HomeMy WebLinkAboutBuilding Permit #721-15 - 575 OSGOOD STREET 3/18/2015�= NORTM
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BUILDING PERMIT oft
TOWN OF NORTH ANDOVER °
_ APPLICATION FOR PLAN EXAMINATION
Permit NO: �iI Date Received
1f �g4rlo �Pp'`�,(5
Date Issued: i , 9SSACHU
IMPORTANT: Applicant must complete all items on this pate — G
LOCATION
Print
PROPERTY OWNER'
Print
MAP NOM PARCEL:ZONING DISTRICT: Historic District yes no
Machine Shop Villaqe yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
❑ Two or more family
❑ Industrial
Iteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic 0 Well
G- Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
Identification Please Type or Print Clearly)
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OWNER: Name: ����d �) ��VK��� Phone:
Address: D'",C2 �
CONTRACTOR Name: Phone.`
Address:
Supervisor's Construction Licensrn / 2� Exp. Date:
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Home Improvement Licenser Exp. Date:
ARCH ITECT/FNGINFER0 (2�011 .' SPhone:
Address. C5 L11 17TfrhG Pd4 Reg. No. 9
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASEDO $125.00 PER S.F.
Total Project Cost: $ �%�� �C�C� FEE: $�
Check No.: / 2 Receipt No.: —�-U
NOTE: Persons o tractin&with unregis!,gred corgactors do not have access to the guaranty fund
Signature
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