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Home My WebLink AboutBuilding Permit #205 - 224 SOUTH BRADFORD STREET 9/16/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 205:: Date Received Date Issued: �o z 5 IMPORTANT: Applicant must complete all items on this page LOCATION A."?,09,41ZA .S�r .I CLI PAW PROPERTY OWNER Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes 6no Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer i�f ES RIPTION OF WORK TO BE PERFORMED: Identification Ple Type or Print Clearly) OWNER: Name: / ` t� Phone: Address: S CONTRACTOR Name: Phone: ' Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ l'1�+*�7�. ec FEE: $ � Check No.: 1�; Receipt No.: NOTE: Persons contracting nre ?er contractors do not have access to the guaranty fund Signature of Agent/Owner _ nature of contractor Plans Submitted laps Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature MMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signatureldate COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses I�Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008 Location �' � � Tv, No. y �� Date -z>1 Nlso , TOWN OF NORTH ANDOVER F O� t A ° Certificate of Occupancy $ sBuilding/Frame Permit Fee $ S6 s�cMua Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1_ 2 ' 4 1 '% _ Building Inspector AORTI, 9 TONM O , .._� ; � 4 over 01 o dover, Mass.,�2-zdl - 0:f COCHICMEwICK 1 � D dSRATED P �5 7 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT � Y� vin r.. � — f'.�5........ .. ............... ..................................................................................... Foundation has permission to ere buildings on .6 ....er.4-4' "' rt.... ....... ..... Rough to be occupied as SJ��`�— — _ — �"— �^ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPI"INNMONTHSUNLESS CONSST�R ELECTRICAL INSPECTOR. Rough ................................................................................. Service BUILDING INSPECTOR Final Occupancy- Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SIDE Smoke Det. A Ouchanan Fireplace LLC Invoice Your Local Hearth Store! Date Invoice# 215 Salem St. 85 Providence Hwy. 8/15/2009 2540 Medford, 02155 Westwood, 02090 !I (781) 395-4808 (781) 329-2444 Terms Rep www.buchananfireplace.com 50%DEP,Bal due @ Install RJB $ill To Ship To Jim Primmer 224 South Bradford Street North Andover,MA 01.845 Qty Item Code Description Cost Amount 1 1-90-00674-1 Accentra Pellet insert 24"Black 3,799.00 3,799.00T 1 KST425 4",All F... 4"X 25'Min.Stainless.Steel Liner Kit 475.00 4.75.00T 1 Labor-Install Install Fireplace,insert,or Stove,&venting 450.00 450.00 Discount grand opening promo -267.13 -267.13 Discount current superoups discount -50.00 -50.00 Massachusetts Sales Tax 6.25% 267.13 Ile Total $4,674.00 Credits $-2,337.00 Thank you for your business. Batance Due $2,337.00 All Deposits are non-refundab . /e, anges or returns on parts or products.Buchanan Fireplace LC is not responsible for venting purchased but not installed by BuchanFirLC.Buchanan Fireplace LLC does not perform any gas work or perform any electrical installation. Tested and , Goaverton Listed By Oregon USA C 01NNi-Test Laboratories,Inc. gatisfait aux ram>cs et rfpond Tests realists par OMNI-Test Laboratories,inc. aux prescriptions de la directive RA ort MRIa pW Ir135-S-12-2 CEM 89133(i(CE ModeUMttdal8: T rit41 Tont 6:A$TM 61509 mrd ULC C1482-M19M hCL'EM�RA INSET Tests Malisk par EMITECH et RFP Elactronfque-Npvem¢re 290 Roam Heater PeQet Foal Bumi Also Seton les nonnes appliques EN 55014-1 Ed.00+A1 Ed.1+A2 Ed.02, ng sol foruse In Moblte Holmes. EN 53014.8 Ed'.97 s Al E102,EPA 610001.2 Ed.01 Appargil de chauffaga 0 grartsllk do boil EN 61009.33 Ed95+At Ed.01,Fitt 603351 Utilisable dans des mobile homes. This pellet burning appliance has been tested and fisted for Ser Fal No. use in Manufactured Homes in aocordance with NQ !aerie OAR 814-23-900 through SW23.909 "PREVENT HOUSE RRES" PAMNItONt1ESINCENDIES Install and use on€yinacoardanceWthmanufacturerainstallation and FQW0181WUPuX1LwwtllUs-insUuabnsduconstructewpWrrfins!illation operation instructions.Contact kraal building or fire officials about et less Wnsigres dsiiespt?cterdes reglas de s4cut0 a en r tri t' eur dans volre r' ' es c torts and inspection in r area. � egan. y� WARNING:FOR MANUFACTURED HOMES:Do not installappkrice AVERTISSEMENTPOUR NOBLE HOMES:Nepas tnsfallerdanstre In a sleeping room.An outside combustan air inlet must be proV&d. chembre..ileg impftff de prdWr une pdsed'ak exl§rieur.VmakjO- The structural integrity of the manufaaured horse floor,calling and slnletmnu ptarorv,eupla"'Md2smursdo&0 tt heht pr"e walls must be Maintained. Se reporter uux instnidions du Fabricant el ma re�It tion8 ues Refer to inantlfacturer's Instructions and local bodes for precautions lomtes ottttearnam les Ptmtnim%requisi a tors 6e I4-traver.*Min mum qtr required for passing chimney through a combustible wall-or oeiting. dunpplafatd.Contiftet nelloyarNqueminlpnttoutie sysornecrovacaalion Insect and dean exhaust venting system frequently in accordance des lutdes eatdormenent aux reaocnmandationsdu aarstnxteur.Rdatiser Ulil ht8ntifa(fUfBr'SitShttcGo5n5. r�tracuanond�w, rnrdnrhshyauttccS�rtlrllgr3pt ?¢rt-0�7G mm ou 142 mm cc tie(a gai ne floft inox double peau com"lift6 dans Use a T or 4"darwer type V Or`PL`venting system,or c staltllass Is Police clViisatktn.Ne pas raocorder ce po V e A,�t orlduB de chePdnde steel flex as per owner's manual. dAutiis6 Pnorim Alum--Pparell. 1)0 not connect this unit to a chimney flue servicing another appliance. FONCT10 M OCLUSIVEMENT AVEC DES GRANULES BE 8019, FOR OSE WITH PELLETIZED WOOD FUEL ONLY inpttt Rnfing W. r 5 lb itrM Consommation nlerdmutn,22710 .Electrical Riling:240 VAG,50 HA Start 2A AMPS,Runt 1.1 AMPS, Caractdristiques dfectdques:240 VAC-%Hz-tmensM au d6marrage U-S.Elec fmi Rating:115 VAC,60 Hz,Start 4.1 AMPS,Run 2.1 AMPS 2'OA-Intens:46latctiomement normal 1,1A Route power std away from un It U.S.Eledricai Raft.115 VAC,60 Hz,Start 4.1 AMPS,Run 2.1 AMPS DANGER:Risk of electfit al shock.Disconnect po5ver supply before To*le cordon eallmemaillon i f6carl du po8le. nici"g DANGER:Risque d'4bCboa,tion-DiFm rtcnerrappareiava*bAe kowm bon. For further instruction refer to owner's manual. Pour une ioNtaraflon pus complete,se reporter A la notice d'tAsefon. Replace glass only with 5mm ceramic available from yo ur dealer. Ne templaosr la viVe gdavec urs vivre odraniqtte 5 mm de mems qu36t6 Keep viewing rand ash removal doors lightly closed during operation. disponible aupr63 de votre rever6a.19T i la pone hemm dement close dmanl le7nrictioitnemertl, Minimum Clearances To Ecarts Minimum de Combustible Material Securltd- Non-cotm'buitible floor protector must extend 6" Le protection de sal Boit Etre ctmstituee de marteriau (Mmm)to the sides and front of unft;measured, incombustableet s'iftrxbsds152,mrn(e)hPmmntatour from the glass face. les e6ttss, 12"1305mm)MantelI /1�-(305mm,Maate2udaCntrrap,ee� (� � nS�a Side Was f aorTsot M ur do 6616 Pan aauou rdnutura � \ V AInm , E E' Hearth Extension I Extension de Mire CLEARANCES&SPAC€S LIBRES: A 0 C D E _frominrertBttdy 10, 12° 8fi' 6" b` (254mnt) (305mm) (19mm) (t52rnmj (162 Manufactured by/Pabriqu6 par.Harman Stove Cpmparty M Mountain House Road,Haiftalt,PA 17092 U.S.ENVIRONMENTAL PROTECTION AGENCY Tftmodel is exempt from EPAceatkation under 40 CFR 60.531 by diefinitiorrM od Heater JA)'Air-to`FueiAaWl Date of Manufacture/Date de fabrication 20.04 2005 2806 JAN FEB BWR APR MAX JUN JUL Ail(# SEP OCT NOV- DEC Installation • Operating Manual The Harman Accentra Pellet Insert TM ARMA H N i 1 � 1 I i We suggest that our * hearth products be o� q installed and serviced by professionals who are ro certified in the U.S.by TOW& � c'16M the National Fireplace U-dey or q-.UsA swum Institute (Nfl) as NFI "Ce manuel est disponible en Francais sur demande" US Rp Specialists. O OMNFW Lab—!.r-IM SAFETY NOTICE PLEASE READ THIS ENTIRE MANUAL BEFORE YOU INSTALL AND USE YOUR NEW ROOM HEATER. FAILURE TO FOLLOW INSTRUCTIONS MAY RESULT IN PROPERTY DAMAGE, BODILY INJURY, OR EVEN DEATH. FOR USE IN THE U.S.AND CANADA. SUITABLE FOR INSTALLATION IN MOBILE HOMES IF THIS HARMAN ACCENTRA PELLET INSERT IS NOT PROPERLY INSTALLED,A HOUSE FIRE MAY RESULT. FOR YOUR SAFETY, FOLLOW INSTALLATION DIRECTIONS. CONTACT LOCAL BUILDING OR FIRE OFFICIALS ABOUT RESTRICTIONS AND INSTALLATION INSPECTION REQUIREMENTS IN YOUR AREA. CONTACT YOUR LOCAL AUTHORITY(SUCH AS MUNICIPAL BUILDING DEPARTMENT,FIRE DEPARTMENT,FIRE PREVENTION BUREAU, ETC.)TO DETERMINE THE NEED FOR A PERMIT. CETTE GUIDE D'UTILISATION EST DISPONIBLE EN FRANCAIS. CHEZ VOTRE CONCESSIONNAIRE DE HARMAN. SAVE THESE INSTRUCTIONS. 3-90-00674 w The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street { Boston, MA 02111 - www.naass.gov/dia Workers' Compensation Insurance Affidavit: Builders!Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): C S4CitAddress: c�I6_ foL L4S4- City/State/Zip: y/State/Zip: � ��f �aphone #: l °��S_4/006 8� Are you an employer?Checkth appropriate box: Type of project(required): I�am a employer with 17 4. F-1 I am a general contractor and I b New construction employees(full and/or part-time),* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.$ 7• ❑ Remodeling ship and.have no.employees These subcontractors have 8, Demolition. working for me in any capacity, workers' comp. insurance. 9. Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.) officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0.Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.0 Roof repairs 11 insurance required.]t employees. [No workers' l 3 Other e 1Y evf comp. insurance required.) *Any applicant that checks hoz#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 1 am air employer that is providing workers'compensation insurancefor my employees. Below is the policy and job site information. 11e 44c-4 Insurance Company Name: , �' , ' / Policy#or Self-ins. Lic. #:1J"8''%90LJ"1l I '� Expiration Dater 3 02 Job Site Address: "I (�( -d City/State/Zip:t "•ill 1WG►L `?� 4 7 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 fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of 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. Ido hereby certify and the pains and penaldes perjur that the 'nforrnadan provided above is true and correct Si nature: ✓� �/ ate: Phone#: / ��—L� L/ J 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.Plumbing Inspector 6.Other Contact Person: Phone#: r t VDAC I�HTaoRD WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6S60UB-96 0L41-5-08j RENEWAL OF (6S60UB-007 L75-0-07) INSURER: HARTFORD UNDERWRITERS INSURANCE COMPANY 1• NCCI C CODE: 80411 INSURED: PRODUCER: BUCHANAN FIREPLACE LLC LISTER INSURANCE AGENCY 215 SALEM STREET 110 CENTRAL AVENUE MEDFORD MA .02155 PO BOX 496 MEDFORD MA 02155 Insured is A LIMITED LIABILITY COMPANY Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 11-23-08 to 11-23-09 12:01 A.M. at the insured's