HomeMy WebLinkAboutBuilding Permit #514-15 - 140 MILL ROAD 12/1/2014 � +� uF NORrH q
BUILDING PERMIT
TOWN OF NORTH ANDOVER
r APPLICATION FOR PLAN EXAMINATION -
Permit NO: ! .- Date Received
Date Issued:
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IMPORTANT: Applicant must complete all items on this page
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Print
F�ROPERTY OWNER LL�Uff' S _Ck -L• 16Z/06�
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MAP NO PARCEL: ZONING DISTRICT: Historic Dlstricf yes _no
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Machine Shp Vitlage yes keno 4,.
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
❑Nteration No. of units: ❑ Commercial
repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
4.0`S6ptiC:. }❑V1►eIC ❑ Floodplain ❑Wetlands 0 Watershed bislrict
a waiter/Sewer
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Identification Please Type or Print Clearly)
OWNER: Name: L S A 0�.�� � Phone: &'" - 14 7G
Address: 'V0
CONTRACTOR Name: Phone: CIO 6
.,,,Address, /
Supervisor'Y7 CC?nSiructibn License
0 a Exp; Date:
Home Improvement License: Exp: Date:
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ARCHITECT/ENGINEER — Phone:
Address: - Reg. No.
FEE SCHEDULE:SCHEDULE:BOLDING PERMIT:$1210 PER 11000.00 OF THE TOTAL ESnMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $_ � - -o
Check No.:_ ""� /�`r _ Receipt No.: <-,
NOTE: Personscontr c 'ng with unregistered contractors do not have ac s d-t e g aranty fui4
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igniature_of_Agerat/Owner Signature of`conttactor 6: