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Home My WebLink AboutMiscellaneous - 301 RALEIGH TAVERN LANE 4/30/2018 RALEIGH TAVERN LANE _ - -- - - - - - 210/107.A-01 27-0000.0 i i i A Location No. /// Date AORTiy TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ Building/Frame Permit Fee $ sACHU Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # f -4 5 Building Insp6�t6r k t _ Date......�'.t.1 .." t kOR7p F?°•t;�`` :'1"�oA TOWN OF NORTH ANDOVER PERMIT FOR WIRING : � r __. ,•', r �7S$ACMUSE� 1w t l`� This certifies that ............ .............�............... T ...4...��,-.!.... D�4 e C- has permission to perform .........a�............�.........CJ.�`.....�................�.. wiring in the building of ............................ at 3O/ � Le{ t 6�tJ s ........................................ . ...�.�.�.......�.... ...,North Andover,Mass. • Fee......��......'.r- Lic.No....i'.7.3d7:��.........Z�m ......... .. ..... AL INSPECTOR V t Check # 6' , 6 6 Commonwealth of Massachusetts Official use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked Rev.11/99] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code( C),527 CMR 12.00 (PLEASE PRINT INVVK OR TYPE ALL INFORMATION) Date:It loto City or Town of: 4 "V' 74 Q dOW-O"' To the Inspector df Wes: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 1/ — �- Map: Lot: Owner or Tenant Y)Cl <K Telephone No. Z�f�• ��O i`� Owner's Address Qr�d' PQM Is this permit in conjunction with a building permit? Yes ❑ No Building Permit# ,Tee. Purpose of Building Utility Authorization No. Existing Service Amps 1,76 l2q Volts Overhead❑ Undgrd T No.of Meters ! Die e-M Amps 126 12YO Volts Overhead❑ Undgrd Ey No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Q A�e C Ir /- e c. -f- Comple4tonofthefi&wing table To be waived the Inspector of Wires. No.of Recessed Fixtures No.of Ca"usp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming.Pool Abd. ❑ In-d. [i go.o Um�racy L ting No.of Receptacle Oudets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices No.of Waste Disposers Heat PnmP Number Tons KVV o.of Self-Contained Totals• Ddection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Coun'd n 11 Other nnectio No.of Dryers Heating Appliances DSV Security Systems: No.of Devices or E uimdent No.of Water ; No.of No.of Data Wiring: Heaters .Sips Ballasts No.of Devices or Equimdent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: $ No.of Devices or Eg uimdent OTHER: Attach additional detail tf desired,or as required by the InVector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue urates$the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibit proof of same to the permit ismung office. CHECK ONE: INSURANCE Er BOND ❑ OTHER ❑ (Specify:) (Expon Date)' Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the aims and penalties of perjury,that the information on this app ' 'o a and complete. FIRM NAME: n j ', LIC.NO.: UrT Licensee: 1 jJC`Gc�IU L7tn3S Signature LIC.NO.:; {Ifapp/tcable,enter'exempt"to the A ense number U�" Bus.Tel.No.- ,Zk•,5-J f- AL9, Address: 1 [/f CoG Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am dwarc that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner ❑owner's agent. Owner/Agent PERMIT FEE.-,$ Signature Telephone No. TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: � DATE ISSUED: I SIGNATURE: Buildlit ildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: io -a/.?7Irood a Map Number Parcel Number \� 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided Sewerage 8 SDisposal 1 t f I 1.5. Flood Zone Information: . ew a osal 1.7 Water Supply M.G.L.C.40. 54) System: Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record fl L F, G!-E Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: �? Name Print Address for Service: z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: --� �� License Number Address / yrl �N✓r 77F 613 Wi l� n v2— 'oc, Expiration Date ic Signature Telephone 3.2 RqgKtered Home Improve ent Contractor Not Applicable ❑ / /� Company Name Z r Registration Number Address _ aa® Expiration Date O L Sin re Telephone SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) 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 permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other U,,"-Specify F�r� O , Brief Description of Proposed Work: , 4"14>-N- ON OUR ��c� S�;,-► G oNr c� 't��R of 