HomeMy WebLinkAboutBuilding Permit #Exception - 1041 FOREST STREET 5/1/2018 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: Date Received
Date Issued:
IMPORTANT:A pplicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building One family
0 Addition ❑Two or more family ❑ Industrial
0 Alteration No. of units: 0 Commercial
❑ Repair, replacement ❑Assessory Bldg 0 Others:
0 Demolition ❑ Other
❑Septic ❑Wei _ 1IFloodpn A
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OFWater/Se�nrer, {
ID . CRIPTION F WORK T BEPERFORMED:
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OWNER: Name: �to'� neo Phone:
Address: 0 y t-orn+;' S�t�e� OIC
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�CON,T, i4CTtOR�:;Name ., >ti FP.i .o.nle$
Address
Super�v ons
ARCHITECT/ENGINEER Phone:
Address: 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: $ X31? FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signatureof Agent/OwnerM.
Signature of contractor '
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