HomeMy WebLinkAboutMiscellaneous - 286 RALEIGH TAVERN LANE 4/30/2018rn
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TOWN OF. 7NRTH ANDOVER
PER�1crjj
-1* FOR PLUMBING
This certifies that ... 11 'r .... �.-r.11 ...................
has permission to perform .... ............................
plumbing in the buildings of 5. /1 .......................
a t ... ............ North Andover, Mass.
Fee. ... .....
Lic. No.. . ........ .. 1- '
PLOMBING INSPECTOR
Check # 7 C
7217
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Date t2 -
Building Location or ICA Towi- JA -t- Owners Name 'Tct,,- 6&,jcr- Permit # ' -2 Ll 7
Amount 27 7-,Z
Type of Occupancy
New 1:1 Renovation 1:1
K- I:!: -%7j IN
RJOW113
�V oil; rk
k' 11 11;
El I I
r-1 I 12 [1-
Wj I I I � F -I'M
r, 1". F re—MI,
Replacement 0
FIXTURES
Plans Submitted Yes E] No [Z
(Print or type) Check one:
Installing Company Name lo", LLC� Corp.
Address _1'7 -T'-41er1*vw- 0 Partner.
P%Ktk-.W . 0 Ix -#&Ae, I .
Business Telephone (66-5 -3f2.- 6-7 33 Firm/Co
I
Name of Licensed Plumber
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box
Liability insurance policy R Other type of indemnity El Bond
Certificate
insurance Waiver 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner 11 Agent []
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing wo n lations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the as c setts S Plumbing Code and Chapter 142 of the General Laws.
.0
JeAA"*�—
By: ure o icensea FlumBer
. "f PI
Title Type of Plumbing License
=k= ---
City/Town LICenSC INUIT10er Master Journeyman
APPROVED (OFFICE USE ONLY
Date ...... 7- / 7-OA�
........................ .
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Thiscertifies that .............................................................................................
has permission to perform lq,�-Po
ap
......................................
wiring in the building of ............................. 5--v - i�� ............................
at ...... ;�O: 4 .... R�! AV, North Andover, Mass.
nlro-1-10
-,Fee.. Y ............... Lic. No.d.6.?0.9—r: ...
Check #
6 8 tj 3
7BE C0AD10jNJVE4LTH0FM1MCMSEr1S Office UW only
DEPARTMENTOFPUBLICS4FEIV
Permit No.
— — �O 0� o a,
BOAM OFFNEPREYEMONREGU4 TIOAS527(UR 12-00 Occupancy & =FeesChecked
APPUCATION FOR PERNff TO PEUORM aE=CAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSAC14USSTS ELECTRICAL CODE, 527 cmR 12:00 0�-v /
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 7/ot/,
Town of North Andover To the Inspector of Wire!
The undersigned applies for a permit to perfbrm the electrical work described below.
Location (Street & Number) 94
A q
Owner or Tenant --r & 5,1,- 1-1-e ,,-
Owner's Address , �"4m-e—
Is this permit in conjunction with a building permit: Yes M No r V1 (Check Appropriate Box)
Purpose of Building /0/?6 "ZI
Sincee-� Utility Authorization No.
Existing Service CZ 0 0 AmpL//6 &�,2p Volts Overhead M Underground No. of Meters
New Service Amps Volts Overhead [= Underground No. of Meters
Number of Feeders and Am pacity
Location and Nature of Proposed Electrical Work C-Aq j2 jj�, In r,
No. ofLighting Outlets
No. of Lighting Fixtures
No. ofHot Tubs
Swimming Pool
Above
ground Elground
Below
Po. ofTransformers
Ge—neratom
I
Total
KVA
KVA
No. of Receptacle Outlets
No. ofOil Burnam.
o. ofEmergency Lighting Battery Units
No. ofSwitch Outlets
No. ofGas Burners
No. of Ranges
No. ofAir Cond.
