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Home My WebLink AboutMiscellaneous - 148 MAIN STREET 4/30/2018 (32) )V/o PICAMERICAN CLAIMS SERVICE IDTO MULTI-LINE ADJUSTERS EWA V BUILDING COMMISSIONER OR BOARD OF HEALTH OR INSPECTOR OF BUILDINGS BOARD OF SELECTMAN 1600 Osgood Street North Andover, MA 01845 RE: INSURED: Suzanne Kramer PROPERTY ADDRESS: 148 Main Street, North Andover POLICY NUMBER: PHOO100814819 LOSS OF: 04/05/14; Water Damage FILE/CLAIM NUMBER 30801 PD Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed $1, 000 . 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 the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim file number. i Craig Gillespie Claims Representative 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. Unless we hear from you within the next 10 days, we will not be obligated to pay any portion of this claim to you. Date 04/07/14 7 KIMBALL LANE, BUILDING C, LYNNFIELD, MASSACHUSETTS 01940 TELEPHONE (781) 245-9516 - FAX: (781) 245-1077 LaMarche Associates 5 North Road, P.O. Box 250 Chelmsford, MA 01824 978-256-8586 Fax: 978-256-8590 May 8, 2014 Building Commissioner/Inspector of Buildings NORTH ANDOVER, MA 01845-2448 Board of Health/Board of Selectmen NORTH ANDOVER, MA 01845-2448 NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B Claim has been made involving loss, damage or destruction of the property captioned below, which may either exceed $1,000.00 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 the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss, cause of loss and LA file number. Insured: LINDA MONTMINY Loss Location: 148 MAIN STREET, UNIT 204 NORTH ANDOVER, MA 01845-2448 Policy Number: PHOO100798103 Date of Loss: 2/24/2014 Cause of Loss: Water LA File Number: MA-2-24491 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. Cara Murphy Adjuster LaMarche Associates,Inc.-800-349-1525 Page 1 of 1 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Insured: Nancy Riley Property Address: 148 Main Street, Apt. C236 Policy Number: H012050919 Date/Cause of Loss: 1/13/2013, Water Heater Let Go File or Claim Number: 28821-R Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 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 the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Ryan Werner On this date, I caused copies of this Notice to be sent to the per ons named above at the addresses indicated above by First Class Mail. Signa re and Date ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Insured: Marjorie Lyle Property Address: 148 Main Street, Unit 221 Policy Number: HP1659872 Date/Cause of Loss: 7/10/2014, Water/Washing Machine Leak File or Claim Number: 29898-R Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 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 the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Ryan Werner 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. Sign to and Date ANDERSON ADJ TMENT CO., INC. 50 Nashua ad, Suite 303 PO ox 1098 Londonderry, NH 03053 Libqy Mutual, Liberty Mutual Insurance New England Region Central Property Unit INSURANCE 75 Sylvan Street Danvers,MA 01923 Tel:(800)566-0323 March 10,2015 Town of North Andover Attn: Building Inspector 120 Main Street North Andover,MA 01845 Re: Property Address: 148 Main St Unit 0301,North Andover,Ma 01845 Policy Number: H6521801992570 Underwriting Company: LM Insurance Corporation Claim Number:031603431-0001 Date of Loss: 1/23/2015 Attn: Town/City Official