received by Building Inspector Date i w 1 �! 7 J( n Z a o_ Niv 10 LL OL in - f,l a o ,, b . �/ / ' in . v � ooOjd'L CERTIFIED FOUNDA TION PLAN LOCATED IN U.%-r► �►noyE--�,. Int a ss._ SCAL E: /"= a-o' DATE 2f(-719a Scott L. Gi/es RL.5 50 Deer Meadow Rood North Andover,Moss. Lq O d0 - - I � A- 1 \� G 41 S -' ��o• 3 v-r- 13 1.3S1�Ac. FO 191r ' 1 i -5 eG.4 I CERT/FY THAT OFFSETS SHOWN ARE FOR THE USE ��Att Of THE OFFSETS OF THE SU/L DING /NSPEC TOR ONL Y SHOWN COMPLY AND SUCH USE/S FOR THE g WITH THE ZONING DETERM/NATION OF ZONING • 139 H SY LAWS OF CONFORMITY OR NON-CONFORMITY fr!STER L1=,s-=" A"-r�wFn WHEN CONSTRUCTED. I L LAND WHEN BU/L T. 2j 1'1(g3 - C. ORTH N 0". O 4 over 0 No:p3 _ r _ A o dover, Mass., 19 COCKICKEWICK ORATED PP �� S BOARD OF HEALTH T _M T D . Food/Kitchen. s Septic System Y , PE INSPECTOR '. . G e� '. R IS CERTIFIES THAT�Uib � �.. .. 6 .,� .Ti.. .. � �� ►. i� Foundation BUILDIN has.permission to.erecw.6.6pfo*qffuildings onjrs,. vemo .. ......... plough to be occupied as.ir)AS.A40..A.A M �► R� .. Chimney provided that the person accepting this permit shall in eve respect conform to the terms o e application on file in . Final this office;and to the provisions of the Codes and By-Laws rel Ing to the Inspection, Alteration and Construction of Buildings-in the Town of orth Andove�J>�PPERMIT FOR FOUNDATION`ONLY PLUMBING INSPECTOR REGULATED BY PARA. 114.8 &C. VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6MOXTQSi - Final f ,C'o o ELECTRICAL INSPECTOR UNLESS.CONSTRUCTION' TART Rough 'HERMIT FOR FRAME/BUILDING •• •• ••••••• • • • • Service . .. .. ..... ... .................... • BUILDING.INSPECTOR - Final .,DATE:. FEE P permit Required to. Occupy. Building g GAS.INSPECTOR Display ,in a Conspicuous Place on the Premises — Do Not Remove Fi ugh - Fnal No Lathing 'or Dry Wall To Be Done FIRE Until Inspected and Approved by the Building Inspector. DEPARTMENT - Bumer PLANNING FINAL i ,a� ? �( CONSERVATION FINAL street No. Smoke Det. SEWER WATER FINAL �rf ;73 yy DRIVEWAY ENTRY PERMIT CERTIFICATE OF USE & OCCUPANCY Town Of North Andover Building Permit Number 031 Date JULY 14, 1993 THIS CERTIFIES THAT THE BUILDING LOCATED ON LOT 13 LANCASTER RD. - #53 MAY BE OCCUPIED AS SINGLE FAMILY_`_ DWELLING W/3-CAR GARAGEIN ACCORDANCE & DECK WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. 04 orN'�1.� CERTIFICATE ISSUED TO Andover Construction & Development Corp. 66 Spring Hill Rd. ° p ADDRESS North Andover, Ma yJSA USf Buil ing Inspector 0 ?1-H Town of Io over 0 Z0 �F�o dower, Mass., 19 #93 CCI C N I C F F.`N I CK � A0RATFD BOAR D.OF HEALTH Wr PERMIT T Food/Kitchen �f� Septic System "" BUILDING INSPECTOR THIS CERTIFIES THAT . VAO ..ftrooieiv �" "' Foundation has permission to erect&V.0*Vf�A**iuildings on%r3. Rough r/ ��.J/''l./y to be occupied as��ASIS...PA.�IA. ....A f I.� .. ... tF imney& z � • provided that the person accepting this permit shall in eve respect conform to the terms o e application on file in tCLQ this office, and to the provisions of the Codes and By-Laws rel ing to the Inspection, Alteration and Construction of Buildings in the Town of North Andover �� PERMIT FOR FOUNDATION ONLY PLUMB INSP•CTOR 114.8.& B 114. B.C. VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. O. ou Z PERMIT EXPIRES IN 6 MOpA eEFEE U ELEC ICAL P CTOR UNLESS CONSTRUCTION STARTS` Rough PERMIT FOR FRAME/BUILC}I;`'G .. ........... . .................... Service BUILDING INSPECTOR Final DATE: FEE P - Pe7'7nict Required to Occ� Buildirl ��` � �y g (SAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough 1 No Lathing or Dry Wall To Be Done F E T. DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING * 'FINAL � Y C 0 N S E RVAT 10 NrLC2.i f FSE" Street No. ,.� �� Smoke Det. 717170 SEWER/WATER U43 FINAL j't 7. SV '/ DRIVEWAY ENTRY PERMIT 7 -IZ-� � � 3 OF: ''� To vv, I I oI . Ir,l;liii �,ir r l AI.,I'I:n1s r:rll . : rl, !'I3t111.1)INt) C:()Ntil it t Vi\'PION 1II\'Vill IN4II' IIi1 it ili!i.I i i'.i r I'i.nnrvwc� P1.y\,NNIN(; (;O(11I WNI'1'1" DI;V111,01'1111 NT CHIMNEY APPLICATION ANO. I'Ll,3IIV MATE �S�l Llthl i'I'. # I LOCATION �tJ� .� //� -c��S� il ve� • )(.LINER'S NAME: 6 CVQ ti Ste, >UILVER'S NAME: ' ' IA SON IS NAME: ,��- f� 141 (ASON 'S ADDRESS: 'ASON'S TELEPHONE: ATERIAL OF CHIMNEY: NFERIOR CHIMNEY:_* ga �t _ EXILRIOR CHIMNEY:_��/1� � U1,1BER AND SIZE OF FLUES: HICKNESS OF HEARTH: b � izz chilliney on. Oiaepcace con(jonul to VLe. u.qu.illen►elt.(:5 u( -01e cul/e and Ilitve "all 3 lullt eg1,l,eati.onz been necc Zved: ATE: IGNATURE OF MASON: ERMIT GRANTED: I'LL BOJ )BERT NICETTA `_lILDING INSPECTOR — VSPECTEV: — _—_— EI+BARKS: --- SOLID BLOCK lt( (ZU11tE'U 7 THIS PERMIT MUS F GE V I SPLAYS O 014 I HE 1'RL1,I I SL