HomeMy WebLinkAboutApplication - 58 COUNTRY CLUB CIRCLE 4/10/2017 "ORTy
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BUILDING PERMIT
TOWN OF NORTH ANDOVER a o
APPLICATION FOR PLAN EXAMINATION
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Permit NO: Date Received
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Date Issued:
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IMPORTANT: A2plicant must complete all items on this page
.:.LOCATION:.: 58 COUNTRY CLUB CIRCLE
PROPERTY OWNER'
DONALD �D. STANLEY
Print .
MAP NO '` 64 PARCEL: ` 5 0; ZONING DISTRICT R-l Historic.District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑ Addition ❑ Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑;Septic ❑Well ❑ Floodplain . ❑:Wetlands . 11 Watershed District
❑w- ater/Sewer
CONSTRUCT INGROUND POOL & SPA, SEGMENTED BLOCK RETAINING WALL
AND FENCE ENCLOSURE, PARTIALLY WITHIN THE NON-DISTUCRBANCE ZONE
Identification Please Type or Print Clearly)
OWNER: Name: DONALD D. STANLEY Phone: 978-857-1959
Address: 58 COUNTRY CLUB CIRCLE
CONTRACTOR Name Phone:
Address
Supervisor's Cranstruction'�icense Exp, Date.
Home lmpro�emenfi License. Exp, Date
GEORGE J. ZAMBOURAS, P.E.
ARCH ITECTIENGINEER ATLANTIC ENGINEERING & SURVEY Phone: 978-352-7870
Address: 97 TENNY STREET, GEORGETOWN, MA 01833 Reg. No. MA 36230
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FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting ►v' u r d contractors do not have access to the guaranty fund
Signature o Agen wn Signature of contractor