HomeMy WebLinkAboutMiscellaneous - 200 SANDRA LANE 4/30/2018;Pta4� General
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April 15, 2015
Town of North Andover
Building Commission/Department
Town Hall
North Andover MA 01845
Re:
Insurance Co.: Massachusetts Homeland Insurance Company
File No.: 1452751
Policyholders: Paul and Marilyn Gilboard
Policy No.: PHD0029503N1301
Policy Period: June 03, 2014 to June 03, 2015
Date of Loss: February 23, 2015
Location of Loss: 200 Sandra Lane, North Andover, MA.
Dear Building Commissioner/Department:
Claim ,has been made involving loss, damage or destruction of the above captioned
property, which may either exceed $1000.00 or cause Mass. Gen. Law, 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 this writer and include a reference to the captioned Insured,
location, policy number, date of loss and claim number.
Kevin S. Briggs, Claim Specialist, Property
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.
KeA1641t13v'6"-k 4/15/2015
Signature and Date
Date.......:..�'.....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that.............................L.�d ��i!C.....................................
has permission to perform R wt R e �o /i � o SFS
......................... ?............... .....................
wiring in the building oft.......... .
.........................................
at ...........C-29 ................. . North Andover, Mass.
0
..... Lic. No.... 0/.q -p.,.. �..........
Fee . ��� � ................
.....,
,q L'LECTRICAL INSPECTOR J j
Check # y/>'a�Vt
WO
C.otnmonuiealth o� �a�ac�el�
a1JePartment o�.}ire �ervicee
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. fx )o
Occupancy and Fee Checked
[Rev. 1/07] leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code C), 527 CMR 12.00
(PLEASE PRINT W INK OR nTLL EWORMA ION) Date: oZ6 --Q ?
City or Town of: To the Inspector of Wires:
By this application the undersigned gives notice of his or her intentiop to perform the electrical work described below.
Location (Street &
Owner or Tenant
Owner's Address
Is this permit in conjuncts with nna building permit? Yes ❑
Purpose of Building Lte5 IGrj�_
Existing Service Amps / Volts
New Service Amps / Volts
Number of Feeders and Ampacity
and Nature of Proposed Electrical Work:
AW W -iv ,, t`1
No ❑
(Check Appropriate Box)
Utility Authorization No.
Overhead ❑ Undgrd ❑
Overhead ❑ Undgrd ❑
Ij 1f
No. of Meters
No. of Meters
' Com letion o the &11 -win table in be waive ' d b h
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
inspector ector o Wires.
o. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators K -VA
No. of Luminaires
Swim of Above El ❑
d. nd.
o. o mergency g g
Battely Units
No. of Receptacle Outlets(
No. of Oil Burner
FIRE A7.ARMS
No. of Zones
No. of Switches
No. of Gas Burners
o. of Detection an
Initiatin Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
g
No. of Waste Disposers
eat Pump
Total
er
...___ .. .......
Tons
wt
__.__......._
.._........._...__..
o. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑umcipa ❑ Other
Connection
No. of Dryers
Heating Appliances IAV
Security Systems:
No. of Devices or Equivalent
No. of Water KW
Heaters
No. of o. of
Signs Ballasts
Data Wiring:
'
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wirsng:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value ofElectricalWork: Q 0 (When required by municipal policy.)
Work to Start: WInspections 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 toa permit issuing office.
