HomeMy WebLinkAboutBuilding Permit # 9/3/2015 ®g p®RTPI
BUILDING IT ��®�RT(4s°
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Permift MO: Date Received
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Date lssued:A13 11--
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IMPORTANT: Applicant must complete all items on this pme
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LOCATIOPH
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PRCyPEtTY OWNER
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Pent
t1l(Ap NO � PARGEt,��O�tNC� D�STRI+uT HistorNG Dlsfirrct yes
; MachEre Shop V�(Iage ,yes.... no, -
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
El-Addition ❑ Two or more family ❑ Industrial
❑Alteration No. of units: LI Commercial
LI Repair, replacement ❑Assessory Bldg CI Others:
❑ Demolition ❑ Other
C1 Septic: ❑We(I t Floodplain= O WeCands ❑ UVatershed Distr�c#:
Water/Seusrer ,
� a g C �11,��i plc
Identification Please Type or Print Clearly
OWNER: Name: f = � F w �c / Phone: �
Address:
CC NT4 ACTOR Name
Address
Superulsar's Construction License Exp Date
Horne Irnprouement License �w .- � E�tp 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 AER S.F.
Total FE 0 i:1'Project Cost: $ 01:1S E. $
Check No.: Receipt No.:
NOTE: Persons c acts g ith un istered c ntr ctors do.trot have ac ess o e ranty fund
Signature of Agent/ ner_(� - re f contractor