HomeMy WebLinkAboutBuilding Permit #Exception - 0 Martin Avenue 5/1/2018 (5) w
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BUILDING PERMIT tLEo
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION _
Date Received � Vo4ATED fly
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Permit N0: c-
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Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION42_
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PROPERTY OWNER.. .
Print
MAP.2-+B- PARCEL: 6 . . . ZONING DISTRICT istorib Distract. yes. `no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
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Residential Non- Residential
ew Building ne family❑Addition ❑Two or more family ElIndustrial
❑Alteration No. of units: ❑Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
gp.1,tWell 0 Floodplain 0 Wetlands 11Watershed District.
ater/Sewer.
D �C'RIPTION O�7WORK O BE PERFORMED: /
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Identification Please Type or Print Clearly)
OWNER: Name: ���c i���� QU;ls��f � �. L((r3.�. T� Phone: 9 7k4 3� �6
Address:--R�) 3 fil A D(g
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ONTRACTOR
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ddress: ( D �cJ �� �� �.y
Supervisor's Construction License: ��� 7�_ �
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Home_Impro'vement License: Exp. Date:
ARCHITECT/EN Phone:
7
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Address: 1 Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 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: Z Total square feet of floor area, based on Exterior dimension4w
Total land area, sq. ft.: 'Ci�(,F)
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANCER 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
Doc.Building Permit Revised 2010/October