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Home My WebLink AboutMiscellaneous - 121 RALEIGH TAVERN LANE 4/30/2018 121 RALEIGH TAVERN LANE j 210/107.A-0113-0000.0 ` I Date..... . .. t NORTI�, 3?;•�;�``°-;°_e""O� TOWN OF NORTH ANDOVER PERMIT FOR WIRING .. ;,SSACMUS� fd . This certifies that .......T-". ..........�=..(1°c..............��..................... has permission to perform ,5:F'./.1.. ........( . wiring in the building of ........ i � �at.... � 1.,.. � d,��. oj ovas. .............................Fee. ..'......... Lic. RICAL INSPECTOR Check # �� 5304 TBE COMMONWE4LTHOFMASSACHUSETTS Office Use only DEPAMMEN 'OFPUBMCSAFMY1 Permit No. BOARDOFFREPREVEMONREGUTAHONS527CMI2.U'J Occupancy&Fees Checked 4PPLICATIONFOR PERMIT TO PERFORMELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 /^ (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date_/Uk-e Zy O 1�� Town_of North Andover To the Inspector of Wires: The ur:dersigned applies for a permit to perform the electrica , o described below. Location(Street&Number) 2, n 4 ( . Owner or Tenant Owner's Address S � Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpo,,se of Building -I h Uti ' Authorization No. / / Z") Existing Service /64) Amps lW/ rzqVolts Overhead Underground No. of Meters New Service ..�� Amps 120/ Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round round , No.of Receptacle Outlets No.of Oil Bumers No.of Emergency Lighting Battery Units I No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. TotalFIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW Nq,,of Sounding Devices N4P-btSelf Contained 1 Det r ction/Sounding Devices No.of Dryers 1 Heating Devices KW Local Municipalr Other + Connections No.of Water Heaters' KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP THER umxeCovetage.Pmwanttothe lequitemcnisofMassachusem52 Laws aveacimentLiabilityhmtruceFbi ' ' Comply Coveaageoriesstil tariUegtuvalat YES NO aWstilxnittedvalidpmofof tr*100c lw YES � IfyoubavudtedredYES,p indicate the typeofcovetageby �g the bo / SURANCE BOND r7 OILIER F-1 FleaseSpa*) ! Z Q E#ationD& EsturA2d VahaeofE1ecWral Wolk$ xktoSf d ( hTecticnDateRWstDd Rough Final nedu&rTr2 Penalti ofpcx (JIo e a MNAME LiNo. Signature Lic=No BusinessTel No. l C e dl(1'l a4LAIL Tel No. W�R'SINSURANCE WAIVER;Isedoes nothaved-kM-q==cowa,oeorjlsatstantialapwakntasmgxedbyMassachuseMGollaws that my signature on ftpennit application waives this mgmement `/U :ase check one) Owner ® Agent ® K -- . Telephone No. PERIVIlT FEE$ �S rgnatzre ot Uwner or gen u The Commonwealth of Massachusetts M d Department of Industrial Accidents Office of investigations 4 . Boston, Mass. 02191 Workers'Compensation insurance Affidavit Name Please Print oil Name: Location: City - Phone # I am a homeowner performing all work myself. 0 , I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone# Insurance.Co. Policy# Company name: Address City: Phone# 1 Insurance Co. Policv# Failure to secure coverage as required.under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to$1,500:00 and/or one years'imprisonment-as_well_as_cixil..penaftiesin.theformnf-a_STOP WORKORDPR.,and a.fine.of.(.$1D0M.)_arlay-against.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. !do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature —Date— Print atePrint name Phone.-# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing El Building Dept ❑Check if immediate response is required ❑ Licensing Board Contact person: ❑ Selectman's Office Phone#: ❑ Health Department ❑ Other �. Date........... ............. `°:°�"� TOWN OF NORTH ANDOVER PERMIT FOR WIRING �,SSACHUS� t�• P This certifies that ..... . .,..