HomeMy WebLinkAboutMiscellaneous - 76 BOSTON HILL ROAD 4/30/2018I
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Permit NO:
Date Issued Z Z
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
IMPORTANT: Applicant must complete all items on this pate
LOCATION --l! tZ as-tb n 'd) l l'l-E,1. IJ o t'M 1°th > > L ". O Kq 01(f(4T
Print
PROPERTY OWNER C ov i r Dube_
MAP NO.: f 4- PARCEL: A � Print ZONING DISTRICT:
6�
TVPF AND ITSE OF RITTIMING 141gTnRlr nlcTurCT VFC�
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ Addition
!,Alteration
jCOne family
❑ Two or more family
No. of units:
❑ Industrial
❑ Repair, replacement
❑ Demolition
❑ Assessory Bldg
❑ Commercial
❑ Moving relocation
❑ Other
❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
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Identification Please Type or Print Clearly)
OWNER: Name:_K e V , n �) Lt bz Phone: I 4-k • z S -c • GJ�o o
Address: -+U lu o e'M t)n r)nvN t9 0 j s L(r
CONTRACTOR Name: C_ tg rte % ra n of Phone: tp (a Q o o t c,
Address: H i t iq MA"%4 n to 19-1g. r o rv.ery j 1L -p, f4 A G a ,4 -t
Supervisor's Construction License: C! - 6 yg o 3 + Exp. Date: -z
Home Improvement License:_ I u 3o !�j i Exp. Date: S- )�� } ✓
ARCHITECT/ENGINEER e I A i ;2a Nur. c Name: Phone: o Lo P 4 a 1
Address: t l P,,n.., ry n K (cA ru . u x jaG�, H A Reg. No. Ll C1 o a q
FEE SCHEDULE. B ULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST B ED N $125.00 PER S.F.
Total Project Cost :$ f I ,,LZ�o x12.00=FEE:$—
Check No.: Receipt No.: 2-91.6
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