HomeMy WebLinkAboutMiscellaneous - 70 RALEIGH TAVERN LANE 4/30/2018N
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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
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This certifies that......J'1
................../.................................. .............................
has permission to perform...
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.......................................................................
wiring in the building of .........�!��?..�f t/...`... -So/ �C.......................:....
at 2 1 Aq.A�...!..u�1....... '�`� RtEicrRICAL
North Andover, Mass.
LFee..L-............ Lic. No. ... -...............INSPHCTOR
Check #
1L 0466
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Commonwealth of Massachuse
ttSFPe;rmit
Official Use Only
Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Fee Checked
v. 1/07j leave blank
APPLICATION FOR PERMIT TO PERFORM! ELECTRICAL ��j pKp�
All work to be performed in accordance with the Massachusetts Electrical Code (ngE• r ORn
(1°LEASE PRINTWINK OR TYPEAa IN.FORtIUTION1 Date:
City or Town o£: NORTH ANDOVER
BY this application the undersigned gives notice of his or her intention to peTo the rform the electrical o Wires:
Location (Street & Number) U `� F described below.
Owner or Tenant A -d /,4-,-"
Owner's Address
t
Is this Permit in conjunction with a building- n
Purpose of Building S' 4 lG P mt? yea u
" . A
Existing Service
Telephone No.
No LLJ--- (Check Appropriate Bog)
Utility Authorization No. //,F-6 � ,
Ps / Vol Overhead r-1 .
New S-- _Service
2vy Amps l / I-_vVolis
Number of Feeders and.Ampacity
Location and Nature of Proposed Electrics( work:
lNo. of Recessed Luminaires
1"Io. of I.cext�inaire Oe,�$1Pt�
. of Receptacle Outlets
--------------
. of Switches
of Ranges
Of Waste Disposers
of Dishwashers
Of Dryers
Heaters KW
Hydromassage Bathtubs
OTHER:
Overhead ❑
n
of Ceil.-Susp. (Paddle) Fans
,fRNe i't;,,bn
Swimming Pool Above
r_--j
Ko. of Oil Burners
lro. of Gas Burners
Jo. of Air Conde
Space/Area Heating KW
Heating APP�nces Kw
Ballasts .
Of Motors Total HP
Undgrd ❑ No. of Meters
Undgrd t � tvo. of Meters
,,win 'table m be waived b� _t_h.e_ I_n�s, �e�ctoro}'
0.0 Tota-�'
Transformers KVA
o. o mergency ig
'❑ 'RnN._._.. TT_.1
ALARMS INo: of Zones
of Alerting Devices
0
Wiring:
Other
Estimated Value of Electrical Work: Attach additional detail if desired or re :red b the I
(When required b m �` ?' nspector of Yyire<
Work to Start y unicipal policy)
-LL=L� ;/ Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no
the licensee.grovides proof of liability insurance including« le for the performance of electrical work may issue unless
undersigned certifies that such coverage is - e and COMP leted operation" coverage or its substantial equivalent. The
CHECK ONE: INSURANCE has exlubited proof of same to the permit issuing office.
I certify, under the pains and penalties o ❑ OTHER ❑ Specify.)
FIRM NAME: fP�Yury, that the informat4an on ibis application is true and complete.
<,a .,
Licensee: LIC. NO. -XV,,, !!,
f Signature , �°
(If applicabl ,
an "exempt " in the license number line.) LIC. NO.• ,
Address: Bus. TeL No.:
*Per M.G. C. 147, s. 57-61, security work Alt: TeL No.:
OWNER'S INSURANCE WAIVER: Ian a at �e Public Safety "S" License: Lic. No.
mqurred by law. BY MY signature below, I hereby waive this does not have the liability insurance coverage normally
Owner/Agent requirement. I am the (check one y
Signature ) owner ❑ owners agent.
Telephone No. PERMIT
ELECTRICAL PERMIT NO. INSPECTION REPORT:
ELECTRICAL INSPECTOR - DOUG SMALL
1. ROUGH INSPECTION:
Passed — ' Failed — [ J Re -inspection required ($50.00) -
Inspectors' comments: L y C 0, tel
(Inspectors' Signature - no initials)
2. FINAL INSPECTION:
Passed — [ J Failed — [ j Re -inspection required ($50.00) -
Inspectors' comments:
- no
3. UNDER GROUND INSPECTION:
Passed — [ j Failed — [ j Re -inspection required ($50.00) -
Inspectors' comments:
Date
Date
(Inspectors' Signature - no initials) Date
4. INSPECTION — SERVICE:
DATE CALLED NATIONAL GRID: NAME:
Passed — [ J Failed — [ ] Re -inspection required ($50.00) - [ J
Inspectors' comments:
- no inittats) Date
5. INSPECTION - OTHER:
Passed — [ ] Failed — [ j R -inspection required ($50.00) -
Inspectors' comments:
'Signature - no initials) Date
DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT
ACCESSIBLE AND A RE -INSPECTION OF $50.00 IS TO BE CHARGED.
14
",t'i 0 2 1 7
Date .... . ..�.—....-3.........— / ./
.........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ................ L ..... �� . ................
has permission to perform ............ 5'67/z az C--
.......................................... r ............. 4 ..........
wiring in the building of ............... �7.6..U.LL'...............................................
.... ... ... ... ....
at ..........7A .f ...... ......... North Andover, Mass.
Fee ... 3'5-7oc— Lic. No..... 19YW.........
Check # 2- 4LEC . HUZ . L I N* PE, �R
1,
nn Official Use Only
L.ommonwea& o/ Vamac"
Permit No. 10Z
2ePe nto/-7i,.semica
Occupancy and Fee Checked
BOAR} OF FIRE PREVENTION REGU ATIOKS er: vo-tjIV leave Manic
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (1a Q, 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFO TION) Date:
City or Town of: 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) Vj /1�--f ,Oz 50, /C
Owner or Tenant
Owner's Address
U
is this permit in conjunction with a building
Telephone No.
Yes ❑ No Cheek Appropriate Box)
Purpose of BuBdhig Utility Authorization No.
Existing Sexviee l Gd Amps Z d I Z ° Versus Overluetsd ❑ Undgrd ED,` No. of Meters l
New e yLU Amps ! Volts Overhead ❑ Uudgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Com,Aetion of the fol{owing table may he waived by the hwoectnr of Wires.
No. of Recessed Luminaires
No. of Ceil.Snsp. (Paddle) Fans
o. of
Transformers
Total
KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators
KVA
No. of Luminaires
ve-
Swimming Pool. Q. & ❑
o. o ergency
Battery Units
g
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
Wo—.51 Detection anIuitiati Devices
No. of Ranges
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat mpr o
T...__....__um __....___ns_....... ...
om
o. o - outained
Ilse
No. of Dishwashers
Space/Area Heating KW
Local ❑y�stonoa
❑ O�
No. of Dryers
Heating Appliances KW
Seen
o, of Ihvicess� or Equivalent
No. of Water KW
Heaters
o. of No. of
Slog Ballasts
Data Wiring.
No. of Devices or Eanivalent
No. Hydromassage Bathtubs
No. of Motors. Total HP
ecommun ca onsr
No. of'Devices or
t Int
OTHER:
Attach additional detail if desirea4 or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: k- -7 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 iiabiiity insurance including "completed operation's 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: INSURANCES BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of , that the information ort this application is true and complete -
FIRM NAME: ,D . ,S` ne: i LIC. NO.: )
Licensee: y{ Sizs%� ane Signature LIC. NO.: I%r�I 78
Addresf7fapphs eruu `+� .17U0^/v noywn , in �tldaClt %%� O% .� Bus. Tel. No.; ` �"eS
Alt. Tel. No.:
*Per M.G.L. c. 147, s. 57-611, security work requires Department 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 (chec&one owner ❑ owner's Mtj
Owner/Agent
Signature Telephone No. PERMIT FEE: $
ELECTRICAL PERMIT NO. INSPECTION REPORT:
ELECTRICAL, INSPECTOR - DOUG SMALL
1. ROUGH INSPECTION:
Passed — Failed — [ ] Re -inspection required ($50.00)
Inspectors' comments:
(Inspectors' Signature - no initials) n4+e
2.. FINAL INSPECTION:
Passed — I ] Failed — I ] Re -inspection required ($50.00) - ]
Inspectors' comments:
(Inspectors' Signature - no initials) Date
3. UNDER GROUND INSPECTION: e
Passed — [ ] Failed — { j Re -inspection required ($50.00)
Inspectors' comments:
(Inspectors' Signature - no initials) Date
4. INSPECTION — SERVICE:
DATE CALLED NATIONAL GRID: NAME:
Passed — [ ] Failed — I ] Re -inspection required ($50.00)
Inspectors' comments:
(Inspectors' Signature - no initials) Date
5. INSPECTION - OTHER:
Passed — [ I Failed — { j Reins tion required
Inspectors' comments:
(Inspectors' Signature - no initials) Date
DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT
ACCESSIBLE AND A RE -INSPECTION OF $50.00 IS TO BE CHARGED.
W
Location
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
�
rr1/Frame Permit Fee $
o
sA�N t�' Q� oundation Permit Fee $
r
�9tor Permit Fee $
Sewe®�Ctsnhection Fee $
Q��V1tter Connection Fee $
®• ` TOTAL $
Building Inspector
Div. Public Works
f
Location
Date
TOWN OF N DOVER
Certificate of Occup cy $
ing/F me Perm" Fee
atio Permit Fee $ --
er Perm t Fee $ -
\*6r Connection Fee
��G 2 WVec`Eonnection Fee
TOTAL
Building Inspector
Div. Public Works
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OFFICES OF:
APPEALS
f3UU X)ING
CUNSERVA110N
H EA L"I'H
PLANNING
HONIy
:r:....• Town of
NORTH ANDOVER
Ss�cwun�`
DIVISION OF
PLANNING & COMMUNITY DEVELOPMENT
KAREN H.P. NELSON, DIRECTOR
120 Main Street
North An(iover, • , '
tv1aSSachU5ct1S c)1 H4 5
(6 17) (N 5477 i
In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit
Number �q / 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 III, S
150A.
The debris will be disposed of in:
SQ I` d .
(Location of Facility)
Signat 10f Pcrmit Applicant
Date
,y IAJa
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector.
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FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant
fills
out this
section*****************
APPLICANT: Ar_ rn�s .
Q'1 1'�
�n���
Phonek9 -79),
LOCATION: Assessor's Map Number Parcel
Subdivision Lot(s) /17A
Street I IR, JAuty', St. Number _
************************Official Use Only************************
RECOMMENDATIONS OF TOWN AGENTS:
Conservation Administrator
Comments
Town Planner
Comments
Health Agent
Comments
Public Works - sewer/water connection
- driveway permit
Fire Department Cad��1JA& J-7:11
is rr; r: -Received by Building Inspector
e' 2 8
Date Approved � w
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
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