�.......................................................................t.... has permission to perform .. ."!. .......... ..................... .......... wiring in the bilding'of. ... F at./ / t` North.Andover,Mass. � ee.Zr... ... Lic.Nof" �. �!.. .�.ee� /...... t ✓ELECTRICALtINSPECTOR Check # / { 5 71 `1 7BEC0MM0NWEAL7H0FMASSACHU�5E77S 01 ce Use only DEPARTAIEff0FPUBIIGSAFElY ` Permit No. BOARDOFFIREPREVENT70N ONS527O 8120 Occupancy&Fees Checked APPLICATTONFOR PERMIT TO P RFORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THEM SACHUSSTS ELECTRICAL CODE,527 CMR 12:00 "qq (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date��.e/C../Z I: Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perfgtm l trical wor described below. i Location(Street&Number) ! �Lq - Owner or Tenants a j Owner's Address Is this permit in conjunction with a building permit: �Aesm No (Check Appropriate Box) Purpose of Building �!-t/� r9/L-( ��2J Utility Authorization No. ` Existing Service 2ew Amps2�Volts Overhead Underground No.of Meters New Service Amps Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Batt7f Units ! No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of zones Tons , - Ido:of Disposals No.of Heat Total Total No.of Detection and _ Pum s/ Tons KW Initiating Devices No:of Dishwashers Space Area He ing KW No.of Sounding De ces No.of Self Contain d Detection/Soundi g Devices No.of Dryers Heating vices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs, No.of Motors Total HP I OTHER i k eCC)V age.Rua>anttothemq*ma& fMamdmsezG=WLaws IiiiwawmritLiab>7rtykoxarrePbhgtzxhdTComple>E Cc)wrWoritsatsunidegrmkit YES NO Iha,&sub twdvandpiuofofsametotbe0lf.YES If you haw drd®dYES,pleoxmdicatethe vArofcDmrageby L dxddngthe apptypaebox. INSURANCE BOND OTHER (Please Specify) _ EshmaledValueofFJechicalWotk$ WotktoStatt �S O S kgectionDaleRequested Rough 1t'4f,/464—' Fmal Signedunciffleftnaltiesofpapry. 11RMNANE LkemeNo. 9C2Licel>� 141 l7/�/f�GL Si�tahue Lic-omeNo BusmmTel.No. At Tel.No. OW HZRSINSURANCEWANER;IamawaredmtthelicemsedoesnothavetheiaranoccomnWoritsatstmtialewivaWasragtmedbyNb%wlLcenCenaa]Laws andthalmysig nahuem d m pmnit apphaton wai%es this m9mi ement ! (Please check one) OwnerM Agent 4 Telephone No. PERMIT FEE$ Signature ot Uwner or Agent TBE COMMONWE LTHOFMASSACHU,5EM Olbce Use only DEPARTMIIVT0FPUBI1CS4FElY Permit No. `/ly / BOARDOFFIREPREVENT70N ONS527Cr1�I2 010 Occupancy&Fees Checked O APPLICA71ONFOR PERMIT TO P ORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THEM SACRUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Z-- Town of North Andover ,n ,, ,Q To the Inspector of Wires: The undersigned applies for a permit to pertg9r�jm the ele trical wor described below. ty�H'Ilii Cr Gj � `'� Location(Street&Number) C2-71 �! Owner or Tenant u e., '+ Owner's Address Is this permit in conjunction with a building permit: es 0 No (Check Appropriate Box) Purpose of Building 'j ?yjLl"k'j� � w, Utility Authorization No. Existing Service Amps-,;'7o/Bio Volts OverheadUnderground �i No.of Meters New Service Amps��olts Overhead Underground' No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Ili 1 rm�, zJL6,ega No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round E3 ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Bat te Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons Cbof Disposals No.of Heat Total Total No.of Detection and Pumps/ Tons .KW Initiating Devices No.of Dishwashers Space Area He mg KW No.of Sounding De ces No.of Self Contain d Detection/Soundi g Devices No.of Dryers Heating vices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs, No.of Motors / Total HP �8 oK vr� Lang �� C- ER- '� � .5Y r1 ?