HomeMy WebLinkAboutBuilding Permit #805-13 - 805 FOREST STREET 5/28/2013Permit NO: Q U -n
Date Issued
LOCATI
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINAT.lO
Date Received
La IIS
IMPORTANT:A
licant must
% A I A Print
PROPERTY ,OWNER r&Vw4_
PE
MAP NO:PARCEL&L ZONING DI
all items on this
/ D� RS 4lD ,61'NO\
° t �
ICT: Historic District yes
Machine Shop Village ves
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
trOne family
VAddition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
Identification Please Type or Print Clearly)
OWNER: Name:
Address:
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License Exp. Date:
Home Improvement License: Exp. Date:
�•I
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 9ost: $ FEE: $
Check No.: 26ZCiao- 11 0 015 Ili 1 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owne `' Signature of contractor
l