HomeMy WebLinkAboutMiscellaneous - 20 STAGE COACH ROAD 4/30/20181
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February 18, 2015
Town of North Andover
Building Commissioner
1600 Osgood Street
North Andover, MA 01845
DINELEY
CLAIMS
SERVICES
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GENERAL LAWS, CH. 139, SEC. 3B
INSURANCE COMPANY: Vermont Mutual
COMPANY INSURED: John & Karen Lunny
PROPERTY ADDRESS: 20 Stage Coach Rd, North Andover, MA
POLICY NUMBER: H012120536
DATE OF LOSS: 2/13/15
CAUSE OF LOSS: ice dam
CLAIM NUMBER: HC206435
PROVIDING
SERVICES IN
NEW ENGLAND
NEW YORK
NEW JERSEY
PENNSYLVANIA
DELAWARE
MARYLAND
OHIO
VIRGINIA
AND
FLORIDA
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
undersigned and include a reference to the above -captioned insured, location, policy number, date of
loss, and claim number.
If no reply is received from your office within ten days, we will assume that you have no lien of any type
against this property, and we will proceed to pay this claim in full.
Insurance Claims Services
Tel 877-302-0203 • Fax 877-245-4987
PO Box 479 • Waitsfield, VT 05673-0479
www.DineleyClaimsServices.com
Date. l V/.O 0//- C9 Y-
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oTOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that.. ?? 1' -VA D
has permission to perform .... D.w..........................
plumbing in the buildings of ..4 :'. K: t'-' .......................
at. ;� 0 . ........ I ...... , North Andover, Mass.
Fee.-?. 3." .. Lic. No.. . ......... . ���... .
PLU WING INSPECTOR
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Check # G Z
5790
MASSACHUSETTS UNIFORM APPLICATION
(Print or Type) i
P
V&V - , Mass. Date
Building
FOR PERMIT TO DO PLUMBING A3 -5--d
GG�E
P ermit #
ewner's Name a�"Zz
Type of Occupancy "��. S ± -D E Q TI A i,.•_
New ❑ Renovation ❑ Replacement 9""' Plans Submitted: Yes ❑ No ❑
INSURANCE COVERAGE:
I have a current IL213ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑ '
If you have checked Vis, please/indicate the type coverage by checking the appropriate box.
A liability insurance policy t,d 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:
Owner ❑ Agent ❑
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 performed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum ' g e andrr7 of the eral Laws.
BY,
Title re of Licensed Plum er
Type of License: Master % Journeyman ❑
City/Town
APPROVED OFFICE USE ONLY) License Number 3 3 5
FIXTURES
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INSURANCE COVERAGE:
I have a current IL213ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑ '
If you have checked Vis, please/indicate the type coverage by checking the appropriate box.
A liability insurance policy t,d 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:
Owner ❑ Agent ❑
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 performed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum ' g e andrr7 of the eral Laws.
BY,
Title re of Licensed Plum er
Type of License: Master % Journeyman ❑
City/Town
APPROVED OFFICE USE ONLY) License Number 3 3 5
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N,2 2554 Date ......./� d/.�)u
AORTH
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .... ..?� SP��� C p�
...............................................................
has permission to perform .! ••�``
...................................................................
%wiring in the building of ...... - ......................................................
•?... c�
at .........�. ...... �.�.:P .. � �......... � ............... ,North Andover s
-�
`Fee .. 15..: �!�! Lic. No. /f �3
ELECTRICAL INSPECTOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Commonwealth of Massachusetts Official Use only
Department of Fire Services Permit No.
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 11/991 (leave 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 IN INK OR TYPE ALL INFORMATION) Date:
City or Town of. -A)Or7 t'f A) ted vee To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) i�VO STa ge- C-oa cA t'`y_ _
Owner or Tenant r e AJ ,LU ,� U Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box)
Purpose of Building i Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Senice Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Completion ofthe follox,ing table may be waived 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
No. of Lighting Fixtures
Above n-
Swimming Pool , ❑ rnd. ❑Batten
o. o mergency Lighting
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
Ran -es
No. of Ran es
No. of Air Cond. Total
Tons
No. of Alertin Devices
g
No. of Waste Disposers
Heat Pump
Number
Tons
KW
No. of Self -Contained
_ _
Totals:
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
el
Local ❑ Municipal [IOther
Connection
No. of Dners
Heating Appliances
PP '
tt este s:
.-cif-Devices or Equivalent
No. of Water KW
o. of No. of
Data Wiring:
Heaters
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 desired, or as required by the Inspector 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: 9 At) (When required by municipal policy.)
Work to Start: e/ �� / 0-1..) Inspections to be requested in accordance with NEC Rule 10, and upon completion.
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: ADT Security-Sen•ices 111 Morse Street, Noni}►od, MA 02062 LIC. NO.: 1533C
Licensee: John S. Bassett Signatur / LIC. NO.: 1533C
(If applicable, enter "exempt" in the license tniniberline•) Bus. Tel. No.: .7R1.-278—_1131
Address: Alt. Tel. No.: 6.03—.59475-92$ resi
OWNER'S INSURANCE WAIVER: I atn aware that the Li ensee does not have the liability insurance coverage normally ONLY
required by law. By my signature below, I hereby waive this requirement. I am the (check one) [I owner El owner's agent.
Owner/Agent
PERMIT FEE: $ �5.
Signature Telephone No.
