HomeMy WebLinkAboutBuilding Permit #Exception - 1402 BASSWOOD CIRCLE 5/1/2018 (4) t%0RT1•/
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BUILDING PERMIT o�
TOWN OF NORTH ANDOVER ° 9
APPLICATION FOR PLAN EXAMINATION e
Permit NO: Date Received_(/ olll
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Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION /`7�V 1 �aSS cuadd C.(rd-k
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.PROPERTY OWNER EQln Vp,-S.SPag .
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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 0 Industrial
❑Nteration No. of units: ❑ Commercial
Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition 0 Other
❑Septic ❑Well 0 Floodplain ❑Wetlands 0 Watershed District
0 Water/Sewer
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Identification Please Type or Print Clearly)
OWNER: Name: e3e��q Phone:
Address:
CONTRACTOR Name: ?k13fta-9al Phone:
Address:
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Supervisor's Construction Licenser Exp. Date:
CS -10900) 3//6
Home Improvement License: Exp. Date:
0-36 15- 3
ARCH ITECTIENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ Nw. 00 FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
Signature of Agent/Owner Signature of contractor ctn'h G✓