Pursuant to M.G.L. c. 139, � 3B, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, § 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, X99, if you intend to initiate proceedings designed to perfect alien pursuant to Mass. General Laws, Ch. 139, § 3A &B, or Mass. General Laws, Ch. 143, 5 9, or Mass. General Laws,Ch. 111,5 127B. This letter should not be construed as a waiver or estoppel of any of the terms, conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address,policy number,claim number,and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 9 0 6 U Date. .,. -.1.�. . . ".��7M�� TOWN OF NORTH ANDOVER �? �� •�OCL ♦ s PERMIT FOR PLUMBING s i -: • SACMUS� /► t C This certifies that h `�.... . . . . has permission to perform . . . . . . V' plumbing in the buildings of . 7o AA YA.+. . . . .{. . . . . . . . . . . . . . . . at . . Y. .5,1 .a 1. . . . . , � �North A dover.,. Mass. Fee.3a:4v . Lic. No.. . . . . . . �R—PLUMBIGINSPECTO —' Check # T? i • • WWI it• LI' t t. ' • 1' ew. r\1 � • •� 1. .11' _ .. � �. � •. �, of . ., • I� / •I •, �+ ..� s •t• FA 0 No MOM 1: aft' .�...-�......-�.-...�-.. rld 1 1• •ul.l :m- � • •'' \ It .\I•' :1• :1// i/. 1 111)it• • /1 1 /: !•1 /' • 11"t 1•' '-tlt '"'!\( 1 t- • ' n(t i• -1 - FAM, ` ■ , I The Commompealt ,,of Massaclursem. K. Ddpirrdit nt ofbidristrlal.46ddeni, .t Office oflnveslxgrt*is 600 Washbigton Sireet S MBoston,MA 02111 . mvw.ntassgov/dla . Worlce& Compensation.Insurance Ai davits Builders/Contractors/Electricians/Ptumbers, Applicant Information". 'Please Print Legibly Name(Business Orgmimdon/individual):�,V/ Vjw ;�,L/l/�• -- �. Address: a& /tOeAAAI.6" e, W, r V,,0 .City/State/Zip: hoiie M Are y u an employer?Check the appropriate.box: . Type of project{required): 1.VII am a employer with 1p 4. ❑ 1 am a general contractor and) f employees(full and/or part-time).* %,have hired the sub-contractors �• �New construction 2.❑ I am a sole proprietor orpartner- .l'tsted:on the attached,sheet.. 7. ❑Itemodeling ship and have no employe _t1t4e sub-contractors have g• .�Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition (No workers'.comp:insurance comp,insurance.; required.] 5: ❑ We are a corporation and its 10.❑ lectrical repairs or additions 3.❑ I am a homeowner doing alf work officers have exercised,their 1.1:[} Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGI:- 12.E]Roof-repairs required.]t c. 152,§1(4) and we have no employees,[No workers' 13.❑Other con insurance-requireL] , Any applicant that checks box gl must also fill out the section below showing their workers'compensation policy inrwratioo. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contmetors must submit a new affidavit indicating such. *Contractors that check this box must attached ati additional sheet showing the name orthe subrxntiaetors and statewhether or not those entities have employees. irthe sub-canuactors have employees,they must provide their workers'comp.po icy number. I am an employer that is providing workers'compensation insurance for my employees Belo»►is the policy aiid job site ` information. p Insurance Company Name:S"G!/ Policy#or Self-ins.Lic.#: �Ly Expiration Date.� Job Site Address: 1!%ID . zyop w lam/ CityJStttte/Zip: �/L1-A/1/ 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 tn'the imposition of criminal.penalties of a fine up to$1,500.00 and/or one-year imprisoiiment,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 statemdnhmay be forwarded to the Office of investigations of the DIA for insurance coverage verification. 1 do hereby certify unjer tlrepalirs arldprrralties of perjury that the in provided above is true and correct: 00, i nature: ��-- ate: Phone M J� 3 Official use only. Donor write in diis area,to be completed by city or town official City or Town: PermiVUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CltytTown Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other Contact Person: Picone ft Town of NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT / qj_ vn 55� c-6,d,) PERMIT NO.: PROJECT: v� I ECT ON DATE: O�T UNIT NO.: FLOOR: WING: BUILDING NO.: REMARKS: r �� cec// Atkc/nef (Le C.— cx- cipt CA,C4 J C14 lec"kod 0o R •eS -L- 0 K- F-41Ae, wa-S t�A l'1A Sc-ew-- lot-yLc*' Excavation-depth and soil conditions Framing- Other: Date: Date: Date: Inspector Inspector Inspector Footings and foundations and drains- Insulation- Other: Date: Date: Date: Inspector Inspector Inspector Electrical-rough- Plumbing and/or gas-rough- Other: Date: Date: Date: Inspector Inspector Inspector Electrical-final Plumbing and/or gas-final Other: Date: Date: Date: Inspector Inspector Inspector Fire Dept- oil burner,tank,stove,smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: -Cof 0# Inspector Inspector Inspector Form#995 Action Press,665-7000 r / tDate. .Y. . Jr t NORTH TOWN OF NORTH ANDOVER FO 9 PERMIT FOR PLUMBING • � '; a �O•�r�°�O"4h �t ,SSACMUSE� `I This certifies that . . .,!f/. .��q A.1.0 . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . !!L. . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . R. . . . . . . . . . . . . . . . . . . at . . . .t J., . . `'f" . . . . . . . . . . . . . North 'Andover, Mass. Fee. 7 G. Lic. No. 3.4. 6. . . . . . . . . . . . PLUMBING INSPECTOR/ Check .H 1/) ? 7650 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) cu!' , Mass. Date 2007 Permit# Building Location ILiq Aft 15TC Owner's Name IWAMA .S Owner's Tel# �'�- $��(oj� Type of Occupency ,AA�2TMr�_ New Renovation Replacement Plan Submitted: Yes No Y Z Z_ ' Zco Y a 0 Z Z W LU ccoo z a X _ z p z m a to Lu fn CO)~ z ~ a w fn Y rn u. ? a Z H m w 0 ? w a vi as ¢ Lu cZ—n ❑ J Z a -j LL H U a x 3 = a Z y Y a O ~ z z a W u- Y w a 'a a = a a o a ° ° a w X X a 00 a 1=- Y m cn ❑ ❑ x m u c� ❑ ❑ a m O SUB-BSMT BASEMENT 1st FLOOR 2nd FLOOR 3rd FLOOR 4th FLOOR 5th FLOOR 6th FLOOR 7th FLOOR 8th FLOOR Installing Company Name Addario's Plumbing&Heating LLC. Check one : Certificate Address 20 Cooper Street X Corporation 2720 Lynn, MA. 01905 Partnership Business Telephone 339-440-8100 Firm/Co. Name of Licensed Plumber or Gas Fitter Steven J.Addario Jr. Insurance Coverage : I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch.142. Yes EX No If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy 0 Other type of indemnity M Bond 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 Agent Owner El Agent El I hearby 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 Gas Code and Chapter 142 of the General Laws. By Type of License: Title X Plumber Gr City/Town Gasfitter Signature of Licensed Plumber or Gas Fitter Approved(OFFICE USE ONLY) X Master Journeyman License Number 13106 BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME &TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE ,2007 GASINSPECTOR i BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE NO. I APPLICATION FOR PERMIT TO DO GASFITTING i NAME &TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE ,2007 GASINSPECTOR MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Mass. Date r3 — 2007 Permit# �E a Building Location 144? AWN sm Owners Name 2�c4A Ira R Owner's Tel# Type of Occupency ,a,P,oQTMrN� New Renovation Replacement Plan Submitted: Yes No z z f Z W J N } O Q !A z W W a Zlu m coW } a W U) Z (L Z a Z O X U Lu _ w i ~ W O _ -j w a Y LL r v j i=- O = a f rn F— z 0 0 cn z z W - O U S 1 Y J m 6 3 J 2 IQ— (A LL 0 D o Q w m O i SUB-BSMT BASEMENT 1st FLOOR t7 2nd FLOOR 3rd FLOOR 4th FLOOR 5th FLOOR 6th FLOOR 7th FLOOR 8th FLOOR Installing Company Name Addario's Plumbing& Heating LLC. Check one : Certificate Address 20 Cooper Street x Corporation 2720 Lynn, MA. 01905 Partnership Business Telephone 339-440-8100 Firm/Co. Name of Licensed Plumber or Gas Fitter Steven J.Addario Jr. Insurance Coverage : I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch.142. Yes ❑x No If you have checked Yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy 0 Other type of indemnity ❑ Bond E3 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 : Owner Agent Signature of Owner or Owner's Agent I hearby 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 Gas Code and Chapter 142 of the General Laws. By Type of License: Title x Plumber City/Town Gasfitter Signature of Licensed Plumber or Gas Fitter Approved(OFFICE USE ONLY) x Master Journeyman License Number 13106 x : 76 ` Date.. . . ./ ��...... ,0RTH TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 41 SSACMUSEt This certifies that . . yz ' . . . . . . . . . . . . . . . . . . . . . has permission for gas !! installation . .f./U4.?. . . . . . . . . . . . . . . . . . . in the buildings of <i 'i? . . . . . . . . . . . . . . . . . . . . . . . . . . . at . .1�,! . .!z t�.�. . .� . . . . . . . . . . . .. North Andover, Mass. Fee. v:. . . . Lic. No-1 3 A ?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer f MASSACHUSETTS UNIFORM APPLICATION FOR PERMILPermft LUMBING (Print or Type) _ ��m // , Mass. Date 19� Building Location `7 d ;.!5;/--Owner's Na Type of Occupancyt New ❑ Renovation ❑ Re pl ement R Plans Submitted: Yes C3 No ❑ FI URES Z Vf N N N O Z N W o z N Y J N Q V N O d ¢ 1 a ¢ ¢ = z O _z N a y CC CL z CL L6 W = < = 3 3 0 Z S Y d W k Y W > F� O y N O v7 0 z O O N z Z W H O 0 T < < S < < O < J J < ¢ ¢ W < O < F- A f r 3 Y J m N C G J 3 Y �.. 40 U. 0 � a 4 S C Ol O � ++ SUB—BSMT. 1� BASEMENT i IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name 1'�0 r3EeT A . gram rn I}-T rQ e 0 Check one: Certificate Address C0/4 C H(1A n) s. ❑ Corporation iY) E%N 1 '&;:-n) . Yo ray i NLI ❑ Partnership Business Telephone 7 t 2-Affn/Co, Name of Licensed Plumber ,r4 f r3 r ,f?T h� SA,�►�ryl�4 Tr4�c" INSURANCE COVERAGE: I have ayes curre!!tjAbility insuran ❑ ce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. a NoIf you have checked Vis, please indicate the type coverage by checking the appropriate box. •A liability insurance policy 2Other type of indemnity ❑ Bond ❑ 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 Agent Owner ❑ Agent C3 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 narformed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum ' g e and apter of the era[Laws. � '�/f..•Lt�c.d Titre re of Licensed Plumber City/Town Type of License: Master % JourneymaA ❑ APPROVED OFIC US ONL License Number 23 3-; n 0 BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES 1 PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED ` DATE 19 PLUMBING INSPECTOR BELOW FOR OFFICE USE ONLY L ' FINAL INSPECTIONS SKETCHES- 1 PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED ` DATE 19 PLUMBING INSPECTOR MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or T)pe) _ A ee 6Ae1f , Mass. Date 19 Permit # 7 Building Location d eC 111 J Owner's Na4.�eS -e- J9,C//"e da - � • , Type of Occupancy t5 S 17 E U ti r1�_ V ' r New ❑ Renovation ❑ Rep ement 2"0' Plans Submitted: Yes 13 No 13 FI ORES 6 N N N O z > N Gs 1- N W Y J N < N O D ¢40 ¢ co S ¢ ~ W (A = a O < a C X Z ¢ m V ¢ N W O Y F- W ¢ W — O < 0 z . a ¢ " ¢ W Q N D 3 J W ¢ ¢ J — c ¢ c LL ¢ W = < S O N 3 O z = Y d O H Q X ,Q W LL. x W +..�. i !-lu N N H t' z O O _Z z W O V x < < s < Q O < J J Q ¢ ¢ a Q 0 < f' r 3 Y J m H O D J 3 x �- of W O = a < S ¢ m O SUB-BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR /� Installing Company Name AlOtMe-T �r'�(r^4TA7 Check one: Certificate Address ?J r) co�4C 4 ma t,) s-P) ❑ Corporation /r E l K i'i_-A) . y?1 A 0 IT(/L,/ ❑ Partnership Business Telephone (,.4 Z-i97 I 9- rm/Co. . Name of Licensed Plumber —'Z,16 F,f?7- fry 5A MA11,4 rr.4,00, INSURANCE COVERAGE: I have a current I" bility insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. 'A liability insurance � rty policy Other type of indemnity ❑ Bond ❑ 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 Agent Owner ❑ Agent❑ 1 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 issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum ' g e and apter of the oral Laws. BY. Title re of Ucensed um r • Type of License: Master % Journeymab❑ City/Town APPR04ED 0 IC U ONL License Number X33 5 ry 0 Date....... 2947 TOWN OF NORTH ANDOVER PERMIT FOR WIRING -SACHUS This certifies that ....14.&T.......5:5.�......... .S.y ........................................ has permission to perform ........./I-/`5..AJ/K............ ................. ..... . . .. ..... wiring in the building of.............6. .................................. ........ .... .North Andover,Mass. at....... t5...........U.14 1!..A ......S.I.:....... Fee... .5.: .... Lic.No. (. ............................................................... ELECTRICAL INSPECTOR C tt ? WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File 17C. A^ DOTI) y Office Use Only Permit No. ly e' 90mumulmo lif Anour4immU Occupancy&Fee Checked 1 Dquirtltimt of IflubliC J&x tg 3190 (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 Ward Area a APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 j (PLEASE PRINT IN INK OR .TrYPE ALL�INF M(AATIION) p Date .3 —a6'9 City or Town of JV � La 4dL� r� To the Inspector of Wires: M C-> The undersigned applies for a permit to perform the electrical work described below. C) Location (Street & Number) Owner or Tenant ST � IA-M-�E Owner's Address Z Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box) I z Purpose of Building Utility Authorization No. m Existing Service Amps_I Volts Overhead ❑ Undgrnd ❑ No.of Meters o New Service Amps_� Volts Overhead ❑ Undgmd ❑ No,of Meters 7Q n Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Instal 13 t i O n of alarm s.s t em No.of Lighting Outtets No-of Hot Tubs No.of Transformers Total KVA M. Above In- I No.d Lighting Fixtures Swimming Pool gmd. ❑ grn d. ❑ Generators KVA v C> No.of Emergency lighting O No.of Receptacle Outlets No.of Oil Burners Battery Units n O No.of Switch Outlets No.of Gas Burners FIRE ALARMS No.of Zones No. of Ranges No.of Air Cond. Total No.of Detection and tons Initiating Devices Heat Total Total No. of Disposals No.olPumps Tons KW No.of Sounding Devices I No.of Self Contained Z No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices v M No.of Dryers Heating Devices KW Local Connection : Other No.of No.of Low Volta c> No_of Water Heaters KW Signs BallastsWiring -G No. Hydro Massage Tubs No.of Motors Total HP L OTHER: `f, M s) �Q� m Lam!L �.w m Z I INSURANCE COVERAGE:Pursuant to the requirements of Massachusetts General Laws 1 have a current Liability Insurance Policy induct r- ing Completed Operations Coverage or its substantial equivalent.YES 0 NO 0 t have submitted valid proof of same to the Office. m n / YES 0 NO D if you have checked YES,please indicate the type of coverage by checking the appropriate box. -t ((( INSURANCE M BOND D OTHER 0 (Please Specify) n r 00 (Expiration Date) Dc- Estimated Value of Electrical/Work S f �l n Work to Start 3,)-;1 Inspection Date Requested: Rough Final o --/LTJ C> 3VVV Signed under the Penalties of Perjury: FIRM NAME LIC. No. 12 31 C Licensee Signature LIC.NO. Bus.Tel.No.617-431-5580 1 Address 60 William St /Well _s1 -1r, MA 0 .1R1 AILTei.No. — _ —5837 -.s e-'OWNER'S INSt1RANCE,WA1VEft:t.arti'aware that the l3cerisee does not have the.insurance oaverage o<its substantial equivalent as re- N� i *�Qr+tredbl►,' tfa"General Lavva,<<tt<nd that my signaritre on this permd apprtcaUor►wanes this tequir�emertL.Owner __ A9ertt �,5�� h.t"�leaSA C11eCfC Cne�� fx,y4,,�" h rnh�}'_.T,��7,`*Pn7'�+3�5gt"L°'�'.¢t ti y. '' "r ✓ t '. .. . � n.�.-vnr�:a...�z" ;s,yg .�... a + .�c`�saca..e-.r`,: } t'rF''r, }' :°fi it•.,.:;;�'+�Te10phOn6 No: ='�'�,. iU PERMlT FEE$ �"��. f .� }},. Otttce Use Only / T t ul!>' �:IITIITTt1III11IP � I of 5�� Permit No. rOccupanel& Fee Checked a +�erlartmE>:ri of �uhtir �f>'fq 3/go (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 C'MR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Eiecirical Code, 527 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date - (X)� or Town of Not TH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical `scribed below. Location (Street & Number) Owrer or Tenant —74-Z Owner's Owner's Address "-4 Is this permit in conjunction with a wilding permit: Yes v No (Check Appropriate Sox) �c � Q S Purpose of 5uiidinc UttyutanzatonN . i^ " J — ~— Existing Set-Ace � Amos _J Vests Overhead '_ Unogrnd I_: No. of Meters New Ser✓ice Ames Vctts Overneac _ Uncgma No. of Nlelers Number of Feeders anc Amcacity Location anc Nature of Prccosed E!ectricai :'lerx INo. at -ransformers Totai No. at L:Sn;ing Cutlets I No. -• ••c• -u'-s KVA Alcove.-- No. of L gnt;ng Fixtures i Swimming Pooi grnc. _ crrc. Generators KVA No. of Emergency Lignttng No. at =ecectacie Outlets No. at Oil Surner5 ; 3arery Units No. of swncn Outlets No. at Gas Burners I =IRE ALARMS No, at Zones Total No. is Cg 0-e is and No. at Ranges I No. a' Air Car.c. ;ons Initiating Cav ces Heat Tatal Total No. of Oisoosais Noor Pu-os 7bns Kry No. of Sounding Oev ces i No. of Sart contained No. of Oisnwasners ScaceiArea Heaurg K4'J oetec;:onrSouneing Oevices I Lecat - Munic?oat —Other Na. of priers Heasnc Oevtces J _ connection No. at No. of I Low voltage No. at 'water Heaters KYJ i Sicns Sailasts Wirmc No. :-iycro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant ;o the recuirem,ents of massacnusa-s gererai Laws _ _ I have a current Liaoiiity Insurance Policy including C:,r..o:erec Oceranens Caveraae or as sues;anual ecuivatent. YES _ NO _ I nave suomiaeo valid proof at same to the Office. YES = NO _ It you nave