HomeMy WebLinkAboutBuilding Permit #Exception - 96 LOST POND LANE 5/1/2018 a TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
,SSACHUSlt• -1
Date Received:
Permit NO:
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION L �..vS'�- ��'"`� �'' ►.�e. s
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PROPERTY OWNER
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MAP NO.: PARCEL: 2 ZONING DISTRICT:
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TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑New Building -bOne family
,gAddition ❑Two or more family ❑ Industrial
❑Alteration No. of units:
❑ Repair,replacement ElAssessory Bldg ❑Commercial
❑ Demolition
❑ moving(relocation) ❑Other ❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
F,
Identification Please Type or Print Clearly)
�r Phone: -I �tZ3
OWNER: Name: Sw
Signature
Address:
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CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License: 05 3-21 01 Exp. Date: ".AI 't tJ�Z
Home Improvement License:
21 Exp. Date: b l 7—f 0 o 6
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ARCHITECT/ENGINEERName: Phone:
Address: �j.�� ( -aAti�... �,� M� -�-�--- Reg.No.
FEE SCHEDULE:BULDING PERMIT:$10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON
5125.00 PER S.F. _
Total Project Cost :$ c b , UJ ''J xI0A0=FEE:$
Receipt No.:
Check No.:
TYPE OF SEWARGE DISPOSAL
Tanning/Massage/Body Art ❑ Swimming Pools ❑
Public Sewer ❑
Tobacco Sales ❑ Food Packaging/Sales ❑
Well ❑
Permanent Dumpster on Site ❑
Private(septic tank, etc.
)TE: Persons contracting with unregistered contractors do not have access to the guaranty fund
;nature of Agent/Owner Signature of Contracto
ms Submitted Plans Waive Certified Plot Plan Stamped Plan
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF- U FORM
DATE REJECTED DATE APPROVED
,ANNING & DEVELOPMENT ❑ ❑
❑Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
►MMENTS
DATE REJECTED DATE APPROVED
INSERVATIO ❑ Ij 2
1MMENTS W sa- (00 , ►til
DATE REJECTED DATE VED
;ACTH �
1MMENTS /(/'� ♦ .t �G�e7s(/f c� y/C L7r�✓ %�-S r �C T �.ti.G Ss y L
ing Board of Appeals: Variance, Petition No:
ing Decision/receipt submitted yes
ening Board Decision: Comments
servation Decision: Comments
er&Sewer connection signature&date
ip Dumpster on site yes no Fire Department signature/date
lding Permit Approved and Issued by:
1 �
PLAN OF LAND
IN
NORTH ANDOVER, MASS.
OWNED BY
PAUL AND JACKIE JACOBS
SCALE. I"=40' DA TE.612312006
0' 40' 80' 120'
Scott L. GilesR.P.L.S.
w Frank. S. Giles R.P.L.S.
car, 50 Deer Meadow Road
North Andover, Mass.
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LOT 5
80,479 S.F. c3: CAEo
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�SSACHUSE(
PUBLIC HEALTH DEPARTMENT
Community Development Division
Date: September 19,2006
Address: 96 Lost Pond Lane
Re: Application for: family room addition
Dear: Mr. And Mrs. Jacobs,
Your application for a at has been reviewed by the Health Department. The application
was
s denied on, September 19,2006 for the following reasons:
1. x Missing information _ V
2. x Passing Title 5 inspection of septic system required — W • o�P 1 �
3. ❑ Location of structure not acceptable
4. ❑ Undersized septic system ** still remains undetermined. Review of floor plan needed
prior to decision
To address the problemsl:
f#1 is checked, please supply:
a. Floor plan of existing and proposed addition–all rooms C�
b. Certified plot plan showing house, septic system and proposed p of iri seal
If#2 is checked:
a. Have the septic system inspected by a.certified Title 5 inspector to determine the size
of the system and
whether it is operating properly: OR
b. Tie-in to municipal sewer
If#3 is checked:
a. Relocate the project
If#4 is checked:
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
R=30.0 PLAN OF LAND
L=14.53' LOT 4 IN
NORTH ANDOVER, MASS.
LOST POND R=60.00' 35¢23, �� OWNED BY j
LANE L=85.48 PAUL AND JACKIE JACOBS
SCALE. I"=40' DA TE.
10/27/2006
a 0' 40' 80' 120'
/ Scott L. Giles R.P.L.S.
l Frank. S. Giles R.P.L.S.
4 50 Deer Meadow Road
14) North Andover, Mass.
WETLANDS
ILL
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LOT 5 �o
80,479 S.F. c3,
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LOT 6 0Ai
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l CERTIFY THATai
OFFSETS SHOWN ARE FOR THE USE
THE OFFSETS OF THE BUILDING INSPECTOR ONLY L» '
SHOWN COMPLY AND SUCH USE IS FOR THE 72 �p
WITH THE ZONING DETERMINATION OF ZONING cIsY�R���
BYLAWS OF L LAS
NORTH ANDOVER CONFORMITY OR NON-CONFORMITY
WHEN BUILT WHEN CONSTRUCTED. `b/Z� 2ab
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