HomeMy WebLinkAboutBuilding Permit #478-15 - 19 JOHNSON STREET 11/18/2014BUILDING PERMIT
TOWN OF NORTH ANDOVER ° o
APPLICATION FOR PLAN EXAMINATION -
Permit NO: Date Received
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Date Issued:—Ll ( Ssgc"use
IMPORTANT: Applicant must complete all items on this Daae
LOCA
PROPERTYOWNER i C CW N
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MAP NO:01(PARCEL W ZONING DISTRICT: Historic Distr
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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
D Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
OWNER: Name:
Address:
JCONTRACTOR Name:
Identification Please Type or Print Clearly)
19
140`0 r--- 107 F_ 36/ - 741_?
Phone: 97%- V5-7-OqW
Address: CSf I� W� IQ/Y��°XiC 10 of ( (3
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date: Qc��
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
x
FEE SCHEDULE: BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED M—
Check
OST BASED ON $125.00 PER S.F.
Total Project Cost: $ �%� - oo FEE: $ No.: 1 ri y - Receipt No.: Z'& 2.11
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner _ Signature of contracto r
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