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Home My WebLink AboutMiscellaneous - 23 ALCOTT WAY 4/30/2018 (2) 23 ALCOTT WAY 210/025.0-0016-0023.E - Liberty Mutual,, Liberty Mutual Insurance ./ New England Region Central Property Unit INSURANCE 75 Sylvan Street Danvers,MA 01923 Tel:(800)566-0323 August 6,2015 Town of North Andover Attn:Building Inspector 120 Main Street North Andover,MA 01845 Re: Property Address:23 Alcott Way,North Andover,Ma 01845 Policy Number:H6521830982270 Underwriting Company:LM Insurance Corporation Claim Number:031779310-0001 Date of Loss:3/6/2015 Attn: Town/City Official Pursuant to M.G.L. c. 139, 5 3B, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, 5 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, 599, if you intend to initiate proceedings designed to perfect a lien pursuant to Mass. General Laws, Ch. 139, 6 3A &B, or Mass. General Laws, Ch. 143, § 9, or Mass. General Laws,Ch. 111,g 127B. This letter should not be construed as a waiver or estoppel of any of the terms,conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address,policy number,claim number,and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 t Date...... ...z O�...�.7 NORTH . i of,.�•�;°�"o TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SS4CHU`'� V This certifies that .....................'...... [/GL.<. !Y................................... has permission to perform ........................................Tort wiring in the building of.............. Et.. ............................... at.......... ... fi G d/. `�................ ,North Andover,Mass. Fee... .-s " . Lic.No...�;TO/.3 .......... .......... ELECTRICAL INSPECTOR , Check # t 7657 -� Commonwealth of Massachusetts Official Use Only Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (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:9/ ZO/D-7 City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notiAro-r his or her intention to perform the electrical work described below. Location(Street&Number) Z I�/ Owner or Tenant -J0C eff 4 d114 0'0'-N Telephone No. Owner's Address Z?j LGy—r wu 4 Is this permit in conjunction with a building permit? I Yes ❑ No '� (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 6p O Amps (?n / I YO Volts Overhead ❑ Undgrd'7� No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: .l Completion of the following table may he waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA A oveIn- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. El d. ❑ Batte 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 InitiatingDevices Tonnss No.of Ranges No.of Air Cond. TotalNo.of AlertingDevices No.of Waste Disposers Heat Pum Number Tons KW o.of Self-Contained Totals Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KWo.o No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP elecommunications Wiring: /f No.of Devices or Equivalent OTHER: 2►— L'O �- //�P_7C�'� Attach additional detail if desired, or as required by the Inspector of 1Nires. Estimated Value of Electrical Work: �j2 (When required by municipal policy.) Work to Start: 9/t Q/V 7 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 the.pains and penlies Qf perjury,that the information on this application is true and complete. FIRM NAME: nar �/ ;�a✓k LIC.NO.: Licensee: teo V Sy(�t'.u.4 Signature e LIC.NO.: (if applicable nter "exem,(�t 11 in the license number line.) ) 'n Bus.Tel. No.:l Address: �0?j /<,`va f1J� /7i /ie-rk, c,. /✓tn O/f y y Alt.Tel. No. *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lie.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/AgentPERMIT FEE. $ Signature e Telephone No. 1 ` To 8 4. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 11 600 Washington Street Boston,MA 02111 www.mass.gov/di a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): C�ong�� w�✓<,y�il � Address: �Ir L-e r f City/State/Zip: ��7G1�Pn F A14 !'/S,/q Phone #: 9 7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet.t Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.�Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip:" 01 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cerci under the pain andpenalties of perjury that the information provided above is true and correct. Si nature: Date: 1, /6 Phone#• 0111 61S-6 A116' Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Date... .. `..... ..J .. . Of.NORTH ,M o� '` ° �°� TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION T �SSACK 5ES This certifies that . 7 ' . r.! `` . � . . . . . . has permission for gas installation . ...... . . . . . . . . . in the buildings of . ... . . . . . . . . .. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . atc: . . , North Andover, Mass. Fee. . . . . . . . . Lic. No... .. _. . . ... . . . .. . ' •+GAS INSPECTOR Check# Acf 6770 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: / /r �7`�� Date:`7"'�0 Permit# Building Locatic Owners Name: r Type of Occupancy: Commercial Educational Industrial' Institutional. Residentiax.. New: Alteration: Renovation:' enovation Replacement.X Plans Submitted: Yes No FIXTURES Ww Y U) N U 0: Q to 0 ~ N U) iii m = 0 Uj w U rn F- rn g w w W 0 w w a m O � w O F- 0 a � aQ rn W F- W a Q 2 U a rLX w W W In � U W Z O J FW— P 0 Z J O OW In = W W W w Z W �- tY U) J Q Q m W 0 Z 0 r j H Z F- F- F- _ m o o IUi 0 0 ix z z g 0 a � m FW- > > 3 � � 0 SUB BSMT. BASEMENT 1 FLOOR 2 NDFLOOR 3 FLOOR 4 FLOOR FLOOR FLOOR VH FLOOR 81HFLOOR Check One Only Certificate# Installing Company Name: [ rY;t.jY1 c Q , Corporation 9 7� Address:/. µ..F�i°'G/1 City/Town .7�1/tC'{L 3State MA Partnership Business Tel:. 