HomeMy WebLinkAbout2009-01-29 MA Highway Permit Application /� �� � w�....errurV
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Massachusetts
Highway Department
Application for Permit to Access State' Highway
To be completed by the Applicant. See reverse for ilistt•lictions.
1. "Town/City: North Andover
2. State Highway route mtmber aticl/or name: Route 1 1 4 - Turnpike Street
3. Descril)tion of property and/ol•facility for whirl access is sought(attach additional sheets if necessary):
Proposed Commercial Building with access via existing adjacent
-paper
4. Description of work to be performed witltill State 1-1igImay LayotiI (attach additional sheets if necessary):
Reconstruction of existing driveways/ removal of existing sign
and stonewall and re-grading lawn areas . _
S. Dig Safe number: _20084003894_
6. Applicant lnformation 7. Proper(},Owner
Naute Theodori Londi Name Carol Larkin
Mailingad(fress 42 Paleologos Street Mailittgatddress 40 Summer Road
.-Peabody., -MA 01960 Berlin MA 01503
Telephone nttmber 5 3 0-7 7 41 Tude)hone number
1 L�78 837-6677
Fax Number: Fax Number:
E-Mail Aciclress: edlondiyahoo,corn E-Mail Address: —
Signature d I Signa(ut-e
Prins Name Theodori Lond L ._ Prim Nance Carol Larkin
Dale 11 /31 , Date 10131 /08
Return MI11)leted-,ypficatian to 13ist-jet I llgliway Director for your Town/City. Itcicr to rcversc slcic liar appropriate tutdress
■ 1
I. Application timber 5. Sectioat 61 Cnding
2. Date received 6. Mass historic action
3. Fee amount 7. Plans returned
4. MEPA regained Revision submitted
ENF-EOEA Cert. 8. Alplication complete
EW-EOEA Cet•t. 9. Permit written/issitecl
Otlicr-COEA Celt, 10. Permit denied
"ALL MASSACHUSL'1TS 1-11GIlWAY DEI'AIZTMEN"I' I'Elttvil`I'S'1'O ACCESS STATE IIIGI IWAY PKOJECTS A1Zi_3 SUBJECT
TO THE RULES ANSD MOULA,riONS OF THE ARCI IITACTLMAL ACCESS BOARD 521 CNIZ 1.00 et seq."
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Massachusetts
Highway Department
Application foir PeIrmit to Access
To be completed by the Applicant. See reverse for instructions.
1; Towu/City: North Andover
2, Stele IlightiMy route number and/or aaame: Route 1 1 4 Turnpike Street
3. Description of proI)erty acid/or'facility for wiaicla access is sought(attach additioaaal slieels if iecessary):
Proposed Commercial Building with access via existing adjacent
paper streets (Booth St and Saville St. )
4. Description of work to be performed with ill State 11iglnvay Layout(attach acid itionaI sheets if necessary):
Re Iacement of existin Water Service line and construction of
282 LF of 8" Sewer along the unpaved shoulder area.
5. Dig Safemmaber: 20084003894
6. Applicant Ilaloranation 7, Property Owner
Nanae Theodori Londi Naa111e Carol Larkin
Mailiaagaddi-ess 42 Paleologos Street Mailingaiddress 40 Summer Road
Peabody, mA 01960 . Berlin, MA 01503
Telel7la0110 nulnbei 978 530-7741 _ Telelalaone member ( 978 ) 837-6677
fax Ntmaber Fax Number: _ _-�
E-Mail Address; tedlondi@yahoo.com E-Mail Address:
Signature Lea ! Sigualtire
1'rinl Name -The ). Print.Name Carol Larkin _
Date 1 0 31 0 8 Dated 04-3-14-0 A
Retul-n completed application to District Highway Director for your"I•owti/City. Iteter to reverse side for appropriate address
r4drOffive Use WAY. DI
1. Applicatioaa ammbei• 5. Section 61 finding
2. Date received 6. Mass historic action
3. Fee amomit 7. Plans i-ettla•ned
4. META aectraired Revision submitted
ENP-EOEA Cert. 8. Applicatioaa complete
EIR-EOEA Celt. _ 9. Pea•Iuit wl'itten/issued
Other-EOEA Cert. 10. Permit denied
"AU., MASSACHUSETTS HIGHWAY DEPARTMENT PERMI"T:S TO ACCESS STATE I IIGI IWAY I'R0JECI'S ARE SUBJECT
TO'TI-IE RULES ANSD REGULATIONS OF THE ARCI IITAC.URAL ACCESS BOARD 521 CNR 1.00 et sect."