HomeMy WebLinkAboutBuilding Permit #830 15 - 146 JOHNSON STREET 4/21/2015 pORTF�
4b BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received ��•---. '`
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Date Issued: h'
IMPORTANT: Applicant must complete all items on this page
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LOCATION 0 � Ieer
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PROPERTY OWNER ,
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MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Ano?:��
Machine Shop Village yes
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 ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
Identification Please Type or Print Clearly)
OWNER: Name: Ve✓1 ", ;17t YZ Phone: " 3aa " q Sc)
Address: )ZJ-6117,561 Jh-eld- 1,41 14401il?'I (6)
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License: Exp. D te:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER AZ& 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: $ (ob6C) 00 FEE: $ X02 c 6
Check No.: 11,7 S'r/ Receipt No.:
NOTE: Perso acting with unregistered contractors do not have access to the#aranty fund
(Signature of Agent/OwneT Signature of contractor Y ��