HomeMy WebLinkAboutMiscellaneous - 250 JOHNSON STREET 4/30/2018 (2)Northeast Property
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TOWN OF NORTH ANDOVER
1600 OSGOOD ST STE 2089
NORTH ANDOVER MA 018451057
July 25, 2016
INSURED: XU CHEN
DATE OF LOSS: July 23, 2016
CLAIM NUMBER: 0422174151 JLC
PROPERTY ADDRESS: 250 JOHNSON ST, NORTH
ANDOVER,MA
POLICY NO.: 000925758353
TO:
PHONE NUMBER: 800-280-0714
FAX NUMBER: 866-547-5534
OFFICE HOURS: Mon - Fri 8:00 am - 5:30 pm,
Sat 8:00 am - 2:00 pm
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws.Ch, 139.Sec.3D
Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectmen
CITY/TOWN HALL: North Andover
ADDRESS: 1600 Osgood Street
CITY/TOWN/ZIP CODE: North Andover, MA 01845
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, Chapter 139, Section 3D is appropriate, please direct it to the attention of the undersigned and include a
reference to the captioned insured, location, policy number, date of less and clairn number.
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.
Copy: XU CHEN AND LING LIN
PROP054
0422174151 JLC
SIGNATURE AND DATE
LOUIS CRITELLI
July 25, 2016
1000020160725TR013001978001001003041
2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accoj ice-wil the provisions of M.G.L. c. 143, § 3L, the
permit application form to provkie notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed
on the prescribed form. 7&r a permit application has been accepted by an Inspector of Wires appointed pursuant to M. 01 c. 166, § 32, an
electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the
notification of completion of the work as required in M.G.L. c. 143, § 3L.
Permits shall -be limited as to the time ofongoing construction activity, and may be.deemed-by the7nspector-of_Wires abandoned -and -invalid if -he—._.
or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written
application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the permit application.
❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of
the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this
puipose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With
limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was
"in effect or existence" during the qualifying period beginning on August 15, 2008 and extending -through August 15, 2012.
8 — Permit/Date Closed:
0 Permit Extension Act — Permit/Date' Closed:
Note: Reapply for new
I
10249
Date ......� .. �.•.
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
11
This certifies that ....... �.i ........Rlry, 411..�� ......
has permission to perform ....... es .. ..........................
wiring in the building of ............ . ..........................................
at ...... ...... 51 North Andover, Mass.
Fee ..-$-- Lic. No. !�.?Y� 7E........
Check # -7
N Commonwealth of Massachusetts official use Only
Department of Fire Services Permit No. Z
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank
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: R a S —/ /
City or Town of: NORTH ANDOVER 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) 350 Soh n So r1 S i ozG&-!
Owner or Tenant )%j cL-rhy GAez-%)l ,- /K Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No 2--- (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service 1190 Amps l ao / c9gbVolts Overhead Undgrd ❑ No. of Meters
New Service �00 Amps D /c:314O Volts Overhead Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Completion of the following tahle may he waived by the In.rnertnr nfWiroc
No. of Recessed Luminaires
:
No. of CeilSusp. (Paddle) Fans
No. o Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Above -
Swimming Pool rnd. 1:1nd. ❑
o. o mergency Lighting
Battery 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
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
g
No, of Waste Disposers
eat Pump
Totals:
..
Number.
Tons
'"- ��-
"""""""".'-"
No. oSelf-Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑Other
Connection
No. of Dryers
Heating Appliances KW
SecuntySystems:*
No. of Devices or Equivalent
No. o Water KW
Heaters
No. of o. o
Signs Ballasts
Data Wiring:
No. of Devices or Euivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
a ecommumcations 'ring:
No. of Devices or E uivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: g -a 6 // 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 cove ge 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 of perjury, that the information on this application is true and complete
FIRM NAME: LIC. NO.:
Licensee: pUlf, Signatureo( 'A f // LIC. NO.:
(If applicable, enter "exempt" in the t ense number line) Bus. Tel. No.• �%
Address: Alt. Tel. No.: - _ y
*Per MG.L c. 147, s. 57-61, security work 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)E] owner ❑ owner's agent.
Owner/Agent
Signature Telephone No.PERMIT FEE. $
Location\ t �� ' -b
No. _^- Date
A
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
s
Building/Frame Permit Fee $ S� u
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
_��,;,r_' TOTAL $
6 ;7(;
Building Inspector
Div. Public Works
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