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HomeMy WebLinkAboutBuilding Permit #195-16 - 25 GREAT LAKE LANE 8/27/2015 NORTH 17 BUILDING PERMIT o�<t�eD -b;�S TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 70 Permit No#: Date Received ArED �gSSACHUS���y Date Issued: IMPORTANT::Applicant must complete all items on this page LOCATION 5 �t ► t,�.`'�1ny Print PROPERTY OWNER *T KZ LLC, Print 100 Year structure yes no MAP T(o PARCEL: S ZONING DISTRICT: Historic District yes Machine Shop Village yes: no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential til New Building YOne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No: of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic Q Well, ❑•--Ibb plan r]Wetlands p 'Watershed Distncfi, ❑Water/Sevver. _ ___- _ _-_ —___ _ _ e. DESCRIPTION OF WORK TO BE PERFORMED: SFR �cuw�.�nX� Identification- Please Type or Print Clearly OWNER: Name: T KZ 1,LAG Phonel78-295Z'yltlZ Address: L( b5) A A461fr 0A ✓r 4 Contractor Name 301 Phone: -BrZ-?az e- t Email: 7`� u cwt - Address: ia T., SzA Supervisor's Construction License: Exp. Date: • y!�I,� Home Improvement License:. Exp: Date: ARCHITECT/ENGINEER Phone: '• Address: Reg. No. L• FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00ER S.F. Total Project Cost: $(�� *508,Ow. FEE: $ Check No.: OG Receipt No.: NOTE: Persons contracting with unregistered c tractors do not have access to the guaranty fu f Location No. �! ��� Date . - TOWN OF NORTH ANDOVER urb Certificate of Occupancy $ k Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ 4 TOTAL Check# +{: A Ing inspector i Plans Submitted Plans Waived ❑ Certified Plot Plan Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer x 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on ure 1 COMMENTS b HEALTH -- Reviean_ Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes l Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer C OnneCtlon/Si nature& Date Driveway hermit DPW Town Engineer: Signature: Located' 384.Osgood Street FIRE DEPAMTMENT - Temp b�urnpster onsite r e m no Located at 124 Main Streetgf�'° �. �, . ��"� Fire DMart t signature/date ,, &` f n,. �,.' • � a � - , 1` r�'', COMMENTS `� � '.`�s-��_ �.�� �,�,�,��,�- ���•��,. ���,w...� s baa; + 4yc�g Dimension Number of Stories: r? Total square feet of floor area, based on Exterior dimensions. 314% Total land area, sq. ft.: i LA O, �Oyq 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) b I T6 1- r-sr- ILI 2S' x 1ZS 3 oto. oT Irl. S0191 64b fee Me #t2 UE -401(o . i j ® Notified for pickup Call Email I Date Time Contact Name Doc.Buildin;Permit Revised 2014 Building Department i 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 j 4. Building Permit Application Workers Comp Affidavit l 4. Photo Copy Of H.I.C. And/Or C.S.L. Licenses !� Copy of Contract If Floor Plan Or Proposed Interior Work Engineering Affidavits for.Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit I Addition Or Decks I 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/Cross Section/Elevation Plan Of Proposed Work With-Sprinkler Plan And Hydraulic Calculations (If Applicable) G Mass check Energy Compliance Report (If Applicable) 4. Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit: New Construction (Single and Two Family) s Building Permit Application I� 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 2012 I ECC Energy code Engineering Affidavits for Engineered products OTE: 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:Building Permit Revised 2014 of NORiM 1ti ti a r' -R R !J 'i�Oa...e..•'410 S T4CHOSE CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 294-2016 on 9/8/2015 Date: October 23, 2015 THIS CERTIFIES THAT THE BUILDING LOCATED at 25 Great Lake Lane MAY BE OCCUPIED AS IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: TKZ LLC 25 Great Lake Lane North Andover, MA 01845 -w— Buil ing Insp c or Fee: PrePaid $100.00 Receipt: 29205 Check : 1606 }'1 t NORTH To'wn ® � _E yAndover •. O 46�1 ,,. , o No. t - a - LAE h ver, Mass, COC"IC Mlw1C1( 1_ TED S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System w1A THIS CERTIFIES THAT, BUILDING INSPECTOR . ....................................... ..%............................. Fo anon has permission to erect .......................... buildings on . ................................................................ ouch to be occupied as �� .... �. �.. . . 'v Y" provided that the person accepti g this permit shall i every respect conform to the terms of the application eim on file in 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 RoughG INSP R � `��d� / VIOLATION of the Zoning or Building Regulations Voids this Permit. 1142 I Final Aw PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC7�'�_ -4u'ILDING RTS Rough G a �v- Service ......... .�.� ................. Final INSPECTOR GAS INSPECT Occupancy Permit Required to Occupy Building Rough fg/�4�/� Display in a Conspicuous Place on the Premises — Do Not Remove Final 044 I 7 }� No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector° Bu r Street No. Smoke Det. _� �� ,i OF NORTy O APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION o�� ��ss"T`°"P.��� BUILDING PERMIT # �s'ZDI ACHus ADDRESS/LOCATION OF PROPERTY: 2 S Gr-&4 �46 [Anes Map ( Parcel �3 Lot Number SUBDIVISION: Ae- (-" (,Av-/ DATE REQUESTED FILED/READY FOR INSPECTION: CLOSING DATE ON PROPERTY: FIVE 5 DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED THIN THIS TIME FRAME. A REINSPECTION FEE OF TWENTY DOLLARS ($20. VILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. APPLI ANT SIGNATURE Permit Issued to: Address: 7-2 C �tE���,�f.✓tl�tU�(; �t-1 d �� ROUTING TOWN ENGINEER; SITE PLAN—DRIVE-WAY REVIEW [d OK r.b Zo CONSERVATION PLANNING DPW-WATER METER ' `�'►�o �� SEWER CONNECTION DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW HC41 V_" SIGNATURE File:Application for OC form revised Ian 2007/2011 NORTH Town of E ndover O th No. A"_ %__ 7�� _ y � 2 LA N■ h ver, Mass, / COCHIC Nl WICI[ %, A°'4^Teo S U BOARD OF HEALTH Food/Kitchen PERMIT T U Septic System w 1A THIS CERTIFIES THAT . BUILDING INSPECTOR has permission to erect .......................... buildings on . ... ................... Fnaarron i � ough to be occupied as .......�1' X.... ��,',. ?sr.G ............................................................................. eimy provided that the person acceptifig this permit shall i every respect conform to the terms of the application on file in 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 INSP711 �� za VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough /F Final �, n� �t PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT'0 RTS Rough �� y n ��- d Service ......... . ........ .... v Final ULDVfINSPECTOR GAS INSPECT711 Occupancy Permit Required to Occupy Building Rough1��®� Display in a Conspicuous Place on the Premises - Do Not Remove Final 044 a 1---, No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Bu r Street No. Smoke Det. 0 2--L"-�9-- Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 508000.00 m $ - $ 6,096.00 Plumbing Fee $ 762.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 762.00 Total fees collected $ 7,720.00 25 Great Lake Lane 195-2016 on 8/14/2015 SFH I I i i I NORT1i Town of s _E ,, ndover 0 . � No. - h ver, Mass /zx coc"Ic"IWICK S U BOARD OF HEALTH PERM- IT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ..............7 ......./.e.. ............................................................................. BUILDING INSPECTOR ���� ��� I�� Foundation has permission to erect .......................... buildings on . ................................................................ Rough tobe occupied as ....... 1 .. . �. [.