HomeMy WebLinkAboutBuilding Permit #1231-2016 - 72 HAROLD STREET 5/24/2016 r10RTh
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TOWN OF NORTH ANDOVER o .
APPLICATION FOR PLAN EXAMINATION i b„
Date Received
Permit NO: � � 09 ,. «
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Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER G ASS %zeAt-'i'-'r t-l-G-
Print
j MAP NO: _ 0 PARCEL ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building i'One family
❑Addition ❑Two or more family ❑ Industrial
*CAlteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
ET Demolition ❑ Other
❑ Septic --' Well 17 Floodplain ❑Wetlands Watershed District
E Water/Sewer
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Identification Please Type or Print Clearly)
OWNER: Name: QP-1---S t?�L;V'f t--L-C- Phone:
Address: PC)V,T}1 R"DdV62 t o%8 4-�;
CONTRACTOR Name: Phone: q"1$ 4Z3 -6SI+
Address: S 1 P X51 -cf' P0 . A wpoxn(Ll M P�oxbq-g
Supervisor's Construction License: G5 -V'1i�'llo� Exp. Date: z 1_1 wig
Home Improvement License: 1c�5o3 Exp. Date:
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: FEE: $
Check No.: 2317 Receipt No.: `f'ZZ
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/ _ nature of coni c or _.
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