HomeMy WebLinkAboutMiscellaneous - 345 RALEIGH TAVERN LANE 4/30/2018Date .. 3 .'e (f-./�� .......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
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This certifies that ........ .................
has permission to perform ....... v
wiring in the building of.........7............................................................
at`.?......... .:: f'-+ .... , North Andover, Mass.
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ELECTRICALINSPECTOR v
Check # Old
9292
vii. �vrasssacnusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of MCT. c.143, §, 3Y, the
permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed
On the prescribed form. After a permit application has been accepted by an Inspector of Wiresappointed pursuant to M. G.L c. 166, § 32, an
electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the
notification of completion of the work as required in M.G.L. c. 143, § 3L.
Permits shallbe limited as to the time of ongoing constructionactivity, and maybe,deemed_bythe.Inspector-of_Wireseabandoned_and-ky.alid,ifbe—
or she has detennined that the authorized work has not commenced or has not progressed during the preceding 12 month period. Upon written
application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written
request of either the owner or the installing entity stated o8 tiro. permit application.
The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of
the Acts of 2012. The purpose of this act is to promote job;growth and long-term economic recovery and the Permit Extension Act furthers ibis
purpose by estabIishvng an automatic four-year extension to certain•permits and licenses ccnceming the use or development ofreal property. With
limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was
"in effect or existence" during the qualifying period beginning on August 15, 2008_and extending'through August 15, 2012.
Rule S—Permit/Date Closed:
— ' _ ❑ Permit Extension Act — Permit/Date Closed:
***Note: Reapply for new
(fommonwealth o/ /1/ wj.a W.tb Official Use Only
Permit No. �"ag9 _
1JeParEmen� o�.tir¢ Jeruice� cs�
Occupancy and Fee Checked'
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leava 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
(PLEA SE PRINT IN INK OR TYPE ALL INFORMATION) Date: 3/16/10
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) 345 Raleigh Tavern Ln
Owner or Tenant Scott Lane Telephone No. 978-578-5329
Owner's Address _345 Raleigh Tavern Ln, North Andover MA 01845-5631
Is this permit in conjunction with a building permit? Yes ❑ No a . (Check Appropriate Box)
Purpose of Building Residential - 1 family Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
rmmnletinn offho {nllm. s mhlo — ho -i-d A" fl— 7..... frsr.-
No. of Recessed Luminaires
No. of CeiL-Susp. (Paddle) Fans
o. of oral
Transformers KVA
No. of Luminaire Outlets
No. ofHot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑ ❑o.
—grnd. d.
o Emergency Lighting
Battery Units
No. 'of Receptacle Outlets
No. of OR Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
o. oDetection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
eat Pump
Totals:
I N umber
I TonsNo.
oSelf-Contained
Detection/Alerting Devices
No. -of Dishwashers
Space/Area Heating KW
Local [ICo nnectioniectio n [I Other
Co
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or E uivalent
No. of ater
Heaters KW
0 0 0. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications icing:
No. of Devices or E uivalent
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: 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.Iiability.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 permitissuing office.
Cl IECK ONE: INSURANCE ❑ *OND ❑ OTHER ❑ (Specify:) Liberty Mutual
I certify, under the pains and penalties of perjury, that the information on this application is true and complete -
F1 RM NAME:NatioAal Grid LIC. NO.: 101?RA
Licensee: Richard F. Caver Signatur LIC. NO.:
(1j'uppllcable, enter "exempt " in the license number line.) BuS. Tel. No.:
Address: Alt: Tel. No.:
*I'er M.G.L. c. 147, s. - secunty wdr requ� es epan7nent of Public Safety "S" License: Lic. No.
OWN ER'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. lam the (check one) ❑ owner ❑ owner's agent.
Owner/Agent
Sign -cure Telephone No. PERMIT FEE: $ 2 .00
NORTq
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SSAC04US�
This certifies that.
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING,,
has permission to perform ..............
plumbing in the buildings of ./ --;- .� ..........................
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Fee ...... Lic . No�?:'� . -. ;,!t.:-t-r-rz.,. f��.<< ............
�/ PLUMB1 GANSPECTOR
Check # /" a v
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RM APPLICATION FOR PERMIT TO DO PLUMB
CitylTown:, North Andover MA. Date: /16/1 Permit#
Building Location:! 345 Raleigh Tavern Ln Owners Name: IScott Lane
Type of Occupancy: Commercial Educational 0, Industrial Institutional 0 Residential
New: Alteration: Renovation: Replacement: Plans Submitted: Yes ( N< ,i
FIXTURES
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Installing Company Name:
Address:, 62 Second Avenue
n � � City/TownBurlington `._ �State. { MA
Business Tot: 781-359-2600 FFax: L? -r
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V( o oration
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I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes;!
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy 0 X Other type of indemnityBond
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that.my signature on this permit application waives this requirement.
Check One Only
Signature of Owner or Owner's Agent Owner Agent
: hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my
Knowledoe and that ail nin—hi— ......L e..a
- s ----------••---••— r—• •�••••�� �••�o: MV NnFmJs Issues Tor tms application will be In compliance with all
ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By l` Type of License:
TitieL _ ✓ plumber ignature of Licens lumb
Cityrrown� Master MP R�7
APPROVED OFFICE USE ONLY Journeyman LD License Number:
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Installing Company Name:
Address:, 62 Second Avenue
n � � City/TownBurlington `._ �State. { MA
Business Tot: 781-359-2600 FFax: L? -r
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I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes;!
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy 0 X Other type of indemnityBond
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that.my signature on this permit application waives this requirement.
Check One Only
Signature of Owner or Owner's Agent Owner Agent
: hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my
Knowledoe and that ail nin—hi— ......L e..a
- s ----------••---••— r—• •�••••�� �••�o: MV NnFmJs Issues Tor tms application will be In compliance with all
ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By l` Type of License:
TitieL _ ✓ plumber ignature of Licens lumb
Cityrrown� Master MP R�7
APPROVED OFFICE USE ONLY Journeyman LD License Number:
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"NOA TOWN OF NORTH ANDOVT1
PERMIT FOR GAS INSTJ LATION
This certifies that . W" /f N . .49. ! .' ( .....................
has permission for gas installation
in the buildings of .- !r1,(-. ............................ .
-r
at North Andover, Mass.
Fee... L.3
.... Lic. No..'? " .......
GAS INSPE40R
Check#
5663
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAStrITTING
(Print or Type)
•
KIA omfla-1 , Mass. Date —3' F/0(,
City, Town Permit # X:CG 3
Building Owner's
AT: Location l4Name��
Type Occupancy
New4 Renovation ElReplacem t
Plans Submitted Yes ❑ No/
(Print or Type)
Installing Company Namee -Po l d Pn_ni' Inc,
Address "1 I L 1,e n to f i n_ 1 H <7 - r p o -4 -
Business Telephone `'I +(I— nn
Check One: Certificate
-
Corp. CJ °•�I n
❑ Partnership
❑ Firm/ Company
Name�f Licensed Plumber or Gasfitter
---I ( I�?. y
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 Permit issued for this application will be in compliance with all pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
1 have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
Signature of Owner/ Agent
I have a current liability insurance policy to include completed operations covera¢e. ❑
By
Title
City/ Town
APPROVED (OFFICE USE ONLY)
FORM 1243 A.M. SULKIN CO. 1989
TYPE LICENSE:
❑ Plumber
Gasfitter
❑ Master
❑ Journeyman
Signature of Licensed
Plumber or Gasfitter
,foo
License Number
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MOMMEMEMEN
(Print or Type)
Installing Company Namee -Po l d Pn_ni' Inc,
Address "1 I L 1,e n to f i n_ 1 H <7 - r p o -4 -
Business Telephone `'I +(I— nn
Check One: Certificate
-
Corp. CJ °•�I n
❑ Partnership
❑ Firm/ Company
Name�f Licensed Plumber or Gasfitter
---I ( I�?. y
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 Permit issued for this application will be in compliance with all pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
1 have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
Signature of Owner/ Agent
I have a current liability insurance policy to include completed operations covera¢e. ❑
By
Title
City/ Town
APPROVED (OFFICE USE ONLY)
FORM 1243 A.M. SULKIN CO. 1989
TYPE LICENSE:
❑ Plumber
Gasfitter
❑ Master
❑ Journeyman
Signature of Licensed
Plumber or Gasfitter
,foo
License Number
5531 Date.......................
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
SAI. iSEt
This certifies that.. �,:/ : �� fes' �' :f
•r
has permission for gas installation ... ! . F ................ .
in the buildings of ..............................
at ....�...:... !�.... '.:.. `.....!....�. '; North Andover, Mass,
d.
Fee..!...... Lic. No............ ...........
-'GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
�\ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO ASFITTING
(Print or Type)0010
�t
it � _• Mass. Date k) A . Permit # J J
Building Location 315 R AC,i 6 h t AUGEN , N -7 Owner's Name u 0 (E C 14 KI H&2
Type of Occupancy l
New p Renovation 0 Replacement tM' Plans Submitted: Yesp No 0
Installing Company NameA. D D A- teats jp k L) m A i pit, Check one: Certificate
Address_ 9 :7 ( - Rn S'TR ECT Cl Corporation
—_- \ E U C KL t m r p& 1 S 1 0 Partnership
Business Telephone T� I� a&9 -3,68(o O Firm/Co.
Name of Licensed Piumber or Gas Fitter —M{Q . SrEU 6f'V -77- # D DM fv / ,.S
INSURANCE COV AGE:
I have a current bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No El
It you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy D Other type of indemnity 0 Bond t]
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:
Signature of Owner or Owner's AgentOwnerO 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 Issued this appf ti II be in oo with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of Fhe Gener S.
BY TyW of License:
Plum t re of UcqbAd Plumber or Gas Fitter
Title d GoAter
or License Number.
Cit /Town Journeyman
i t1S L
ONE
MEN
0
It -Ike,
MEMOMOMMEEMEME
INS
no
NN
Installing Company NameA. D D A- teats jp k L) m A i pit, Check one: Certificate
Address_ 9 :7 ( - Rn S'TR ECT Cl Corporation
—_- \ E U C KL t m r p& 1 S 1 0 Partnership
Business Telephone T� I� a&9 -3,68(o O Firm/Co.
Name of Licensed Piumber or Gas Fitter —M{Q . SrEU 6f'V -77- # D DM fv / ,.S
INSURANCE COV AGE:
I have a current bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No El
It you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy D Other type of indemnity 0 Bond t]
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:
Signature of Owner or Owner's AgentOwnerO 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 Issued this appf ti II be in oo with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of Fhe Gener S.
BY TyW of License:
Plum t re of UcqbAd Plumber or Gas Fitter
Title d GoAter
or License Number.
Cit /Town Journeyman
i t1S L
15 1
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