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING t
(Print or Type)
l NORTH ANDOVER Mass. Date 11,e
4uilding Location � Sia 9� ��.�� Pe mit # a 5
(A- t,4
Owuers Name,,7
'i
' New 77 Renovation II Replacement e Plans Submitted 0
v .rEIX
(Print or Type)
Installing Company Name ANDOVER PLG. & HEATING CO. ,
Address 573 1/2 SO. UNION ST. -
LAWRENCE. MA. 01843
Business Telephone:
508 685-8383
Che one: Certificate
N. Corp. 2122
Partner.
Firm/Co.
Name of Licensed Plumber or Gas Fitter GEOHR F I AROSE
Insurance. Covera e LndtZe.,,`type of insurance coverage by. checking the
appropriate box: Liability insurance policyr her type of indemnity'[ Bond
Insurance Waiver: I, the undersigned,_ have been made- aware,,that',ah(, licensee of
this application does not have any one of the above three insurance coverages.
Signature of owner/agent of property Owner Agent El
I hereby certify that aU of the Qetllli and Information t hare aubotitted (or entered) in above avplieation are true and accurate to the best of mY
knowledge and that al! plumbing work and Installations Desformod under Permit issued fo: this application will -be in 00 pliance with all V=t1nent
provisions of the Massachusetts State Cas CvEe and Chapter 14: of the General Laws. • •.
By PE LICENSE:
Plumber
Titleasftter Sign Lure of Licensed
City/Town Master Plumber or dadfitter
Journeymen 99f3�
APPROVED (OFFICE USE ONLY) `' License IJumber
i
man
MEMEMENNIMMUM
IMMMMMIMMNMMIMMMI
MEN
(Print or Type)
Installing Company Name ANDOVER PLG. & HEATING CO. ,
Address 573 1/2 SO. UNION ST. -
LAWRENCE. MA. 01843
Business Telephone:
508 685-8383
Che one: Certificate
N. Corp. 2122
Partner.
Firm/Co.
Name of Licensed Plumber or Gas Fitter GEOHR F I AROSE
Insurance. Covera e LndtZe.,,`type of insurance coverage by. checking the
appropriate box: Liability insurance policyr her type of indemnity'[ Bond
Insurance Waiver: I, the undersigned,_ have been made- aware,,that',ah(, licensee of
this application does not have any one of the above three insurance coverages.
Signature of owner/agent of property Owner Agent El
I hereby certify that aU of the Qetllli and Information t hare aubotitted (or entered) in above avplieation are true and accurate to the best of mY
knowledge and that al! plumbing work and Installations Desformod under Permit issued fo: this application will -be in 00 pliance with all V=t1nent
provisions of the Massachusetts State Cas CvEe and Chapter 14: of the General Laws. • •.
By PE LICENSE:
Plumber
Titleasftter Sign Lure of Licensed
City/Town Master Plumber or dadfitter
Journeymen 99f3�
APPROVED (OFFICE USE ONLY) `' License IJumber
�t%1's}.isr]ilyii�Tit'r iYi�.r>.��N-YTtt '.r` .�__ _ Y't= ,., - y: �I• !—rIy�..�'"-- t - .. _ _}'M
2405 Date .
I.) •-z3-
,ORTN � TOWN OF -NORTH ANDOVER �a
PERMIT FOR GAS I INSTALLATiOM
0 9 r
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This certifies that .� ..
has permission for gas installation . �d-.. v� !r.`_'
': • "
in the buildi1gss of
f .... A Y
at c:? + 414 -,�? f ... , N.orth,,Andover, MasE
Fee. �. Lic. No. r JCC ......
! �(�� GAS INSPECTOR t
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer _ GOLD: File
ti
Date.....................
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that .............
.................
,has permission for gas installation
in the buildings of
...........
..;North Andover, Mass.
Fee� Lic. No...........
AQ "4 ..........
A 1 P2
- *1 N P2
Check #
Sw
o�
MASSACHUSETTS UNIFORM A
(Print or Type)
PPI_IOATiON FOR PERMIT TO DO GASFiTTING G
Mass. Datef47—X—
BuildingLoCatiori 20,03
t /
Permit l _
2-6 COAC
-L-ab owners Name 1—UAI A l
Type of occupancy �L Si,� �{/Uj
No.W ❑ Renovation p Replacementaw. Plans Submitted: Yes ❑ NO ❑
-Installing Company Name C/j LL A
Address
Business Telephone_
%arise of Licensed Plumber .or.Cas Fitter
v
—(-14 Ak-
Check one: Certificate
Q�Lorporation % C
❑ Partnership
❑ Firn'I/Co.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent, Which meets the requirements of MGL Ch. 142.
Yes Er -r No ❑
If You have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy ❑,. Other type of indemnity ❑ Bond
❑
OWNER'S iNSURNACE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter
342 of the Mass. General Laws, and that my signature on s perm application walves this requirement
S I gnature oowner or 0 Wnet's Agent
Check one:
Owner ❑ Agent ❑
I hereby cerdfy that all of the details and information i have submitted (or enteredl In above application are true ant accurate to the t of
MY knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in compliance th
all pertinent provislorm of the Massachusetts state Cas Code and Chapter 142 of the Gene Laws.
Type of License:
By ❑ Plumber
Tidc [--G=fitter S r Of c d Plu er or Cas F1ttnr
MPROCity/Town
License A.pPROVED (OFFICE USE ONL1) I License Number
ID Journeyman