HomeMy WebLinkAboutBuilding Permit #76-15 - 49 CROSSBOW LANE 10/26/2009i
BUILDING PERMIT .,•`tom - �`
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Permit NO: " _ Date Received 9 To P-
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Date Issued:
LOCA
IMPORTANT: Applicant must complete all items on this
ss Gow L P N E
Print
PROPERTY OWNER GRED RE D n N D i� _
R 1 N G R► WA H O M
// Print
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MAP NOA PARCE1b ZONING DISTRICT: Historic District yes
Machine Shop Village yes
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
ne family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
-i Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
U Septic ❑ Well
❑ Floodplain (i Wetlands
L Watershed District
❑ Water/Sewer
14 flbh , 0z CIO/
/s. 7 o
21. h/G /S -7. 200
Identification Please Type or Print Clearly)
OWNER: Name: Ri,/H RR o RN D Giq w a R I N61 HIlM Phone:
Address: I
e. N - Rndow
CONTRACTOR Name: r)at) M((A rG ill Phone:
R-0►9W5
Address: 111 r�>a K I <, o n M-, Mo Ick n , H p - 6 21 Lf S
Supervisor's Construction License: .1b4
b4 S-4 6 Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Dnin P- Sipoppek Phone: 832-9
Address:,2-1 Vte di C+ 2.2 n( Reg. No. 504 0 c�—
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
I Total Project Cost: $46,9 1 Li FEE: $ 5 6 . q -I-
Check No.: oQ I I a Receipt No.:
NOTE: Persons contra ng w' unregistered contractors do not have o t le guar my fund
t .
signature of Agent/Ow r Signature of cont ct r
rj r
Location
No. 33 '2— Date / Q6. of
tORTN TOWN OF NORTH ANDOVER
• O�
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 4;)� / ?-? �
2 L V i Building Inspector