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Home My WebLink AboutMiscellaneous - 1024 TURNPIKE STREET 4/30/20187p N21 , 3'�70 Date .... (Z -h. ®1... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... �..q ...................... has permission to perform ..........4-..! Vit.�0........�—.XS ................................ 0 wiring in the building of .... . ................. L/ ....... ............... /,,fqorth AndoverXa Lic. No .............. ............. ELECTRICAL NSPECtOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer C11,1 -eat(h o f r11a9dae1ue�e!L! Of;lcial Use Only m - IQ -7, BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Citec.`:ed ([Rev.---- /lr�v.. i.l•.,.1\ APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perlormcd in accord;urcc with the Vlassachusctts Electrical Codc (NIEC), :37 Cr%IR 13.00 (PLEASE PIZIiVT I!V IYVK OR TYPE ALL ItVf-'01W,1770i) Da tc: s`/aOI D/ City or Town of: ffid ver To the Inspector of pines: By this application the undersigued gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) J�>�{ 1 U✓n.nl Yo �. Owner or Tenant Owner's Address Telephone No. 88� Is this perutit in conjurtctioli with n building permit'. Yes No ❑ 17 (Check Appropriate I3os) 1'urluise of 1? ;1,17 lis/��I Utiiity Authorization No. Existing Bernice t\ni is Volts (� U 1 O� critc::d Undgrd !`retic Service Amps / Volts Overile:'d ❑ Undard Number of Feeders and Arnpacily Locition and Nature of Proposed Electrical Work: No. of Meters No. of:lleters No. of Recessed Fixtures No. of Lighting Outlets :, N'o. of Ceil.-Susp. (Paddle) Fairs No. of Mut Tubs rcrore ural- Uc narccd ov!hc /rrsr cera o' if'irc;. IND. of 1 otal Transformers KVA Generators 1-�VA Lightins Futures INo. of Receptacle Outlets a lIt- IS++-imming Pool Above arlid. (- arnd• No. of Oil Burners 1 0.01 :neroencv hitting ❑ Batter; Units FIRE ALAI )MS INo. of Zones No. of Switches No. of Gas BurnersNo. of Detection and Initiating Devices i'�u. of Ranges No. of Air Coad. •total Tons ,INo. of Alerting Devices I ` � . of Waste Disposers 1'icat Pump 'Number Ions Totals: `— -�—�` - I!��' ! — - - !No. oCScit-Contained 1D etectiott/Alertina Devices No. of Dishwashers Spacc/Area Heating KWLocal ---- AIt.Tel.rNo.: � ILHd3-LA' 5q ttilunicipa[t ; Connection L O l e: 1 No.h o. of Drvers `o. oil Water INo. Ileticts h+v 1 Heating, Appliances It\ : nl IND. of B $igits allasts I� �r.: �cuur:,, '-stems: \o. oCDe�ices or Equi•.eient 1V L:r —ir;ua- ;No. o OF ices qui. aiell ro. rivur;:nassa�re 15autuos �.u. of oto, iuur:untca.uons Ylrrrlg:Totai kP No. of Devices or (OTHER: �oui:a[ent or a: rcc:.: -,. IN"SUR.-\:,NCE COVER -\GE: L"r,icss'xzi;cd „_- - �. by the c noc,.:ca! tite licensee provides proof iiabi. insurance including,' `ccr,:pi�` er ::c : won., coves P or:is suostaritiai Undersigned certifies that such coverage is i'n force, and has exhibited proof at sc-;e to tl:e oermit issui CHFCKON'E: INS L'R.\NICE iL7 O -f -HER ❑ Estiinzted Vaiuc cCE1cctrical ��' �ork: (',b'hen requlred'o,, ::,u:uctoal (` rt er. tej po(ic•.'