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HomeMy WebLinkAboutMiscellaneous - 90 WOODSTOCK STREET 4/30/2018T9� N �O o D o v 0 o � 0 Date./ TOWN OF NORTH ANDOVER F;PERMIT FOR PLUMBING °SACMUSE` `� This certifies that .. x....5..1 {�"y' ..................... . has permission to perform .... plumbing in the buildings of ...................... at ... j�}..t,,+..� ,,. .c. t A .............. North Andover, Mass. Fee .1/6. .... Lic. No. j.& 1.4 . . ..vF., PLUMBING INSPECTOR Check # 72-8 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS (� / r1 7 /� / Date � Building Location G 0 �U O y�,/ S fO C'" `owners Name EU G `l e �— Permit # t- y Amount Type of Occupancy New Renovation Replacement [],— Plans Submitted Yes FIXTURES (Print or type) �% �j' Check one: Installing Company Name `y 1 ��P /� G� Corp. _ Address -- parer, Business Telephone �Firm/Co Name of Licensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 11 Bond No 0 Certificate 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 11 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 an tallations performed er Perm' Issued for is application will be in compliance with all pertinent provisions of the Mas c setts S to bing a and hapten 14 of the General Laws. By: i a ureo kens umver milli Title Type of Plumbing License City/Townkens um er Master Journeyman APPROVED (OFFICE USE ONLY W-1:171170 7 D 3 a Z111 WCOUrl- W-71al�� I I f�� i l�� (Print or type) �% �j' Check one: Installing Company Name `y 1 ��P /� G� Corp. _ Address -- parer, Business Telephone �Firm/Co Name of Licensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 11 Bond No 0 Certificate 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 11 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 an tallations performed er Perm' Issued for is application will be in compliance with all pertinent provisions of the Mas c setts S to bing a and hapten 14 of the General Laws. By: i a ureo kens umver milli Title Type of Plumbing License City/Townkens um er Master Journeyman APPROVED (OFFICE USE ONLY NORT/1 Date .l.7: Z $- 0. 7 TOWN OF NORTH ANDOVER PERMIT FOR WIRING .o, ;7SSACHUAT- S� This certifies that ' '+� .................................-.c.........................fi...�......................... has permission to perform . K/�y�C C '¢�� ...... ....... ....,I `T o �A�1 /W 9 L07-' wiring in the building of ........................................... .................... j. at ......... ....................................... . North Andover Mass. Fee ... Al IC.... Lic. No,4 /11-"!l/.............y .. ......... '7 ELECTRICAL INSPECTOR Check 7906 le -3 —D7 Ao�— 5�=—I-,� u, a Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 11' (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:�1 'Z Z 07 City or Town of: NORTH ANDOVER To the Inspector of Wires By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) rytyn C �` Owner or Tenant Telephone No. Owner's Address l,' 'v V r r/y"' U4r-Vt,-' I -- Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building 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: A E — FEE �) DEL Cmmnletinn nfthp fnllnwina tnhlo .n.,n ho ,, i—d h„ fl.o r» -f,,,. „rW:.-,... No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Tota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- ❑ rnd. rnd. o. o mergency Lighting 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 Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number Tons _" W ' ' """" ""' o. of Self -Contained Detection/Alertin2 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 Water Heaters K�'4' No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: � . Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: . 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 "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE XBONDEI OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: a t c t'oi+L LIC. NO.: i Ce Licensee: 16{'{ph.p,*_1 /k/Gry�04_ Signature LIC. NO.:AI( (If applicable, enter "exempt" in the license numb ggr line.) Bus. Tel. No-, 7 " - Address: IO W 11( (art?. S^�P�` �� (`� Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, 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 a ent. Owner/Agent ` Signature Telephone No. PERMIT FEE: $ / Y Date.... .