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Location 4c) ID
No. Date
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TOWN OF NORTH ANDOVER
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,�^ A Certificate of Occupancy $
Building/Frame Permit Fee $
,ssACMU`�E< Foundation Permit Fee $
Other Permit Feee#tm cY $ �
Sewer Connection Fee $
Watte``rr�C�,o�nnection Fee $
AY 1 190, �
Building Inspector
No. Andover Collett., Div. Public Works
Town of,
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CHIMNEY APPLICATION ANO 1'LI�M11
DATEPERHIT
LOCATION_ yD
OWNER'S NAME:
GUILUE-R'S NAME:MASON'S NAME: moo`,j --- -
MASON 'S ADDRESS: D e px
MA
SON'S TELEPHONE:
h1AfiLRIAL OF CHIMNEY:_13gl(�j VL (` -501 ezc)c
INTERIOR CHIMNEY:- - /`v Q,41/46E! LAI LRIOR C111MNLY:
NUMBER AND SIZE OF FLUES: 21 t-X (PA-/2
THICKNESS OF HEARTH: ? " --
G)itt clv,n tey on. ()icenEace con(lanln to aIle i(e.qu,uleme►I.t:5 u( .the code and have -ull'e.s am(
n.eg u,Eat i.onz been aecesv ed: -
9AT,E: a.
SIGNATURE OF MASON:
PERMIT GRANTED: l�ixr �� f�S I 1--EE
ZOBERT NICETTA
.UILDING INSPECTORe o
[NSPECTEO:
ZEMARKS: * v ISSULOD
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SOLID BLOCK ltE'QUIItL'U
THIS PERMIT- ldtlSf U UISPLAYLU 014 111E 1'UMISLS