HomeMy WebLinkAboutBuilding Permit #514-2016 - 575 OSGOOD STREET 10/26/2015 (3)BUILDING PERMIT
TOWN OF NORTH ANDOVER
�1��Zdo APPLICATION FOR PLAN EXAMINATION
Permit NO: ` Date Received
Date Issued: 16
IMPORTANT: Applicant must complete all items on this
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LOCATION S 7 S d3 gQDCJ S4 -
Print
PROPERTY OWNER acs u,�-bpi Re --H m Pu -0+ CA4 M u w
2, Print
MAP NO:PARCEL:� JZONING DISTRICT: Historic District yesno
Machine ShoD Villaqe ves no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
I Addition
I I Two or more family
❑ I dustrial
El Alteration
No. of units:
Commercial
epair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
5r)L,( rD AN7A ltg'"Dr f0U0 - 2000
OWNER: Name:
Address
Identification Please Type or Print Clearly)
C - d (EvV a06 fZ C- Phone: q 19-_ 7 IS- V/ !7
5- 6.5 6 o OCl gT . ti go -'r H liijodO69- e -i
CONTRACTOR Name: Phone: Z �r/-766 2
dL`t� sc�azsZ 6.-cA�
Address: 2S7 �.c i21 �ti;?� 3 C `t c C'y� t �o �. �✓ � IZj,7y► 610 Z f/ 3.
Supervisor's Construction License: D 9 9 y Exp. Date: 2
Home Improvement License: Exp. Date:
15,7
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.
Total Project Cost: $ 9l, yZd .�0 FEE: $
Check No.: 2—'75-c-0 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to a guaranty fund
Signature of Agent%Owner Signature of contractor -!