HomeMy WebLinkAboutBuilding Permit #Exception - Exception 5/1/2018 (4) TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT:A licant must complete all items on this page
LOCATION
P int
PROPERTY OWNER. e
Print
MAP NO: PARCEL: 2 D ZONING DISTRICT: Historic District yes no
Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building 9-6ne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
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ESCRIl'_TIONr OF TO BE PERFORMED:
Identification Plea a Type or P CIearly)
OWNER: Name: ,��� i one: 1
Address: �U ��� //Uw
CONTRACTOR Name: E4 C a6 f r, 'S Phone:
Address: ��O �� ' �%�'` A),n tGi
Supervisor's Construction License: CC)7`7-3-�-- Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECTIENGI NEER � �/� .� Phone:
Address: �� 1� Q(P/0 Reg. No.
FEE SCHEDULE.BULDING PE MIT:$12.00 PER$1000.00 OF THE TOTAL,ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
:..._igna.#ure of_Agent/Qwrer. ;:Signature of contr_acto[ ::
Dimension
Number of Stories: =Total square feet of floor area, based on Exterior dimensions.. 1 t:
i�
Total land area, sq. ft.:a
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$10041000 fine
NOTES and DATA— For department use
® Notified for pickup - Date
Doc:.Building Permit Revised 2008