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HomeMy WebLinkAboutBuilding Permit #Exception - 24 GILMAN LANE 5/1/2018 • BUILDING PERMIT cf "°oT" qti TOWN OF NORTH ANDOVER 3? 6`tt r *6 0 APPLICATION FOR PLAN EXAMINATION w Permit NO: '' �4 0 � �� Date Received ���•�-�• ' 4 ,y Date Issued: ACHUS IMPORTANT:Applicant must complete all items on this page �. - .., cis ,� ,� �- v �,� �. " �„ s• �*�� � �•a-¢. lIL.N - ''�� �„SA`a• `� fi 14"`s "P Y!'� R gl 4. ",qt `�' �'�m§'�` �'g" �Zv� �'t ' a..3��. � ���,•4� _ ��tc���`ta7•esa. �� 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 5P, �t . Others: Demolition Other .ti�� ;ter/�_ vY�'• ter. Y1 .,��u;'�. �,� r�n��;,, ;.� .'a'aE'.;"- '.�..�`" �<� r,� x a� � cx;; *n,`�e €�.� fi`ti :. Fl DESCRIPTION OF WORK TO BE PREFORMED: Qot an i e co b to l — a . ' Identification Please Type or Print Clearly) OWNER: Name: F rU J ( , kQ " Phone Address: C7,Jn b It�I W, 1'on .;4p }� p�i�i,- �� k�-..* � _ ��✓,•�, �� "rya ':Ea ,�� � � ali- ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total.Project Cost: $ o J F-7. ©3 FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with.unregistere4,contractors do not have access to the guaranty fund mature a MRNEO, ,: mature 4 ctic�ntracto P4ans gubmitted 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 COMMENTS D DA REJECTED DATE APPROVED A CONSERVATIO COMMENTS DATE REJECTED DATEAPPROVED HEALTH COMMENT510/a .4i� Zoning Board of Appeals Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connect!on/Sig nature &Date Driveway Permit Located at 384 Osgood Street 'DE 7,11 j �*jpdbj' n 1401'ft V1 H natdreldaW, e "AN Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACHUSETTS System Pumping Record <r Form 4 RECEIVED DEP has provided this form for use by local Boards of Health. Theelo §u2oog Rc cord must be submitted to the local Board of Health or other approving a. thor ip-t `91841 11VLU V�1'1 A. Facility Information HEALTH DEPARTtyIENT Important: When filling out 1. System Location: forms on the r / computer,use GI f ! �A ::If—. Gt —e only the tab key Address to move your cursor-do not use the return City/Town State Zip Code key. 2. System Owner: Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record I 1. Date of Pumping e 3 - 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. Syste Pumped By: Name Vehicle License Number Company 7. Location wherQn—t n er isposed: Vizir ok 6urg wycamil -MA. Signature of Hauler Date http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect t5form4.doc-06/03 System Pumping Record•Pae 1 of 1 Y P 9 9 4. E s d�. ' \.ry.'it�;rrd 'IY$$���` 1•1 - ... ,f Y T f"f'vJ�t 1 1- � � t I � f �SIFu'u! I1 .fr i• t A p- 1 - f f 1''��r r i siL 1�j Ji a+�.,]"Jtlf !lt'p':,:J�,t T1.•1Y^l ih;Xt: j -{,J l - i�- I ro r �w OCT 0 7 2005 N OF NORTH VA Irk . JY8TE1�'1 PUMP1Nu (U�'1:\ If`RTHAND C Q k1. Jf l\� OVER HEH�.'s ri DEPARTMENT APOREss • PEC' t P0� - �; r :NA ruK� it. :, Ue�ttRY�rt l rl � - l�Ut�J 1 a00D CONflI TIUNi FULL ry tuvt X KOO qb n aM,E, r i I v :..6+�CSIY6fsOk1�$ RUN$/1C'Kr PLQ4D�D SOLID CA KA Y0 YtA,.._..O'rKE',R EXPLAIN .�.. .. tt .l 'i i' .rT .1' ••.yr Irx�iH�r��txr�u i� d rY