CHECK ONE: INSURANCEXenallies
BOND ❑ OTHER ❑ (Specify:) ZVn C -A j 1,( {� a kj �e „
I certify, under the pains a ofperjury, that the informati on this application is true and complete -
FIRM NAME: 2 p p P1G t—rf 4 LIC. NO.: 1�
Licensee: Signature LIC. NO.:
(Ifapplicable, enter "exempt" in the license number line - Bus. Tel. No.-, 97E, (ft -53
Address:6110-Al
L L Alt. Tel. No.: 3�
*Per M.G.L. c. 14 , . 57- 1, security ork requires Department 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
Signature Telephone No. PERMIT FEE. $
,,u�hj,-rr xmrr r EES
(Effective March 12, 2003)
�fi;o RCie5000
NO SE CABLE ON
011TSIDE OF BUILDING
Air Conditioners: $40.00 each
Alarm Systems Security: (for fire
systems see smoke/heat detectors)
Residential: $40.00
Commercial: up to 10 Devices
$60.00 additional devices over 10-
$1.00 each
Carnival Equipment: $50.00 each
Ceiling Fans: $1.00 each
Commercial New Construction or
Alterations:
$100.00 per 1,000 Sq. Ft. of
Construction Space
Commercial Service Change/
Repair:
Must have Utility Authorization Number
$100 (fust 100 amperes or fraction, one
meter)
a) each additional 100 amperes
capacity or fraction. $30.00
b) each additional meter $25.00
Commercial Temporary Service:
$100.00
Must have Utility Authorization Number
Commercial Repair and/or
Maintenance Permit: (Blanket
Permit) up to 2 Electricians $150.00
per pair of Electricians over 2 $50.00
Data/Telecommunication:
Residential: $1.00 per port
Commercial: $30.00 up to 10
devices over 10 - $1.00 each
Dishwashers & Disposals:
$5.00 Each
Dryers: $15.00 Each
Emergency Lighting (Battery Units)
$ 1.00 each unit
Feeders or Sub -feeders:
each 100 amp capacity of fraction
thereof
Residential: $5.00 each
Commercial: $15.00 each
Gas/Oil Burners:
Residential: $20.00 each
Commercial $20.00 each
a) including photovoltaic &
generating Equip Per KVA $1.00
b) un -interruptible power systems,
per KVA $1.00
e) batteries over 100 amp. hours, per
cell $1.00
Heat Devices: $1.00 each
Heat Pumps: $40.00 each
Hydro -Massage Bathtubs/ Hot
Tubs: $20.00 each
Lighting Fixtures $1.00 each
Lighting Outlets: $1.00 each
Major Appliances: (not listed)
$20 each
Motors: (per hp or fractional part
thereof) $2.00
Oil /Gas Burners:
Residential $20.00 each
Commercial $20.00 each
Office Furnishings: per circuit $10
(Relocatable Partitions/Cubicles)
Outlets & Fixture: $1.00 each
Ovens Built in/Counter Top Units:
$10.00 each
Panel Change/Circuit Breaker:
Residential: $20.00
Commercial: $25.00
Phone Jacks: See
datahelecommunications
Ranges $15.00 each
Receptacle Outlets: $1.00 each
Recessed Fixtures: $1.00 each
Re -inspection Fee: $25.00
Repair to Service Residential:
$20.00
Residential New Construction
(Dwelling): $220.00
(with service up to 200 amps)
Must have Utility Authorization Number
for services over 200 amps see below
a) for each 100 amps capacity or
fraction add $20.00
b) each additional meter $10.00
c) each additional panel/sub panel
$25.00 '
Residential Additions/Alterations:
$220.00 maximum
Residential Service Change or
Underground Service:
$40.00
Must have Utility Authorization Number
a) one meter, up to 100 amp capacity
$40.00
b) each additional 100 amp capacity
or fraction $20.00
..,D I U.UU I
Sewer Ejection Pump: $25.00 }
Signs: $25.00 each ballast
Smoke & Heat Detectors &
Initiating Devices:
Residential: $1.00 each
Commercial: $60.00 up to 10
devices over 10 - $1.00 each
Space Heaters:
area heating $1.00 each
Sub -Panel: $25.00
Swimming Pools:
Residential:
Above Ground: $25.00
Inground: $50.00
Commercial Pool: $100.00
Switches: $1.00 each
Temporary Service:
Must have Utility Authmization Nunlller
Residential $25.00
Commercial $100.00
Transformers:
a) capacitors, Per KVA $1.00
b) ducts, conduit & conductors
(Associated w/ Padmount Transformers) $�
c) each manhole $10.00
d) each handhold $5.00
e) per KVA $1.00
f) primary feeders, $25.00 each (ove
600 volts, non-utility owned)
vaults and equip. $25.00 each
Washers: $15.00 each
Waste Disposals: $5.00 each
Water Heaters: $30.00 each
*For Multi -Family &
Lame Commercial Pirojee-
see Wiring Inspect®r for
pricing:
Paul Kennedy (978) 623-8306
(Office Hours 8 ani to 1.0 ani)
*Inspection Schedule:
1 ROUGH
1 FINAL
1 TRENCH (f applicable
ADDITION-AJ-
INSPECTIONS
DDI.T.IONAJ:INSPECTIONS *$25.00 (if
applicable)
(revised 07/05)
Date': -`-3 -.0.7..