��............................................................................. Chimney provided that the person.accepting this permit shall i every respect conform to the terms of the application Final on file in 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO RTS Rough Service AV- ........ .... A. ................. Final UILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Registry ID: Rating Number: Certified Energy Rater: Tom Barnes AL Rating Date: August 17,2015 25 Great Lake Lane Rating Ordered For: No er, 45 *-A. .. . A --/N----+ Estimated Annual Energy Cost Associates, Inc. Based on Plans leers and Consultants www Use MMBtu Cost Percent 5 Stars Plus Heating 128.9 $1365 41 Projected Rating: Based on Plans, Field Confirmation Required Cooling 4.1 $179 5% orm Energy Rating System Energy Efficient Hot Water 23.6 $211 5% tar 1 Star Plus 2 Stars 2 Stars Plus 3 Stars 3 Stars Plus 4 Stars 4 Stars Plus 5 Stars 5 Stars Plus Lights/Appliances 35.7 $$211 43% 401 1 400-301 1300-251 250-201 200-151 150-101 100-91 9C 85-71 70 or Less Photovoltaics -0.0 $-0 -0% .S Index: 58 Service Charges $120 4% eralInformation Total 192.3 $3317 100% Conditioned Area: 4664 sq.ft. HouseType: Single-family detached Conditioned Volume: 39336 cubic ft. Foundation: More than one type Bedrooms: 5 This home meets or exceeds the minimum hanical Systems Features criteria for all of the following:Heating: Fuel-fired air distribution, Propane,92.OAFUE. 2009 International Energy Conservation Code2012 International Energy Conservation Code Heating: Fuel-fired air distribution, Propane,92.OAFUE. Cooling: Air conditioner, Electric, 13.0 SEER. iuct Leakage to Outside: 183.00 CFM25. Ventilation System: Exhaust Only:71 cfm,35.0 watts. ,grammable Thermostat: Heating:Yes Cooling:Yes ding Shell Features Ceiling Flat: R-49.0 Slab: R-10.0 Edge, R-0.0 Under Sealed Attic: NA Exposed Floor: R-30.0 Vaulted Ceiling: NA Wndow Type: U-Value:0.300, SHGC:0.300 Above Grade Walls: R-21.0 Infiltration Rate: Htg:3.00 Clg:3.00ACH50 Foundation Walls: R-0.0 Method: Blower door test is and Appliance Features �oaT6a�F Percent Interior Lighting: 100.00 Range/Oven Fuel: Propane GDS ASSOCIATESA Percent Garage Lighting: 100.00 Clothes Dryer Fuel: Electric 1155 Elm Street,Suite 702 z° ' � Refrigerator(kWh/yr): 600.00 Clothes Dryer EF: 3.01 Manchester, NH 03101 Dishwasher Energy Factor: 0.46 Ceiling Fan(cfm/Watt): 0.00 603-656-0336 No. 9s o98 > IF The Home Energy Rating Standard Disclosure for this home is available from the rating provider. 866-611-3791 sq " ��`O REM/Rate-Residential Energy Analysis and Rating Software v14.6.1 c`'�!OITA-000 This information does not constitute any warranty of energy cost or savings. ©1985-2015 Noresco, Boulder,Colorado. HERS PERFORMANCE ENERGY RATING CERTIFICATE 0pRTGgG� Projected Rating: Based on Plans - Field Confirmation Required. ply HERSO Index More Energy 150 No. 1998-098 ". 140 ` 1c GDS Associates s Inc. Existing Engineers and Consultants Home130 REo�TA?tpN 120 Estimated Annual Energy Cost 110 Estimated Annual Energy Consumption Standard 100 $/yr New Home ` 90 MMBtu/yr i 4000 3317.3 i 80 200 192.3 3000 70 This Home 150 128.9 2000 365.2 1442.2 60 58 100 1000 . 50 50 35.7 178.7211.2 120.1 23.6 0 40 4.1 -- (] U 30 c ,c .- Q �'v o a`Di °o atDi 20 a`9i °o ami a, o U 10 o -J Zero Energy 0 J Home Less Energy Address: 25 Great Lake Lane Annual Estimates*: North Andover,MA 01845 Electric(kWh): 11627 GDS ASSOCIATES OORTGAC Propane(Gallons): 1671 1155 Elm Street,Suite 702 0 � House Type Single-family detached CO2 emissions(Tons): 16 Certified Rater: Tom Barnes Cond.Area: 4664 sq.ft. Annual Savings**: $3089 Rater ID: 4583495 v"r � it No..y 98 098' Rating No.: Registry ID: M� g Issue Date: August 17,2015 *Based on standard operating condition. Rating Date: August 17,2015 q� CRs Certification Verified **Based on a HERS 130 Index Home p,TATO"' REM/Rate--ResidentiabEn`ey Analysis and Rating Software v14.6.1 't This information does not constitute