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Home My WebLink AboutMiscellaneous - 20 CHRISTIAN WAY 4/30/2018 (2) C ' 20 CHRISTIAN WAY 210/104.D-0141-0000.0 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: Gregory & Pamela Bird Property Address: 20 Christian Way Policy Number: HP2466665 Date/Cause of Loss: 8/2/2015, Water/Boiler Malfunction File or Claim Number: 32444-M 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. Mike Peterson 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. Signature and Date ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 Commonwealth of Massachusetts Otticial Use Only / Permit No. �J 9`7` Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/051 leave blank) ' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(M C),5 .7 CMR 12.00 (PLEASE PRINT IN INK OR T PE AL M ORMATION) Date: City or Town of: 2 i fl/d�J.�.h. To the Ins ecto of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street& Number) ' v h, S ,,J Gy/ d Owner or Tenant _ a ` Telephone N(f t Owner's Address Is this permit in conjunction with a buildigg))ermit? Yes LUf No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service-Fr= A ps d / oVolts 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: 3 SQ��d 0,CJ, Z, e c" d y -J J Se_ Ji j Completion o the ollowin table may be waived by the Ins Lector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans o.of Total Transformers KVA No.of Luminaire Outlets 'Z— No.of Hot Tubs Generators KVA No.of LuminairesSwimmin Pool Above ❑ n- El o Emergency Lighting �i g rnd. rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.o Initiating et ng D an Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers eat um Number ons o.oSelf-Contained Totals I Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local❑ Municippi ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: y No.of Devices or Equivalent No.o aterKW o.o o.o �. Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications No.of Devices or Equivalent OTHER: ` Attach additional detail if desired, oras 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 same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under thEM a p nalties of pier'uty,th t the inf anon on th s application is true and complete. FIRM NAME: .✓ �G.- t' t LIC. NO.: 'ZIROl�►'6dZ Licensee: / /A At Signature �' LIC. NO.: Ot'11/t (If applicable,enter 'e m t"int a licens be i e.) Bus.Tel. No.: Z r Address: i sJ .9 � 0 Alt.Tel Nc �� z. *Security System Contractor License fequired for this work; if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: 1 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. _ J Date......�r ......./ ... NORTH °t<"`°;•�"a TOWN OF NORTH ANDOVER p PERMIT FOR WIRING sib � ,SSACNUS� This certifies that .........�U ........ v ..............................................�. ..... . . ... has permission to perform ...........': ........ _r wiring in the building of.... .. ..... i. at.... ......fir^..'............. .:North An >��. Fee......yrs....`�.`... Lic.No.�.........'/� .............. . .......... ....................... ."'ELECTRICAL INSPECTOR Check # r WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Commonwealth o f Madaaclwudef Official Use Only L� C� Permit No. WOW cc�� O� f �U,part°nted 15ire Sw viead Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev. 11/99] Heave blank) 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 LV INK OR TYI'L• .4LL INFOAVATION) Date: � ~ ? --G 0 City or Town of: A/-c), /9n 0(a J P/ To the Inspector of tYil-es: By this application the undersigned gives no cc of his or her intention to perform the electrical,work described below. Location(Street S Number) PZ a Owner or Tenant _ �(�. /.4 C( Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Ihtdgrd ❑ No.of Meters New Service Antps / Volts Overhead❑ Undgrd ❑ No.of Meters- ` Number of Feeders and Atnpacity a Location and Nature of Proposed Electrical Work: Sip i 6 .S fyl L )q /1/10. Coni lesion of the following table niav be waived b•the!ns'cctor of(Vires. No.of Recessed Fixtures No.of Ceii:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of(lot Tubs Generators KVA No..of Lighting Fixtures Swimming Pool Above ❑ In- E] No.o mergency Lighting rnd. rnd. Battery Units No.<of Receptacle Outlets No.of Oil Burners FIRE ALARIMS No.of Zones No.of Switches No.of Gas Burners 716—.61 Detection an , 1 Initiatin Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste llis users Heat Pump umber Tons_ W No.o elf- ontatne P Totals: -'-� _'~- Detectiott/Alertin Z Devices No.of Dishivashers Space/Area Heating KW Local ❑ Iuntc}pa ❑ Other Connection No.of Dryers Heating Appliances KY ecuritySystems: No.of Devices or Equivalent o.of W atero.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP 'Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if deAred.or as required by the Inspector of iVrres. 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 ❑ OThIER ❑ (Specify:) a- (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. 1 certifj-, under the pant.•and pettalties of perjnry,that the itrfOrtnation on this application is trite and complete. FIRINI NAME: -� ;IA) ` C LIC.NO.: R -J 9 Licensee: �oF - G G* Signature �-�- - LIC.NO.:,4 -sr(� 1 41 (If applicable, enter "evempt"h:the license n:unber line.) Bus.Tel.No.• `'. 7 -`3°�� - a Address: Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee floes not have the liability insurance coverage normally required by law. By Tuy signature below,I hereby waive this requirement. I am the(check otic)❑owner ❑ owner's agent. Telephone Pj: FEE Rt1IIT Signature Owner/Agent )tone No.P