1 ��2 �C f{c�L^ lF S/i ; IY GLS rl J Eja e C .f H : N (r L>t i D SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USI<a C}NLY Completed by permit applicant 1. Building (a) Building Permit Fee C) 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 BUILDING PERMIT I, Z-1 7,/A as Owner/ thorized Agent f subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, ;Q� as Owner/Authorized Agent of subject prope y Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Pr i ame Si a e of Owner/A en Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2ND 3RD SPAN DIMENSIONS OF SILLS DM ENSIONS OF POSTS DINSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CH11MNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE r TravelersPropertyCasualtyI WORKERS COMPENSATION e moron«a TravelersGroup AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6KUB-663X466-A-00) RENEWAL OF (GKUB-449X779-3-99) INSURER: THE TRAVELERS INDEMNITY COMPANY NCCI CO CODE: 11347 1. INSURED: PRODUCER: RAYMOND DAMPHOUSE & SONS INTERNET INSURANCE AGCY ROOFING CO INC 526 CHICKERING RD 73 BUTTERNUT LANE NORTH ANDOVER MA 01845 ME THUE N MA 01 844 Insured is A CORPORATION Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 08-25-00 to 08-22-01 12:01 A.M. at the insured's mailing address, 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compen- sation Law of the state(s) listed here: MA B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT WC 20 0306 i� D. This policy includes these endorsements and schedules: ...r SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Pians. All required information is subject to verification and change by audit to be made ANNUALLY. i i DATE OF ISSUE: 08-28--00 ML ST ASSIGN: MA OFFICE: ORLANDO INDUS AFF 161 PRODUCER: INTERNET INSURANCE AGCY 753XF 002998 : = HOME IMPROVEMENT CONTRACTOR a � Registration' 109862 Expiration: 06/29/2002 r' Type* Private Corporatio RAYMOND E. OflPHOUSSE, JR. Raymond Damphousse, Jr. L�w �v-7f 6xe W8utternut lane ADIONISIRHTOR Methuen MO 01844 i �� :J✓rc r„�o�r�rrrravzr�+�+zE� n��a.7Ar.[ra�r� BOARD OF BUILDING REGULATIONS ' License: CONSTRUCTION SUPERVISOR Number: CS 046636 6 ” 0610211948 Birthdate: h� rWi Expires: 0610212001 Tr.no: 9974 Restricted To: 1G I RAYMOND E DAMPHOUSSE JR _ 75 BUTTERNUT LANE METHUEN, MA 01844 Administrator f i i i � a a o W a. z W w w p w � H .tr��rcm.y4•�sy,�;:c "li"tC:ly9`ay4Tr"" .««s..••.4a",�i'tish•`a"'Jly:,, u.�.• .• .. . ;'f;.�;.w'a .a. •c•�,,r,>4 r.�a:.�,-a. r` V w f'fr`+d.1t.«...-. _ . .r• : .. tF•. :<• rvr... i - 5 RAYMOND E. RiOHOUSSE, JR. AND SONS ROOFING CO., INC. BOX 431 LAWRENCE P.O. MA. CONSTRUCTION LAWRENCE, MA 01842 ' SUPERVISOR LIC. #046636 TEL: 683-4588 HOME IMPROVEMENT REG. #101862 ROOFING - SIDING - INSULATION I Date ?t4_ From: 'Y f f-1 r�i.(> i= ,._ [ �• �d (N ems) (Address) TO: RATYOND E. DAMPHOOSSE, J9. AND SONS ROOFING CO., INC., BOX 431 LAWRENCE P.O., LAWRENCE, MASSACHUSETTS 01842 I (we) hereby authorize the Contractor to furnish all materials and ;labor necessary to Install, construct and place the Improvements described below in-on building located at No. Z ! i_ Street, City ,�! ��70✓ `i State in accordance with the following specifications: i..- /�'�� ,� ^'•��i,r /"'-!.)vhf-•t!� !'1/_n^�� /�! /_ �J� .:' � l,? .-�S �� J�:-1 ! �') A1��.1'� r.T^ 1?e, S/./ ',IGt/; r / f— I'ft.tj /3:g 0-7— /-1 : v! f All of the above work to be done in a good and workmanlike manner. All men and equipment Insure d. Premises to be left clean upon completion of work. { For the total sum of ///:j? i�h u( =' d'1 !—o ✓•Z �I!/!�/?:2.! i) �� G �r_...(.—/ dollars. • Entire Sum to be paid immediately upon completion in accordance with plan as shown below. ° TOTAL CASH SELLING PRICE . ...... ... S T U - DOWN PAYMENT IN CASH . . . ...... . ... DEFERRED BALANCE UPON COMPLETION ... .. . . . . . . . . . . ... The undersigned agrees to keep property mentioned in this agreement properly Insured against loss by fire Including the Contractor's interest therein. This agreement shall become binding only upon the written acceptance hereof by said Contractor, and upon such acceptance 46.0 mak. 11 ..---614..6., 66- 66_61. ...._4.__4 --A 6._ 6,_4:__ ..___ — -- •`-- _ .1--- `-'-- •- w,sitw,V, utasttxue i asnereinsettortn. it istheintention of the parties hereto that this contract shall be binding upon their respective heirs, executors, administrators, successors and assigns. ,, t