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HomeMy WebLinkAboutMiscellaneous - 300 RALEIGH TAVERN LANE 4/30/2018/ 300 RALEIGH TAVERN LANE ` 210/107.A-0128-0000.0 ' 9767 L(- .Z?- . !v Date..... .. ......... 't f NORTH 1 TOWN OF NORTH ANDOVER 10- F PERMIT FOR WIRING C14U5� s ' This certifies that ..................... ............................... n/M has permission to perform .............. ................................................wiring in the building of . /U ` . at................©v.°>1, i.�..41. u:!t`.. ......,Noah Andover,Mass. Fee.. ---��.. Lic.No..I?J.2�A...................... . ....... .. ...... i ELEcTR cn�.Lrs wwR .Check # �-� S Commonwealth of Massachusetts Official Use Only s Department of Fire Services Permit No. �- l Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 11 - 18- I 0 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 35v 12A,11,20V\ TA V E nL � a O e , Owner or Tenant (�1 '(?p�M�.�1 Telephone 1 _ Owner's Address J AAMC Z�'� � dlLl 7i/47e- Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. 1 d H Da 3 1 Existing Service aDD Amps 120 /240 Volts Overhead❑ Undgrd[A No.of Meters New Service aQ0 Amps JW /240 Volts Overhead❑ Undgrd [Vf No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 9 1 o GAAP Qj(IS�1 tJ U Nd�i1 Y 0 t)�� SC'V V 1 CC " �ue -�a Se-e+1c, 1CACInift lEt� Wstwll, eve Secvr�r �p�du�Completion othe ollowin table m be waived b the Inspector o Wires. 4 No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above [:] In- '❑ o.o Emergency Lighting nd. nd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. Total Tons g o.o No. Alerting Devices No.of Waste Disposers Heat Pump Number Togs_.. No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: « Heaters Si s Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: I ad ' 10 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under thepains andpenalties ofperjury,that the information on this application is true and complete FIRM NAME: A V i 1 l3 Me e6vl LIC.NO.:A$ 1-A(o Licensee: S•P,(Vi- Signaturei� LIC.NO.: (If applicable,enter"exeMpt"in the license►ambe ling.) Bus.Tel.No.•g7� Jr �IE3 Address: 4 N1 u i bt$rif V -D2 PZA-6o C)I q(o 0 Alt.Tel.No..G2,9'r,-0-Lg-40 d a *Per M.G.L c. 147,s.57-61,security work requireibepartment of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ ��� �1�2���� �� 00 M XCI 4- V L-Alo The Comwnwealth of Massachusetts A N t Department of Industrial Accidents Office of investigations v, �. 600 Washington Street Boston, MA 02111 t 1 www.nwss.gov/dia . Worken' Compsusation Insurance Affidavit: Builders/ContractorsTlectricians/Plumbers Ainkant Informatiop t ' Plea PrintLegibly Name(Busineworganiaation/lndividual): �2 W Address: 4 M iA6 '_DV,, City/State/Zip: Rk6oA MA, 019GO Phone#. . L44 (S Are you an employer®Check the appropriate bort Type of project(required): 1.0 l am a employer with 4. [1 1 am a general contractor and 1 6. [3 New construction employees(full and/or part-time),* have hired the sub-contractors 2.�I am a sole proprietor or partner- listed on the attached sheet: 7. Remodeling ship and have no employees These sub-contractors have 6. 0 Demolition working forme in any capacity. workers' comp,insurance. g, 0 Building addition [No workers'comp.insurance 5. E] We are a corporation and its 10.J�Electrieal repairs or additions a required.] officers have exercised their exemption right of per MGL 1 1.[]Plumbing repairs or additions 3.❑ 1 tun a homeowner doing all work g l� p myself,[Nonworkers'comp. a 152,§1(4),and we have no 12,0 Roof repairs insurance required]t employees. [No workers' 13.0 tOther comp.insurance required.] •Any applicant that checks bort#I must also fill out the section below showing their workers'compensation policy information. t HomeownM who submit this affidavit indicating they an doing all words and then hire outside contractors must submit A new afrIdavit indicating each. scontrr,otors that check this box must anitahad an additional shoat showing the some of the sub•contractoru and their woricerscomp.policy information. I arra an employerthat is providing workers'compensadon insurance for niy employees. Below is the policy and job site i�1ormation. Insurance Company Name: Policy#or Self-ins. Lie.#: Expiration Date: Job Site Address: City/State/Zip- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL e. 152 can lead to the imposition of criminal penaltios of a ` fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby ce r under the pains and penalties of perjary that the IS&-oration provided above is true and correct correct , i Mono#• of Wal use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License V Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing inspector 6.Other Contact Person: Phone h: IO'd SO:ZT OTOZ 8T AON VZSZZ2S8Z6:XPJ ONI OI�10313 00-13H 9702 Date............ ... ....... ; E ti 40RTM 01 TOWN OF NORTH ANDOVER OL r p PERMIT FOR WIRING ,SSACIdUSEt t This certifies that .... ,�/�(J1�l�...1..�.L �i�1�9�"" ................................... has permission to perform ....�1 ,f...2 4:'...... ........................ wiring in the building of ! ......` m 9.... .............................................. at... Q.v....16 4� h. ��'`'� ... ,North Andover,Mas M. ... ............ I ELECTRICAL INSP� Check # �► Commonwealth of Ma�sachaseUs °��''U80 Only Department of Fire Services Permit No. 17f>2 Occupancy and Fee Chocked BOARD OF FIRE PREVENTION REGULATIONS ptay.m7l 1.m black APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Ali work to be perfwmad in accordance whit the Mmsadwsetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR nTEAU INFORMATION) Date: City or Town of: NOM ANDOVER To the Itrapeetor of Wires: By this application the undersigned riot---of his or hntontion to perforin a electrical w described below. Location(street&Naetber) !J 0 i�6 ` ' � �,A Ownor or Taamt Telepbone No. Owner's Address is this permit in conjunction with■building permit' Yea ❑ No (Cbeck Appropriate Box) Purpose of Building Utility Authorization Na Exletmg Serviee Amps — / Volta Ororbesd❑ Uedgrd❑ Na of Meters • Now Service — Amps / Volta Overboad❑ Undgrd❑ No.of Meters Number of Faders and Aampsetty Landon and Nature of Propostd Electrical Work: W 1 iCt 5e1, Mo t!, �t QAC SLr+lAC6e5, A. aDolkeiAk t?a*IRt CwykaoxrheINImag may br wetW by dna 1SM o Wim- Tani Na of Recused Lmminsires No.of Cal.-Susp.(Paddle)Fans T�fon nen KVA Na of Luminaire Outlets No.of Hot Tabs Gaerators KVA Na of Loaaiesiires Swimming Pool Above ❑ °- IND.a uu,wy L11100119 ❑ B Units Na of Receptacle Outlets Na of Oil Sermon FIRE ALARMSW'7 oduam Na otZonaa Na of Swltches Na of Gas Burson Iutdam D No.of Ranges No.of Air Coad. Tons No. Alerting Devices P166 Of SM-00atm-W Na of Waste Disposers mm ons - — Detection/ Devices No.of Dishwasbors SpAwAr"Heating KW Local❑Coaaeetion ❑ OdW r` No.of Dryers Heating AppliancesKW No.of Devieet or B uivalel t ter No.of ec o Neaten KW o. Ballasts N Wolff i er iwalout wtrow Na Hydromesser Betbtabs Na of Motors Toes HP iib 17%!of D to or ivs OTHER: Mach addfeioxol derail jfdaanrd or as rapdnd by On/equator of Wires, Estimmod Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in aocordacc with MEC Rule 10,and upon aomptetion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may into unless Ow licensee provides proof of liability insurance Including"completed operstion"coverage or its substantial equivalent The undersigned cortifies that such coverage is in force,and bw exbrbitod proof of same to the pemtit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify.) I cer*,wader Awgptnx and pens ies of duo,that die�on IM gpplicadorr is bee and a RM FINAME: kv,. Mov^ nr LIC.NO.: A 112<v Ueeasee: Signature .rr LIC.No.: A I(a(a (TfWIkobls. a rn ebb ticeare number fhu Bus.Tel.No.• d Address: A Vit. AZ=Y MA. Ot 910o Alt.To Na• i *Per M.G.L a 147,s.57-61,w&jrity work requires deIiartment of Public Safety"S"License: Lic.Na OWNER'S INSURANCE WAIVER: I am aware that the Licensee does no have the liability insurance coverage itortrwily required by law. By my signature below,I hereby waive this requirement. 1 am the(check one)❑owner Q owner's a ant Signature Telephone No. PERMIT FEE: 5 � r rl �J v Location 114j No. Date NORTh TOWN OF NORTH ANDOVER F _ OSA Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ � s�cMus Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector f95 12-04 65.00 PAID • Div. Public Works Pyj,rA,,-lf NO. 050— APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP i4O. LOT NO. 2 RECORD OF OWNERSHIP :DATE BOOK :PAGE ZONE I SUB DIV. LOT NO. LOCATION Q pA J7 PURPOSE OF BUILDING OWNER'S NAME , la-40 NO. OF STORIES OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY t IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST " ® U` Q PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PERS . FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FIL D AND 4PPROVED BY BUILDING INSPECTOR DATE FILED � /L� BUILDING INSP[CTOR SIgoWjTt4RE OF OWN E AUT AGENT r FEE Ste' OWNER TEL.# �f PERMIT GRANTED y� r CONTR.TEL.#19 � CONTR.LIC.a H.I.C.J/ IQ 131:7 L°k t l,�-qz) BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY I STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY _ OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA. APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE B 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA _ 1/1 1/1 '/. FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARD"�'D _ ASBESTOS SIDING _ COMMCN _ VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER ELK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR UATE _ ADEQNONE 5 ROOF 10 PLUMBING GABLE I� HIP TOILET FIXE— GAMBQELII MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY ,WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ T TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE _ FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS' OI L B'M'T 2nd ELECTRIC 1st 13rd NO HEATING r z � RT own t �� over No. 032 �.� ? .¢-7--North • dower, Mass., 41;;N- a'5 199.1, .- . �9 Q „< LJ; AERATED PPS{U �;:l ✓ BOARD OF HEALTH Food/Kitchen PERMIT ILD Septic System • • • BUILDING INSPECTOR THIS CERTIFIES THAT.......^�T�» F� !VO .... �:Sb•� ...' �• � � �• •. Foundation has permission to dW......./ -.!. F-.......... buildings on .. t�+�' ..."Al. . ... . ••••••• Rough to be occupied as.. !.P ...f�.�r. .... 1 s4--....� Chimney provided that the person accep{ing this per��fin everyrespect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION RTS Rough ' .................. ...... ................. ............. ,..,................... Service ......... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner 'PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. ' SERI IER/WATER FINAL DRIVEWAY ENTRY PERMIT M 120 Main Street OFFICES OF: °m Town of APPEALSNorth Andover, ! -. °. NORTH ANDOVER Massachusetts o 1845 BUILDING +@BACNUSE54 DIVISION OF CONSERVATION HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number 10/-? I is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: I 4 —711 (Location of Facility) . Signature of Permit Applicant A- 10 � Date �^ NOTE: Demolition permit from the Town of North Andover must be obtained for !^, this project through the Office of the Building Inspector.