HomeMy WebLinkAboutBuilding Permit #639-13 - 52 FERNVIEW AVENUE 4/2/2013BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: '� Date Received
I Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION , '2)-1�p Y k" \i JQ W 2
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PROPERTY OWNER O e `� \- 5 � LJ c l (4
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MAP NO: . I PARCEL: 00��, ZONING DISTRICT: Historic District
Machine Shop Vi
yes
no
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
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
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Identification Please Type or Print Clearly)
OWNER: Name: c1�'� S��s\c Phone:
Address: 5�)- VW
CONTRACTOR Name: M , Phone: q7'is -` :3- ?33 7
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Address: if
r477�`Lzlce l �cC��;�J �������t11� , �, EI G�`255 '`j
Supervisor's Construction License: Ca 1 f � Exp. Date: 911-3
Home Improvement License: ( �c G �) i Exp. Date:
ARCHITECT/ENGINEER A Phone:
Address: Reg. No.
FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ S16 -co FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unre .�stered contractors do not have access to my fund
Signature of Agent/Owner Signature of contractor
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