HomeMy WebLinkAboutBuilding Permit #784-13 - 11 HAMILTON ROAD 5/16/2013 E 'l NORTH q
BUILDING PERMIT 3�°�`r.``o `=6�°�
TOWN OF NORTH ANDOVER ° o
APPLICATION FOR PLAN EXAMINA N + - �
Permit NO: Date Received * At;.
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Date Issued:
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IMPORTANT:Applicant must complete all items on this page
LOCATION 1�( LrTDO
PROPERTY OWNER_ A F C LI C,I A 1+0 VCJI ISA S
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MAP NO: PARCEL ZONING DISTRICT: Historic District yes no
Machine Shop Village yes o
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building YOne family
Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑Other
❑Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer 1
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Identification Please Type or Print Clearly)
OWNER: Name: + Q U CI A oPK.II�S Phone: ,�
Address:
CONTRACTOR Name: Phone: 91b
Address: 1 (0q WPKk I g&-nt4 ST DI q Z (
Supervisor's Construction License: C s b1 Z+9 Exp. Date:
Home Improvement License: 2-to 125 Exp. Date:
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ARCHITECT/ENGINEER W A RUML i�,y � A SSOCIAI_Es Phone: 911 4-16 5Z03
Address: 6krL-r 1.--r Ste -I n7 Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ M5 fe l FEE-. $ (L7
Check No.: Receipt No.:
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NOTE: Persons acting with unregistered contractors do not have ac ss to the guarantyfund
Signature of Agent/OwnerSignature of contractor
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