The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 143 Farnum Street / 10 143 F,rnum Street 1 \\ BUILDING FILE � Date. TOWN OF NORTH ANDOVER .1090 PERMIT FOR PLUMBING w • � �• a SA us This certifies that ?.��fes` `". . . .i�.�.�'. }. . . '?J:-�. . . . . . . . . . has permission to perform . . . . .� . ,. . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., North Andover, Mass. Fee. . . . . . Lic. No.. . . . . . . . . � ./"�. . . . . PLUMBING INSPECTOR Check # > >^ 7 8660 i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS - lY Co ' Building Location /�T '�'"f��✓l�J�-� DatePermit# Owner Amount New ❑ Renovation Replacement Plans Submitted Yes No rl FIXTURES summ WNW M E OM 2%EOM 3MROM 4IHROM SIHHDWI 6M ELOQZ 7MEOM gm FUM EE (Print or type) 7 1 Check one: Certificate Installing CompanyN.--A/ Corp Address S l�� n� 7" S?' El Q Partner. Q Business Telephone 477- aiz l - Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate a of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond El Insurance Waiver: L the igned,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 under permit Issued for this application will be in compliance with all pertinent provisions of the Mas-- P bing Code and 142 of the General Laws. By: rgna o rcens um Title Type of Plumbing License City/Town r e um Mas 'i APPROVED(OFFICE USE ONLY E10 Journeyman rl The Commonwealth ofM¢ssachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass-gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lei�bly Name (Business/Organization/Individual): L,vS b) Address: !w c City/State/Zip: Phone#: you an employer?Chec the appropriate box: 1. am a employer with 4. 11I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 1 7' ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. [No workers' comp. 5. 9. ❑Building addition p ❑ We are a corporation and its required-] 10.❑Electrical repairs or additions 4 ] officers have exercised their eP 3.❑ I am a homeowner doing all work right of exemption per MGL 11-❑Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12. Roof r insurance required.]t ❑ epi q ] employees. [No workers' comp.insurance required] I3.❑Other , ;Any applicant that checks box#1 must also fill out Fhe section below sh^s Wb+-"�work,fig'comr�.satioa tic, f Homeowners who submit this affidavit indicatingth S r po ,}ontractors must submit motion ndicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their woorkers'comp.policy iinformation. PPo Y� I am an employer that isproviding workers'compensation insurance for my employees. Below is the po information. licy and job site Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: �y ;�-,.� L�� City/State/Zip: ,,dz� Attach a copy of the workers'compensation policy declarationa e(showing ILS_ p g ( wing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day 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. I do hereby certift under the pains and penalties of perjury that the information provided aba is true and correct Si afore: Date: Phone#: [uin only. Do not write in this area, to be completed by city or town officiaL n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspectorson: Phone#: 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 of hire, express or implied,oral or written." An employer is defined as"an 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 or 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 of 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 completely,by.checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)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 be 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 law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number m 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job 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 licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (II i.e. a dog license or permit to bum leaves 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 Industrial Accidents Office of Lavestivations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 wwu%mass..govfdia Date. .� �°.... .. ,SOF TIy Of 3? TOWN OF NORTH ANDOVER 40 • PERMIT FOR GAS INSTALLATION 9SSA USEt This certifies that . . . . . . .'. . . .1/ z/I-. . . . . . . . . . . . has permission for,gas installation . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at North Andover, Mass. Fee. v . . . . Lic. No../. ?.! G. . . . . . . . . l (3AS INSPECTOR Check# Y- )- 7258 )"7258 �r MASSACHUSETTS U1�TIE'ORM APPLICATON FOR PERMIT TO DO GAS G (Type or print) Date �(J NORTH ANDOVER,MASSACHUSETTS Building1-3q (✓!. ^ ` Locations Permit# +- 17r Amount$ 7 Owner's Name New❑ Renovation a Replacement Plans Submitted ❑ U r.. O W _ z Z Z) w H x z z w a W e�qq w W rU x a W c a z d O O rz 0 z� C4 p F W 3 a a a o 0 � o SUB -BA SEM ENT > Aw BASEMENT i� 1ST. FLOOR 2ND . FLOOR w 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8_TH . FLOOR (Print or type) 1 Check one: Certificate Installing Company Name ElCorp. Address 7 Partner. r BusinessTelephone'- 40" PFtm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE cone: I have a current liability Insurance policy or it's substantial equivalent. No[3 If you have checked yes,plea a indicate the type coverage by checking the appropriat box. Liability insurance policy Other type of indemnity 0 Bond E] Owner's Insurance Waiver: I am aware that the-licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner El 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 Massachusetts State Gas C de and Chapter 142 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber /�'/ City/Town Gas Fitter Icense um er Master APPROVED(OFFICE USE ONLY) Journeyman �I >r I The Commonwealth of Massachusetts Department of Lndustrial Accidents Office of Lnvestigations .60U1 0 Washington Street � Boston, MA 02111 www.mass:.gov/dia Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le�bly Name(Business/Organizafion/Individual): �� Address: City/State/Zip: , < Phone#: Z/,7 91s Ar you an employer?C eck the appropriate box: Type of project(required): I am a employer wi 4. ❑ I am a general contractor and I employees * _ .6. New construction full andlo art- ' have ❑ on � trine . hired th P ) the 2.❑ I am a sole proprietor or partner- listed on the attached sheet 1 7. ❑Remodeling ship and have no employees These sub-contractors have 8. []Demolition working for me in any capacity. workers' comp. p insurance. 9. Building addition [No workers comp. insurance 5. We ❑ g °Il p e ❑ are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions r 3.❑ I am a homeowner doing all work right of exemption per MGL 11. Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.[]Roof repairs insurance required.] t employees. [No workers' comp.insurance required.] 13.7 Other • Any applicant that checcs box#1 must alsoz�l out the section beioa s'.nnt^:rb we 4 e r'comF=sation Folic} t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.Policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: G` Policy#or Self-ins.Lic.#: _ Expiration Date: Job Site Address: /S y r-n LfYe) � City/State/Zip: /� �, /V� Attach a copy of the workerscompensation policy declaration page(showing the Politynumber and expiration xpiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day 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. I do hereby certify u er th ains and penalties of perjury that the information provided above is true correct Si ature: Date.: Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# 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#: Information as d 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 of hire, express or implied,oral or written." An employer is defined as"an 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 or 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 of 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 completely,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 �f 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 I a policy is required. Be advised that this affidavit may be 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 perait or license is being reques zd,not the Department.of Industrial Accidents. Should you have any questions regardag the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. 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 permitllicense number which will be used as a reference number. In addition,an applicant that must submit multiple permitilicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job 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 licenses. A new affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or permit not related to any business.or commercial venture (i.e.a dog license or permit to bum leaves 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 Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 021.11 Tel. # 617-727-4900 ext 406 or 1-877-MAS.SAFE Revised 5-26-05 Fax#617-72.7-7749 )Arwu,.mass..aov/dia I / TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING s T6Nsedift tbtMimi : BUILDING PERMIT'NUMBER: DATE ISSUED: .