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Building Permit #728 - 57 LONG PASTURE ROAD 6/10/2008
BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: / Date Issued: ` d� _`o 4— IMPORTANT: Applicai Date Received.. 6-' k-ek' must complete all items on this page Print PROPERTY OWNER Print ri MAP. Na-loOl PARCEL ZONING DISTRICT. -JS Historic District Machine Shop Village yes no ves no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family %e -1 - Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement- Assessory Bldg Others: Demolition Other Septic Well "; _ Fl000lain-. q . -; WetlandsWatershed District Water/Sewer V Identification Please Type or Print Cle ,ly) ce i � �7 9 :23 9 OWNER: Name: 0VJ -f Phone: Address: `� 1 ®. L/ CONTRACTOR Name: Phone: Address: Supervisor's Construction License:. -Exp. Date: t Home Improvement License: _ Exp. ,Date: ARCH ITECT/ENG I NgEf Phone: Address: 1 tp SJ;Ntm-eZ AIA, vo Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BBAASED$125. PER S.F. Total Project Cost: $ f/ — FEE: $ -l� 0 3 0 ? Check No.: Receipt No.: NOTE: Persons contracting w;th un'registerAd contractors do not have access to the guaranty fund 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 ❑ 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 ° P .. nses ✓t eKe- ©VV%",— 'EO.A— p 2, 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well (l�j Tobacco Sales Food Packaging/Sales rivate (septic tank, etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED V/PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on .5-1 (0-0 g COMMENTS NO � S � d HEALTH Reviewed on - 0;,7 COMMENTS / �a'�`'-/�p�'®✓ �� r C/ 'e -c;' an— Zoning 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 ` u*ature: Lo ed 364 USgood Street FIRE DEPARTMENT -Temp Dumpster on site yes r , no Located at 124 Main Street a / Fire Department signature/date: COMMENTS I Amension lumber of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: 3- to ` -V V-��-7 ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 2 1 A —F and G min.$100-$1000 fine NOTES and DATA - (For department use) No Doc.Building Permit Revised 2008 e -e N owO S 0) mk,/,J S�v -50 `t/ O w . 8 pyo C� ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Location `7 Lon r �c<S 7y✓t e - g No. :Zane _ Date NaR,M TOWN OF NORTH ANDOVER . L A ;o Certificate of Occupancy Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ C, TOTAL $ / �^ Check # �Q 2 1 2 2 5 Building Inspector .ter TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ;aA Date Received1. r� Date Issued: 6-'lAd IMPORTANT: Applicant must complete all items on this .. age LOCATION =6-1 I- �"��- ��'•P1 / C��: 41 'S F -1 P t PROPERTY OWNER #A,41-odl V ce e 4,0Z 0 Print MAP NO: l0(,4 PARCEL:_J l( ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT ❑ New Building -- ❑ Addition AAlteration ❑ Repair, replacement ❑ Demolition OWNER: N Address: '9J ? -{ PROPOSED USE Residential ❑ One family L' ❑ Two or more family No. of units: ❑ Assessory Bldg ❑ Other DESCRIPTION OFXORK TO, BE PERFORMED: CONTRACTOR Name: Address: Supervisor's Construction License: Home Improvement License: Please Type /o-rPri t Clearly) lk ,�wv /29: Non- Residential ❑ Industrial ❑ Commercial ❑ Others: Exp. Date: Exp. Date: IJ ARCHITECT/ENGINEER Phone: Phone: Address: Reg. No. FEE SCHED U�L'E. BULDING PERMIT' $92.00 PFR $1000:00 OF THE TOTAL ESTIMATED COST BASED ON $925,00 PFR S F, QtM&ect Cosi: S .ti/ / FEE: $ d Check No.: Jl� ' Receipt No.: Ir� NTOTE: Persons contracting with unregistered contractors do not have access to the guaYanty fund .. we Location .-7 No. Date 3 �� TOWN OF NORTH ANDOVER ;o> Certificate of Occupancy $ ��s::�„S •A Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ 'i TOTAL �IA14I $ Check # 1?U 24, '1 4 r Building Inspector OF µORT" TOWN OF NORTH ANDOVER 0 OFFICE OF BUILDING DEPARTMENT ^4 .