Total
FIRE ALARMS
No. ofZones
Tons
No. ofDisposals
No. of Heat
Total
Total
No. of Detection and
Pumps
Tons
KW
Intitiating Devices
No. of Dishwashers
Space Area Heating
KW
No. ofSounding Devices
I
No. ofSelfContained
I
Detection/Sounding Devices
No. ofDryers
Heating Devices
1
KW
Local Municipal
Other'
No. ofWate r Heaters KW
No. of
No. of
0 Connections
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
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FIRMNAME LbmseNd
Lio�ezzf,q/v
6/
&6=TdNh 9,7g-3,10-_ ?.Z.7-3
OWNER'S JNSLRANCEWAIVEI� lam M='d11drLX=d1omM the inommmlyml@�a-lts Alt.TVlo.
m#redbyMmxhl:E& GmeW Lam
(Please check one) Owner M Agent F-1
Telephone No. PERMIT FEE
SEAV
wim OW-
V-�-P�k
P��
w /
Location
No. Date
Check #
16 o" 7 9
Building Inspector
TOWN OF NORTH ANDOVER
0
0 0
Certificate Occupancy
$
of
"us
Building/Frame Permit Fee
$ /y
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
Check #
16 o" 7 9
Building Inspector
"r .4
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPA14,
RENOVATY2 OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NT
SIGNATURE:
Building Commissio—ner/Inspector of Buildings Date
SECTION I- SITE INFORMATION
1. 1 Property Address:
r 6
,)- 0 44ic
1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
4 -Az Poyit�?—
1.3 Zoning Information:
Zoning Dia;ic—t Proposed Use
1.4 Property Dimensions:
Lot Area (sf) Frontage (R)
1.6 BUILDING SETBACKS (ft)
Front Yard
Side Yard
Rear Yard
Required Provide
Required
Provi&d
.:I--Pr(yvi&d
1.7 Water Supply M.G.L.C.40. 54)
Public 0 Private 0 Zone
1.5. Flood Zone Information:
Outside Flood Zone 0
-- --- -
1.8 Sewerage Disposal System:
municipal 0 OnSiteDisposal System 0
I I
—
SECTION 2 - PROPERTY OWNERSHW/AUTHORMD AGENT
Historic District: Yes N 0
2.1 Owner of Record
ra4- s4&-Vzx-
Name (Print)
7�9,klrlr-A, LAI
Address for Service
79 - (9 ;t 9- 3
Signature
Telephone
2.2 Owner of Record:
Namelrkint
Address for Service:
Signatur4
Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
J&Z T . 177-4-A/
Lic'ens'ed Construction Supervisor:
1Y Vlx&)!!!� �'77
Address
4-,!;
Signaftrre�' I'/— -TeTephone
1712- S -IS--
Not Applicable 0
License Number
Epiration Date
11-2-0 -0�e
3.2 Registered Home Improvement Contractor
)v - r.?,- , C— 1/ 5
Not Applicable 0
Company 1jame
-�- 1-:�,4 ,V
Registration Number
Address
9 011/
Expiration Date -7
Sig(fatuie
Telephone
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I SECTION 4 - WORKERS COMPENSATION (MLG.L C 152 4 25c(6) I
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building pprmit.
Signed affidavit Attached Yes ....... 11 'No ....... El
SECTION5 Descriptiono Proposed Work (check applicable)
New Construction 11
Existing Building MI"-
Repair(s) 0
Alterations(s) 0 1
Addition 0
Accessory Bldg. [I
Demolition El
Other 0 Specify X&�Idp J_�T
Brief Description of Proposed Work:
T �4 6 7 -kilt x!,a elt-Ilyec S,61-1-ly 44c s o
ON& 1,kyCle- op
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by pen -nit applicant
. . ... .. ...