cnecxea YES. ~tease indicate the ivice of coverage cy cnecxrng the aoGraenate cox. INSURANCE = BONO = OTHER = (Pease Scec:'.y) (Exo ration Oates sumatec Value of E!ec:ncal 'Nara S Wcrx :a Start Insoecttan Oats Racues;ec: Reugn Fnai Signed unser ;he Psnatttes t perly�/ � FIRM :NAME'/ UC. NO. Licensee yiC-c�Gs I/ Slgr.azure UC. NO. Sus. '741, No. Alt. Tel. No. Address OWNER'S INSURANCE WAIVER: I am aware that the !:censea aces re- not nave ;ne insurance coverage or its suostantial eeuivalenAt, es ie auirea my Massacnusetts General Laws. and mat my signature an :nis cermit aeoiicatton waives this reaurement. 0y r �� (Pease cnecx one) ,�// -eiecnone No. PERMIT FE. 5 (Signature of Owner or Agents Date.... ...../ ...... 396 NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACHU This certifies that ................................................ has permission to perform .......... -eleq- ........................ .................. wiring in the building of....... f t>r ........................................................ Llk M '?'11 W........................ ... . at......... .......................... North A7ndove Fee../4—dd. Lic.NoXb�............. Cj >4LECTRI ALI 08/16/96 12:06 15•%ANRW Building Dept. PINK:Treasurer WHITE:Applicant Date. . . . . . . . . . . . . N°aTM TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 40 s � �• a SSACMUS� !V.k(This certifies that �.� /1. � has permission to perform r/ X, has .f.� . . . . . . . plumbing in the buildings of c�-�� ! at .Ale,?.M4;0( Z.-f . . . . . . . . . . . . . . North Andover, Mass. FeeLic. No.. IG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # 650 r I 10 o _ WATER CLOSETS KITCHEN SINKS LAVATORIES 4 Z a ,'1 BATHTUB 'tl SHOWER STALLS _ DISHWASHERSQ IC a DISPOSERS ; t .� LAUNDRY TRAYS 31 WASH. MACH. CONN. HOT WATER JANKS TANKLESS g SLOP SINKS Z e FLOOR DRAINS g OAS TRAPS o [:1 O o URINALS DRINKING FOUNTAIN Z AREA DRAIN WATER PIPING f l , ROOF DRAINS CKN � fl O. BAFLOW PREV. O OTHER FIXTURES: q� BOILER MATE VV O GREASE TMP `� C Scu LERY SINK Ic g SHOWER VALVE Z AFTSEWERAGE EM n c.s.� d BELOW FOR OFFICE USE ONLY ` FINAL INSPECTIONS SKETCHES FEE PROGRESS INSPECTIONS NO. APPLICATION FOR PERMIT TO DO PLUMBING UNDERGROUND ROUGH COMPLETE ROUGH FINAL INSPECTION PERMIT GRANTED DATE PLUMBING INSPECTOR Ii Date,`. 30 . �. . n N2 r 4- 7 11 4o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING LOW SSA�MUS� This certifies that `. .?. . . . . . ... .... ..--. . .. . . . . . . . . . . . has permission to perform plumbing in the buildings of . . .�. . .r.... . .. .. . . . . . . . . . . . . . . . . . . . at�`l� . . . . . . . . . . . North Andover, Mass. e-✓ Fee^ . ."`. . .Lic. No.. . . . . . . . . . :. . . ... / . . . . . . . . . . . . I//-— PLUMENG'1NSPECTCIR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) -r(4 AND 0✓��- , Mass. Date P __ 77 Building Location_ ry S Ts Names 6,1 t C LL t AJQ ✓, J�Vs)--e rNl✓a - b( N'Z�- Type of Occupani 5 D 1=U TI A L_ New ❑ Renovation ❑ Replacement 2 Plans Submitted: Yes ❑ No ❑ FIXTURES Z _z 4f H Z x < H N N O z > UsN W Y J N < V ~ N O D ¢ N Z N < ¢ z p = N a O Jf' W ¢ UW Vx ¢ 0Y WZ HxV Z Co N W >- < H z ¢ n- p a < 3 ¢ W O O ¢ < N ¢ < W W G J 2 .