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HomeMy WebLinkAboutBuilding Permit #Exception - 337 PLEASANT STREET 5/1/2018 TOWN OF NORTH ANDOVER pORT11 O�s��eo eA7'p APPLICATION FOR PLAN EXAMINATION O1-7 Date Received Permit NO: R,T.o�•° 4`� �SSAC HU`�� Date Issued: =PROPERTYOW:NE:R TANT: Applicant must complete all items on this page J Print Print EL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building di6ne family ❑Industrial d dition ❑Two or more family Iteration No. of units: ❑ A ❑Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Demolition ❑ Others: ❑ Moving(relocation) [I Other ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) Phone: OWNER: Name: Address: 'ST le CONTRACTOR Name: USCi�,u� J!-L- Phone: Address: ZS LNY Supervisor's Construction License: CJ Q 7 9 U Exp. Date: -a 1 05 . Date. I 1 Home Improvement License: Exp ARCHITECT/ENGINEER Name: Phone: Address: Reg.No. FEE SCHEDULE:BULD/NG PERM I:1�.0 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ ' FEE:$ Receipt No.: Check No.: Page I of 4 TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales El Permanent Dumpster on Site ❑ Private(septic tank,etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner `- Signature of contractor' Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ []Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVE HEALTH ❑ © �, Z Y f,..7 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 Temp Dumpster on site yes—no— Fire Department signature/date E K SURVEY INC e HAWMILL,MA Phorw 97 9-1t 5♦Fax978469MM6 �r mW REF. RTt31t3 i PLAN REF. --�- ADOMSS OF PRINtCI Ic.Dlt•1C DATE OF 11,49 CTI�ON SCALE:I'=�t i 4 r I x y 1) Boat Tank t f LoT' ! zor 3 S.zQa A1A i ,oh 14 3 _ 4 S . G✓,,, 1 fiVDEL �. ThE location ai tttg proms ruclurcts �artw�t{.el 1rLa.j Na.36M .r �IataEM �j( ' CERTtFIt:d,TIOPI TO: �anra:w T his MO1198W Plot Plan was 1Xspeeffir. Y torsow d a� with the lOcat xbtMlW fNlews u1 effect wt►en aon9trucfe+J mwt9qp P Y F fC151L� end 1 b not Y*ecded or��'� Jsi S'� 8ndl Or is eooEnlpt tram viollion enfaraErtf to be a P(OMW lime or lei SOWY This it[fit to be used �N u u�,0 &OW under Maas B.L. Title VII,Chep 40A.Sec 7 to estobtah any of the pruPWY OfM for"purpose.No 0 SUbjW building b not in a flood Hexad Ate*. responsibdllly is a i*rtd*d to the land owner aP OC4WOnl. 0 SUbjqd bugdtnp is in a Flood Harard Area. This Oartificati)n is based on the todafion Of auneY rrr;*W Flood Hazard determined from 00 FIRM MWO Of odd, Oeted JOB# ��� N Commonwealth of Massachusetts City/Town of RECEIVED a System Pumping Record Form 4 AUG 1 1 2009 M DEP has provided this form for use by local Board f� y be used, but the information must be substantially the same as tha T g this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System L cation: Left front of house, Right front of house, Left rear of house, Right rear of house forms the computer,use01 W only the tab key Address to move your a cursor-do not City/Town State Zi Code use the return p key. 2. System Owner: Name feOO' Address(if different from location) City/Town State,. Telephone Number B. Pumping Record p 9 1. Date of Pumping Date 2. Quantity Pumped: canons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes'2-�o If yes, was it cleaned? ❑ Yes ❑ No 5. Condit1w of System: 6. System Pumped By: Neil Bateson Name Vehicle License Number F5821 Bateson Enterprises Inc Company 7. Location where contents were disposed: L.S.Y Lowell Waste Water Signature of Hauler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD r� DATE. - { SYSTEM OWNER&ADDRESS SYSTEM LOCATION 4 (example: left front of house) - rSfr� � I 4 ` r;���'r��9`i•'•C'k�4l kLl.T �'{, '1.2.+ri i+ +`�1 f ...t a r... i ,n..`. - .. .. .. .. DATE.OF PUMPING: —C7I QUANTITY PUMPED-Z,-�5)PGALLONS �, ,{;}f�r6 CESSPOOL: NO YES 'SEPTIC TANK: NO YES r,r r r k t a tl 1 ' 1 �!'NATURE OF:SE � . .,. RVICE: ROUTINE EMERGENCY ()SERV_ ATIONS: '�t GOOD CONDITION ,__ FULL TO COVER HEAVY GREASE BAFFLES IN PLACE E ROOTS LEACHFIELD RUNBACK XCESSIVE SOLIDS _ FLOODED _ SOL'IDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: �f b'v p { i OrvI 4.ENTS: Inoi r, 4� t�NENPS TRTSFERRED TO: i d� 1 I ZJA 1711 _�-- `l,i��'�.���;�l�S�l