I Building
Ll
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
-3 Plumbing
Building Permit fee (a) x (b)
-4 Mechanical (HVAC)
-5 Fire Protection
-6 Total (1+2+3+4+5)
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BURDING PERMIT
T
as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building pennit application.
of Owner Date
-Signature
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, je�41 T, as Owner/4j��f subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
I/A,/I-
Print e
Siatug of Date
-NO. OF STORIES SIZE
-BASENENT OR SLAB
-SIZE OF FLOOR TINIBERS IST 2ND 3RD
SPAN
_DRAENSIONS OF SILLS
-DINENSIONS OF POSTS
_DRVIENSIONS OF GIRDERS
-HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOO'flNG X
-MATERIAL OF CHEVINEY
-IS BUILDING ON SOLID OR FELLED LAND
IS BUILDING CONNECTED TO NATUTAL GAS LINE
NORTH ANDOVER BUILDING DEPARTMENT
Tel: 978-688-954
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be disposed of in properly
licensed solid waste disposal facility as defined by MGL Chapter 1, 11, S 150 A.
The debris will be disposed of in:
12 4 /Y 5 9 1 1//(-/Z- 7- Co -Z // 2 k Co,.v?,n
(Location of Facility) vovoy A-3'7�
st
Signa(ure OR ant
,!!�i�ppiic-
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for this project
through the Office of the Building Inspector
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 102467
Expiration: 7/2J2004
Type: Private Corporation
NEW ENGLAND CUSTOM DF-SI(3
Vat'Lanza
226 LOWELL ST.
WILMINGTON, MA 01887
A liniStrator
C17
BOARD OF BUILDING REGULATIONS
s
Licen e: CONSTRUCTION SUPERVISOR
Numbw:,CS 008828
Birthdate: 04/20/1951
Expjre�s: 04/20/2004 Tr. no: 20132
Restricted: 00
VAL J LANZA
34 BIXBY ST
REVERE, MA 02151 Administrator
License or registration valid for individul use only
before'the expiration date. If found return to:
Board of Building Regulations and Standards
One Ashburton Place Rm 130'1
Boston, Ma. 02108
Not valid ithout re
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1-1 -3 3845
This certifies that
Date /�
2
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
has permission to perform . . . ...........................
'P. . . .
plumbing in the buildings of . 5/'q'�� v'rt� .....................
at —24-.6. RP11-1. .5J. - 1,.q .......... North Andover, Mass.
Fee. Lic. No.. <9 3.3.) . ...............
PLUMBING INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
3845
%_ -, _'�' - ."V
Date
TOWN OF NORTH ANDOVER
-PERMIT FOR PLUMBING
This certifies that .......................
has permission to perform ... P �� ...........................
plumbing in the buildings of .....................
North Andover, Mass.
Fee. fv?�� Lic. No.. ?'. 3 . ..............................
PLUMBING INSPECTOR
I
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
19
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 130 PLUMBING
(print or T . . I V
02 4L/W Mass.. Date A'4L /L-511 9-!Y Permit
-Z;, .162k- -
Building Location -VA01, -1-- ....er's Name&
A"--&L-*4Ft .� -7/2
Type of Occupancy Ti A c—
New 0 Renovation 0 Replacement 2"" Plans Submitted: Yes 13 No 13
FIXTURES
Installing. Company Name "'kaEez a P (r ^4 T Aen Check one: Certificate
Address C04o4mt4t') 13 Corporation
E T�4o C-7AJ - Al t4 0 1 T (/L/ C1 Partnership
Business Telephone 17 7 1 qirlr�/Co.
Name of Licensed Plumber r3 F?- 7- iq - ��A ej�,mjq reqo-Oc-.
INSURANCE COVERAGE:
I have a curre illity insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No 11 .1
If you have checked ves. please indicate the type coverage by checking the appropriate box
Ilk liability insurance policy Other type of indemnity 0 Bond 13
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance covemge required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner 0 Agent 0
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum g e and of the eral Laws.
ritle of Licensed Plumber
M/T m Type of License: Master Joumeymah E]
Fig _F_
W OFFICE
U ON
L License Number D3
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Date.2-/� .- ��
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ... R. /1-� 1%
has permission to perform .............................
plumbing in the buildings of .................
at North Andover, Mass.
Fee..76� Lic. No.5'e��.e .. ....... ......
MBING INSPECTOR
Check # )/
6106
k
-3 b, tAl
MASSACHUSETTS UNIFORM AI)PLICATION FOR PERMIT TO Do PLUMBIN
(Type or print)
NORTH ANDOVER, MASSACHIUSE S
9 Date
Building LocationtV f Owners.. 'a'me IZ?A, j )Alp Permitj(
Amount
Typjof /cupancy
New r I I Renovation Re Vh�ent El, Plans Subinitted Yes. No
FIXTURES
5-1 W 5 Nj a g 17
E, I 1 -1 10 Fell
El I.- 10 ro-T
ral-RUFF-Um
011110 MUM
I 1 -1 1 a I ral"M
(Print or type) --1-- 14 Check one: Certificate
Installing Cqpipany Namea I �) A"/ F1 Corp.
Address Z::142 n Partner -
Business Telephone Firm/Co.
Name of Licensed Plumber:
Insurance Coverage:' Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity El Bond F1
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner
I hereby certify that all of the details and information I
best of my knowledge and that all plumbing work and4
compliance with all pertinent provisions of the Massa(
OVED (OFFICE USE ONLY
Agent El
ted -(or -entered) in above application are true and accurate to the
.3erforme under Permit Issued for this application will be in
nd Chapter 142 of the General Laws.
�ype of Plumbing License
11' A 4 01"
License 7773177- Master u Joumeyman
Date.. 7. � ?.-
N"N
TOWN OF NORTH ANDOVER
0
PERMIT FOR GAS INSTALLATION
This certifies that
has permission for gas installation .................
in the buildings of
at
North Andover, Mass.
Fee. 1� .... Lic. .........
GASINSPECTOR
Check # �' .5 /
4792
MASSACHUSEM UNIFORM
(Type or print)
NORTH ANDi
Building Locations
TO DO GAS FfITNG
Date
Cq/
Permit # L1717 -2-
Amount $
er's Name
New Renovation Replacement Ell Plans Submitted
(Print or typ
Nai
Address
Name of Licensed Plumber or Gas Fitter
Check one: Certificate Installing Company
Corp.
Partner.
Finn/Co.
INS ZANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 0 No El
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy r". Other type of indemnity Bond
Ana 0 11
owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
�h �f Owner or Owner's Avent Owner 13 Agent 1:1
6. -
I hereby certify that all of the details and information I have
best of my knowledge and that all plumbing work and ins
compliance with all pertinent provisions of the MassaA 3t,
�, e_
� by:
Title
City/Town
OVED (OFFICE USE ONLY)
(or entered) in above application are true and accurate to the
'cirmed under Permit Issued for this application will be in
and Chapter 142 of the General Laws.
gignature of Licensed Plumber Or Gas Fitter
b
Plumber 9-X
Gas Fitter Licertsd'Number
M Master
M Joumeyman
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-BASEMENT
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1ST. F L 0 0 R
2ND. F L 0 0 R
3RD. FLOOR
ISUB
4 T H F L 0 0 R
5 T H F L 0 0 R
6TH. F L 0 0 R
7 T H . F L 0 0 R
9 T H. FLOOR
(Print or typ
Nai
Address
Name of Licensed Plumber or Gas Fitter
Check one: Certificate Installing Company
Corp.
Partner.
Finn/Co.
INS ZANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 0 No El
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy r". Other type of indemnity Bond
Ana 0 11
owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
�h �f Owner or Owner's Avent Owner 13 Agent 1:1
6. -
I hereby certify that all of the details and information I have
best of my knowledge and that all plumbing work and ins
compliance with all pertinent provisions of the MassaA 3t,
�, e_
� by:
Title
City/Town
OVED (OFFICE USE ONLY)
(or entered) in above application are true and accurate to the
'cirmed under Permit Issued for this application will be in
and Chapter 142 of the General Laws.
gignature of Licensed Plumber Or Gas Fitter
b
Plumber 9-X
Gas Fitter Licertsd'Number
M Master
M Joumeyman