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HomeMy WebLinkAboutMiscellaneous - 332 RALEIGH TAVERN LANE 4/30/2018N w � W O N O V frn D b= W D m z os z m 6/2/2016 20348 This is an e -permit. To learn more, scan this barcode or visit northandoverma.,iewpointcloud.com/#/records/20348 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that James S Kouyoumjian has permission to perform Reconnect heat pump system wiring in the buildings of MCGRATH. TIMOTHY. J. at 332 RALEIGH TAVERN LANE, North Andover, Mass. Lic. No. 51619 Date: May 18, 2016 Or._ 13 913 q v.. 1/1 ";irae-v<.aers s�tt�cdamna�aure-', x l,'o'/oma.vlewPolnkloud.mm/i;;reax:�;2034^ iii vw Town of North Andover, MA ` 20348 -Electrical Permit - Fixture/Appliance New and/or Replacement (Commercial or Residential) TIMELINE N t i a", ,...... .. Submission mcei%vd May17.MM. . - _ b - c S� - Electrical Permit Review ® 6 Competed May 18, 2016 at 6:55101 �' .P "• -^'•^^--�- _ Pemtt Fee james kouyoumjian 1 332 RALEIGH TAVERN LANE, NORTH Cj Nid M, 18, 2016 It Twam 7787760-5212 (ANDOVER, MA @ jskdodge l@gmail.co.. I nner - �A] Pemic lssuan:e ¢ MCGRATH. TIMOTHY, 1. �F+ Issu^d May 18, 2016 e! 7:39sm Attachments �....---_.......___.... LLplua.<�;e c=rt Wed Wy_18 2016 10:55:.pdf :: . c.,d.d At!— rA------------- Primary Contractor Search far your contractor using the search bar below. Either the Firm's Nome or licenses is - lames S Kouyoumjian - 51619 07/30/20161 cute Type' Jren:e An:v. . �..._. �.Yii �� M 6'r � •S ©� Rl t�1' r4t �t6 � _ Thursday, Jun 02, 2016 03:53 PM 9800 Fredericksburg Road San Antonio, TX 78288 USAW 04664.20RYD.JSS1095358758.01.01.2488 TOWN OF NORTH ANDOVER 120 MAIN ST NORTH ANDOVER MA 01845-2420 Reference: MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B Attention: Building Commissioner I am writing regarding the claim referenced below. Policyholder: Timothy 3 McGrath Reference #: 002747016-26 Date of loss: February 27, 2015 Location of loss: North Andover, Massachusetts Address: 332 RALEIGH TAVERN LN 01845 August 10, 2015 A claim has been made involving loss, damage or destruction of the property referenced above, which may either exceed $1000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to my attention and include the reference #. You may submit correspondence or questions to me. My contact information is: Address: P.O. BOX 659460 SAN ANTONIO, TEXAS 78265 Fax: 1-800-531-8669 Phone: 1-800-531-8722 x42472 Sincerely, Elise S Walton Property Unit 8 United Services Automobile Association PO Box 659468 San Antonio, TX 78265 Phone: 1-800-531-8722 x42472 Fax: 1-800-531-8669 3DB/ELW 002747016 - DM -04664 - 26 - 9999 - 01 54577-0715 Page 1 of i Date ...... 0. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... 'TO -14A .................................................................. has permission to perform ........ ��I ...... ........ ....... wiring in the building of ...........AV, F7e.<—a?v........................................... at .....:33..2-..... ........ . North Andover, Mass. ......... Fee, ... Lic. No. dl,�773k*:: ..... --tOCTRICAL i;ZE Check 'q /� 10747 _ (.ommonwea a� /I%a�ac etf� official �use jonly c7Permit No. �S�a,�inen� o�.lira �e,vices - Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS gov,1/67]Oem blank). APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with ffie Massachusetts Electrical Code (IvtEC), 527 CMR 12-00 (PLEASE PRINT. RV B4K OR TYPE ALL INFO IATION) Date: I "Z_,_ City or Town of: o To the Inspector of Wires: By this application the undersigned gives notice o his o; ter intention to perform the electrical work described below. Location (Street & Number) Z(�.o l e Owner or Tenant '1�,-4,,..t 1,-, Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No a-- (Check Appropriate Boa) Purpose of Building Utility Authorization No. Existing Service Amps / Volts New Service Amps / volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Overhead ❑ undgrd ❑ No. of Meters Overhead ❑ undgrd ❑ No. of Meters Completion ofthe followinr table may be waived by the Imnector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp..(Paddle) Fans of d Transformers KVA No. of Luminaire Outlets No. of Hot Tabs Generators KVA d No. of Luminaires Swimming -Pool Above Q ❑ d. d. o. o cy Lipting Butte units Units No. of Receptacle Outlets No. of Olt Burners FIRE ALARMS.. No. of Zones No. of Switches No. of Gas Barriers o etechon an o. Initiating Devices No. of Ranges No. of Air Cond. Toonnss No. of Alerting Devices - No. of Waste Disposers eat mp Totals• am er ons o. o Self -Contain . etectioRW2 . Devices No. of Dishwashers Space/Area Heating KW Local Coin%on ❑ Other No. of Dryers heating Appliances KW ceNa of Devices or F4uivalent No. of Water, Heaters No. o o. of signsBallasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wrungg•. No. of Devices or E rnLnt OAR: - - - - ori Attach additional detail ifdesired or as required by the Inspector of Wires. Estimated Value of Electrical Wo 17610,(When required by municipal policy.) Work to Start: Inspections to be requestedin accordance with NEC 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 adu'bited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Licensee: ,yA,i— L < (Ifapplicabk enter "exempt Address: — r ' *Per M.G.L. c.147, s. 57 OWNER'S INSURANCE required by law.. By my sig Owner/Agent Signature _ Signature _ LIG NO-- LIc.No.: 7z.9Sr73 C - Bas. Tel. No.:7&/ - 7'Z( PIM Alt. Tel. No. rdy work requires0epartment of Public Safety "S" Licence: Lic. No. MR. I am aware that. the Licensee does not have the liability insurance coverage verage normally below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent Telephone No. I PERMIT FEE: S l�o �'�� �'� � ��� �.-- ���-� n�. o � � ashmgtox Street kvl] I 1/Bost^ MA 02111 li ww.mass.gov dia 'Worke& Compensabon bmance Affidavit: Bwlders/ContracionAgectncimm&lumbet s Apel;cant Information Please Primf Leailtly Name (Buttaslorg magonlladividttat?: Address: '13 O�� Q �ty cit)-1su zip: -Vlbbg raD G 1 LO t Phone#: 70 g q l -110 0 Arg- an eruployer? Check tate appropriate bor. 1. MI am employerwidx_& 4. [ I am a general e€ n ar or and I employees (full and/orpart iimel* have Utd1he sub-cottactors 2.E] I am. a soleprgd-dor orpartuer- ship snd'have no employees luorldng farmein anympacity. [No workeW comp. 3.Srance 3.01 am ahomeovmer doRg all work nW8e1f [NO WOdM txtmp. insurancerequimik) f listed on €lis aftached sheet t These sub -matadors have workm' comp. iasunmce. 5. [J— Weare a empordion and its officers have exercised their A& ofexemptionpermM c. 15% §I(4), aadwehmno employees. [No workers' of project {required): 6. ❑ Now dm&actioa 7. [ Remodeling 8. Demolition 9, ❑ Bail -ding addition. 10.eElecWoal repairs car additions I I.n Plumbing rep & or additions 12.Q Rcofrepairs 13.1 Offwr �A3n,T'r�t�atck�ixrr�T m�Tatsai�i aut�zeser�ioabs�ivtsi�nwi�igi6egwtakets's�mp�fionpolicyfinfm�ation. �hwv�nersw?wrJimirthis�4d�r�ind�tmgbc��tidoingsSiwosksndEeeahireouLsid�coofa�st�ustsnhmits�waf edaviti�c�ingsue�s. �Co res t2 caAfhissbcanuAayacbedanofthesut-ontno bMend theirworka ecomp.policy brOMa£ion. Ftrtn an e.�ts�7a}���cat irprorid%tg x/orkers' crrnrpersatian uunrancefvrrry er�loyee� Eelow is thepnllcy crrrdgub �e informadom Insurance Company lob -Site Address: 332- - ,CityI8taWZig- Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Page to secure cor/r age as ragWmdundar Section 25'A ofMGL c.152 can lead to the imposition of cdmind penalties of e A fine up to $1,500.00 andJor one-year imprisonment, as weltas cirri penalties in the foam of a SMPWORK ORDER and a tine of up to X50.00 a day against lite violator. Be advised faaa copy of Ikb statement may be forwaded to the O$xee of Investigations of the DIA for insurance coverage ve Ywation. I ate hereby certify milder iiseyaias andpelwWks qfpe*uy that #Tie i ftrxmttoa;pr»viW above Is bre and cornet. OffWal use only. Dv not wMe in this area, to he completed by city of town Official City or flown: _-- — Pe�nzit/iee�nse Issuing Authority (circle one}: 1. Board of Health 2. Building Dq mrt ment 3. Cit Mown Clerk 4. Metrical Inspector 5. p'ltunbing Inspector 6. €Dfher - - Contact Person: Phone v: DATE: ` TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD (example: left front of house) kous-�- DATE OF PUMPING: ` 1q -L). -QUANTITY PUMPED DO CESSPOOL: NO YES S TIC TANK: NO NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: COMMENTS: GALLONS YES FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) CONTENTS TRANSFERRED TO: 6, C, `J TOWN OF V SYSTEM PUMPING RECORD DATE: " -9 2003 SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: QUANTITY PUMPED: < � GALLONS CESSPOOL: NO -- YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: