HomeMy WebLinkAboutMiscellaneous - 24 SUMMIT STREET 4/30/2018Safety Insurance
P.O. Box 55098
Boston, MA 02205-5098
1-617-951-0600
July 14, 2016
Building Commissioner or Inspector of Buildings
Fire Department or Arson Squad
Board of Health or Board of Selectmen
City Hall
NORTH ANDOVER, MA 01845
Insured: JONATHAN BOJAS
Property Address: 24 SUMMITT STREET, NORTH ANDOVER, MA
Policy Number: HMA 0382762
Claim Number: BOS00070545
Date of Loss: 7/9/2016
Notice of Loss Under M.G.L. c. 139, 4 3B
This communication shall serve as written notice pursuant to M.G.L. c. 139, § 3B that [Safety
Insurance Company] ("Safety") has received a claim involving loss, damage or destruction to a
building or other structure at the above -referenced address which may either: (1) meet or exceed
$1,000; or (2) cause the condition or the building or other structure to render M.G.L. c. 143, § 6
applicable.
In accordance with M.G.L. c. 139, § 313, if the city or town intends to initiate proceedings
designed to perfect a lien under Section 313, M.G.L. c. 143, § 9 or M.G.L. c. 111, § 127B, please
notify Safety of the same by certified mail. Kindly forward such notice to my attention, at the
address indicated below, and include with such notice a reference to the above-described insured,
property address, policy number and claim number.
If you have any questions regarding this notice, please feel free to contact me directly at (617)
951-0600 EXT 3213.
Sincerely,
Allan Leavitt
Claim Examiner
WA
Date....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
v-�
This certifies that ............................
1�—rb ................................ . ..............................
has permission to perform ....
wiring in the building of ...... iz- ..................................
at ...... IY. .....
................................ . North Andover, Mass.
Fee A/5–.:',!:!!,:,M Lic. No.. �.Cl .......... �..
ELECTRICAL INSPECTORd
Check #
8836
�-\ L,..O/f<�f'A/uLIGLLi Of �: i-1h�1LG�aCIi
8CAR0,0F FIRE PREVENTION REGULATIONS .
Official Use Only --
Permit No. 1
Occupancy and Fee Checked
,cv. 1/07](leave blank)
APPLICATrION FOR PERMIT TO PERFORM ELECTRICALMORK .
All wor}c to be performed in accordance with the Massachuse?S Elc-=ical Code (NI EQ. 527 CMR 12.00•
(PLEASE PRIM N L1VK OR TYPE � L LtVFORll4 TION)' Date: L/ CP % d�
City or Town of: _To the Inspector of Wires:By this application the undersigned gives nodcc of his or her intention to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant "AJ I'r-= Telephone No.- er2-OIL->
Owner's Address _
Is this permit in conjunction with a building permit? Yes ❑ No (Check Aoprooriate Box)
Purpose of Buildi
Existing Service Amps / Volts
New Service Amps / Volts
Utility Authorization No.
Overhead ❑ iindgrd ❑
Overhead ❑ Undard ❑
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:.y->`�
No. oCtl:eters
N0. or Meters
Gttt i :pf (-ire— 14t a—Pi
�STPm
Completion of the following table may be waived by the Inspector of Wires.
No_ of Recessed Luminaires
a-urcL_
No. of Ceil: Susp. (Paddle) Fans
No. of ota
Transformers' KVA'
.No. of Luminaire Outlets
No. of Hot Tubs
GerieratOrs K.VA
No. of Luminaires
Above ❑ n- ❑
Swimming Pool-
a rnd_ -IMd.
t o. of meraency. :g.itrng
Batter Units -
No- of Receptacle Outlets
Na. or Oil Burners
FIRE ALARMS,
No. of Zones
No_ of Switches
No. of Gas Burners
o. of etection an •
...;tinting Devices
No. of -Ranges
No. of Air Cond. TonSL
No. of AIerting Devices . Z
eat ump
um er ons
o. of belf-Contalrle&
No. of Waste Disposers
Totals:
Detection/Alerting Devices
No. of Dishwashers
S ace/Area Heating KW
P e
Municipal ❑ Other
Locil ❑ Connection n
No. of Dryers
Heating Appliances KW
ecu o- o yysvice:s
No_ of Devices or Equivalent
No. o
caters KW
No -
o_ o o_ of
Suns Ballast,;
Data Wiring -
I`Io_ of Devices :.r E uiv :l:rt
No. Hydromassage Bathtubs
No. of 'iotors Total HP
e ecommunica[ions wiring '
No. of Devices'or E uivnient
OTHER: %'o�5-(��o�
-- -----�t.. .
!1(!QC/7 UQUILfO/1Ql uc/urc yucit�cc{ yr rcyuucu uy ,...per..••-• 1 - - --
Estimated Value of El I Work_ 7(When required by. municipal policy:)
Work to Start Inspections to be requested in aScordance with MEC Rule 10, and upon completion.
.INCOVERAGE. Unless waived by the ow, rier, nn permit foe tfrc performance of cleetrFeal 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 penalties ofperjury, thct the information ors this application is true and.complete_ c.
FIRM NAME: A�-T S�Curl. LIC -NO.:
Signature' ��� LIC- NO.: —Y k
Licensee: _ —}— _59
{If applicable, enter "ece pt" in the lice num cr line.) ,Ina Bus. Td. Nb.. —
Address- f 1? L I IJTM %P- � �it5 kA' 60'4? Alt. Tel. No.:
Per M.G.L. e. 147, s. 57-61, security q p ry o G l 9
* work rc sties Dc artmcnt of Public Safety "S License: Lie. No. SCC'
OWNER'S INSURANCE WAIVER-- I am aware that the Licensee does not have the liability insurance coverage normally
ry.quired by law. By my signature below, I hereby waive this requirement. I am the (c;hcck one) ❑ owner ❑ owner'sgent. .
Owner/Agent ��
Signature TeIephorie No. PERTi�'EE: g e
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