HomeMy WebLinkAboutBuilding Permit #Exception - 1402 BASSWOOD CIRCLE 5/1/2018 t%ORTF/
BUILDING PERMIT <�``0 '°q~o
TOWN OF NORTH ANDOVER °
APPLICATION FOR PLAN EXAMINATIOP4
Permit NO: Date Received I l//Ohl
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Date Issued:
IMPORTANT:Applicant mus/t�complete all items on this page
LOCATION j2OG 4Q,001 DRIVE I l findoo el (11• n i k V-T-
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PROPERTY OWNER Mi r h c,t I -FcrA 100Y e
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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 0 One family
0 Addition 0 Two or more family ❑ Industrial
❑Weration No. of units: 0 Commercial
Repair, replacement ❑Assessory Bldg ❑ Others:
0 Demolition 0 Other
0 Septic 0 Well ❑ Floodplain ❑Wetlands 0 Watershed District
❑Water/Sewer
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Identification Please Type or Print Clearly)
OWNER: Name: bone. Phone:
Address:
CONTRACTOR Name: ?k1-352.9132 Phone:
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Address:
�Z LI ber4�/ S+ I:Asw IcA 1 t nr1 t 1 OI 43 5
Supervisor's Construction License: Exp. Date:
CS -10700)
Home Improvement License:
3C�lJExp.
Date:
/ /
ARCHITECT/ENGINEER Phone:
Address: 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: $ 50 . 00 FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor � �