HomeMy WebLinkAboutBuilding Permit #339-2017 - 18 HARKAWAY ROAD 9/29/2016 pORtH
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BUILDING PERMIT ` t �� s•�d - 6
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION ti
Permit NO: '010 I � Date Received 9 XO r b• '` °+ -,�� •
ATIP
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Date Issued: 6
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IMPORTANT: Applicant must complete all items on this page
LOCATION Y bad
PROPERTY OWNER S i �rint Lal ,
Print
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
❑Alteration No. of units: ❑ Commercial
PRepair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well O Floodplain ❑Wetlands ❑ Watershed District
❑ Water/Sewer
Identification Please Type or Print Clearly) A
OWNER: Name: nf6sS 1 r Uo MI Phone: o
Address: dor I�Ct2oad I Yl r?Y 1
CONTRACTOR Name: NAtz..1 ,,��Phone:
x.lY)Os I S
Address: . -N)9 D I `1 R
Supervisor's Construction License: C►S _ 0 l I O L Exp. Date: I Zq ]2D 1-1
Home Improvement License: .1 S Exp. Date: Z 3
to HS 12-01-7
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULD/NG PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ Bit _FEE: $
Check No.: 3137 Receipt No.: 3 0 g
NOTE: Persons contracting with unregistered contractors do not have access to th my f d
��Signature
of-Agent/Owner Signature of contractor