HomeMy WebLinkAboutBuilding Permit #Exception - 0 Martin Avenue 5/1/2018 (4) r
BUILDING PERMIT of"O oT"��
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received ATEoW�Ppy�
�SSACHUS��
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION r k&nl :
PROPERTY OWNER.. .
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MAP. 6PARCEL: ZONING DISTRICTS istoric District. yes. no
Machine Shop Villageyes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
ew Building 6,dne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
lter/Seiker.:optic 'D Well � Floodplain '. 0 Wetlands ❑ Watershed District.
DECCRIPTION OV�ORK ,O BE PERFORMED:j__
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Identification Please Type or]Print Clearly)
OWNER: Name:UvL L r � �� ����'ls,rr � -=ccr. T� Phone: 97k-' Q IYR
Address., 3. 11i!E4- D(g
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TOR Name:�� t'//""`Ph6V-{ O ' c1� .�� /t��9'1 'G� lcQ'G��2jl�/11�j s.Construction License: OK) �7`3 Z. Exp. Date o'Vemeni License: Exp. Date:-
ARCHITECT/ENGINEER Phone: '�/ �D—✓�� ��
Address: & Reg. No. �, >
FEF SCHEDULE:BULDING PE'RMIf•$92,00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON
$125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor
Dimension
Number of Stories: , ''2 Total square feet of floor area, based on Exterior dimensions '
Total land area, sq. ft.:� c-).-
ELECTRICAL:
)ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA- For department use
El Notified for pickup - Date
Dor—Building Permit Revised 2010/October