HomeMy WebLinkAboutBuilding Permit #447-2017 - 52 HEWITT AVENUE 10/26/2016 � � Gf NORTh q i
i BUILDING PERMIT
TOWN OF NORTH ANDOVER °
APPLICATION FOR PLAN EXAMINATION
Permit NO: eDate Received j O ted/fa
Date Issued:
�9SSACHUS�t(5 i
IMPORTANT:Applicant must complete all items on this page
LOCATION .� 4,
Print
PROPERTY OWNER A,/
Print
MAP NO: _PARCEL 0 0 ZONING DISTRICT: s�_Historic District yes n
Machine Shop Village yes
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 0 Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
A -, &df"c Ooty 05'
J
Identification Please Type or Print Clearly)
OWNER: Name: AJ(A-o Lu RVan Phone: q /0)y
Address:
CONTRACTOR Name: Phone: _?�3
f5_ 2
Address: 01 , t //
Supervisor's Construction License: Exp. Date:
C.S .. 0�6 ii S�6 -�✓�.3/ 6.�-
Home Improvement License: /
��� �3 Exp. Date: ,,
y
ARCHITECT/ENGINEER 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 Co $ �y/�, FEE: $
s :
Check No.: Receipt No.:
NOTE: Persons contracting ith unregistered contractors do not have access o the guaran fund
Signature of Agent/Owner Signature of contractor
s --