.) `YVor:: to Start: Inspections to be requestca In acc orda::cc ..... ',/IEC Rule 10, and dean certtft•, urrrlcr (Ile /rairrs and Penalties of ;eijurr;•, thar t/re informationl n!r flus rrt)nlicV.Un is true and co111011e(e. FIIU[ t\'.A`IE: bri r1 _S Hzmt Licensee: � 01r -)•O Cr-Dtz,\-e- Signatur2 LIC. r0.: OGI t l rlfr;/;n+ic.::;ie,errlc:' ;':rr;;l•irr;Ire•r(Cc/:<<uurnC�r(iuc.l 5; I3li2S.Tcl.NO.:'-,17��-1•`S 7-U`4y3 Address: +55 ��t'Sv � 51t li�ll�lr(1c� n 1�1r� UI� 1 AIt.Tel.rNo.: � ILHd3-LA' 5q O\Z` +ER'S (NSU[\-ANCE ``i'AIVEIZ: 1' ant aware that the Licensee do(!j Pc:....:e the iiablilty insurance co.e:age :-Cmmaily required by ia\ Ev.n. si rtaturc beiuw, 1 ite;eby wai,,c this requi.crrc::t. I :I:-. 1::lt tc!,c� 011c) ❑ 0-ticr O+vncrr:��cat Sigliatul•c 1'0!cnhone N, o. PI.R:1fIT FLS: Location /W %y/'�J ��l�e S r No. Date % & i H NORTH TOWN OF NORTH ANDOVE8 3?O: tt.o •'�hOL � A Certificate of Occupancy $ s ; ; Building/Frame Permit Fee $ a ss•►CMU st` Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ g TOTAL $ li i/ Building Inspector .i3351 Div. Public Works 0 M r^ J Oq M r G � z z, N C C C G — L :n U u U > F z ^ C C = c c L ¢ Fwr r6 c z z C C C cCd :v 1 G Z O O c. �r J O z � t o J -NIL u _ _a o z lk C C Ln f 22 4 r^ J Oq M r � z N C C G — L :n U u U > F ^ C C = c c L r^ J Oq M r FORM U - LOQ' RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. Ali SUBDIVISION LOT (S) STREET/02Y �� JT jC ST. NUMBER l' -)c) *****************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: /NSfAll )gA4A04 I- (5-M WS d-�4✓C � CONSERVATION ADMINISTRATOR COMMENTS 31X OWN PLANNER COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SE.P1 SP R- ALTH DATE APPROVED DATE REJECTED el I COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTION DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING iNSPECTO Revised 9197 jm DATE L D OCt , ******.***********************,APPLICANT FILLS OUT THIS SECTION""*****"� APPLICANT 6�9 UA%A L/O/ % PRONE 20 �'F3`( 76 0 a LOCATION: Assessors Map Number O 6 tc PARCEL Ali SUBDIVISION LOT (S) STREET/02Y �� JT jC ST. NUMBER l' -)c) *****************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: /NSfAll )gA4A04 I- (5-M WS d-�4✓C � CONSERVATION ADMINISTRATOR COMMENTS 31X OWN PLANNER COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SE.P1 SP R- ALTH DATE APPROVED DATE REJECTED el I COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTION DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING iNSPECTO Revised 9197 jm DATE L D OCt , S .yF.•PE�Y cE.crii�Y 7, 1 r rir Tb THE B.4.V.r T.s4q�' T•s'E �a'ECL.cNt I:r LgCATE� O.c/ T.yE cvr,�s s.�vm-a �v vo rwrirpars ccw�aeM /iV !Y/TN T.S/E Taws/ ' of A/ 4 ZZWI.V6 .c�E6lIc.4TilSWS .Q!-r6vI.�0/.t�SS SETeGIG.t'S FEOM ST�PEETS lOT L/.vES. '' �i�0 . �•cl�O ✓E e� //!q S.S, S FlI,ClJY� LE.rT/FY T.t/.IT T.f'/s OAr'ELL/iY6 /S it/OT LOG4TE'p /N T.f�E FEAE.CAG FiCGiOO fiWLI.�O 4,e c,4. �iP/�%1✓/V fQiP SHOWK ON' FEM•t ' 44"AeeI.V17'y AeAIGG 2soa9g aaaBC w,� y� �'o,e Fes, tHOF 1%ATED 6/2/93 j 2/, 1996 //0 NN ' ^' #36381 ssco�� '' gtia £,�dt' INE.P.P/�!l•4Gf' E.V6.ct%EE.P/•l/6 SE•P/�/lES suFty 66P.4,(W .sT.rEET A.t/LQOt'E.P, Iy1.4.S..£oG��/.SETTS O/B/O ' � J ' 737.00 / �1 gr •� .�/7 19c, . b aAld w►�i�s of g uess b � R I �noPo3e.oX N'e'Hlf�.►�mo2 w/ fj I'AIr�S �'-6 ❑ Q f06E QF OfL/NEA7� p f �3.'' Q� aErC�NG$ N' EX 16 r/A/4 - _ FuNOAT/OAV `_ 7S Oar S .yF.•PE�Y cE.crii�Y 7, 1 r rir Tb THE B.4.V.r T.s4q�' T•s'E �a'ECL.cNt I:r LgCATE� O.c/ T.yE cvr,�s s.�vm-a �v vo rwrirpars ccw�aeM /iV !Y/TN T.S/E Taws/ ' of A/ 4 ZZWI.V6 .c�E6lIc.4TilSWS .Q!-r6vI.�0/.t�SS SETeGIG.t'S FEOM ST�PEETS lOT L/.vES. '' �i�0 . �•cl�O ✓E e� //!q S.S, S FlI,ClJY� LE.rT/FY T.t/.IT T.f'/s OAr'ELL/iY6 /S it/OT LOG4TE'p /N T.f�E FEAE.CAG FiCGiOO fiWLI.�O 4,e c,4. �iP/�%1✓/V fQiP SHOWK ON' FEM•t ' 44"AeeI.V17'y AeAIGG 2soa9g aaaBC w,� y� �'o,e Fes, tHOF 1%ATED 6/2/93 j 2/, 1996 //0 NN ' ^' #36381 ssco�� '' gtia £,�dt' INE.P.P/�!l•4Gf' E.V6.ct%EE.P/•l/6 SE•P/�/lES suFty 66P.4,(W .sT.rEET A.t/LQOt'E.P, Iy1.4.S..£oG��/.SETTS O/B/O ' � J / L- `- -�--�--��--- � ----� �� / / � | ' _ � | ' / i • c� m c 'cam �cccc V:mc cc w o m E a L .1 Z 00 •s v V � rOr y L: E c c L: co c a� m ' m m O: L N co 6;m3 m•�:`� = N W i' N av` 2 : C.:: mor C7 N O ..:'NE'`. c o c F- a `Q H c = m :moo 0 :a CO) o �- W c Moe-0� .. 0 j.. 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U �CD o � v Z y a (C% V C O U O � cc y � Q LU 0 cn Ir W crLU U) -Alol�e!pawwl jepuss loeluoo eseeld 'jo1Ja ul allwlsoe) s143 anlaoaj noA )i luiluepil"o sl pue JanlaoaJ eyi ;o esn 041_10J PePuelul sl peuleluoo ulaJay uollewao;ul ay'L --r kj- S� _10 ;3JdSS3Vil 9 -1-171 : w 0 H3 1 *.S3!DVd# y b!t 2 :31VO xe; 99SL-tvS6i x 00 offog:�I In/y &O� SN - ORI Ow", 0 w 4, Ue Q Q � a I, x .% X. n:i ice Use only The Commonwealth of Massachusetts Perrlt No: Department of Public Safety occupancy b Fee Checke BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 3/90 (leave blank) L� II f o QRmPed )ERoMIT TOrdance with PERFORMa)ELEZCT ELECTRICAL WORK ASR 12:00 E PRI2iT ili INK OR E ALL INFORMATION) D 44 _1e p City or Town of ��/j�j� �1� To the Inspector of Wires: ndersigned applies for a permit �� to perform the electrical work 7described ' below. 1 ion (Street & Number) Owner or Tenant /] A64 IJ-lPjb s�f'i,n / 1/d- Lrn - rn I Owner's Addres Is this permit in conjunction with a building permit: Yes 16 No U ('Check -Appropriate Box) Purpose of Building 111"d Utility Authorization NO. Existing Service -"' Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service S—_ Amps _Volts Overhead Undgrd ❑ No. of Meters_ Number of Feeders and AmpacityJf Location and Nature of Proposed Electrical Work No. of Lighting Outlets 4No. of Hot Tubs No. of Transformers o Total Signatur No. of Lighting Fixtures Swimming Pool Above In- grnd. ❑ grnd. ❑ Generators Qi KVA No. of Receptacle Outlets Z No. of Oil Burners No. of Emergency Lighting Bat ery Units No. of Switch Outlets check one) No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local 1:1 Municipal ❑Other Connection Telephone No. No. of Ranges g Total No. of Air Cond. tons No. of Disposals heat Total Total No. of Pumps Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices '0 KW No. of Water Heaters KW No, ofo. o Signs Ballasts Low Voltage Wiring /) he No. Hydro Massage Tubs 0 No. of Motors Total HP OTHER: 7 SJ'IOJCeS �%1� INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current L ability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES NO ❑ I have submitted valid proof of same to this office. YES ❑ NO [3If you have cher ed YES,,please indicate the typeof /coverage by checking the appropriate box. INSURANCE BOND ❑ OTHER ❑ (Please Specify) /, t�, J�q I) �'� /nS j )( � &? GD Ex rati n ate Estimated Value of Electrical Work $ 3 k Work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury: 7 FIRM NAME NO. _f Licensee aCK Signatur _LIC. IC. NO Address Bus. Tel. No. Alt. Tel. No. - C7% ►�, OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its su stantial equivalent as required by Massachusetts General Laws, and that my.signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S Signature of Owner or Agent �."r�'�i"e.t�.:n"sr�'Y'�y.� -�`. ✓'��"r�''�^-"✓»"''A' ""`�, ./ter.+Avg"r`'.�+"r.-.d�,�.��..r..,,_r�" -��r. �.� Date.�..�? ?.9 4155 r �'<: •:�h TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... 1—r! fO' ! ... C4 .. Ci f C .................. has permission to perform .... plumbing in the buildings of ... C?' v `?!? ..' ................ at. ....... , Noorrt`h� Andover, Mass. Fee . . Lic. No. �. 7 .`/ /. ....... -:- .� - - - ..... . ^� LUMBING INSPECTOR 10/15/99 13:38 275.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer I i -,.fit MASSACHUSETTS UNIFORM APPLICATION FOR PERMI O DO PLUMBING (T FOR RD NORTH ANDOVER, -MASSA SETTS � � Date Building Location Owners Name (f Permit r 1 Amount— Type of Occupancy New Renovation ❑ Replacement ❑ FTRTTTRF.S Plans Submitted Yes, ❑ No ❑ (Print or type) / Check one: Certificate Installing Company Name 71;11 dv ❑ Corp. Address ❑ Partner. t Business Te ephone —1. q17 Firm/Co. Name of Licensed Plumber L "GC/ / Insurance Coverage: Indicate fhe type of it •urance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mas sat Plu ' in Code and Chapter 142 of the General Laws. By: $ignakure of Licensw Wumver Type of Plumbing License Title Z 7l�l City/Town 7icense Numner Master ® Journeyman ❑ APPROVED (OFFICE USE ONLY / Building Permit Number 30319 $ THIS CERTIFIES THAT Date /c9-// THE BUILDING LOCATED ON �o a # 49 c;2 y —�—�rW k� s MAY BE OCCUPIED AS S(.� 4 0? 6Q/ U44IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO ADDRESS '+s CHUS�' Building Inspector s .• N } a <.....,_,...]....:2:...::�5'i..� ., .e._:.�:ina�-..n. ..., ...�. ut_-....+..:Y,�c_...... CERTIFICATE OF USE & OCCUPANCY Building Permit Number 30319 $ THIS CERTIFIES THAT Date /c9-// THE BUILDING LOCATED ON �o a # 49 c;2 y —�—�rW k� s MAY BE OCCUPIED AS S(.� 4 0? 6Q/ U44IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. 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A RE -INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRWTL).RE DOES NOT MEEALL APPLICABLE CODES. SIGNED ROUTING b CONSERVATION ---,4 PLANNING >C DPW - WATER METER NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO U MITTAL OF TH.E OCCUP CYIINSPECTION REQUEST DPW Signature File: OC farm revised 6/8198 Location No. �. Date ., TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 9/1 Foundation Permit Fee $ Other Permit Fee $ �+ Sewer Connection Fee $ r Water Connection Fee $ OTAL $ - -7"X' Building Inspector o i' 10567 . Div. Public Works .. w c� a W u a. i 9 ) `0 Z J m F p W Z J m J A z 0 z a 0 0 0do W L U) 6 O W �I < < W m 0 ; F W Z W Z 3 0 (7 ; N W i N J N F (A Wo 0 Z F 0 L C c W L Z ' LL O O J J i F �' J N p LL CC t7 � Z x E = 4 O 0 O < 3 m IL W N w 0 W �.,. m m O O p z (� u X x F X �. 