any warranty of energy cost or savings. ©1985-2015 Noresco, Boulder,Colorado. The Home Energy Rating Standard Disclosure for this home is available from the rating provider. RESNET HERS Index Certificate r HERS®Index Projected Rating; Based More Energy on Plans - Field 150 140 Confirmation Required. _ Existing 130,. Homes F— 120 110 Standard ' 1e0 New Home so 80 r 70 - This Home GDSASSOCIATES sa 58 p'sS 1155 Elm Street,Suite 702 so �' Manchester, NH 03101 40 603-656-0336 30 20 10 This home has been inspected Zero Energy O Home and performance tested in accordance with Chapter 3 of 4 r Less Energy the RESNET standards. www.resnet.us �r II ,. RESNET HOME ENERGY RATING Standard Disclosure For home located at: 25 Great Lake Lane City: NorthAndover State: MA 1. X❑ 'The Rater or the Rater's employer is receiving a fee for providing the rating on this home. 2. In addition to the rating,the Rater or Rater's employer has also provided the following consulting services for this home: ❑ A. Mechanical system design ❑ B. Moisture control or indoor air quality consulting ❑ C. Performance testing and/or commissioning other than required for the rating itself D. Training for sales or construction personnel ❑ E. Other(specify below) 3. X❑ The Rater or Rater's employer is: ❑ A. The seller of this home or their agent ❑ B. The mortgagor for some portion of the financed payments on this home X❑ C. An employee,contractor or consultant of the electric and/or natural gas utility serving this home 4. ❑ The Rater or Rater's employer is a supplier or installer of products,which may include: Installed in this home by: OR Is in the business of: HVAC systems ❑ Rater ❑ Employer ❑ Rater ❑ Employer Thermal insulation systems ❑ Rater ❑ Employer ❑ Rater ❑ Employer Air sealing of envelope or duct systems ❑ Rater ❑ Employer ❑ Rater ❑ Employer Windows or window shading systems ❑ Rater ❑ Employer ❑ Rater ❑ Employer Energy efficient appliances ❑ Rater ❑ Employer ❑ Rater ❑ Employer Construction(builder,developer,construction ❑ Rater ❑ Employer ❑ Rater ❑ Employer contractor,etc.) Other(specify below): Rater Employer Rater ❑ Employer ❑ I attest that the above information is true and correct to the best of my knowledge. As a Rater or Rating Provider I abide by the rating quality control provisions of the Mortgage Industry National Home Energy Rating Standard as set forth by the Residential Energy Services Network(RESNET). The national rating quality control provisions of the rating standard are contained in Chapter One 4.C.8.of the standard and are posted at http://resnetus/standards/RESNET Mortgage_lndustry_Natc The Home Energy Rating Standard Disclosure for this home is available from the rating provider. Tom Barnes 4583495 Rater's Printed Name Certification# August 17,2015 Rater's Signature Date RESNET Form 0300-2 I � Na.y�9aoes ,a GDS Associates,Inc. e'ngmeais and Conspanrs aagao'rATIO AIR LEAKAGE REPORT Date: August 17,2015 Rating No.: Building Name: 25 Great Lake Lane Rating Org.: GDSAssociates,Inc. Owner's Name: Phone No.: (603)656-0336 Property: 25 Great Lake Lane Rater's Name: Tom Barnes Address: North Andover,MA01845 Rater's No.: 4583495 Builder's Name: TZK LLC Weather Site: North Andover,MA Rating Type: Based on Plans File Name: Preliminary Report-3 Great Lake Lane.blg Rating Date: August 17,2015 Blower door test Whole House Infiltration Heafing Cooling Natural ACH: 0.22 0.18 ACH @ 50 Pascals: 3.00 3.00 CFM @ 25 Pascals: 1253 1253 CFM @ 50 Pascals: 1967 1967 Eff.Leakage Area: [sq.in] 108.0 108.0 Specific Leakage Area: 0.000161 0.00016 ELA/100 sfshell: [sq.in] 0.891 0.89 Duct Leakage Leakage to Outside Units Ducts Ducts CFM @ 25 Pascals: 124 59 CFM25/CFMfan: 0.0572 0.0272 CFM25/CFA: 0.0395 0.0388 CFM per Std 152: N/A N/A CFM per Std 152/CFA: N/A N/A CFM @ 50 Pascals: 195 93 Eff.Leakage Area: [sq.in] 10.68 5.08 Thermal Efficiency: N/A N/A Total Duct Leakage Units CFM25/CFA CFM26/CFA Total Duct Leakage: 0.0398 0.0394 Ventilation Mechanical: Exhaust Only ASHRAE Sensible Recovery Eff.(%): 0.0 62.2-2010 Total Recovery Eff. Rate(cfm): 71 92 Hours/Day: 24.0 24 Fan Watts: 35.0 Cooling Ventilation: Natural Ventilation Regarding ASHRAE 62.2 Ventilation Compliance The ASHRAE 62.2 flow rates shown above are the CONTINUOUS mechanical fresh air ventilation which will meet the'whole-building'requirement under that version of the standard. Both values incorporate any appropriate 'infiltration credit. Intermittent mechanical ventilation may be used if the flow rate is adjusted accordingly.For example,the runtime can be reduced to 12 hours per day using a doubled flow rate,as long as the system provides ventilation at least once every 3 hours. For more detail,refer to the appropriate standard. REM/Rate-Residential Energy Analysis and Rating Software v14.6.1 This information does not constitute any warranty of energy cost or savings. ©1985-2015 Noresco,Boulder,Colorado. HOME CERTIFIED TO MEET THE PROVISIONS OF THE 2012 INTERNATIONAL ENERGY CONSERVATION CODE This home built at 25 Great Lake Lane, North Andover, MA by TZK LLC exceeds the minimum requirements for the 2012 International Energy Conservation Code August 17, 2015 Building Features Ceiling Flat: R-49.0 Duct Leakage to Outside: 124.00 CFM @ 25 Pascals Sealed Attic: NA Total Duct Leakage: 125.00 CFM @ 25 Pascals Vaulted Ceiling: .NA Infiltration: Htg:3.00 Clg:3.00ACH50 Above Grade Walls: R-21.0 Window: U-Value:0.300,SHGC:0.300 Foundation Walls: R-0.0 Heating Fuel-fired air distribution, Propane,92.0AFUE. Exposed Floor: R-30.0 Cooling Air conditioner, Electric, 13.0 SEER. Slab: R-10.0 Edge,R-0.0 Under Water Heating Instant water heater, Propane,0.82 EF,0.0 Gal. Duct: R-8.0 The organization below certifies that the proposed building design described herein is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the 2012 IECC requirements in compliance with Chapter 4 based on Climate Zone 5A and with all mandatory requirements. Name: Tom Barnes Signature: Organization: GDSAssociates, Inc. Date: August 17,2015 The 2012 International Energy Conservation Code is a registered trademark of the International Code Council,Inc.("ICC"). No version of this software has been reviewed or approved by ICC or its affiliates. REIWRate-Residential Energy Analysis and Rating Software v14.6.1 ti h _._.............. (. ��.. jl I i II { a _ IL _N I i � f ! r f � I 1 ;42.1 (__s..: L.. �. i 3 i.r•rJ' I ins I ` i .., ..._..-._..�. I _............. INS Vb /� i �� � c�vcoOxlQdB l -•�._-II , � ,�v —. _...__– i la w Ul T n. 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W"- ry:'•'£ -A F E'x i f te.f'5 SCALE!Vj�lfsti ep tw-4KI,.e,;_ t°,:i.�R�st+�:b3:ts 2 Cc t��-• s,!'7e+,xe.i�€2 i,r.,tk"t3;t. i'in:"v.i�.:vG:,+�r la�_'A;:saTF-t'�a^,ia:3 r•�i�,- I:a,C. - r 'PROFESSIONAL NGIN ►`S&LA D,,SUR M _yo R.? ltil}+tilt i t'SfREf T, H'il� .> '" RC54—ENGt_CtM TEL.9 373,1 31.E F . 7i�.x3-"La5 15 I Plans Submitted 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 ❑ I� . THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On J Signature_ ' COMMENTS �/}� CONSERVATION Reviewed on 6olo-)-') Si nature` c COMMENTS c�l� - HEALTH Reviewed on Si nature ' COMMENTS Zoning Board of Appeals:Variance, Petition No: N Zoning Decision/receipt submitted yes Planning Board Decision: 1t 1 Comments Conservation Decision: Its Comments Water&Sewer Connection/signature&,Date / I A /I Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEP °RTMENT: Temp ®u k ster®n sit $� �� MreDe artment si,• n ure' date� ts. : ����. ���' � •.� _� � ��_���,� i I I i I 51_(i+�� 'fit' ii I t it T` if i �i pip t t� .. 1, !• t � t '. + i��� I•d�� I � I�+ + F.��� +' j IFFI 1 4 f r v� S, i t t 1 I: IA to 411.0 1 , W"' .i i. i , ... .. _... ... C j, }� I P r -y i 1 �� i .f f +..:.U.. 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