791. G, -N_� Fax. � v2'��.7 '.Firm/Company Name of Licensed Plumber/Gas Fitter: C ?a INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yesx Nq, If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy�ki 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner Agent Signature of Owner or Owner's Agent By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: of Plumber Title v 'Gas Fitter Sig ature of nsed Plumber/Gas Fitter Master Cityfrown Journeyman License Number: APPROVED OFFICE USE ONLY LP Installer i FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(S) FEE: S PERMIT# APPLICATION FOR PERMIT TO DO GAS FI I'TING NAME&TYPE OF BUILDING LOCATION OF BUILDING SKETcll PLUMBER,GASFITTER,LP INSTALLER LICENSE NUMBER: PERMIT GRANTED DATE: GAS FITTING INSPECTIOR Date. .. ... V . .... . RTm °f 4,Sao ,n,ti° 3� TOWN OF NORTH ANDOVER O D PERMIT FOR GAS INSTALLATION SA US This certifies that i. . / - . v - d. . . . . . . . .. . . . has permission for gas installation . . . :-. . . . . in the buildingss o 1 . . . . ... . . .. . .. . . . . . . . . . . . . . . . . at �'`� . . . . . . . ?. . . . . .J 4 , North,Andover, Mass. Fee. .': . . . . Lic. NO...�c�:�.. . . f l .f es. . . . . .. .. . C GAS INS ECTOR Check# 6533 i MASSACHUSETTS UNEFORM APPUCAT'ON FOR PERMIT TO DO GAS (Type or print) Date S7 NORTH NORTH AN++DOVER,MASSA,CHjUSETTS ( Building Loqations 4' I -'ry `-v ' Permit# Amount$ Owner's Nam 6 New Renovation D Replacement Plans Submitted W vi 'd F a �' w a w m F F dd G�7F Z z Q x a w F q F z w > C z W Z O z w C F ° z > o 00. o SUB-BASEMENT BASEMENT 1ST. FLOOR 2N D. FLOG R 3RD. FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR STH . FLOOR (Print or typ heck one: Certificate Installing Company Name Corp. Address 4 S-e Partner. L C usess a ep one mti0.ry irm/Co. Name of Licensed Plumber'or Gas Fitter Ila INSURANCE COVERAGE Chec on I have a current liability Insurance'policy or it's substantial equivalent. Yes ' If you have checked es ple a in 'cate the a coverage b checking the No� Liability insurance otic tyP g Y g appropriate bo P Y91 Other type of indemnity D 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. Signature of Owner or Owner's Agent Check one: Owner 10Agent 13 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 inst I rf ed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mas us hapter 142 of the General Laws. By: n re of L' d Plumber Or Gas Fitter Title ;Plu erg 6 City/Town, Gas Fitter (cense Number Master _ APPROVED(OFFICE USE ONLY) Journeyman i COMMONWEALTH OF MASSACHUSETTS IN;PLUMBERS AND GASFITTERS " f LICENSED"AS A:MASTER PLUMBER; ISSUES THIS.LICENSE TO JEFF S AG'NEW a 55 CHASE ST METHU'EN` MA "0'1844-370 1,2060 0'S%.Ol/10 455559 k Fold,Then Detach Along All Perforations n 7 Date. NORTH L o p TOWN OF NOR MOVER • PERMIT FOR GAS INSTALLATION ♦ s � s CH „ i This certifies that . . . �/4�' �� 1. . . ./��.�j. . . . . . . . . . . . . . . . . has permission for gas installation in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . at . ., . .f l c. �1` . .L ' .`! . . . . . .. North Andover, Mass. Fee. . 3c� Lic. No.. .).z.t ?:-. . . . . . . ..r..�� - GASINSPECTOR Check# cj r 6120 MASSACHUSETTS UNIFORM APPUCATON FOR PERmrr TO DO GAS FITTING (Type or print) Date (� (� NORTH ANDOVER,MASSACHUS TTS Building Locations 3 lG Permit# G`Ala Ax;xqA- I Z G A r�.�� Airyount$ 1 0 � Own r s Name l fR/u New D Renovation D Replacement Plans Submitted � zwz ui W W 0 a F a G� .a a O Q o F Gw z u w w a C > z F z o w w H W H m a x o x 3 0 d o o w a 0 x SU B-BASEM ENT u C > o a BASEMENT 1ST. FLOOR 2ND. FLRGR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR p 7TH . FLOOR 8TH . FLOOR (Print or type) Name l� 90 Che k one: Certificate Installing Company r Corp. Addres txJ lQ K- Partner. Business a ep one Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE 1 have a current liability Insurance policy or it's substantial equivalent. Check h c13 If you have checked ves,please indicate the type coverage by checking the appropriate box. No� Liability insurance policy 0 Other type of indemnity 13 Bond 13 Owner's Insurance Waiver: 1 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. Signature of Owner or Owner's Agent Check one: Owner 13 Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurato best of my knowledge and that all plumbing work and installations performed under Permit Issued for ththe is application will to e to compliance with all pertinent provisions of the Massachus State s as Code d ter 142 of the General Laws. By: Signature of Licensedlumb/ Or Gas Fitter Title Plumber 7G City/Town Gas Fitter dense Number Master VE APPROD(OFFICEUSEONLY) r3 Journeyman