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The building applicant shall provide all of the necessary information as requested below. Name of Applicant on Building Permit (below) Address of Property for Permit (below) ��6- I-Je r '�' s &" °t 102Y 7 207 Pliu al't J -df a Map and Parcel: Purpose of Application (check below) Phone Number o�Ap�licant: X Single Family _ Two Family -07Y- I78y 50 ) I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. 4The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.c are met and/or represents Dwa�Iling units for senior residents, where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section "senior" shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmlpnd. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for buiiaing pe". its,(i.e. all other permits from all other boards and commissions have been re ;eive.d and the pioject's in compliance ,, :ih tbose-p:>rmits), and the. D.eveiopment_.Schedule_.. .. does not accomr„odatn ;nb:;ng a building permit in "rat Year, one bukiing permit will be issued per Year per Development until such time as the Development Schedule accommodates issuir.0 'Uvi:-fi ,v narm;,s App:ic.-iintrnust supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information the checking off of an above item which does not comply, whether done to my knowle a or not, is g ou ds for ref al by the Building Department to issue a Building Permit. Sig atur er or u n d ent who signed the Attached Building Permit ate This fo ust be attached to the Building Permit upon application for such permi . GUNYA CORP. 9 Travers Street Haverhill, Alass. 01830 508 374-4784 AuOust 14, 1996 Building Inspector Attention: Kermy Town Hall Arulex 120 Main Street North Andover. Mass.. 01845 Dear Keruiv: Pursuant to our conversation today. this letter will serve as an addendum to plans submitted to your office. This specifically relates to building permit applications fior lot 2. 1024 Turnpike Street, and lot 3. 1060 Turnpike Street. As there is a setback of 30' from the property- line on lot 2. and a conservation setback oil lot I. the decks shoNvn oil the rear of the buildings are hereby deleted. Each plan will be amended to have a landing and steps pursuant to the ?Massachusetts State Building Code. Prior to construction. I will have \Merrimack Engineering. Services, Inc. verify, lot comers and setbacks.. they will do this again upon completion of as -built foundation dra�� iilgs «�hich will be submitted to your office for approval. Thank you for vour assistance. Upon review and approval. could you kindly call me at the above number and leave a message as to the amount due for each permit. and when I might pick them up. Sincerely. r Y/ FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out.this section***************** APPLICANT: S kin Phone -� Zai) 53Y^76aa LOCATION: Assessor's Map Number i0`%�� Parcel % Subdivision Lot (s) Street St. Number�� t ************************Official Use Only************************ RECOMME 7 -;/ OF O GENTS: tY�� Conservation Administrator Comments 0 (9-a Town Planner Comments Food Inspector -Health /J� /eye Septic Inspector -Health Comments Date Approved obt Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Public Works --sever75aater connections m " - driveway permit SSt/ 9' Fire Department Received by by Building Inspector t .S�— U Date