HomeMy WebLinkAboutBuilding Permit #1095-15 - 24 HIGHLAND TERRACE 6/24/2015 1A 1,1 pz�
BUILDING PERMIT l��O`tt`!O 1,
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: __JJ
Date Received
Date Issued:
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I ORTANT:Applicant must complete all items on this page
LOCATION rl
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PROPERTY OWNER J ' L 11
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MAP NO: bzq PARCEL: Eb4 -ZON G DISTRICT: Historic District yesno
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
I. ❑ New Building ane family
❑Addition ❑Two or more family ❑ Industrial
❑A ration No. of units: ❑ Commercial
NfRepair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
Septic Well 1J Floodplain C; Wetlands Watershed District
C Water/Sewer
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Identification Please Type or Print Clearly)
)WNER: Name: ,-./fly /*V,�/, Phone: 1
fddress: H � T�F�W� D
CONTRACTOR Name: �, Phone:
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' ' Address:
Supervisor's Construction License, Exp. Date: ,1 ,
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Home Improvement License: 24?i � Exp. Date: ., J
6
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
IFEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $ sj�yb
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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ignature of Agent/Owner ,, Signature of contra