HomeMy WebLinkAboutBuilding Permit #865-15 - 86 WILLOW RIDGE ROAD 4/30/2015 014
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BUILDING PERMIT
TOWN OF NORTH ANDOVER 0-
APPLICATION FOR PLAN EXAMINATION " -
Permit NO: (v J Date Received .=tea...�•sb
Date Issued: 77� CHUI
IMPORTANT: Applicant must complete all items on this page
LOCATION 9& W I (1 Z5W
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PROPERTY OWNER 13 0-i6th 2Y
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MAP NO:-1�PARCEL:—bO`ZONING DISTRICT: Historic District yes f
Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building A One family
Addition ❑ Two or more family r-, Industrial
F.Alteration No. of units: C Commercial
Repair, replacement ❑Assessory Bldg Others:
1 Demolition ❑ Other
11 Septic [_ Well ( Floodplain J Wetlands L Watershed District
F,,Water/Sewer
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Identification Please Type or Print Clearly)
OWNER: Name: RE-IG.tn ae_((.O_e Phone:
Address: Lcszt. / ;J e- /21 /v,�ro— low
CONTRACTOR Name: Ca,( ��10 Phone: 105--503Z
Address: -.5Z_ ✓ �S�-� /�, OS�15-Z
Supervisor's Construction License: Z 73 �( Exp. Date:
&0 7- � t 91
Home Improvement License: Exp. Date:
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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: $ , l� FEE: $ 37'
Check No.: 5.2.7s- Receipt No.: Of, 7/3
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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Signature of Agent/Owner �G /�� Signature of contractor 1,a .