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Home My WebLink AboutMiscellaneous - 11 ANVIL CIRCLE 4/30/2018 / 11 ANVIL CIRCLE 210/107.13-0170-0000.0 F J SUBURBAN ADJUSTMENT 226 LOWELL STREET, SUTTE B5 WILMINGTON,MA 01887 978-988-5959 FAX 978-657-8969 Form of Notice of Casualty Loss to Building Under Mass. General Laws Ch. 139, Sec. 3B TO:Building Commissioner or Board of Health or Fire Department or Inspector of Buildings Board of Selectmen Arson Squad City or Town Hall City or Town Hall City or Town Hall North Andover,MA 01845 North Andover,MA 01845 North Andover, MA RE: Insured: Amy and Marco Pallota Property Address 11 Anvil Circle PolicyNo .• HMA0239112 Loss of: 08/01/2014 File or Claim No.: 14137 Claim has been made involving loss,damage or destruction to the above captioned property,which may either exceed$1,000.00 or cause Mass.Gen.Laws,Chapter 143,Section 6 to be applicable. If any notice under Mass. Gen.Laws,Ch. 139 Sec.3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured,location,policy number,date of loss and claim or file number. Brian Merrick Property Adjuster i On this date,I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. 08/10/2014 Signature and Date I Addlilkh, Safety Insurance Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall NORTH ANDOVER,MA 001845- NORTH ANDOVER,MA 001845- RE: Insured: AMY PALLOTTA and MARCO PALLOTA Property Address: 11 ANVIL CIRCLE,NORTH ANDOVER, MA Policy Number: HMA 0239112 Claim Number: BOS00044603 Date of Loss: 8/1/2014 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Lisa Poente Claim Examiner 8/4/2014 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 5333 Fax: (617).535-5811 Email: LisaPoente@Safetylnsurance.com Safety Insurance Form of Notice of Casualty Loss to Building . Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845 RE: Insured: AMY PALLOTTA and MARCO PALLOTA Property Address: 11 ANVIL CIRCLE,NORTH ANDOVER, MA Policy Number: HMA 0239112 Claim Number: BOS00039208 Date of Loss: 9/4/2013 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Daniel Olsen Claim Examiner 9/6/2013 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3323 Fax: (617) 531-2762 Email: Danie101sen@SafetyInsurance.com 2012 Massachusetts EIectrical Code Amendments 527 CMR 12.00§Rgle 8: In accordance-with the provisions of M.G.L.c.143,§.3L,the f f 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.01 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. Z Permits shallbe limited as to the time of ongoing construction.activity,and may be,deemed-by-the dnspector_of_Wires abandoned-md.invalid.if he—. or she has determined 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 on the.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 this purpose by establishing an automatic four-year extension to certain-permits-and licenses concerning the use or development of real 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. ule,8—Permit/Date Closed: Z- _y/ **Note:Reapply for new permit 0 Permit Extension Act—Permit/Date Closed: 96b4 Date..... Z.U.::. TOWN OF NORTH ANDOVER PERMIT FOR WIRING .o*.T.. S.IS S CH S This certifies that ......... 2 ............................. has permission to perform ........ ................ wiring in the building of............ ..........................7...r....................................... at........... r/ ..................... .North Andover,Mass. Fee W�t ........... Lic.No ................. DLECTRICAL INSPECTOR 7 Check V ' -• LIUM11"U//WICal"I UN /'YG8.9�686s0/6d�47U 6►8 -� j Department of Five Services PernutNo. ��sy Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank `M 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: dpl0 City or Town of. NORTH A"OVER 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) A)O Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box),;?j k-,201( Purpose of Building /� 4) 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:' Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.of mergency ig ing No.of Luminaires Swimming Pool rnd. grnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Detection and No.of Switches toNo.of Gas Burners Initiatin Devices Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat,PP Pump Number Tons KW No.of Self-Contained Detection/Alerting Devices Space/Area Heating KW Local❑ Municipal F] Other No. of Dishwashers Sp g Connection Heating Appliances KW Security Systems:* No.of Dryers No.of Devices or Equivalent No. of Water No.of .'No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent ti 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: l 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. /1 CHECK ONE: INSURANCE 0 BOND ❑ OTHER ❑ (Specify:) X certify, under the pains and p ties of perjury,that the information on this application is tr a and conzptete. FIRM NAME: LIC.NO.: Licensee: gem& Signature LIC.NO.: e�6 (If applicable e er "xen pt"iryie license ber line us.Tel.No.: 2 Address: Alt.Tel.No.: Z *Per M.G.L c. 147,s.57-61,security work requires eparhnent of Public Safety"S"License: Lie.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 Owner/Agent PERMIT FEE: $ Signature Telephone No. The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 �� ,,•• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Leizibly Name(Business/Organization/Individual): ��,f ( d •/L�✓ Address: City/State/Zip: k/N 1 hone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑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. ❑Remodeling ? ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.El am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. .p $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. +� I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: 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 c. 152 can lead to the imposition of criminal penalties 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$250.00 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. I do hereby certi n r the p 'ns a d alties of perju at the i ormation provided above is true and correct. Signature: Date: / Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# 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#: Dateg �'.40 RT" TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING Q "SA us This certifies that.` "'. . .�.�. . . . . '. .1 : . . . nn ^^S—� k } 5 ► ►� has permission to perform . .ice! . . . . . . . . . . . .ci . . . . . . . . . . . . . . . plumbing in the buildings of . n ��IJ . . . . . . . . . . at .�.�. . .4�.�.�. . C r G v . . . , North Andover, Mass. Fee. .!�. . . .Lic. No.. . .9.331 1. . . . . . . . . . . . . . . . . . . . . . . . . �-? PLUMBING INSPECTOR Check # 8677 ASSACHUSETTS UffORM APPLXCA.TXON FOR PERP TO]DO PLUMBING Ii� (Type or print) NORTH AND OVER,MA.SSACHUSEM Date I Q o f u l o.rc`•t Owners Name N tw �a� Permit# " - Building Location Amount Typb of Occupancy ?S; IL New Renovation � Replacement Plans Submitted Yes El No FIXTURES ° LD N ° rnE a , " a � � w � � a• w a � � w � � P-, a ° a d A a E-t m A a W 1Jll�'�1�J.1a 2ND FIJOCR annom 41aNJOcR 5xEr-OCR 6]HH!()(R nlerFr�oa� Check one: Certificate (Print-or type) P+�} Corp. Installing CompanyName S�. Address 1- ` Partner. Business Tel 701 ` 3Cs'7-/d-5S Firm/Co, Name ofUcensed Plumber: _ Insurance Coverage: Indicate the type of insurance ro;ver#e by checking the appropriate typbox: Bond El Liability insurance policy El Other e of indemnity. El ,Insurance Waiver: I,the undersigned,have been made aware that the licensee o£this application does not have any one o£the above three insurance _ Signature � Owner � Agent ti 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 my1mowledge 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 Plum ode d hapter 142 of the General Laws. By: 'Signature o rcens um er Type of Plumbing License Title r9331 - City/Town cense um er Master Journeyman APPROVED(0FHC]3 USE ONLY - s The Co rnnZonverzlth of Alassachuseas d)CPnttment o f£radust ialAccidents Office Of)Wvestioations 60.0 Waslzingtorz,Street .$octan, 3LI 02.71-7 • IMM-nzccsagovIdia Workers' Compeniyation Insurance Affdaldt:$enders/Contractors/Electricians/Plumbers �.n licantInformation Please Print Legibly Name (Bus-iness/organization/Individual): t _ tAA03 1✓ City/State/Zip: c �j� c�c� �'il►a U lQi�;-Phone#: 781-3o7-16 -Are you an employer?Check the appropriate box: LEI I ant a employer with 4. ❑ I am a a Type of project(required): . bin eral contractor and I employees(full and/or pant time).* have hired the sub-contractors �" ❑Near construction 2. P am a sole proprietor or partner- Misted on the attached sheet.t 7• ❑Remodeling A ship and have no employees These sub--contractors have working for mein any capacity: workers' comp,insurance S' El�emO�hon [No workers'comp. inc,l,�nce �. 9. (]Building addition p ❑ We are a corporation and its 3.[] required.] ofncers have exercised their 10.[]Electrical repairs or additions .r am a homeowner doing all work right Of exemption per MGL 11.[❑Plumbing repairs or additions myself.[No workers'comp. c. 152,6-1(4),and we have no inrancerequired.] t employees. [to �„ workers' 12•❑Roof repairs comp., snraanc�required] 13-Elother `n,'zPPBcaut that 65ckss bov m i u� •^af also MI Cwt Flomeowness who submit'this affidavit indicatia th ,a— oxi�s co�Y s�oa• •t: ...,..^ Y"•'J cilir.-.icruu. g 3e:Ti�au ane then hireoutside contactors gist b it a new amdavit mdirating such. +Connectors fhatchecr� Tt_9 bo, attached aadiIIonai sheet showing the:aame•of the sub-contractors and tiieirwarkers'comp.polka,informadou. .f am an employer that is providing workers'compensation insurance for my employees Beloitr is the poficJr andjob site. information. Insurance Compiny Name: Policy#or Self-ins.I,ic.#: 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 c. 152 can lead to the imposition°f criminal penalties of a Ent up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form o=a S Of up to$250:00 a da a TOP WORK ORDER and y gainst the violator. Be advised a nee vlsed that a copy of this statem Investigations of the DIA for insurance coverage verification ent may be forwarded to the Office of I do hereby certify under the pains and peizaltaes ofperjury thczz the rn•farmauon provided above is true and correct SieAature: _ -- Date• _. Phone#: Official use only. Do not write•in this area, to be completed by cite or toren offzciaL t Cita=or Town: I ermitUcensg# Issuing Authority(circle one): I.Board of Health 2.Building,Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person:--. Phone'#: � Safety Insurance Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845 RE: Insured: AMY PALLOTTA Property Address: 11 ANVIL CIRCLE,NORTH ANDOVER, MA Policy Number: HMA 0239112 Claim Number: BOS00037033 Date of Loss: 4/20/2013 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Allan Leavitt Claim Examiner 4/23/2013 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3213 Fax: (617) 531-8891 Email: AllanLeavitt@SafetyInsurance.com Date. No r 7 O RT:��, TOWN OF NORTH ANDOVER ° PERMIT FOR PLUMBING SACHUS� This certifies that . . ? . . :I• . has permission to perform . . . .. . . . .. ... . . . . . . . . . . . . . . . . . . plumbing in,the buildings of . r.?. .. ... . . . . . . . . . . . at;�/. . . . . . .. . . . . . . .. . . . . . , North Andover, Mass. '. . . .Lie. No.. . . . .. . . . . . . . . . . . Pl, WING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) A/f/N6DVL2 Mass. Date' Permitq Building Location // AVV'4- ell- Wr `6 Owner's Name pUCTE NOtiIE Cde�r /1£S I6Ctjjzd L- Type of Occupancy r New K Renovation ❑ Replacement O Plans Submitted Yes No O ( FEATURES ` z z cn cn m z V5 w cn W x " a rn Y * a a U z O � Cr Q Q w 0 Q J Z Q n .O li CC z _ 3 0 z = 3 Y a ¢ z z w Y w Q z a cn f- Y CO cn o 0 5 3 = ►- to LL 0 5 o ¢ 3 m m o SUB•BSMT. BASEMENT ' 13T FLOOR ' 2ND FLOOR 3 Z 3RD FLOOR 4TH FLOOR Y 5TH FLOOR. 6TH FLOOR 7TH FLOOR -44-H- 8TH FLOOR Installing Company Name FRAZ/ER t/ l(�Eu S /ti(�U�I�rI�IC/1(_ Check one: Certificate Address P. y, r�0 X S3 9?""Corporation 2 f G 0 C M' q QS/F3`�� O Partnership Business Telephone 978'681-77/ O Firm/Co. Name of Licensed Plumber 1'HA2L1S 20CS/.t>S Y INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes O No O If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy ❑ Other type of Indemnity O Bond O OWNERS 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: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent 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 for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By 5 9t&-i:Cj gna ure o censePlumoer Title Type of License: Master)< Journeyman O Ciry/Town License Number l S6 8 APPROVED OFFICE USE ONLY) Location .0 rJ I `t'�, ;4 �� t `rc IC No. c Date 5-9- 01 �oRTM TOWN OF NORTH ANDOVER f �,y 3j � SOL 1- 9 ►; ; Certificate of Occupancy $ Los s orb+,�Y `: • NusBuilding/Frame Permit Fee $ ~ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # c oo 3 S Building Inspector APR-09-2001 04 :36 PM MARCHIONDA&ASSOCIATES 781 438 9654 P. 02 u7 U5� I A Ut ' l t vc 1� S58'53'28"W 45,49' 3 4 S63'41'0 7' S52'07'56"W 17,667 16.95' � S73'51 04 w 22.76' DGE OF WETLAND '- - IN IN i EASEMENTS _ 72.2' I I Iry �rF o S,o �.. _ � Qy� �9 S� mac,c, i I c i SPACE 37.9 EX. CEL 'C' p EL-150.09' I o I or I EXISTING �n 51.0' 15.4' z I EASEMENT ACCESS I � LQT 46A I i 55A cn LL 18986 S.F_ I I 11283 S.F. a w i 0.44 Ac. 0.26 Ac. 68.2 I IN OF 40.g4, STEP �tUC 03-9 .Q c4•�'s No. 39049 O �0., � `5,x.•6' C/ � .... � Oo �o ,�,oJ GSR o� of fs WE HEREBY CERTIFY THAT WE HAVE EXAMINED j THE PREMISES AND THAT THE BUILDING IS LOCATED THIS PLAN IS INTENDED FOR ZONING AS SHOWN. THE STRUCTURE SHOWN CONFORMS PURPOSES ONLY. IT WAS PREPARED TO THE ZONING LAWS OF THE MUNICIPALITY FROM EXISTING PLANS AND RECORDS WHEN CONSTRUCTED, ALSO, ACCORDING TO THE WITH THE STRUCTURES SHOWN LOCATED F.E.M.A•/H.U.D, FLOOD INSURANCE RATE MAP, BY AN INSTRUMENT SURVEY, THIS PLAN DAM COMMUNITY NO. 50098 0015TURE SNOT LOCATED LINESHOULD NOT BE USED FOR PROPERTY IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE. LINE DETERMINATION, CERTIFIED FOUNDATION PLAN LOT 46A FOREST VIEW ESTATES MARCHIONDA & ASSOC. ,L.P. NORTH ANDOVER, MA ENGINEERING AND PLANNING CONSULTANTS PREPARED FOR 62 MONTVALE AVE, SUITE I PULTE HOME CORP. OF NEW ENGLAND STONEHAM, MA. 02180 257 TURNPIKE ROAD SUITE 200 (781) 438-6121 SOUTHBOROUGH, MASSACHUSETTS 01721 1 SCALE: 1 =40 DATE. 4/9/01 ,. ° �' : 3 3 Date....7/171/... t gOR7M, ti 0� TOWN OF NORTH ANDOVER A PERMIT FOR WIRING SACNUSEt This certifies that .... ...!.C �ct.......... G J 1-c . n ................................ ................................... has permission to perform �v�. !� J' ....... ........................................................ � r wiring in the building of...... ....4A..`..`.�:.......OA1 1 z................................ 'J at ry �.t. r� c �e at................................. ........l.................. ............. *North A nd over,Mats. 4 Fee,<.O:.�'. Lic.No:46:.J "*./ .... r�`-' ..Y...r.............. / �LECTRICALINSPECTOR Check i'I WHITE: Applicant CANARY: Building Dept. PINK:Treasurer The Commonwealth of Massachusetts Ptrm 11 °T" No. Department of Public Safety 3Ck "-CV f+• Chrck.d Ik■�r bt■nkl BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12-00 APPLICATIONtoFORmePIERo � All"rk peridance MITTO PERFORM ELECTRICAL WORK the Mattach"Setts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR E ALL IiFORMA,TION) Date City or Town of To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) O.Ter or TenantS r� QQr,J Owner's Address CJiJiYl.111nd /�/.L � /j°J�. Is this permit in conjunctio ith a building Permit' Yes No ❑ (Check Appropriate Box) Purpose of Building E z Utility Authorization N0, d ot Existing Service o .6 Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service 2yt) Amps /L� /Z''`` --------- 7'O Volts Overhead ❑ Undgrd a No. of bete.- f s f Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work r No. of Lighting Outlets Total No. of itot Iubs No. of Transformers " Z No, of Lighting Fixtures Above ❑ In- INA mm = Swiing Pool No. of Receptacle Outlets grnd. grnd, ❑ Generators KVA No. of Oil Burners No: of Emergency Lighting 3 No, of Switch Outlets N. Batte Units No. of Gas Burners FIRE ALARMS • No. of Zones oNo. of Ranges No. of Air Cond. Total No, of Det tons ection and No. of Disposals Heat Total Total Initiating Devices _ W No. of J Pumes Tons KW No. of Sounding Devices D No. of Dishwashers XSpace/Area Heating KW No, of Self Contained t< = Detection/Sounding Devices a No. of Dryers Heating Devices KW Municipal Local❑ t ❑Other t LL No. of Water Heaters KW No, of to, o Connection 7 1 Signs Ballasts Low Voltage Ix Wirin o No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES® NO[] I have submitted valid proof of same to this office. If you have checked YES, please indicate the type of coverage by checking the apprYES[A NO INSURANCE ® BOND ❑ OTHER [—] (Please Specify) opriate box. Estimated Value of Elec Uical Work S Expiration ate Work to Start WILL CALL Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME _JAMES E. BUCHANAN ELECTRIC INC. ------ Knot�av-,,� LIC. tro.A15616 Licensee JAMES E. BUCIIANAN ----- Signature LIC, NO. E32062 Address P.O. BOR 544 SUTTON MA 01590Tel, No. 508-865-3335 OWNER'S INSURANCE WAIVER: I am aware that the Licensee doA It. nsurTel.ancecoverage oritssub- stantial equivalent as required by Massachusetts General La , my signature on this permit application waives this requirement. Owner Agent (Please check one) Signature of Owner or Agent Telephone No. PERMIT FEE S zSQ No Date.... d./ _ � . � / ......... a f N°RT"1 ° ,"`° ''•"� TOWN OF NORTH ANDOVER 3: ��,r .......,• of PERMIT FOR WIRING ,& ACNUS� This certifies that ..... !A cn ,,,.......�= � C�..2..!.� ............. has permission to perform .�. N v�l��- . . :.............................................................. wiring in the building of.....R LA.. .4.E......... ............................... at.... ��1.,.!):..�....�.:..%.,4//. e ........................... .North Ando er,Myass,/' Fee.. .5.....:v�.. Lic.No.,I.t / -616.................�...... EL•ifcrRICAL INSPECTOR Check ;!t �d 7d v WHITE: Applicant CANARY: Building Dept. PINK:Treasurer oaf. U•. 0MV life Commonwealth of Massachusetts P-11 No •� PfeClcevn•„cy �- �/ Ugx�rtmcnl of Public Sdy I/90 - �C\ 13OA110 OF FARE PREVEN110N REGULA110NS 527 CMR 12-00 it,-li t APPLICATION FOR PERMIT- TO PERFORM ELECTRICAL WORK All "rlt to be ptrlormed In acrordenct wllh list MO-9-11nstlle Elechkal Code, 527 CMR 12:00 (PLEASE PR11Tr Ill DIK O xyi'G A1.I, I1IEORIIATIO11) Date �6/�/ City or Town of. L-x,11 1 WZ— To the Inspector of Wires: The undersigned applies for a permit to perform tiit! electrical work described belov. Location (Street S Number) I I �`J L, \— b IZ.L'Lir 4 6 Owner or Ienant-FV L-7Z JAC>h l W Ql— +-48- 'j g•1 -Ouc'z. Owner's Address 25`7 TU Tz19 P I Y,(—= AIt, Z,->c QL.MAZDJKX��c>1 7 �-Z- Is this permit in conjunction with a building pet-nit: Yes No r_1 (01eck Appropriate Box) Purpose of Building NL1.J t-1UMi- Utility Authorization 110. 11v1 -tsc't Existing Service Amps / Volts Ovethead 11 Undgrd ❑ it,,. of lieters New Set vice —Amps IZV / Z4�Volts Overhead U Undgrd t1o, of Tlete;s } N=ber of Feeders and Ampacity_ j ` Location and Nature of Proposed Electri.cal Work '0 No. of Lighting Outlets Ito. of Ilot Iubs No. of Transformers Total u _ KVA Z No. of Lighting Fixtures Swimming Fool Above in- grnd. — grnd. a Generators KVA i No. of Receptacle Outlets No. of Oil Burners No. of Emergency lighting Battery Units No. of Switch Outlets • No. of Cas Burners FIRE A1ARli5 No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and ° tons Initiating Devices W No. of Disposals T1o. of 11cat Total Total W PCPs Ions KW Tlo• of Sounding Devices D No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices ti No. of Dryers Ileating Devices KW Local 0 ttunicipal t Connection❑Other u° No. of Water Heaters KW 110, of Ito. low Voltage Signs Ballasts Wiring a No. Hydro Massage TubsNo. of Tbtors Total IIP OTHER: + INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES[@ NO[] I have submitted valid proof of same to this office. YESIN Ito (] If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ® BOND 0 OMER 0 (Please Specify) te Estimated Value of Electrical Work S � — WILL CALL, expirationa Work to Start Inspection bate Requested: Rough Final Signed under the penalties of perjury: FIRM NArae__JAMES E. 13UCIIANAN ELECTRIC INC. I,tC. 11.,.A15616 Licensee JAMES E. BUCIIANAN Signature LIC. NO. E32062 Address P.O. BOR 544 SUTTON MA, 01590 Bus. Tel. No. 508-865-333 Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee Idoest havethe Insurancecoverage or is sub- stantial equivalent as required by Massachusetts General � and that my signature on tris permit application waives this requirement. Owner Agent (Ptease check one) /1 Telephone 110• PERMIT FEF. S r a~ `� Date.... .. ............ ............ f 3 raORTF� °f^"`°:•'"° TOWN OF NORTH ANDOVER °t ' PERMIT FOR WIRING ;,SSACMus This certifies that .......L✓...` �.�.��..4� . ..........�_ ............................................ ' ' has permission to perform P `v! S f �? yr< wiring in the building of....... ......... .............................. at.........Il.....,, .h...l lU..'....�/� � ...............�,North Andover,Mass. 11411 c Fee..3��0.A. .. Lic.No.dr1.644.......... ...... J ELECTRICAL INSPECTOR Check # / G� WHITE:Applicant CANARY: Building Dept. PINK:Treasurer The C017 MOnwealth of Massachusetts p.,.,,1, No. °T""' '" On S13 Deportment of Public safety �.nev 3/90 rr..,. + tom. ctiK4.,1 BOARD OF FIRE PREVENTION REGULATIONS 527 CMR JZ:W b1.n41 APPLICATION FOR PERMIT TO PERFORM RM ELECTRICAL WORK performed In accordagce wrlh the Mee:achu:eus EteclNea) Code. 527 CMR 12:00 (PLEASE.PRINT IN INK OR E A. L INFORK&TION) Date City or Town of NU42Z t To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street b Number) O�.rer or Ienant t/C � Owner's Address 25` f✓x.,i s ccs �2.J '�`2vc� Is this permit in conjunction with a67,190 -7`7 2— building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building M,.4 Utility Authorization N0. 4 v Z U 8 Existing Service Amps / 201ts Overhead ❑ New Service Undgrd ❑ No. of Meters 9 /e Amps/�j / 7 O Volts Overhead ❑ / NuabUndgrd D— No. of Meterser of Feeders and Ampacity 3 ,¢�••� Location and Nature of Proposed Electrical work �— No. of Lighting Outlets u No. of Not Iubs No. of Transformers Total Z No. of Lighting Fixtures KVA i Swimming Pool Above in- grnd. ❑ grnd. ❑ Generators KVA NIKK o. of Receptacle Outlets No. of Oil Burners No:' oE Emergency Lighting 3 itets No. of Switch OutlBatte Units No. of Cas Burners FIRE ALARMS ' N'0. of Zones tons No. of Ranges No. of Air Cond. Iotas No. of Detection and l of Disposals Initiating Devices m . posas Heat Total Total w No, of p� s Tons KW No. of Sounding Devices J No. of Dishwashers X Space/Area Heating KW No. of Self Contained No. of Dryers Detection/Sounding Devices Ir Heating Devices KW Local ❑ Municipal '--- y LL No. of Water Heaters Ku No, of o, o Connection❑Other Si nsBallasts Low Voltage o No. Hydro Massage Tubs Wtrin �. No. of Motors Total HP 9 OI11ER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES® NO❑ I have submitt If you have checked YES, please indicate ed valid proof of same to this office. YES[N NO the type of coverage by checking the appropriate box. INSURANCE ® BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work S _5,e c, R xpiration' ate Work to StartWILL CALL Inspection Date Requested: Rough Signed under the penalties of perjury: g Final FIRM NAME _JAMES E. BUCHANAN ELECTRIC INC. Licensee ^ JAMES E. BUCgANAN LIC. tr,.A15616 Signature LIC. NO. E32062 Address P.O. BOX 544 SUTTON MA 01590 Bus. Tel. No. 508-865-3335 Alt. Tel.OWNER'S INSURANCE WAIVER: I am aware that the Licensee doe of have the insurance coverage or is sub- stantial equivalent as required by Massachusetts General ws� and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Signature of Owner or Agent Telephone No. PERMIT FEE S�D