- .. �g".p.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that � . ...................................................................... T��tft/ has permission to perform........I ....................................................................... wiring in the building of ......................F��e at ................................... . North Andover, Mass. Fee %✓ ......... Lic. No!�.� 3 .............. /! i. .!:!-�? r..... 7 `�1� ELECTRICAL INSPECTOR'' Check # _7 Y ?T 7163 y- Commonwealth of Massachusetts Official Use Only Permit No. 7 Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: / y d `7 City or Town of. NORTH ANDOVER To the Inspec or of Wires: By this application the undersigned gives 'notice o his �r her intention to perform the electrical work described below. Location (Street & Number) �G WDU S 0 4- t - Owner or Tenant MV Ful lav Telephone No. Owner's Address R0 1x. 1c, c, & 5 ec �L Is this permit in conjunction with a building permit? Yes 1. No ❑ (Check Appropriate Box) Purpose of Building K� �'G t r- P—e-,,C V'N+1 �� Utility Authorization No. Existing Service Ivo, Amps l lb / 2ZL-, Volts Overhead Undgrd ❑ No. of Meters 1 New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: K i �e.�, Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires 9 No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- ❑ rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets 41 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 41 No. of Gas Burners No. Detection and o Initiatin Devices No. of Ranges f No. of Air Cond. Tonal No. of Alerting Devices No. of Waste Disposers Heat Pum Totals Number Tons J.KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Mun'c'pal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: r`Cr1vwA,,"e Attach additional detail if desired, or as required by the Inspector of Wires Estimated Value f Electrical Work: (When required by municipal policy.) Work to Start:�-OQERAG`E: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCEnless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [g BOND ❑ OTHER ❑ (Specify:) /certify, under theains and penalties of perjury,�that the information on this application is true and complete. FIRMNAME: VN'e-c [���-,f�,�'erv��-cIn ® LIC. NO.:12-3641 ( Licensee: L-Rf rti r�N (-C Signature ✓�- �_-`� LIC. NO.: IZ 3 4 ,4— (If applicable, ter/"exempt" in the l'cense num er line. )/Bus. Tel. No.: �� �� 24 '36 Address: ) E APx i 2 l ►��vr`-' 'A_I15 N H 0984114 Alt. Tel. No.: 6& 3 1 s *Security System Contractor License required for this work; if applicable, enter the license number here: 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. 1 am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ R s-ct j1t 0 fC [ ,- t T-0 7 1241 r, �,�Or"e cw-c- ol -! N° �; 632 Date. . .. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ....... ... .. ....` ... ............. . has permission to perform .—.4" . � - '�. '-� _ :`?..... "/ plumbing in the buildings of . ............................. at . /.!' . ..................... , North Andover, Mass. Fee'...... Lic. Nod 7�.. �`-''"............. PLU/'MB'ING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building of Occuaancv '51YAW /G New ❑ Renovation ❑ Replacement K44 Il 1' Date Permit # Amount Plans Submitted Yes ❑ No (Print or type)�Lv�� y, Check one: Certificate Installing Company Name ❑ Corp. Address - ❑ Partner. Business Telephone Cf ��g - Z s6 �¢a 7 ❑ Firm/Co. Name of Licensed Plumber. % CAidAi9 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box Liability insurance policy a Other type of indemnity ❑ Bond ❑ igned, have been made aware that the licensee of this application does nor. have any one of the above Insurance Waiver >, the unders 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 ;b' der Permit Issued for this application will be in compliance with all pertinent provisions of the Mass�� �State�g Code an ter 142 of the General Laws. �LIUC City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License /9 7 s55 icense um er Master Journeyman r Location No. % OF' / Date c =� r© NORTh TOWN OF NORTH ANDOVER _ O F � .. 9 i Certificate of Occupancy $ s,.".. 