HomeMy WebLinkAboutMiscellaneous - 133 AUTRAN AVENUE 4/30/2018 (2) 133 AUTRAN AVENUE U-B
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BUTTERWORTH & O'TOOLE, INC.
P.O.BOX 8294
SALEM,MA 01971-8294
ADJUSTERS/APPRAISERS
FOR INSURANCE COMPANIES ONLY
TELEPHONE(978)741-5731 FAX(978)740-9109
April 06, 2004
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 Selectmen
City/Town Hall City/Town Hall
ADDRESSES
North Andover, MA 01845 North Andover, MA 01845
RE: Insured: Terry and Margaret Cook
Address : 133 Autran Avenue
North Andover, MA 01845
Policy No. : F0112982
Loss of : 04/02/04
File or Claim No. : 041-0727
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,
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.
If no reply is received from your office within ten days, we will assume
you have no liens of any type against this property and we will recommend to the
insuring company that this claim is paid.
Vicki Gardner
Adjuster
Date...dL .................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
I, -SQIWAW
ACMUSEt /
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This certifies that. ...r•c.�. .,... ....�_ .....:...: ...r.......:.........................
has permission to per`form..�f:. ��!. !. `....A .......
�wiring in the
/biii�ldi'ng�'of.�-...../...r:;�....................................................... .
at l /., , !:...! : --t ......../North Ando e r,Mass.
Fee..Z. :--�....� Lic.No./ ... ! i .. 1. � �...
ELECTRICAL INSPECTOR
Check #
`57
5J L 8 e
i
- Commonw al th of Massachusetts Official us n y
�Q& Permit No.
ria Depa ment of Fire Services
'I Occupancy and Fee Checked
N. BOARD OFF RE PREVENTION REGULATIONS [Rev. 11/991 (1,,v,.blank ,
APPLI ATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All wo to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE P NT IN IN OR PEA I O AT N) Date: --`���/�
City or To of. To the Inspector of Wires:
By this applica ion the ndersi d gives noti of his her in ntion top erform the electrical work described below.
Location(Stre t& um er) �, /
Owner or Tena Telephone No. g - �
Owner's Address
Is this permit in conjunction with a building permit? Yes. ❑ No (Check Appropriate Box)
Purpose of Building Utility 4puthorization 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: _ Installation of Security system
�I
Completion of the followin table maybe ivaived by the Inspector of Wires.
No. of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No. of Total
Transformers _ KVA
No.of Lighting Outlets No.of Hot Tubs Generators KVA
Above In_ o.oEmergency ig i mg
No.of Lighting Fixtures Swimming Pool grnd. ❑ grnd. ❑ Batter Units
No.of Receptacle Outlets 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. TotalTons No. of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: I Detection/Alerting Devices
No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:
No.of Devices or Equivalent
No. of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
y b No.of Devices or Equivalent
OTHER:
ti Attach additional detail if desired,or as required by the bispector of Wires.
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.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
(Expiration 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, ruinerhe pains and penalties ofpeijuiy, that the information on this application is true and complete.
FIRM NAME: ADT Secwrity Services 12 ClAt6nLIC.NO.: 1
Licensee: John S. Bassett _ Signature j' < /C 'Y-=-a ~�- LIC. NO.: 1533C
(lfopplicable, enter"exempt"in the license number line.) Bus.Tel.No.: 603 594 5928
Address: ' / Alt.Tel.No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability instuance 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
Signature Telephone No. PERMIT FEE: $ �