HomeMy WebLinkAboutBuilding Permit #109-15 - 10 WALKER ROAD 7/30/2014 (5) NORTH q
BUILDING PERMIT 3?Qt�TL!° •b�OL
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received °
Date Issued: PSsgc►+us�
I ORTANT: A licant must complete all items on this page
LOCATION iT a ho OgZvL- ,
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PROPERTY OWNER a� -t--l:��a I/Vt 0- r-a
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MAP NO: �PARCEL710 ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition KTwo or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
Demolition -0Cr (y- ❑ Other
❑ Septic ❑ Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
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l I dentifi/c�ation Please TType or Print Clearly) (i /
OWNER: Name: '�.0- n4 - -G�d� �- ���'1 Phone: �e3 �� 3363 —J� 0�6td, 1'1
Address: o �)a ` 0,0d7—
CONTRACTOR Name: Phone:
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Address: ad w a q A;�,d
Supervisor's Construction License: S ��7�o� Exp. Date: ����3 )�
Home Improvement License: L Exp. Date: Wa /
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESPIWATE/D COST BASED ON$125.00 PER S.F.
Total Project Cost: $ 41 I. FEE: $ U1 o
Check No.: I al -:�I Receipt No.: 2-1
NOTE: Persons contracting with nregister c retractors do not have access to the guaranty fund
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Signature of Agent/Owner Signature of contractor
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