¢ a ¢ W W < x 3 3 o z x U a ¢ F- < Y m W a ¢ I- V > 1- O x a O N I- z 0 0 N z = Q F LL p Y W Q o < J _j < ¢ ¢ a 1 a O < F- 3 Y J m H O O J 3 x I.. v, W O a a S ¢ m O SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR 4 Installing Company Name IA 0Eez Atrm 4-rAe-c Check one: Certificate Address ,)4) C 4C H Mf4n) P ` ❑ Corporation IY1 E l N I 'Fn)- yyl A ❑ Partnership Business Telephone_ 7 1 p-A /Co. Name of Licensed Plumber f!r3 r,f?T fry �A,'VlM, rr4, INSURANCE COVERAGE: I have ayes ent I ility ins ❑ ce policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. If you have checked Les, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of Indemnity ❑ Bond ❑ 1OWNER'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'sAgent Owner ❑ Agent C3 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 owned under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum ' g e and apter of the oral laws. Title rs of Licensed Ium r Cityll'own - Type of License: Master % Joumeymar 13_ APPROVED OFFIC U ONL License Number �33 5 BELOW FOR OFFICE USE ONLY I i L FINAL INSPECTIONS SKETCHES 1 PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME &TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE 19 PLUMBING INSPECTOR MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING 6? � (Print or Type) NO�T(4 An/DC)✓e*<-- , Mass. Date 6 'AiP Building location r ni S T s Name /1 ko Oy T W✓a . 0 t N<- Type of Occupancy�t S� DE ti i i A L_ V New O Renovation O Replacement I!r, Plans Submitted: Yes O No O FIXTURES Pz = y a y Z Y F- y y O z > y Us W Y J 0 )1- 0 < 0 0 0 x ¢ y Z N < ¢ V < W Z O z¢ _ < yWZaJp y Cy: a3: OX¢ Z 16 0 < _ < y W o =Z ¢o m ¢ 16 ic W 1.1 W = < _ 3 ; O z S Y d 0 h- < z < W W Y W h- V > !� O S tL V7 1- Z 0 O y z = W 1- O U 2 < H < < = y y < < O < J J < Cr ¢ Cr. < O < f- 3 SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR • Installing Company Name ktlyEeT -S4(rM 4TAe7 Check one: Certificate Address Int:/4C H(Y)f4n) s.Pi ❑ Corporation IY) E%N ! )0 Al t 0 VL/ ❑ Partnership Business Telephone -i97 l 2-i irrn/Co. . Name of Licensed Plumber F?-7- fig • ,5,4 mm,4 req o-Of' INSURANCE COVERAGE: I have a curregnt Imo' bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes C3' No ❑ If you have checkedrtes, please /indicate the type coverage by checking the appropriate box. .A liability insurance policy 1d Other type of indemnity ❑ Bond ❑ 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 Agent Owner El Agent O I hereby certify that all of the details and information 1 have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations Derformed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum ' g Oode and apter of the oral laws. Title re of LicensedPlu-mber " Type of license: Master % Journeymab❑ City/Town APPROVED 0 IC U ONLY) License Number q33 5 AMERICAN CLAIMS SERVICE MULTI-LINE ADJUSTERS BUILDING INSPECTOR/COMMISSIONER, BOARD OF HEALTH AND/OR BOARD OF SELECTMAN Building Inspector Town of North Andover 1600 Osgood Street North Andover, MA 01845 INSURED: Linda Montminy ADDRESS: 148 Main Street North Andover POLICY: PHOO100798103 LOSS DATE: 02/06/2015 LOSS TYPE; Ceiling Spots ACS FILE: 31117 CG Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed $1,000.00 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 the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim file number. Craig Gillespie Claims Representative On this date, I caused copies of this notice to be sent to the persons named above at the e addresses indicated above by first class mail. Unless we hear from you within the next 10 days, we will not be obligated to pay any portion of this claim to you. Date 02/12/2015 7 KIMBALL LANE,BUILDING C,LYNNFIELD,MASSACHUSETTS 01940 TELEPHONE (781)245-9516/FAX(781)245-1077 E-MAIL—daims.acs@verizon.net