HomeMy WebLinkAboutBuilding Permit #771-2017 - 180 AMBERVILLE ROAD 2/17/2017Permit NO: 73— 9-0/
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
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Date Issued: I
I RTANT: Applicant must complete all items on this page
LOCATION Awa
Print
PROPERTY OWNERly�j�i l'f1A
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MAP NO: _LqLPARCEL:,3_,a� 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
WAlterationG �� c{--
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic 0 Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
'gWater/Sewer
0
OWNER: Name: M6r
OC7(-
Identification Please Type or Print Clearly)
r7 -(,37 -SVS f
Address: /
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CONTRACTOR
Name:Phone:
/ /1cy� r5949
Address: 40 /I f��Co
Supervisor's Construction License: Exp. Date:
tv- 7
Home Improvement License: Exp. Date.
ARCHITECT/ENGINEER 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: $ ok Z-0 FEE: $ 3 (�
Check No.: 10 w Receipt No.: 3
NOTE: Persons contraetitjiwit unregistered contractors do not have access to the guaranty fund
0
Location 1 7,b A f y K 1�l u L (�)
No. -1 -i 1 - gU �]
Check #�� T
I
527
Date g . I S- - ), a 1-7
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL
.0 /�L -
// Building Inspector