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HomeMy WebLinkAboutMiscellaneous - 42 SPRING HILL ROAD 4/30/2018 (2) 4a Raw R bAD WAAQ 10-7 �AACet,*233 - 95 , 0 t Date......"17- ................ f NOR7N 1 TOWN OF NORTH ANDOVER 0 p PERMIT FOR WIRING SSAc11u5� This certifies that ............... v 1I......,7*.:�7..........................`...... has permission to perform ........ wiring/in the building of................�. �. .. ! ..................... ......... ,at..`T.z.....,.1�./�cwa-c......fe. ..........ZE ..North Andover,Mass. "F ' s'�-- ee...:................ Lic.Nos ...�:3�................ ........ .. .. .......�.1.. ...... CTRICALINSPEC QJt Check # Department of Fire Services Permit No. Occupancy and Fee Checked 1 BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank i APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME9),527 MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1-2 1/2.1 l City or Town of. NORTH ANDOVER To the Inspector oJ Wires: By this application the undersigned gives notice of his or her intention top rform the e Jctrical work described below. � Location(Street&Number) [ Z YI h C Owner or Tenant ✓ ( C.�S4 Telephone No. Owner's Address S 0-M Is this permit in conjunction with a.buildin ermitiYes No ❑ (Check Appropriate Box) Purpose of Building %11 Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No. of Luminaire Outlets No.of Hot Tubs Generators KVA AboveIn- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Battery Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump I.NR TonsKW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of WaterKW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 1 (When required by municipal policy.) Work to Start: `r Inspec ions 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 i the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove;;age is in force,and has exhibited proof of s e o the ermit issuin of ce. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) 1 31 lU I certify,under the pains and penal ies of erjury,th t th�iu,(ormation on is application is true n d c mplete ST,ep��� FIRM NAME: J eC� l LIC.NO.: 33 Licensee: J , I /y Signature _ LIC. . (If applicable,enf�r�`exempt"in lice se nu r er line.) t Bus.Tel.No.: Address: `( V 1 0 S Alt.Tel.No.: *Per M.G.L c. 147,s. 57-6f,security work requires Department of Public Safety"S"License: Lic.No. 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,I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's Owner/Agent Signature Telephone No. PERMIT FEE. $ i j M r N- 3 '1 40Date.,-7--- ...A. �a t pORTM TOWN OF NORTH ANDOVER o • '° PERMIT FOR WIRING ,SSACMUS� This certifies that ..................�� :..........-...............pp.............................................. has permission to perform ...... ... ..... ..:N.��..`.... t............................................. wiring in the building of......... 4.�.`�`� '.��� - C4,- ............. at...................... ............. ....................a.................... ,North Andover,'1VIass. kFee— S'. .. Lic.No %� ... ... '- .....6 f . f: r.......... S ELECTRICAL INSPECTOR Check # ( ?2f/ WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Official Use Only Permit No. � Vq—X -r 4;Dad?&Sa`kpy Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 -- APPLICATION FOR PE'R'MIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance?with the Massachusetts Electrical Code 527 CMR 12:00 (PleaCa Print in ink or type all information) Date zoo To the Inspector of Wi s: Town of North Andover The undersigned applies for a permit to perform the electrical work described belckc Location(Street&Number Z S 2 Owner or Tenant 'J USI{ yl bp YVIVI t C Owner's Address Is this permit in conjunction with a building permit YesNo ❑ (Check Appropriate Box) Purpose of Buildingf) t ` Utility Authorization No. Existing Service Amps Voits Overhead ❑ Undgrnd ❑ No.of Meters_ New Service Amps Voits Overhead ❑ Undgrnd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical WorkaJ —•-- - s� v ►t_cT- Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above G In ❑ No.of Lighting Fixtures Swimming Pool grnd 11 grnd ❑ Generators KVA DNo.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.c�Switclo9Rws No of Gas Burners FIRE ALARMS No.of Zone _ Total No.of Detection and No.o'Ran es No of Air Cond Tons Initiating Devices No.of Di osal Heat Total Total —--'— No. Pumps .Tons KW No.of Sounding Devices No./of Self Contained — No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices No.of Dryers0 Municipal ❑ Other Heating Devices KW —� Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No Hydro Massage Tuds No.of Motors Total HP — 01 HER: INSURt1NCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO = have submitted valid proof of same to the Office YES= NO = If yoh checked Y" ple a ind ate the type o cove ge by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specify)_ 1 ) I� �� �� p 1 Estimated Value of Electrical Work$ (Expirati n D!! e) Work to Start_ Inspection Date TRsquested— Rough Final Signed under the Penalties of perjury: n �� (^ ,r — FIRM SI/JNE `L •t LIC.NO. 4 533 Licensee 4. 0 Signature / LIC.NO. Address is l C ) Bus.Tel No. ! 7( pOF 3—,� �C Ait Tel.No. OWNER'S INSURANCE WAIVER: I am awU that the Licenses does not have the insurance coverage or its substantial 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. PERMITTEE (Signature of Owner or Agent) I Date. . '..� . .`. . �. .... . . ,Of N0 oTM 14, o= TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION s • th �,SSACHUSES This certifies that . . . :. . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . .'! : .�. :. . . . . . . . . . . . . in the buildings of . . . 1 r.f!. : ... . . . . . . . . . . . . . . . . . . . at . . .? . . : !' .' �. . . : .! .!. .;'. . . . . . ., North Andover, Mass. Fee. . .I. . . . . . Lic. No.. !. . ?. . . . . .. . . . . . GAS INSPECTOR Check# I Sv5 ;' jg((T,y, 'MASSACHUSETTS UNIFORM APPLICATON FORPERMIT TO DO GAS FITTING pe or print) Date 9 NORTH ANDOVER,MASSACHUSETTS ^ V. Building Locations yd- S r' ; -1 S / �� 4/ Permit# I'aAmount$ �)� Owner's Name K)e/,� Pie C q S'7 . New❑ Renovation Replacement ❑ Plans Submitted ❑ w z w ¢ o x > w N NSUB-BASEM ENT ASEM ENT 1ST. FLOOR 2ND . FLOOR 3RD. FLOOR 4TH . FLOOR 5TH. FLOOR 6TH. FLOOR 7TH . FLOOR 8TH . FLOOR Nameor type) �U v^,5MS'S ,,p i b OL �', Coe Certificate Installing Company Addr ss L,) 0 `' I ll // (Rol ❑ Partner. 4-1 S 4✓d V1,56 / Ff 7 Business Telephone 7g — /_57 — 7 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter S ✓� Ar {�U V.S P-s—f INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy In Other type of indemnity ❑ Bond ❑ 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 ❑ 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 StatF Gas Code and Chapter 142 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title ❑'Plumber f) f q y City/Town ❑ Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) ❑ Journeyman Date. Z. .�. . `. . '. . . N° 4 5 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING n•I�.(9 SSACNUSf This certifies that . . . ./. . . . .r.. ^ . . S.� . . . ? . . . ./. . . . . . . . . . . . . . . has permission to perform . . . . . . . : . : . . .�. . . �. i . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . .�`. .^ . '. . . .!.:`."�. . . . . . . . . . . at . . . `T. .L . .t. . .t.�. . . . .. . . . .r. . . ,/ North Andover, Mass. Fee. . .3 Lic. No.. . . . . . . . . . . . : . . . . . . PLUMBING INSPECTOR Check # 5 r WHITE: Applicant CANARY: Building Dept. PINK: Treasurer i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, ,p ers #MASSACHUSETTS Building Location �� t h Al S 1p r f� F� OwnName Date a 0 f1C�CS1�S Permit Amount Type of Occupancy New Renovation Replacement ❑ Plans Submitted Yes ® No ❑ FIXTURES r W W A .y A SLRBM RASRVIIVf IST FLOOR Z 2M FFLOQLOOR 4W HOC R SIH HOM 6IH ROM 71HIUM gm H-" (Prim or ingtype)P Y 9 Se SS ek v, fg` Check one: Certificate Installing Company Name Yj V r ,�/ � Corp; Address /��yt 9 9`� El Partner. «�,9s c�►�Q � 9 g � 9 Business Telephone q7F _ f — (o Firm/Co. Name of.Licensed Plumber. 