^, 1600 Osgood Street �qss *so Of Building 20 Suite 2-36 ac"us North Andover, Massachusetts 01845 Telephone (978) 688-9545 Gerald A. Brown Fax (978) 688-9542 Inspector of Buildings AFFIDAVIT FOR FINAL COST OF CONSTRUCTION In accordance with the provisions o the Massachusetts State Building Code, Article 1, Section 110.4 and 114.2, the total estimated cost of the con ctio inc; ' all lated construction costs* of the building located. at .� amounts to I, -r6Y7&6"f_ l -'f identified below, do solemnly swear that the made in good faith. the person referred to as the owner made herein are strictly true and correct and *Related construction costs included all work done with or concurrently with the work contemplated by the Building Permit including demolition, plumbing, heating, electrical, air conditioning, painting, carpentry, landscaping, site improvement, etc. Furnishings and portable equipment are not part of the total construction. costs. Si ture o Owne COMMONWEALTH OF MASSACHUSETTS S. S. Then personally appeared the able named and Made an oath that the above statement is true. JEAN P. ENRIGHT Notary Public Before, Me, Commonwealth of Massachusetts MV COrTNnls M Expires � October 6, 2017 otary Public OFFICIAL USE: Final Cost: , �� e2©() Original Estimate cost of general work: b Cost Difference: Additional Fee Required: TO AMEND FEE UNDER PERMIT NO.: r" ivy Inspectional services Department 2005 FAfi na l costaff i day i tfo nn BOARD OF APPEALS 688-9541 Strict code enforcement makes the town safer Before buying, renting, leasing check zoning CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 'top o w CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 728 Date: May 3, 2011 THIS CERTIFIES THAT THE BUILDING LOCATED ON 57 Long Pasture Road, North Andover, MA MAY BE OCCUPIED AS single-family home, garage, pool IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Fee: 100.00 previously paid Receipt: 21225 Howard and Marguerite Cooper 57 Long Pasture Road North Andover, MA 01845 Building Inspector Date... 2 ... L2Z TOWN OF NORTH ANDOVER PERMIT FOR WIRING -'- y - - This certifies that � ..... 'D m, ................................... U—*---*****—**—* ... has permission to perform ...... ......... /17-) ........................................... wiring in the building of ..................................................... .,:, —P .... ..-7 . ............. I ...... North Andover, Mass. 0 ...... L. NoA,2gzz? ... 2 ELEcTRicAL 114SPEL-rOR Check # 852-0 Bf 1 official Use only C'o�rnantuea�lt o` �%aesacch�ae�e � cc�� cc•�� Permit No. .1Je/ogrinwnt o`. fire Servicee Occupancy and Pee Checked 4!� BOARD OF FIRE PREVENTION REGULATIONS ev. l/0?] leave blank) APPLICATION FOR PERMIT TO PERFORM EL�ECTRICCMEC), 527 CMRALWORK as All work to be performed in accordance with the Msachu Date: (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) �• — --� -- City or Town of: To the Inspector of Wires: By this application the undersigned gives notice of big or her intention to perform the electrical work described below. % a — O n A i1 Location (Street & Number) Owner or Tenant Telephone No -V&-175--1 L Owner's Address r � - ❑ o nate Box Is this permit in conjunction with a building permit? Yes ❑ No (Check Appr o. Utility Authorization N Purpose, of Buildingo. �� E]Uadgrd No. of Meters Existing Service Amps �/ Volts Overhead ❑ Now Service Amps E�2 / 0 Volts Overhead ❑ Undgrd No. of Meters _ Number of Feeders and Ampacity i �- Location and Nature of Proposed Electrical Work: 5 E Com letian o the ollowln table m be waived the Ins dor o Wires. o. o KVA ��t l� Na of Recessed Luminaires 113 No. of Ceik-Susp. (Paddle) Fans Transformers Generators i KVA S No. of Luminaire Outlets `2 No. of Hot Tabs o. o mergency g ng No. of Luminaires Swimming Pool nd e Elrud. Ba tte Units FIRE ALARMS No. of Zones No. of Receptacle. Outlets No. of ON Burners 0.0 ct<oBan ' No. of Switches No. of Gas Burners 2— Initiatln Devices ILL oW° No. of Alerting Devices. No. of Ranges No. of Air Cond. Tons - Beat , Prom ,eos No. of Waste Disposers Tota.p o. o on ne Detection/Alertin Devices Local ❑ umcipa El Other No. of Dishwashers SpacelArea Heating KW Connection Appliances KW �KCW Secur ty stems: 9 No. otDryers Heating App Na of Devices or aivalent No. o afar o Data Wiring: G� Heaters KW °' S• Ballasts No. of Devices or aivalent `� Te ecommumcations ringg. No. Hydromassage Bathtubs No. of Motors 2 Total HP Na of Devices or E aivalent �% OTHER: AttachiddItimal detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: U: >� ` (When required by municipal policy.) Work to Start: ASA Pi inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completedoperataon" coverage or its substantial equivalent. The undersigned certifies that such W07890 is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Ej BOND ❑ OTHER ❑ (Specify:) Y certify, ander !h pains and Ates o perju{y, the ht% m tion on this ap d' anon is true and complete: FIRM NAME. dd,�� , LYC. NO.: m1 a�- Licensee: j ? �f i��� u �. Signature --�.,-- LIC. NO.: (ifapplicable, e r " p " in the ftee numb 11 .) Bus. Tel No. Address: Att: Tel. Na ": *Per 1vi.G.L: c. 147, s. 57-61, security work requites Dep ent ofpu lic Safety "SLicense: Lia NoS'Sj' d&A/.Y ` OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, Y hereby waive this requirement. 1 am the (check one owner owner's a ant. Owner/Agent Telephone No. PERMIT FEE. $ / © 9 �. Signature Ta 0- t o ! 2 , lo- , g P pl-� 00-07,-O� Pw 0 c ,. a s The Commonwealth of Massachusetts Department of Industrial Accidents Office of fi Investigations i 61 ` 600 Washinpon Street Boston, MA 02111 wwx�-Mass.gov/dia Workers' Compensation Insurance -Affidavit- Builders/Contractors/Electricians/PIumbers Appficant Information Please Print Leaib}v Name (Business/Organization/Individua.l): � L Address:/ City/State/Zip: Phone #: % 6 i7 � S i % Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor employees (full and/or part-time).* 2, ❑ 1 am and I have hired the sub -contractors a sole proprietor or partner- listed on the attached sheet I ship and have no employees These stab -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required_] 3. ❑ I am a homeowner doing officers have exercised.their all work myself. [No. workers' comp. right of exemption per MGL c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required_] *Any appfioant,that checks box #I -must also fill out the section below snowing their workers' co t= Type of project (required): 6. ❑ New construction 7. ❑ Rernodeiing �• ❑ Demolition 9. ❑ Building addition 10:❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 1.3.❑ Other omeowners who subnut.thrsai,.ideett iociieatira� they est daiE: • r: t;.Jr mpensation policy mrormation. =tiu iiaen hire outside eoniracturs must submit a new affidavit indicating s� Contractors that check this box -must attached an additional sheet showing the na_•n I an an employer that is proviifing e of the sub ecrstractors and their workers` comp, polio} information' workers' compensation insuranceor , information. f +►q mployees. Below is the policy and job site Insurance Company Name: Policy # or Self -.ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: 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 canlead to the imposition of criminal penalties of a fine up to 11,500.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a da} 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. ! do hereby cert lid the pains andpeG% fje jury that the information provided above is true and correct Sisnature: G /✓ ^' Date: �7 •� Of use onlp. Do nor write in this area, to be Completed by city or town officiaL City or Town: _ PermitlLicense # 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 4�: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined. as "...every person in the service of another under any contract ofhire, express or implied, oral or written." An employer is defined as `pan individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house -having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state o r local licensing agency shall withhold the issuance or renewal of a license or permit,to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence o►f compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit compi-etely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an..LLC or LLP does have _ employees, a policy is required. Be advised that this affidavit may submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the lam, or if you are required to obtain a workers' compensation policy, please call the Department at the numirber:listwd belovr. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit5icense number which will be. used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, ecd only submit one affidavit indicating current policy information (if necessary) and under ".lob Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or Iicenses. A new affidavit must be filled out each year. Vdhere a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burnleaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industt-ial Accidents Office of Investigations 600 Washington Street Boston, MA (12111 Tel. # 617-727-11900. ext 406 or 1-877-MASSAFE Revised 5-26=05 Fax # 617-727-7749 WWM'.mass.gov/dia �aa�c CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Temporary permit Building Permit Number 72.8Date: February 1, 2011 THIS CERTIFIES THAT THE BUILDING LOCATED ON 57 Long Pasture Road, North Andover, MA MAY BE OCCUPIED AS single-family home, garage, pool IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Fee: 100.00 previously paid Receipt: 21225 Howard and Marguerite Cooper 57 Long Pasture Road North Andover, MA 01845 Bui ding inspector TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO, A Date Received Date Issued: `� �`6 % EWORTANT: Applicant must complete all items on this page —6-1 141-1-mlle, Z. -7z P PROPERTY OWNER Print MAP NO: 1061 PARCEL: -a-16, ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED -USE Residential Non --Residential ❑ New Building - ❑ Addition Alteration ❑ One family ❑ Two or more family ❑ Industrial No. of units: ❑ Commercial ❑ Repair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Others: ❑ Other O�Septi> l . ®Wells ] r c -.. . 1�'®alters h ed D�¢ strict;p r gaYPAd��`l�e`iyF�AWetlan;Fdc�F lO - TSF..qC:RIPTION OF WORK TO BE PERFORMED: OWNER: Name Address: CONTRACTOR Name: Address: Supervisor's Construction License: Home Improvement License: Please Type or Print Clearly) Exp. Date: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. Phone: FEE SCHEDULE. B ULDING PERMIT: $12,00 PER $9000;00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ FEE: $ a 6,6v v0 Check No.: Jr,� G� Receipt No.:_,�,/` NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 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 ❑ 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) o 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals AL the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording ist be submitted with the building application Doc: Doc.Building Permit Revised 2008mi Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERA.GBDISPOS.AL Public Sewer ❑ Well ❑ Private (septic tank, etc. ❑ Tanning/Massage[Body Art ❑ Swimming Pools ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION COMMENTS HEALTH, COMMENTS Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decis Comments Water & Sewer Connection/Signature & Dater Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster onsite 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.______ 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 Doc:.Building permit Revised 2008 9 r rA tv C y � C � ca J•C j m CD C C vJ -- C C: $ a CA O !� 000 0 �- CD C �ca cc a 0 3 M CA C C=D y 1 � � C m � ycc0 r-1 V m0 C c 0a Q aCA� m as O � V v y 0 Z _ c C CL ca = ov oz3 N F-- 0 y m $ ~ m ti c evt o r W ® ,ate+ CCAR .� .y dL W C Z OC 0 *r Ili .y O W .E 41 = v cm C* a 4D 0 � 16- = ca R .0 N .= C f- z Sam v -t C�<, L CD CM CA ® 'fl ca m m ® O CD CLL v CD --,Cm 0 Cf) e_va o =CL ®! tco) I C _ = c CIO C//)� U) �� V w�, W rs c Z co t V y ® I Cc C + C C cc C. 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