HomeMy WebLinkAboutBuilding Permit #513-2017 - 1402 BASSWOOD CIRCLE 11/16/2016 1/ OF %&ORT11
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4 ( BUILDING PERMIT :. •_,..:6 0�
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APPLICATION FOR PLAN EXAMIWATN �*
Permit NO: Sf'3 — g^-01� Date Received ///AN
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Date Issued: / D/(Q 4SSACHU
IMPORTANT:Applicant must complete all items on this page
LOCATION /!f0l J3cS,,& oed C trc/e i ! filor ec it 06- Ot$YS'
. PROPERTY OWNER �I C.M t�I•�
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MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
❑Meration No. of units: ❑Commercial
Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
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IdentificalItion Please Type or Print Clearly) '
OWNER: Name: �l C�t���t hca Phone: -
Address:
CONTRACTOR Name: )) ?kJ-3q,2-90.1 Phone:
Address:
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Supervisor's Construction License: Exp. Date:
CS `10900)
Home Improvement License: Exp. Date:
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: $ NCO. 00 FEE: $ , 0
Check No.: 1S'0 Receipt No.: 3 ft lrS—
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NOTE: Persons contracting with unregistered contractors do not have access to a guarantyfund
Signature of Agent/Owner Signature of contractor
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Location h/0' A5,05-<k/W!1 (r UE �1 M6 LO'" 7
Ivo. S/ 3-,20 7 Date
• • TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ yO�r
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#O'1 07
85 Building Inspector