'Al 5r if du V^ rss Insurance Coverage: Indicate the type of insurance 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 R 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 I 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 Mass husetts State PIurt}bing Code and Chapter 142 of the General Laws_. By S,lgna me of Licensea aiumt)er Title ' Type of Plumbing License lCity/Town icense Number Master Journeyman rj APPROVED(OFFICE USE ONLY 1_l I I i I Location —� ►^��' AP No. / Date MaRTM TOWN OF NORTH ANDOVER � s • i Certificate of Occupancy $ Building/Frame Permit Fee $ n y Foundation Permit Fee $ Other Permit Fee $ / TOTAL $ Check # �X J Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 16 BUILDING PERMIT NUMBER: ` DATE ISSUED: j_ ®j M SIGNATURE: APW .� Building Commissioner/1for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: LiCLa toy a33 Map Number Parcel Number \ 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required. Provide ReqWred Provided Reqwred Provided 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zane Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal _ ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSI11PIAUTHORIZED AGENT 2.1 Owner of Record SV5j\.j ry`rvCASA 4a- ttc,v� Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: z Signature Telephone SECTION 3-CONSTRUCTION SERVICES go 3.1 Licensed Construction Supervisor: Not Applicable ❑ S eta e s wI\ j S-� ✓� Licensed Construction Supervisor: 5 O 5`t`7 1 g, License Number Address ` C3 OZ4. -7$ $$7 3 U 3 Expiration Date Signa a Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name a b a ok M Sao S N1; A s Registration Number fi Address [till i D-001 n..,,. 9Zs S--6-7 3 o y s Expiration Date Si nat re Telephone SECTION 4-WORKERS COMPENSATION(M.G.L.C 152 § 25c(6) 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. Si ned affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all a ilcable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑* Specify Brief Description of Proposed Work: lZer�odeNc2, '1< AC4\en) PcZo-'i"ostd 90\--,4P out gg� ;.J ki�Ctie� 'N-e Oec 57i54%"o Sce-e*'Q 2C1, SECTION 6-ESTIMATED CONSTRUCTION COSTS r Item Estimated Cost(Dollar)to be ''Of 3NI.!St, Completed by permit applicant 1. Building (a) Building Permit Fee y D K Multiplier ° 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 t Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, �`A Yv��S 5 A as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my°knowledge and belief Print Name Si ature of�wner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIvMERS iST 2 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CH[MNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE •. ..,, FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT PHONE 11% 3 o'3.3 ASSESSORS MAP NUMBER E o 1 LOT NUMBER 3 SUBDIVISION LOT NUMBER STREET ST » R,� STREET NUMBER y Z OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS (vM DATE APPROVED CO SERVATION ADNIIIIISTRATOR / DATE REJECTED COMMENTS L CJ DATE APPROVED TOWN PLANNER DATE REJECTED CONMENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH /// DATE REJECTED' Co1vIwi'm G= sc lq c.�i� T�?r?��� �41 /c 4 PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTNIENT DATE REJECTED CONMIENTS _ RECEIVED BY BUILDING INSPECTOR DATE pEQCEIYE APR 11 2001 BUILDING DEPT. i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address "I Q 6 �V (t _ U Owner. /� Date of Inspection: rVW H /(\'-C -� 9--2e-9(10 SKETCH OF SEWAGE DISPOSAL SYSTEM: �Qsi include ties to at least two permanent references landmarks or benchmarks —JJ locate all wells within 100' S{ .30'L4 rA0s3 =33sff a � Lh ,-3 to's a c. ' -A0 �-- � - (S s„ DEPTH TO GROUNDWATER . Depth to grottadwater:Vr1�:�w�+tfeet method of determinpoon pra p tion: / ! Y (revised 11/03/95) 9 !46.25' — LOT 10 Ogg) 4orl'i1� Q • �o LOT 9 - LOT Ji Ae42 •- r s.��.Ab SPRING HILL ROAD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: ��rv.� 5 �f' S�' V Location' City Ni 0 2 h 0\ry 01t-t 2 Phone am a homeowner performing all work myself. ©I am a sole proprietor and have no one working in any capacity I am an employer providing.workers'compensation for my employees working on this job. Company name: Address City Phone#: Insurance Co Policy# Company name: Address City: Phone#: Insurance Co Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Q-V e 1 Date y//0 Print name I Phone# q1 �' "�' 3 0 3 ,Official use only do not write in this area to be completed by city or town official' ❑ Building Dept E]Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#. ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION Town of North Andover o� Na oTN �ti bye °o Building Department o 27 Charles Street ` North Andover, Massachusetts 01845 ?, mr (978) 688-9545 Fax (978) 688-9542 ���`°` " •,�1 �9SSgcHu5���� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit-ht the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, s150a. The debris will be disposed of in/at: DVy%-25- t 0S�� Facility location Signat&e of Applicant `1110 for Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. S 11a p' T . a ! 4 1 V O , 1 1 I ' I � I + 1 i , I I I, I I `4G I K� nE �a4 .4_ - I t.-T. TA ci I T - i fit^ _ �1 I � U ' ... .Y.. _.�•__. ' '-t'___"? "-Y _ - y-. _r'- - "t- -rte._--r -t�® � .__1'_ r _ , _ �. I I r r - --r ✓✓ , � r 1 --+- • dw^ ,A�, ]Ell TI r r + ♦ r i r -r r + T t /yJ+ r r r T T + + t t —r t t .. + T T . � - i •�� ' I I I �—'---,— —"��� r t + t T t + f f -�- + -t t t � + + t ; �.� �� +l�fi�;n Z,3S + ,r r r + r • r r i ; I � i�� i i I i I� I I � ••�C�cl Cl``v t`E1 Z.0�! �- } � fits ' � � i � i � a � t , + t t t i I ' ! I I I � ' � ' � I � � I I � � I ' � � I� + + r r fi- -� + -� � t r t t r t � + { t t r , + � r t � I t r t ♦ t r I I I � I + T + � � +� T —+ '� T T I � ' • � • r � 11 -t � * + �- t + -t + t � � + t , t t r r r + i t 1 Y � � � �- t- �• - + � t t } t �-} t + j I� t t' t t t + i t r t + r � r r t r t + - + t t � � r + r + -t -f -+ t �-- -} t • + -F * • �'} T � r r + } t r + r i t • e r r - .. T + r -r -+ f� + { -}- -F- -t r t 7 + + + + + t + t + t r t ♦ - t i , r r - r r r + - t t • • r + i I . t t t + T + + + r + t r T� + i } + t r T + r * t * i � � � � I ' • r e t } 1 � + - i } * T H + + t f Y + + + y- t + r + • r ♦ r + r r i � e�i�,t � �N:� tea,! • ♦ r •. t t T + + * T t r * t + * + 7 * t i Y t + r } } + t r + i i + r f Y f i 1 } . - + � ' i � � ._ i + a NORTFI. Town of 4 over q O ' o dover, Mass. �� a? yrs —ca OO/ COCKICH K > AD''ATED P`P�,`�� 1 S H BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...... �� Q N N CI�s 14 Foundation .............. ... . .............. ............. has permission to mW... f 4 '�.�... buildings on ......4.a.....�Vr�v � .......... Rough to be occupied as..91 4-e � *"1 p. .�K.�... aV w� N ooyv Chimney ........................ ........................ y provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. M I Or? 1* Q 33 y PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION START ELECTRICAL INSPECTOR C Rough 4M..... ...................... .... . ........... ............... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. ' SEE REVERSE SIDE Smoke Det. SCA"evA) FORM - U - LOT RELEASE FORM ►MoaL kC,-4 INSTRUCTIONS: This form is used to verify that allnecessary approval/permits from Boards and Departments having jurisdiction have been obtained.This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT 3'a s e 5 k 4 PHONE 9? $bo61 -3 o 3 ASSESSORS MAPNUMBER ° l LOT NUMBER 3 3 SUBDIVISION LOT NUMBER STREET STREET NUMBER y a OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS �j DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED CON%4E-N'I`S TOWN PLANNER DATE APPROVED DATE REJECTED COMMENT'S,. DATE APPROVED FOOD INSPECTOR-BEALTI4 DATE REJECTED -- - DATE APPROVED SEPTIC INSPECTOR BEALTH - /// DATE REJECTED COMV1ENIB ��' � 1LJ ' L�-'/ 4 �°r 7 1 c' ne--C- PUBLIC WORDS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT t DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE pECE0Yr APO 11 2001 BUILDING DEPT. I ' I I Q 5ZP•1p`a'tO k -yb fA- , i a 9 i r i 1. L � ( T I 1 , � I -- . , \t L 71, � 1 l 4- , ! I +- �_-- �I r � a 1 , I L- i f L 1 I I