'i Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # 13655 ' Building Ins eG(or TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING This Se+etioa far imciva Use Oal BUILDING PERMIT NUMBER: v / DATE ISSUED: A) � O V SIGNATURE: to& 00000* 0 - .010 oe��lf uildine Commissioner/Insoector of Buildings Date cFr T[!)N t- CITR INFORMATION v 1.1 v Property Address: 1.2 Assessors Map and Parcel Number: d 416r Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lat Area (SO Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) Public ❑ Private ❑ Zone 1.5. Flood Zone Information: Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record s)st�+N n ty,421l- ��IIS qa U)8t sIz�c,k <ig.-id: Name (Print) Address for Service : Signature Telephone 7� E- 9//6 2.2 Owner of Record: Name Print Address for Service: SECTION 3 - CONSTRUCTION SERVICES I 3.1 Licensed Construction Supervisor: k-,E,rNEik 3 ICc4511 Licensed Construction Supervisor: 72,1 /Jew; 17 A✓E NJ Rtj Sin JErt, Address g - Zoe S e Telephone 3.2 Registered Home Improvement Contractor Company Name Z,I cWi V 4,1 E- N. AOJAt9(1fn- Not Applicable ❑ S2 64 License Number Expiration Date Not Aoolicable 0 Registration Number W fF8 Expiration Date -)2-400 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 buil&g permit. Signed affidavit Attached Yes ....... No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building 0 Repair(s) C?' Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: NIw Li�� • ��i��2�4�E �lC.Z�Su�r�c�^� SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building �l r T (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical (IiVAC 5 Fire Protection 6 Total (1+2+3+4+5) 1 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 , as Owner/Authorized Agent of subject property Hereby authorize ��( r INp E-A 3 u Sa t✓ — KEFN L daJ�/Ltl G�� to act on My behalf. in all matters relative to work authorized by this building pennit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1 ,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 Signature of Owner/Agent Date BE=— 1 11111111111111 NO. OF STORIES SIZE BASEMENT OR SLAB RD S17E OF FLOOR TRvIBERS 1 2 3 SPAN DfN4ENSIONS OF SILLS DDA NSIONS OF POSTS DUENSIONS OF GIRDERS f m-, c,fIT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND ie ni rn nrw', CnNWCTFn TO NATURAL, GAS LINE u I 41 r=-� _ _ The Commonwealth of Massachusetts =,e Department of Industrial Accidents gmee of/n'Vestigations Washington � 600 _ :• _� - /� a Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit A licant to oonFwgl1lin, q: Zeas _ eai 1 �. • e..Iii name: /C Echl 00"d NS 4-1- Pl' � . , location: 77— .!7 EGtI i /y[l� city A/A • 91-jda U1, !/// Rhone # 72 G ?1- S Z,6) ❑ I 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 c m anv name. / do hereby certify under theloins and penalties of perjury that the information provided above is true and correct. / .. Print name _ kg A)A1 E th U • Ar e E . - - . -. - - ._ .__._. phone # _ 21-7 - 6 -5Z10 official use only do not write in this area to be completed by city or town official ,:.:...._ city or town: permittlicense # nBuilding Department — —' check if immediate response is required C] Lice i singBdardC]Selectmen's Office contact person: phone #; ❑Health Department nOther r O O z x w A a o a u u b w (U r U L C/)wo O w o4 z z Q 5 'O C .� D0 ao' U m ii a o U W 04w is w a 0 W a4 P a W moo ao' v V 'E V) w p H a z m w w d A w y G w� z y � cn v o o � Sac o �m c o � C H :�.a c , ev mc m N = `• O.� m C m p = it co coN cm .w m :oma d � N A m m co CO) • � N m E0 ,. Lv y'm m c cya E= m cc Z c o It _ . amo N3 eyv w m u.i c c 20 c O c «. .y MO c u �ui E cw •y ca cm C3 a COD ZID Z e0 o H �p H t S cpm W z) C7 (v�I l ' E � a � U Z C Zip o (n ca N 0 O �T� C C/)m oc C/) c Lia m � � L o I� CD c 0 CD O co 0 z O cm y coMa .E O L CD O CD cc r. m CO3 O d N! C O u O G N 1 >, cc Z �+ C o J O QM C 0.— cc .cc m 3� O G O `o a a G Q ccca J -0 O CO z CO3 G PER'lift NO. ,950 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 440. I 2 RECORD OF OWNERSHIP DATEBOOK PAGE ZONE SUB DIV. LOT NO. I LOCATION 0 ��� � �'�" PURPOSE OF BUILDING OWNER' AME Svsc t 0.R u k NO. OF STORIES SIZE 011X/6 r OW 'S ADDRESS er0 I_ W }oo Sj k r1 , J BASEMENT OR SLAB HITECT'S NAME SIZE OF FLOOR TIMBERS 1ST,?A /� 2ND 3RD T r BUILDER'S NAME MQ Q kaP f (16 S ' L. W ``r SPAN DISTANCE TO NEAREST BUILDING ---r DIMENSIONS OF SILLS DISTANCE FROM STREET ^3 % POSTS DISTANCE FROM LOT LINES – SIDES fL / REAR j [3 "' GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING / X IS BUILDING ADDITION 1 (f 1/I% n �� y� A.� J / / /` CJ !` K ,MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Y—ef T IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FAILED AND APPROVED BY BUILDING INSPECTOR DATE FILED A's %a-, /,%,'/ FSE E 4% 9oeb PERMIT GRANTED p 14 19 l l CONTR. LIC. 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST a, ow EST. BLDG. COST PER SQ. FT. 6 VIXJ EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN 1 � BUILDING INSPECTOR 'NV1d 101d S30V1d3M SIHl 'a3SOdWlH3dnS '013 'S30VU -V'J 'S3H:)UOd H11M 'S9NIa11n8 AO SNOISN3WIa 10VX3 aNV S3NIl 101 WONA 30NV1SIO ONV 101d0SN0ISN3Wla 10VX3 MOHS1SnW NOLUMS SIHl tk; .. Z l I ADNvdn00o L aV03B i ONiaiin8 0NIlV3H ON _ I pie I r 01. PUL 1.W.9 DIa1D313 110 SWOON i0 'ON L SVO Sd31V3H 11Nfl W's '✓ f✓ SS31iVa DOOM 0.1.H 1NVIOVa ONINOI110NOD SIV aOdVA a0 a.1.M lOH 'S10J 18 'SM 1331S WV31S _ 'SlO:) V 'SW9 a39WIl 'Nafli SIV 1014 03DSOd 3DVNaf13 SS313dId _ c 1SIOf BOOM 0NIIV3H Ll I ONIWVIIi 9 OOVa 3111 x0013 3111 _ S3af11X11 M30OW `JNIi00a 110a _ a3MOHS llV1S 13AVSO 8 Vi ONI9Wflld ON 31V1S NNIS N3HDIDI S30NIHS DOOM ASOIVAV1 S3IONIHS 11VHdSV 13SO1D a31VM 03HS 1Vli rm Z) 'Wd 131101 OaVSNVW 1389wV0 X14 C) HIV9 dIH 319V0 ONI9Wflld OL d00a 5 1 313V r-1 a Od 3aofla03das ONINIM 3WVa4 NO 3NO1S ASNOSVW NO 31\101S ')119 S3019ID bO 'JNOJ _I 80011 8 'ShcS DI11V 3WVM NO A:)IS9 ASNOSVW NO )IDIa9 —� C 6 1 SIIOOti 9 3111 'HdSV ITO—YIWOD 3WVSi NO ODDf11S ASNOSVW NO ODDf11S ONIOIS 'lain ON1011 1011311V O.mOaVH ONIOIS 1lVHdSV HAV3 S31`JNIHS DOOM 313aJNOJ D 6 S08VOUVINICIIS S11VM b N3HD11X NS3(10W WOOS CIV3H S3DVld 3814 1.W.9 ON V3aV DI11V 'N13 V3SV .1.W.9 'N13 '/a 1/1 %i 0 11(13 V3SV 1N3W3SVS £ Z _ 1 £ 'N13Nf1 11VM ANG Sa31d 631SVld O,MOSVH 3NO1S a0 XDIa9 3NId ')1.19 313SDNOD 3138JNOD HSINIi H01831NI 8 _ 1 NOI1VONnoi Z N0u:)nUlSN00 S1N3WIdVdV S3D1330 AIIWVd 'I1lnW S3180!S _- A11WV3 310NIS Z l I ADNvdn00o L aV03B i ONiaiin8 CD O I m 9-4 = 0 p at O " ~ v v c u 0 . �y y y 6wJ z C6 CL CL � 1L Z � Z � Z W W W Q O 21 cf Z 0 O Z ? V 3 3 w E O u ° =z r ZD• o CID m L c J L .Wd L U Jc Y > :..L: n E a• �' �++ W CL 0 � o :Ec LU O c / • c is C c ¢ y ui m ai � Cc U ii a it u cr vii ii vi W ii FE S O z c u . �y y z a � o � � 21 cf 0 0 3 3 w E O ° =z r ZD• y6J 3 > :..L: ��/'� I Z CL 0 . LU / • is C ' r y p� � C: 0: a a ,: _ vi W V� Lu —j Z • _ _• aai C O ° DO v x c CLcc i r �• C a 'a y s °° w p (� ..� C a ° a '� •� y p "0 ,.., ..a F•• s ° a m > S O z 71 FORM U TOWN OF NORTH ANDOVER ' 4 LOT RELEASE FORM SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) PERMANENT ASS (,1S��IG,�IE BI D(P�w. } STREET �/ APPLICANT �f�SA.n d- / LA'2�C %y�l�/? PHONE DATE OF APPLICATION TOWN USE BELOW THIS LINE PLANNING BOARD DATE APPROVED TOWN PLANNER DATE REJECTED CONSERVATION.COMMISSI N R ` CONSERVATION MIN. BOARD OF HEALTH HEALTH SANITARIAN DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT SEWER/WATER CONNECTIONS FIRE DEPT. RECEIVED BY BUILDING INSPECTION DATE DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED This form shall be signed by the agents of the Planning and Health Boards, the Conservation Commission prior to the issuance of any building permits for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) PERMANENT ADDRESS STREET <�? () ,--. Folin U TOWN OF NORTH ANDOVER LOT RELEASE FORM " G,�1EI� B D (P�W. APPLICANT �ClSan + nq,/ _11&1? PHONE DATE OF APPLICATION TOWN USE BELOW THIS LINE PLANNING BOARD TOWN PLANNER CONSERVATION COIiMISSION . PIA ` CONSERVATION ADMIN. BOARD OF HEALTH HEALTH SANITARIAN DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT SEWER/WATER CONNECTIONS FIRE DEPT. RECEIVED BY BUILDING INSPECTION DATE DATE APPROVED DATE REJECTED DATE APPROVED S aAt DATE REJECTED DA'T'E APPROVED DA'T'E REJEC'T'ED This form shall be signed by -the agents of the Planning and Health Boards, the Conservation Commission prior to the issuance of any building permits for the subject lot. This form shall not releive the applicant from the. compliance of any applicable Town requirement or Bylaw. k