`I ic SIGNATURE: Building Commissioner/Innwor of B uddings Date z SECTION 1-SITE INFORMATION' - i -- 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O 6()7z f� Map Number Parcel Number � edcr 96D(e-, q 1.3 Zoning Information: 1.4 Property Dimensions: 33 C7 /S� 444 Zonis District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided v 1.7 Water S M.G L.C.40. 54) 1.5. Flood Zone Information: -/ 1.8 Sewerage Disposal System: / D Public ❑ Zone Outside Flood Zone IY Municipal ❑ On Site Disposal System L9/ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT , 2.1 Owner of Record Name.(Prino Address for Service - 25 - � 5 e Telephone 2.2 Owner of Record: 0 Name Print Address for Service: z M Si azure Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicabl ��G\ Licensed Construction Supervisor: 'P,pi License Number "n Address > Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ p� Company Name 1�� Registration Number �1r r Address z Expiration Date G) Signature Telephone Q f SECTION 4-WORKERS COMPENSATION(N.G.L C 152 § 25c(6F7771 Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Workcheck aH a cable New Construction 0 Existing Building ❑ Rgir(s) Altera ' ns(s) Addition ❑ Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: beak_ : d ''NC 'T C,3 6, b e4` I ' ''CL 1 ot�t W c 4 !A tPri z.Z �isr3D Cr �� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(,)x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 f Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ` I, �� 1 �� ' Owner/ uthorized Agent of subject property Hereby authorize 4.&y 1 to act on My behalf 'i at4DatterqjelAtiv r auth ed by this building permit application,. ire er Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are L*ue and accurate,to the best of my knowledge and belief Print Name Signature of Owner/.Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TI1vIBERS 1' 21 3 SPAN Kv DIMENSIONS OF SQ.LS DIMENSIONS OF POSTS DIMENSIONS OF G.MDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X — MATERIAL OF CH VINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: (Location of aci—fit y igna ure of Permit Applicant l D Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector a „ORTM TOWN OF NORTH ANDOVER OFFICE OF 0 . p BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 �SJ�1c►n►s�� D. Robert Nicetta, Telephone(978)688-95454 Building Commissioner Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: q1 I O JOB LOCATION: l 3 Number Street Address Map/Lot HOMEOWNE Name Home Phone Work Phone PRESENT MAILING ADDRESS all 6tfzl,!r City Town State Zip Code The current exemption for"homeowners”was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNAT APPROVAL OF BUILDING OFFICIAL li1).\R1)(g., IPPEALS()98-9541 CONSFR\';\TION 698-9530 11YALT1I 68X-9540 PLANNIM.;689-9535 MORTGA GE INSPEC TIO N PL A N NO. 13 4 FA R N UM ST. IN N. ANDOVER , MASS. MIDDLESEX SURVEY INC. LAND SURVEYORS I3/ PARK Sr. N. READING , MASS . SCALE.' / "' = /00' DATE.' JULY /8, /996 CERTIFIED T O.* ANDOVER BANK B RICHAW A. MCGLYNN LOT 4 44 44, 330�S. ,r* z8 a7 .ST NOTES.' / OFFSETS ARENOT TO BE USED TO ESTABLISH PROPERTYL/NES. y :. 2)LOT L /NES ARE COMPILED INFORMATION u+ T/TL E REFEREN�'E' DEED BOOK -ay pAiJIMYKNOWLEDGE S ) /HEREBY CERT/FY BASED INFORMATION AND BELIEF THAT THE STRUCTURES ONTH/S A AN ARE LSj�OCA TED�fINONGTHE GROUND APPpROX/MATEL Y ASZSHOWN. BACEppU/REMNroWN AT THE T/ME OF CUNOS�RUCT/ON AND THE PARCEL /SNOTIN A FLOOD HAZARRD ,q RREA,q AS SHOWN ON F. E. M. A MAP COMMUNI T Y NO. 250098C ZONE.' ..y EFFEMVE DATE.' 6-2-93 NO. P9070 Subject:S GYM— `s t� e G)� Date: D 1 r f - • __: Ve 4 r y I t t i r i- 1 ' e — X h C i y1 l r r r Subject: Date• i t i i i t 1 i I 1 r a i i � f Fidelity Proprietary http://mgs.fmr.com/fidelity2000 AM 4// Subject: l d Sc Date: flylo < �....__.._.._iL _ 'f P i { , p p 7 1 1 t 01 1 ._ng ttt J Ij\ _ a p a p 1 f ^ E 09S�—�— T 1 = -�, w t o t 4— 40 Q- g , v e t ¢ ; p A r t 1 e � r ' p � 6 � t 5 d P y a ' P ' f i f p Subject: Date• s I .t i e _ s i r Fidelity Proprietary http://mgs.fmr.com/fidelity2000 p 4.1'/�w`v 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 or requirements. APPLICANT FILLS OUT THIS SECTION � DD APPLICANT' S-`t� � �fr PHONE2�'ZY?-85 LOCATION: Assessors Map Number Z/O PARCEL A oZ /�C SUBDIVISION A/A LOT(S) t STREET ST. NUMBER OFFICIAL USE ONL C N F TOWN ENTS: V C NSERVATION AD INISTRATOR DATE APPROVED_ DATE REJECTED i COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS �Q dl VA „ [ PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE R*v WW 0197 Jm