HomeMy WebLinkAboutMiscellaneous - 2053 SALEM STREET 4/30/2018O N
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New England Claims Services, Inc.
131 Dodge Street, Suite 6
Beverly, MA 01915
Phone #(978) 927-3000 Fax # (978) 927-3002
Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec 3B
To: Building Commissioner or
Inspector of Buildings
City Hall
North Andover, MAO 1845
To: Board of Health or
Board of Selectman
City Hall
North Andover,MA 01845
RE: Insured: Cleon & Jane Richards
Property Address: 2053 Salem Street, North Andover, MA 01845
Cause of Loss/Date: Lightning/ 9/6/2014
File or Claim No: BOS.052756
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.
Robert L. Smith, Jr.
Adjuster
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
Date
/�1/, i
r35 8 2 Date... �./Oh� ....
4 'k0RTjj
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...... .............................
,has permission to perform .... ......
,=wiring in the building of .............. .
at ............. )--6--5 .. 3 ...... ......... North Andoyer-,,Mass.
/."do A/
Fee.. � ............ Lic. No.M-0.3 .......................
IC,
INSPECTOR
Check#
The � Massa Commonwealth o a Dente Use Pat>r
. ch;useits
Department --
of Public, &of ' ''•`••" �° - ,
BOARD OF FIRE PREVEN71W REGU.LATIO.NS SZ7 CMR iZpO "°'nQy i r.. QKe .k
3t 90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM
All work to be performed in accordance With the Maesachu:cns Electrical Codc, 527 CMR 12;00 �O R K
(PLEASE PRIHT Iii XM OR TYPE ALL ZNFO
RHdTION) Date —o' -d -l'7c�i
City or Town ofJJ_-_ _0—_ ., AYVf�L1CrT_ .
ft"WavoomTa the ud ooter d6 �Ofi�o�r1
e undersigned applies for a permit to p
perform the electrical work described below.
Location (Street b Number) d� ��1
Owner or Tenant k
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 Am s
-- -P �volt=r hrcrhta® ❑ Ufid® ❑ Ne* of leer
New Service � APs 1 volts.
Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampaeity
Loc-ation and Nature of Proposed Electrical Work
1
No. of Lighting Outlets
No. of Lighting Fixtures
NO- of Receptacle Outlets
No, of Switch Outlets
No.t`tof Disposals
No. of Water Beaters
No. Hydro Massage Tubs
FIRE ALARMS No, of Zon
Noe of Deteat'ion ohd
Initiating Devices
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
Local ❑ Municipal
Connection❑ Other
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
2 have a Curren - abilit Insurance Policy including Completed Operations Coverage o is substa'
equivalent. YES NO I have submitted valid
proof ntial
If you have c pr of same to this
Y checked YES, please indicate is office: YES bNO
o
the type of coverage by checking the appropriate boxy
INSURANCE
B
OND ❑ OAR ❑ (Please Specify)-- 1
Estimated Value Of Electrical Work S (Lxp4ration ace
Work to Start Inspection Date Re uested:
Signed aRie
FIRM NAMpenalties of perjury: q Rough _ Finale
I
igNhMae cxw ' .._ LIC. N0: J�
S l•gna Lure �LI N0
i AddressS 5"j`• Gvj�C� �Lj,� GZ� Bus. Iei. No _
OWNER'S 'INSURANCE 6�AIVER: I am aware that the Licensee does not have theAlt. insurance coverage or its sub-
stantial equivalent as,required by Massachusetts General—Laws, and that my signature on this permit
application waives this requirement. ,Owner Agent (Please check one)