HomeMy WebLinkAboutBuilding Permit #1068-15 - 700 MIDDLETON STREET 6/17/2015 414
f$OR6UILDING PERMIT �•?o�``t`�eD.;y"�;"oma
TOWN OF NORTH ANDOVER °
APPLICATION FOR PLAN EXAMINATION -
00
Permit N0: zw" l Date Received
Date Issued: ( SACHUS�
IMPORTANT: Applicant must complete all items on this page
LOCATION r �"►
rint
PROPERTY OWNER '
Print
MAP NO: _'PARCEL: ZONING DISTRCCT: Historic District yesnn
Machine:Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building FV6ne family
❑ Addition ❑ Two or more family ❑ Industrial
/Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic '❑ Wella ❑ Floodplain I Wetlands U Watershed District
Water/Sewer
10154-0m lwel Ue &9) v j-n w K--P 4 lack wfl 4- /A h.dci S
Identification Please Type or Print Clearly)
OWNER: Name: M Q,yl* Yl FI scy' Phone:9 M-6283-- 31k 30
Address: -100 PA I oL.d (e ,► P,W ffo• tin do✓er 6 t S
CONTRACTOR Name:: _ hone- °7 O
Address: Som
I )
Supervisor's Construction License: 53 Exp. Date: - ..�
Home Improvement License Exp. Dater f'
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 Cost: $ Z6 000 FEE: $ `(Q
Check No.: 1__;z, ,?3 Receipt No.: ;2J"9 9 2
NOTE: Persons contracting with unregistered contractors do not have accesItole uaranty fund
§ignature of 6gent/O lk Signature of contractor