HomeMy WebLinkAboutBuilding Permit #495-2016 - 134 MILK STREET 10/19/2015 9111!9-
BUILDING PERMIT
TOWN OF NORTH ANDOVER
l l APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received '� °� :
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
Print -
PROPERTY OWNER
Print
MAP NO: PARCEL , ZONING.DISTRICT: Historic District ye_ no
Machine Shop Village ye no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building )<One family
❑Addition ❑ Two or more family ❑ Industrial
Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic O Well D'Floodplain ❑Wetlands ' ❑ Watershed District
❑Water/Sever
�e
Identification Please Type or Print Clearly)
OWNER: Name: r T AL e Phone: ' 39 ` 7
Address: % WIk 5
CONTRACTOR. 'Name; Phone: 771 Y-6 c� 5
OUC D
es'i 9
Address:
Supervisor's Co-nstruction License. ro �FExp. Date:
161 0? . oZ ,
Home Improvement License: Exp': Date:
&L-Z,
ARCHITECT/ENGINEER Phone:
Address:
-Reg. No.
e9
FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. `r
Total Project Cost: $ 2ZE /0` , Ofd FEE: $ S 11 `o
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
Signafure_of_Agent/Owner -- Signature of'contracto
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