maili ig address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s)listed here: MA B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 policy Limit Bodily Injury by Disease: $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by-audit to be made ANNUALLY. DATE OF ISSUE: 11-26-08 TB ST ASSIGN: MA OFFICE: ORLANDO DA HTFD 05G PRODUCER: LISTER INSURANCE AGENCY 72RDT r 'TOWN OF NORTH ANDOVER AFFIDAVIT Rome Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units...or to structures which are adjacent to such residence or building"be done by registered contractors, with certain exception, along with other requirements. I �� Type of Work: .�—n5T�-� �) I� - -1152t� Est. Cost yea Address of Work OV �S u+k Bra l-(2c( �?I� et Owner Name: i lv\� r"Le-1— Date of Permit Application: I hereby certify that: Registration is not required for the fd wing reason(s): For office Use Only Work excluded by I Permit No. Job under $ Date Buildi of own -occupied her pulling own permit Other (specify) Notice is hereby -given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND UNER MGL c. 142A. Signed under penalties of perjury: hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name ✓fLG "�/Om7/IIL4'lZfl1P,Q.LIIL 4�..f�O�YLUQP-�6 _ Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 149713 Board of Building Regulations and Standards Expiration: 2/2/2010 Tr# 263741 One Ashburton Place Rm 1301 Type: Ltd Liability Corpor Boston,Ma.02.108 BUCHANAN FIREPLACE LLC ROBERT BUCHANAN 215 SALEM STREET ,` MEDFORD,MA 02155 Administrator Not id without signature llassachusctts-Department of Public Safct.N Board of Building Rc!�ulations and Standards Construction Supervisor Specialty License License: CS SL 98459 Restricted to: SF' ' ROBERT BUCHANAN 11 NORTH PLAIN STREET NORWOOD, MA 02062 Expiration: 12/12/2012 ( ranrr.iaicr Tr#: 98459 I I O�No oT s�ti0 BUILDING PERMIT �? TOWN OF NORTH ANDOVER ° L APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: �9SSacHuS�S�y IMPORT�JAN�T:Applicant must complete all items on this page LOCATION 90-9 5aL�'1 � 4�� 61_1ele7i "� Print PROPERTY OWNER ,� I PA `1' �i ('A 0A1e_j` /z Print MAP NO:�U PARCEL: 01-/,C-ZONING DISTRICT: Historic District yes Machine Shop Village yes to TYPE OF IMPROVEMENT PROPOSED USE Residential- Non= Residential ❑ New Building XOne family ❑ Addition ❑ Two or more family 0 Industrial ji(Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑ Water/Sewer II )DESCRIPTION OF WO K TO BE PREFO €D: �/1 �� C k! f�dr 60 41 Identification Please Type or Print Clearly) OWNER: Name: J l tveu pri., th na C',P' Phone:9 Address: l �T • , CONTRACTOR Name: l&Urf � 4� Phone: c5-- 11C70ec? Address: cL �' l 0 Supervisor's Construction License: Exp. Date: Home Improvement License: / �" / Exp. Date: o�Q /o ARCHITECT/ENGINEER Phone: Address: Vz Reg. No. FEE SCHEDULE.BOLDING PERMIT:$12.00 PER$1000.00 OF THE TO ATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ y�, � O $ Check No.: ceipt No.: NOTE: Persons contracting.with unregistered c do not have access to the guaranty fund Signature of Agent/Owner ignature of contractor Plans Submitted L✓1 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ '_7 ❑ C I1IIME-NTS / r .) . MIT /1:7� DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes- Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit Located at-384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. ��/Z Total land area, sq. ft.: / 3 /tcS ELECTRICAL: Movement of Meter location, mast is dr p requires approval of Electrical Inspector Yes o DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — For department use L4D X�❑ Notified for pickup - Date Doc.Building Permit Revised 2007 i