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Home My WebLink AboutMiscellaneous - 186 BOSTON STREET 4/30/2018N_ O V W O O 8 O O E May 3, 2016 Claims Department Building Department 1600 Osgood Street Building 20, Suite 2035 North Andover, MA 01845 75 Sam Fonzo Drive I Beverly, Massachusetts 01915 800.227.2757 1 Electricinsurance.com/Claims_Center RE: Insured: Karl Seaburg Property Address: 186 Boston St Claim Number: 2016050300601 Policy Number: 5A23446H1 Date of Loss: 04/15/2016 Cause of Loss: Unknown driver damaged homeowner's electrical wiring Form of Notice of Casualty Loss to Building Under Massachusetts General Laws Chapter 139, Sec. 3B Claim has been made involving loss, damage or destruction to the above -captioned property, which may equal or exceed $1,000 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 to the attention of the undersigned and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. On May 3, 2016, copies of.this notice were sent by first.class mail to the entities and addresses noted herein. Jay Rinaldi E�ECTR/C INSURANCE MMS• COMPANY November 19, 2012 Building Commissioner or Inspector of Buildings 120 Main St. North Andover, MA 01845 RE: Insured: Property Address: Claim Number: Policy Number: Date of Loss: Karl Seaburg 186 Boston St _ 2012111908101 5A23446H1 11/19/2012 Form of Notice of Casualty Loss to Building Under Massachusetts General Laws Chapter 139, Sec. 3B Claim has been made involving loss, damage or destruction to the above captioned property, which may equal or exceed $1,000 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 to the attention of the undersigned and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. On November 19, 2012, copies of this notice were sent by first class mail to the entities and addresses noted herein. Brett Scialdone Claims Specialist Cc: Board of Health or Board of Selectmen 120 Main St. North Andover, MA 01845 Fire Department or Arson Squad 120 Main St North Andover, MA 01845 75 Sam Fonzo Drive Beverly, MA 01915 800.227.2757 www. Electricinsurance.com Date.. !�_ ?--�'/ Z This certifies that .........v. !7� ..=-�T . , , ... , has permission to perform. �� I�Gz. .. �� ........ . wiring in the buiillding of ..........5. o . a/? .. . . ... . .. . . . at .. ! �. ... !��S .....�T- ....... North Andover, Mass. Fee .-�342 �=Lic. No. .57.9 33 4 .... . ..... J.. . . >.. � ELECTRICAL INSPECTOR 1 �.�ieck # � 2- Lt C7 11238 -V .a p Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 1 I _ --� 9 Occupancy andeeF Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (ME ), 52 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORTION) Date: / Z/ / Z MA City or Town of: NORTH ANDOVER To the Inspe for of Wires: By this application the undersigned gives notice of hiss r her intention perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address Telephone No. Is this permit in conjunction with a buil ing per t? Yes U Ny�J (Check Appropriate Box) Purpose of Building ✓ i sle q� Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:QC•Q yC� No. of Meters No. of Meters w")A rmmnletinn nfthe following table may be waived by the Inspector of Wires. 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: 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 a4me to the nermit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the mzd p Ities perjury, hat the . ormation on this application is true and complete FIRM NAME: �1,eh �A `�9 l L C LIC. NO.:Licensee: �i �J U Signature X, LIC. NO.: (If applicable, enter• `exe(t" 'n the It nse number line.) Bus. Tel. No.: WW Address:o Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work quires Departmen of Public Safety "S" License: Lic. 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 agent. Owner/Agent [PERMIT FEE: $ Signature Telephone No. V Total No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans Trsformers KVA Trans No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ivo-.—OT rnd. rnd. Emergency Lighting Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones Detection and No. of Detection No. of Switches No. of Gas Burners In Devices In No. of Ranges No. of Air Cond. Tons Tot No. of Alerting Devices Heat Pump Number Tons KW No. of Self -Contained No. of Waste Disposers P Totals: ....................................................... Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P o n ect oln El Other Local ❑ Connection Con e No. of Dryers y 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 Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices. or E uivalent 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: 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 a4me to the nermit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the mzd p Ities perjury, hat the . ormation on this application is true and complete FIRM NAME: �1,eh �A `�9 l L C LIC. NO.:Licensee: �i �J U Signature X, LIC. NO.: (If applicable, enter• `exe(t" 'n the It nse number line.) Bus. Tel. No.: WW Address:o Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work quires Departmen of Public Safety "S" License: Lic. 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 agent. Owner/Agent [PERMIT FEE: $ Signature Telephone No. `r r r , JuuJeiu.,l..Cv.�l•,�.cti��.e�-tc.+C�.grey+.rC�0.1�.rex�R•R(0)p�.�y�.jyc _.[!reTn'L.I.CY-q.�.t��llglSJLJei��U'�.,_. .. ._ - � .. � ■ WeH— � ] �e-xnspectZou xe�uixec�($�OAD) � ( � 3nspectoxs' cop tants: y ir. ((-AsPedoxe sigaatuxe ••xao :Xdtials) Pate MAL 3?asse�•-- �'ailet�--j } � ;ttexnspectioxtxer�uixec� ($0.00}-• j � ' Inspect S' omm, ts; (fxispectors' � atar oto xnxtials) Date 3, UNDERCR.OUM MgP) CT`XON. inspectors' comments: (lnspectoxs',�zgnaiure�to?nitiais) Pate :APE WO RD NA T ONAIGRID. J�V'.AM : 3sseci--[) a— rhe-Impectionrequired ($50.90)-[ � ovectbrs' coJmmeits, ( spectoxs',�zgnatuxe��ozniiials} Date IQ7�3.'EC�'.�O��T'-• OAR: ' s eei �- [' � �'ailer� � [ }- ' �Le �nsp ectton xequized ($50.0 D) •• [ } - pectoxs" cobim.ents, . • S ' �!y sp ectors" Signature - 3a xnitiais} date 3 O TAGNAM TO DB)NEED UFT ON19I -9I` TMAAPXA TO BE WSPECTED Xg NOT Date. Al.-. ! ! '! . 'V 4376 TOWN OF NORTH ANDOVER sj •` -. 0 'Lae p PERMIT FOR PLUMBING S Hu This certifies that has permission to perform .._.-�.<:*.- .!...= �l'��/...... . plumbing in the buildings of ,*� - -. �/^................. at '........ North Andover, Mass. FeeQ:� . ' .. Lie. No/(10,j...... /�-j k� .:-........ . s � PIUMv G SPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer - zx! MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBIN G az j �-\ {Print or Type) }� Zona Mass. Date ermit Building Location �1 " OwnerameQ� (`0� ft „ 'I New Renovation ❑ Replacement ❑" FIXTURES of Occupancy, Plans Submitteol: --i Yes ❑ No);r Installing Company Name _ _ fheck one: Certificate gAddress IIgAFFEI PLUMBING INC. =- E Corporation 198 High St., Ipswich, MA 01938 _ ❑ Partnership Business Telephone TEL (978) 356-1122 • FAX (978) 356-8722 ❑ hrrn/Co. Name of Licensed Mun,ua, ��.�,.� cyv -- "P INSURANCE COVERAGE: I have a curren iabilfty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked Les, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy Ig 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 ❑ 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 perfo under the permit issue for th' do a in compliance with all pertinent provisions of the Massachusetts State Plumbi de Chapt r of a ner s rTjV Signature f Li sed Plumber Town Type of License: Master Journeyman p� APPROVED OFFICE USE ONL License Number_ (i�' Y • • • • MEN No noun son 0 ME no 1ST FLOOR so MEN IN no so MEMNON MEN No on ar�now��■®��ON no FLOOR■��®on SON M■ N now OWN ON MEN no ■MEMNONiMEN�l��Ot��■■��■ Installing Company Name _ _ fheck one: Certificate gAddress IIgAFFEI PLUMBING INC. =- E Corporation 198 High St., Ipswich, MA 01938 _ ❑ Partnership Business Telephone TEL (978) 356-1122 • FAX (978) 356-8722 ❑ hrrn/Co. Name of Licensed Mun,ua, ��.�,.� cyv -- "P INSURANCE COVERAGE: I have a curren iabilfty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked Les, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy Ig 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 ❑ 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 perfo under the permit issue for th' do a in compliance with all pertinent provisions of the Massachusetts State Plumbi de Chapt r of a ner s rTjV Signature f Li sed Plumber Town Type of License: Master Journeyman p� APPROVED OFFICE USE ONL License Number_ (i�' Y H a O N W CL. N Z 0 z W a a. J z. :W 0 � O W lu cc ^ :3 -16 m ...W. IL us Y H a O N W CL. N Z 0 z