HomeMy WebLinkAboutBuilding Permit #416-2017 - 575 OSGOOD STREET 10/19/2016 1 i�
,,c l�,T�eo a�Ar0
BUILDING PERMIT 3+ 0• r_ o�
TOWN OF NORTH ANDOVER � _ p
APPLICATION FOR PLAN EXAMINATION
/0- Pr7 dam'/
Permit NO: Y Oil Date ReceivedArco
�9SSACHt15
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION c�?S ��dDd/
Print /�l
PROPERTYOWNER
Print
MAP NO: 50 PARCEL: Ot 3 ZONING DISTRICT: Historic District yesn ,
Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑One family
❑Addition ❑Two or more family F1 Industrial
❑Alteration No. of units: ,'Commercial
i i Repair, replacement i i Assessory Bldg I I Others:
❑ Demolition ❑ Other
Septic I i Well i i Floodplain i i Wetlands I I Watershed District
❑Water/Sewer
AND Cf-"D-E 0- 366b
Identification Please Type or Print Clearly)
OWNER: Name: /fib Co/?O1`a, Phone:97 Y-715-- 336D
Address:
CONTRACTOR Name: R1� ZV V I Phone:
T)
Address: 2?7 6-
Supervisor's
Supervisor's Construction License: 4 Y 9 Exp. Date: Z Z g- fel Y
Home Improvement License: �5�7�U-7 Exp. Date: �v to)-7
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
dD
Total Project Cost: $ , Z3 a FEE: $ 6 3q ✓--
Check No.: 3.S-a:7 Receipt No.:_/
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
ignature of Agent/Owner Signature of contractor
r