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HomeMy WebLinkAboutMiscellaneous - 154 HICKORY HILL ROAD 4/30/2018 (2) 154 HICKORY HILL ROAD ' 210/062.0-0100-0000.0 I i I I i 1 I pw 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: KELLY TORTOLANO and MICHAEL TORTOLANO Property Address: ' 154 HICKORY HILL RD,NORTH ANDOVER, MA Policy Number: HMA 0400754 Claim Number: BOS00046095 Date of Loss: 10/22/2014 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. Holly Coughlin Claim Examiner 11/7/2014 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3026 Fax: (617) 531-6684 Email: HollyCoughlin@SafetyInsurance.com I i i Date . °.t.��//Z . . owl TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . ... . . . . . . . . . . . . . . . . . . in the buildings of. t-IF'r. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . .LVI . . .P A+ Mass. Fee .33,.�q . Lic. No. . . . . . . . . . . .. GASINSPECTOR Check# 1109 8375 MASSACHUSETTS UNIFORM APPLICATION FOR A.PERMIT TO PERFORM GAS FITTING WORK CITY:/Ute"A A7/a MA. DATE: PERMIT# JOBSITEADDRESS: OWNER'S NAMEC GOWNER ADDRESS: Y MG��/n, TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ PRINT EDUCATIONAL ❑ RESIDENTIAL CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:&r PLANS SUBMITTED: YES❑ NO❑ APPLIANCESI FLOOR—+. Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER M INSURANCE COVERAGE I have a current Iiabilijy nsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES B NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND ❑ OWNERIS INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted(or entered)regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME 16'eo . jo ya 1 LICENSE#/ &MATORE COMPANY NAME: O �/Er/ >� 9�' T-A.0 L ADDRESS: /Dino Y'cL� CITY AA bdl STATE I / " ZIP: ` FAX: TEL: `d-vU CELL: EMAIL6cA�i rQ A� AA lip Air",ti71 PIAPi C014 MASTER JOURNEYMAN❑ LP INSTALLER❑ CORPORATION # gam PARTNERSHIP❑# LLC❑# X l C�� .�Gas ���.9 '�,.' „M i _ � NORTH Town of _ RAndover o ,. :; rn o L A o dover, Mass., COCHICHEWICK RATED P P9��,�C, 7 H BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT....... ..1 A.I{� ,Pry!/.�C �I BUILDING INSPECTOR Foundation has permission to rwot... /.!V./...�. g � ' ....W'#!rO A* /�j��..'P0� o ..... buildings on ........ �� �� to be occupied as.... E M t ti*... r A �r • 'i �� p V Awe � Chimney .................................. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. to ` V2 J01 coo PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough i Final PERMIT EXPIRES IN 6 MONTHS ELECTRIC IN UNLESS CONSTRUCTION S` S Rough � if ...........���.............4..................................................................... Service E BUILDING INSPECTOR Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Dec. N° 3 U 2 1 Date.../. 0...`.... pORTN °ft °:•�"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SSACNUS� This certifies that Y 1 (S ( PC� Cl1 C ..... ....... .... ...........................................................�..../......;` has permission to perform .......... u P h Pt' ........ l �.1.!".,�`......... .............. ..... . o wiring in the building of..............?2..".................. ..1.............,........................................ / � c �dd�� 1 at....../... ...� .....��.)). . ................. ...1 ...1./.... ..... , h Andover,M�as'a�. Nil Fee..... ,. �'I ic.No..., Jam ....... -s...... ..........Y.. ..EL^ECTRICAL INSPECTOR Check # WHITE:Applicant CANARY: Building Dept. PINK:Treasurer I THEC0A M0NWE4LTHOFMA&"CHUSE77N Office use only y DEPARTMENTOFPUBLICSAFETY Permit No. — - 1 S"0 r BOARD OFFDZEPREYE/VIYONREGUL4TIOAN S27CMR 12.00 UVAA Occupancy&Fees Checked PPLICATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: �Yes[M-No M (Check Appropriate Box) Purpose of Building fl= Utility Authorization No. Existing Service Amps Volts Overhead M Underground a No.of Meters New Service �__ Amps / Volts Overhead r--1 Underground Q No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work on7.7777; 7742 No.of Lighting Outlets f No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ound No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets / No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal a Other Connections No.of Water Heaters KW No.of No.of } Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER lrsuraroeCaraage Ptastrar>tbthetagt>itar� seflsGaraalLaws IhmeaanutLibililyi swaxePoliq mdudffigCbn#Ak0pwafixs CamaWorits s bsutialecg&Werit YES ® NO a IhmeabiniftedvandproofofsametotheOffi=YES n NO r7 Ifjcuhaw dwcWYES,pleasemdrmetheWofmaagebydakingthe INSURANCE ® BOND OTHER (PlamSpeafy) EVizimD Est¢rg"ValueafEch WWolk$ WotkbShatt Irsl edmD&RgxsW Rough _ Final SigwdutrkrTr%>idusofpetjitry o Au.A� FIRMNAME S u.. Lioasae :J-19'd'YI CSS1l`t (e 2 Si�Iahne LiarseNo BisvMTd.Na 6 e''- ',z ,5-( 2-9t Alt.TelNa OWNER'SML ANCE ANFR,I.amawatet dthelicemdul!$ni $teitisiraroeco►e�eorGsst ir>trale:grivala asregttQadbyIvi }xis (3ataaiIaws and ditnTyWulur-unthis pamkWpka6mwwiA5ftnquianert (Please check one) Owner Agent Q Telephone No. PERMIT FEE$ ^� Date.................................. N t HOR7M 1 TOWN OF NORTH ANDOVER A PERMIT FOR WIRING US This ll�dllyThis certifies that .....?Orm � ......' ..- . .............................. has permission to per ......... ............................ . ................... wiring in t building of.:L. .f ..J .:.....�Y../........................... at ........:� .. ...,.�!.1. 1 .. l�orthlndover,Mass. Fee.2 ....�.......... Lic.NeKNm........................................................... ELECTRICAL INSPECTOR r Check # 7-6A� ' 5333 TBECOAMONREALMOFAWSACHUSETIS Office Use only DEPARTNIENTOFPUBIICSAFM211 Y i' permit No. BOARDOFFIREPREVEMONREGUT47YONS527O Rl2W / Occupancy&Fees Checked APPLICATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 1L/ (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 2— Al _7 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work d_escribed below. Location(Street&Number) . 1 ed- Owner or Tenant U / c7 ` Owner's Address �l Is this permit in conjunction with a building permit: Yes L No (Check Appropriate Box) Purpose of Building � �c��L�' Utility Authorization No. Existing Service ��-db� Amps _Volts Overhead Underground ® No.of Meters New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local 0 Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• h 4ffX oeCDMaW.R>tsmtmtheteWMIr soflVlMada>se &maliaws IhneaomatLmhkksm=FbkyjwkxhngCmipiceOGDNer4eoritsa*st2nbalequI a1at YESIE NO lha'�,esubmhkdvalidproofofsametothe0ffim YES IfyouhavechedodYES,p}!vseindkatethetypeofcoWrWby gdle box INSURANCE BOND OTHER (P1e w Spedy) �K" d ExpitatimDale Estirrl WValueofDearicalWOdc$ WodctoSt ut IrWeCrionDaleRecluested Rough Final signed underTiePenakiesofpe .r• FIRMNAME ., LicenseNo. Licensee -T '�►t s ) Signature Q�l�l r �"/--[ Y.c-�, Liar>seNo rr .� t ,t✓ BMMTU NO.j�"aAddtess_ '217 !u`� © Alt Tel.No. OWNER'SINSURANCEW Iamawateth dELX)MSP-doesnothavetheinst noc)NuageoritssubStanhalffFi laltasmquffedbyMmdluseZGeiiaalLaws andthatmysigrlatumonthispmi tapplicarionwaivesthisIegttierlalt (Please check one) . Owner Agent Telephone No. PERMIT FEE Signature o caner or gen i