HomeMy WebLinkAboutBuilding Permit #068-14 - 165 MASSACHUSETTS AVENUE 7/19/2013 (4) BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: d ` Date Received
Date issued:
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1IPORTAr'\T:Applicant must complete all items on this page
LOCATION_Z66 ?y SS/��/�'rJ�z/�S,*U�
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RQ PROPERTY OWNER Q9&0i Is—,C*111L"0
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MAP NO: PARCEL: DISTRICT: Historic District yesno
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building < ne famiI
Ad ' ' 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 1yl+4uc ✓fT_ rV � .�
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Identification Please'type of Print Clearh)
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OWNER: Name: ' Phone:
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Address: 1l/'/� �1 �"✓S�; :*-lr� > .�I— C�fctTG ice . J�ld -�s - cr;5,0/
CONTRACTOR Name:1?,,2 Phone:
Address:
//Y? /"-'rn) --Cr St/riz/� 3- �r ss�`'7
Supervisor's Construction License: Exp. Date-.
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER "''/a* Phone:
Address- Reg. No..
FEE SCHEDULE.-B ULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost-. $. c2y� 7 S�� FEE: $
Check No.: Receipt No.: _
MOTE: Persons col tracting 11, r [lire rstered contractors do not have Ire gu rranty fund
Signature of Agent/Owner Signature of contrada% G O
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