HomeMy WebLinkAbout20181129 Form A Application 31 Inglewood D. Kalemba 1
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PLANNING DEPARTMENT
Community&Economic Development Division
Form A®Application for APPROVAL NOT REQUIRED
DATE: aV2 _ �� 4011
Bring three application forms to the Town Clerk's office to time stamp. Leave one application with the Town Clerk and bring two
applications to the Planning Department, Petitioner must submit an electronic PDF version of all submission material.
The undersigned,believing that the accompanying plan of property in the Town of North Andover,Massachusetts,does not
ponsiitute a subdivision within the meaning of the Subdivision Control Law,herewith submits said plan for a determination and
endorsement(hat the Planning Board approval under the Subdivision Control Law is not required.
Please do not prepare Mylars until the Planning Board has reviewed the application.
1. Name of A plicant:Q�'I V//) KALL—1)1&, __ 1!' NGic'�G/1� 5 LO4-
Address:. / J4- L C cc,.0W) 0 i/r2 /yll/
Phone&email: !Z 7 — f$e2 — 96 A y
21 Location and Description of Property[include Assessor's Map and Lot and Zoning District(s)]:
t� oil.0 `00eig 0000,
CMG=-600 — 6000
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3. Deed Reference: Bookk��.+'�/ Page b j 0
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or Certificate of Title:_ 1
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4. Name of Surveyor: 61 j--]& 41h e:K' (:Xl G'iAl6-- �A en VI CC—X
Address:
Signature of Owner(s): + Y1 !4
Address:9 l /t1 -' �' " c� GL,,z-::
Please do not prepare Mylars until the Planning Board has reviewed the application.
Page 1 of 3
120 Main Street,Planning Dept.,North Andover,Massachusetts 01845
Phone 978.688.9535 Fax 978.688.9542 Web www.northandoverma.gov
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Please Indicate the grounds(either A,B,C or D,not a combination)on which you believe your plan not to be a
subdivision.
A. Each lot on the plan meets one of the following criteria:
1. Has the frontage,lot area,and lot width required under the Zoning By-law on:
a)a public way,or
b)a way which the Town Clerk certifies Is maintained &used as a public way,or
c)a way shown on a plan approved and endorsed by the Planning Board underthe Subdivision Control Law,
recorded in Plan Book Plan ,or
d)a way in existence before the adoption of the Subdivision Control Law by the Town and which the Board finds
adequate for the way's proposed use,or
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e)a way shown on a plan of a subdivision recorded at the Registry of Deeds or the Land Court prior to the
adoption of the Subdivision Control Law.
B. Each Lot has been clearly marked on the plan to be either.
a)joined to and made part of an adjacent lot,or
b) labeled"Not A Building Lot".
C. Each lot on the plan contains a building that existed prior to the adoption of the Subdivision Control Law.
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D. The plan shows an existing parcel with no new lot division(s)and has frontage on a way described above. I
Received:Town of North Andover Town Clerk(date stamp): 7
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Signature of Town Official receiving this application:
No c to APPLICANTITOWN CLERK of action of Planning Board on accompanying plan:
The North Andover Planning Board has determined that said plan does not require approval under the
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Subdivision Control Law,and the appropriate endorsement has been made upon the same.
2. The North Andover Planning Board has determined that said plan shows a subdivision,as defined by&L.c,41,
s.81•L,and must,therefore,be resubmitted for approval under the Subdivision Control Law.
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Very truly yours,
North Andover Planning Board
By,
Date: 17 Ji
NOTE: if endorsed, Notice of Plans: The petitioner Is responsible for recording the endorsed plans at the Essex North
Registry of Deeds, Lawrence, Massachusetts and shall provide a certified recorded copy of these documents to the
Planning Department.
Page 2 of 2
120 Main Street, Planning Dept,, North Andover, Massachusetts 01845
Phone 978.688.9535 Fax 978.688,9542 Web www.northandoverma.aov
PLANNING DEPARTMENT
Building Conservation Health Planning Stevens Estate Zoning
Certification of Payment of Municipal Taxes, Fees, Assessments, Betterments and
Other Municipal Charges
The Town of North Andover General Bylaw Chapter 129-1, provides that any application for a
permit or license may be denied, suspended or revoked if the applicant or holder thereof has
failed or refused to pay any taxes, fees, assessments, betterments or other municipal charges
assessed to the applicant or holder to any business, corporation or trust in which that individual
has an interest. By signing this application, the applicant represents that he or she has paid all
such taxes and fees.V G-IV Clef I/II- 3 /l A-( 4.--_AN 6
1 06 it/12 a- /W 1I-L G=4,16 certify under the penalties of perjury that to the
best of my knowledge and belief, I have not nor has any corporation, trust or any other
commercial entity in which I have a financial interest neglected or refused to pay any municipal
taxes, fees, assessments, betterments or any other municipal charge including amounts
assessed under the provisions of section twenty-one D, or am not applying for a license or
permit with respect to any activity, event or other matter which is the subject of such license or
permit and which activity, event or matter Is carried out or exercised or Is to be carried out or
exercised on or about real estate whose owner or any business, corporation or trust In which
that individual has an interest has neglected or refused to pay any local taxes, fees,
assessments, betterments or 1any other municipal char+g . Q Q f
Signed under oath: 2 �/ C,f %� � ✓��
aiame
Address
Does the Property Owner own any additional property In North Andover? (YJN).
If yes, please list the property address of any additional property.
Property Address: 4 �� -" i
�Urli!'�t b+>o\(,8e- U 11 ,p oco(D
North Andover Tax Collector Signature
Name
Date