� 03 Z �L 7J Covezage.Pt>tsua�xtotbetagttiternattsofMC,enaalLaws az=Ldi>7 katta=PbkyffrWffgCorrVlee CovdreoritsatsWUe#vaiat YES NO a vaWproofofsanletotheOffice YES IfTubaredlecl®dYES,plemi theMrofaiveraWby BOND MIERt (Please Speafy) �—+ EVi abort)& EstimAdVakl dEkctncalW0ik$ h>Spet�ottD&Regt>ested Rough Final a Cie Penaltiesof P aw. Llce wNo. �✓F L Siglauue `< Li=wNo Busim Tel No. A)t:Tel Na QSURANICEWAIVFR IamawatethattheLi=wdoe notharetheinsumcecowWoritsmbswntWeWival ntaswgmedbyM GalaalLaws griAm cn this pear AM*abon waits this mw*ff in m ck one) Owner M Agent Telephone No. PERMIT FEE$ tgna ure of Owner or Agent { r w 1:WiIV S '9,u� �w dR YaX 7 � � •e« a;� iJ "Aa �'Y� "...� �� via �,.A •��7�l,fit'' R �•.: v ; Date.:,�.. .. ....... ... ...... . r " TOWN OF NORTH ANDOVER 3?O�t�.•o ,••e QOL PERMIT FOR WIRING ;7Sg,�CMUSEt This certifies that .......,,` "t / �C ...................... { '!..`.1......... .......................... e has permission to perform ...... .P e ��........ `.. ` .................. wiring in the building of.....�/ 4/?. .�. Y..` ..........r................................ at.... . . ..� ........ orth Ander,, As. Fee... ............ Lic.No/1... ................ . . ............... .................. /ELECTRICAL INSPE R Check # 5202 TBE COMMOAWEALTHOFMASSACHUSMYS Office Use only DEPARTAIEW0MIXICS MY Permit No. (1 BOARD OFFIREPREVE MONREGUI�1770N�S27CMR I2.'00 Occupancy&Fees Checked APPLICATIONFOR PERMIT TO PERF RMELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSA CHU TS ELECTRICAL CODE,527 CMR 12:00 /Z (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) A Date Town of North Andover ,' To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work esc ' d below. Location(Street&Number) 1z i �/T2.d 1 K Owner or Tenant tiVO Owner's Address ` Is this permit in conjunction with a build' permit: Yes EnNo (Check Appropriate Box) Purpose of Building J, Utility Authorization No. Existing Service Amps / Volts Overhead Underground z No. of Meters New Service �.. Amps JW/ ZWolts Overhead r1 Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work tl.) Ld7C No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Be]ow Generators KVA round round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones R Tons No.of Disposals No-of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW Nq.of Sounding Devices No'of-Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP )THER s TMXCDI�1 .PLIlSUallttothe oflvlass� laws iaveaamentliabi'tityk urance inchx�IgComplete Commwcritsstil�ltialegtuvalat YES Ej NO iamahniedvalidgoofof to the0&m.YES Ifyou havectiErlcedYES,pleaseindica�Ttlrp/eocovaageby �tg the ISURANCE BOND (7hIFIZ (Pleases EstimatedVahaeofE ctdcalWodc$ aktostit h>spectionDate Rou l Feral ;ted under7i Penahies of perjtuy -rz ZMNANIE (i 11oaWN0. Si I iesnseNo BusbcssTel No. 7c) VNER'S INSURAN WAIVER;lain aware that tlle Iii does notbak the insurance mvaage orl substantial egtuvalent as mgmed by MassachuscLs Cff e Laws .(hat my agriAm on this penr]it a*cadon waives this requ mT)ff t ease check one) Owner ® Agent Telephone No. PERMIT FEE$ ignature of Owner or Agenf The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone#: Insurance.Co. Policv# s , Company name: Address City Phone#: Insurance Co. Policv# . Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine.up to$1,500.00 and/or one years'imprisonment-as-well_as_civil..penaltiesintheforrn-of-a_STOP WORK_ORDPR..and_a.fine of_(.$1D0.00)_a dayagainst.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. l do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. ' I Signature Date 1 Print name Phone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing I] Building Dept [-I Check if immediate response is required Q Licensing Board E] Selectman's Office Contact persona Phone#. I] Health Department ❑ Other N2 20 f 9 Date......7A/7 7A/7 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...........�a.k .0c has permission to perform ..... wiring in the building of.... .......................................... at.... ................. ....T ...!��Worth Andover,Mass. Fee..3.0.%W Lic.No/14".. .��............................................................ 7qgqELECTRICAL INSPECTOR C 09/02/98 09:20 30-00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Otttce Use anty p� t ye C��IE LIIIYIYIIIIIIIIIEII of 5mizir4la Permit No. ;3r;ZI3' Zrrt IIf-puhlit �fEtg Occupancy A Fee Checked BOARD OF FIRE PREhlE.�I710N REuULAT10NS 527 US 12:110 3J90 peace bank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacnusetts Electrical Cade, 527 C.MR12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Oate (XX or Tawn of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical `Nark described below. Location (Street 3 Numbbe'r) 12- - Owner or Tenant C`.vner's Address Is this permit in ccnlur.c:ion with a building permit: Yes _ No � (Check Appropriate Sex) urcese Cf 3utid nc /zi"�� it Utility Auincnzation No. Existing Samce Amos ' Vcits Overheac Uncgrnc I No. of Meters Ne`.v Service Amps t/crts Cverr.eac _ Uric;--c _ No. of Meters Numcer at =eecers enc Amcac:-y _ a,• ,, sr �lar_ra _: ?rcccsec =:ect. ..ai :1cr:c Tatai No. No. cf'ranstcrmers t(;'A No. at L: n —ztures Swimmin .=Cos ;once-- rt — g � KVA= grrc. _ cr-c. — Ganeratcrs No. at Er..ergency :ignting No. _t =ecectac:e Cutlets No. at Cil _urners i 3arery Units No. at Swaan Cutters NO. at G35 =..••ef5 I =ilRE ALARMS No. of Zones Total I No. ct Cetec::on anc No. at ; Inns initiating;Ages NO. ct Air �:.r-e. �avices rear Total Tatai No. at Zisccsais ! No at Pu-cs Tors �'•v Na. at Stunning Devices No. of Sart Cantainee No. of Z�snwasners - I �'� Oeter.:cnr5ouncin •Zevtces ScacerArea reattr.c 4 - I Municicai —Other NO. of ']CVe[5 reat:-c zewces KW I �Ccat CJnnec::On Nc. of No. at i ",w ,citage No. of .Vater =eaters KY! Sic..^.s 3aiias:s Nir:rc NO. FivCro mas5aCe at Motcrs alai INSURANCE CC'rE=AGc. ?arsuant :a the recuirements at aassacr!"acs ;er.erai '_aws — — I have a current ^iaciiity Insurance ?citc/ !nc:cc: ng Carnc:etec Cceraticns ---zverace cr Its suostantial ecutvaient. YES — NO — nave suorniree vatic ::,---ct ct same to :tie Ctfics. YES 7- NO _ it •jcu nave =necxee YES. xease Lnatcate me tyre at c:verage Zy cnecxing ae aecrocriate cox. INSURANCE BONO = O -ER = (Piease Sce:!y) (Exeiration 0aami sarratee value of Eiec:ncai wore 5 ' ' ^nal werx :o Star. Inscec-mr, Cate Aacues:e- Raug. Signee anter :ns Penait�ies NO. at cerlu /�/ FIRM NAME c �-/`� ��lF�'r/liC UC. liJ�censee ' `C. u0. Bus. Tei. No. dk 3 / Aceress ,e.Z ( f�ICICFie!/pQ //O />y�D� ,alt. lei. No. OWNERS INSURANC=—WAIVEFI: I am aware tnat the -;censee toes rot nave :tie insurance coverage or its suestantial ecutvaient as re- cwreo ov Massacriusetts General Laws. ana :nat ny signature an 7a =erm:t aecitcation waives :his reouirement. Cwneyf Agent (Please cnecx one, eiecrrcne No. ?EFPMIT FE= S Sicr.awre ci C•nner cr.tgenti • =_=