HomeMy WebLinkAboutBuilding Permit #496-2017 - 100 HICKORY HILL ROAD 11/10/2016 a
TOWN OF NORTH ANDOVER . � ,
APPLICATION FOR PLAN EXAMINATION NORTH
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Permit NO: 6 Date Received
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Date Issued: !/-/0 ayl('D
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IMPORTANT: Applicant must complete all items on this page
LOCATION 10 y �'W� ��� �' i' 1 (`
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PROPERTY OWNER f 0
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MAP NO.: PARCEL: f ZONING DISTRICT:
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TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non-Residential
E New Building kone family
❑ Addition ❑ Two or more family ❑ Industrial
Alteration No. of units:
t(Repair,replacement ❑Assessory Bldg ❑ Commercial
❑ Demolition
❑Moving relocation ❑ Other ❑ Others:
❑Foundation only
DESCRIPTION OF WORK TO BE PREFORMED 7-1
Identification Please Type or Print Clearly)
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OWNER: Name: ` \ v `" Phone: ��� � �
Address: 00 14- ( C k-o� / 14 1 D IV,. /W/-)()vC. l
CONTRACTOR Name: -t:sTa ` - Pho e: l' , y r V9 U)
Address: 3 -7 7 4 a vUC l 1 J / v✓ Id I-1 0/D��
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Supervisor's Construction License: 1666 �'V Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.•$72.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BA ON$125.00 PER S.F.
Total Project Cost :$ A::-- x12.00=FEE:$ 01
Check No.: Receipt No.: S I I (0 y
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