This certifies that'��''.... ...... ......
c.i r % C-
has permission to perform ...........,.;,�:*-� .......:.............. .
plumbing in the buildings of :.. '. ..`"................ .
at _ ''' '..... '.` ....... , North Andover, Mass.
Fee..
....... Lic. No:. d . / ..... ............. .
V PLUM�Bt. G INSPECTOR
Check it
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
SSACMUS�
This certifies that'��''.... ...... ......
c.i r % C-
has permission to perform ...........,.;,�:*-� .......:.............. .
plumbing in the buildings of :.. '. ..`"................ .
at _ ''' '..... '.` ....... , North Andover, Mass.
Fee..
....... Lic. No:. d . / ..... ............. .
V PLUM�Bt. G INSPECTOR
Check it
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
fZ
/ld/j ie Mass. Date Permit #
C Building Location QQ Sa,dtm kQf10 Owner's Nam �_�_�(�_ % �L64=1-d
/Z 4 — 60, "— �o C Type of Occupancy Residential
New Renovation O Replacement ( Plans Submitted: Yes ❑ No D
FIXTURES
Installing Company.,Name Heritage Htg. &Pig. Co. Inc.
Address 35 Pleasant Street
Stoneham, Ma 02180
Business Telephone ,. 781 -438-7776
Name of Licensed Plumber Gordon Switzer
Check one: Certificate
IX Corporation 7.14
[] Partnership
F.1 Firm/Co.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ® No 0
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy [S Other type of indemnity O Bond O
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 11 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 performed under the permit issued for this application will be in compliance with all .
pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
6y g t-�
Signature iif lacensed Plum er
Title
Type of License: Master j� Journeyman F]
City/Town 8322
APPROVED (OFFICE USE ONLY) License Number
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Installing Company.,Name Heritage Htg. &Pig. Co. Inc.
Address 35 Pleasant Street
Stoneham, Ma 02180
Business Telephone ,. 781 -438-7776
Name of Licensed Plumber Gordon Switzer
Check one: Certificate
IX Corporation 7.14
[] Partnership
F.1 Firm/Co.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ® No 0
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy [S Other type of indemnity O Bond O
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 11 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 performed under the permit issued for this application will be in compliance with all .
pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
6y g t-�
Signature iif lacensed Plum er
Title
Type of License: Master j� Journeyman F]
City/Town 8322
APPROVED (OFFICE USE ONLY) License Number
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Location—700
No. ZZ Date
k
NYa
8321
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee ujc
$
Sewer Connection Fee
$
Water Connection Fee $
TOTAL $
Building Inspector
05/30/95 15:11 25.00 PAID
Div. Public Works
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Job No.- 362853
Cp /-7i 1Q�t/l-✓EAG T.•4/ woe >G A 6 E C G, ' '
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This plan was not prepared from an instrument
survey. Offsets and distances shown should not
be used 'to establish property lines.
This plan is intended for mortgage.purposes
only.
certify that the structure shown on this
Plan W -As • in conformance with the zoning
setbacks in effect at the time -of construction.
I certify that the parcel shown is %moo 7 -
located
located within a flood hazard area as depicted
on FEMA Flood Insurance Rate Maps for
Community No: --Ls,--no -9,9
A I
MORTGAGE LOAN INSPECTION
LOCATION: zoo
SCALE: 'DATE:iy-
REGISTRY-
TITLE REFERENCE:
PLAN REFERENCE:
COREY & DONAHUE. INC.
Enzineem t Surveyors
i'J8 Cambridge Road, Woburn, MA 01801
Z.
4 O�IILI7L0'K s.:
F 94 : t,
!_ w DEPARTMENT OF PUBLIC SAFETY
.i license: CONSTRUCTION SUPERVISOR
Number Expires Birthdate
CS 962941 0610611998 060611968
JOHN J_ TORNANE
82 LINDEN AVE
COM MISSONER . N ANDOVER, MA 01845
f"\ HONE INPROVENENT CONTRACTOR
_ Registatioe 118789
Type - INDIVIDUAL
ElATSUOR 04/20/97
JOHN J TORNANE !; "
F39 JOHN J. TORNANE,�
' LIBERTY ST `
jj AM STRATM NIOOLETON NA 01949
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