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Home My WebLink AboutMiscellaneous - 39 DAVIS STREET 4/30/2018c 'IT �nT 1111i I D E THE PR(WIDENCE MUTUAL, FIRE INSURANCE COMPANY FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GENERAL LAWS, CH. 139 SEC. 313 To: BUILDING COMMISSIONER OR BOARD OF HEALTH OR INSPECTOR OF BUILDINGS BOARD OF SELECTMEN TOWN CLERK'S OFFICE 120 MAIN STREET NORTH ANDOVER, MA 01845 RE: INSURED : NICHOLAS PELLETIER PROPERTY ADDRESS :39 DAVIS ST, NORTH ANDOVER, MA 01845 POLICY NUMBER : HP 015444005 DATE OF LOSS : 02/09/2015 CLAIM NUMBER :15-1777 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. INCLUDE A REFERENCE TO THE CAPTIONED INSURED, LOCATION, DATE OF LOSS AND CLAIM OR FILE NUMBER. CC: FILE 41, V-6 IGNATUR DAf E PROVIDENCE MUTUAL FIRE INSURANCE COMPANY P. 0. BOX 6066 - PROVIDENCE, RHODE ISLAND 02940 TEL. (401) 827-1800 FAX (401) 822-1921 EMAIL: CLAIMS@PROVIDENCEMUTUAL.COM ON THIS DATE, I CAUSED COPIES OF THIS NOTICE TO BE SENT TO THE PERSONS NAMED AT THE ADDRESSES INDICATED ABOVE BY FIRST CLASS MAIL. SIGNATURE DATE 340 I ° 'I !.I:'. I I , WARWIC"K, ISI 02886 0 lI1f- (401) 82-7-180 r.vtA IANC . fl)l)R.ES . P0. I1O1( 6066, PROVIL)I'N(X, ISI 02904 '1'()Lt., FRE. , I-87';7-763-1800 - EAX< (40.1.) 822.192 I. Date... Z.?...-... �- ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... ............ ) &Zn..z ..... ..................... has permission to perform ....... Z.-........... k_,r:.A .................................. wiring in the building of .....A.: 16 .................... / ..................... ................. at ....2 9 ............ . ............................. . North Andover, ass. Id ie Fee ... Lic. No.; ........... . .. ...... .. Check # 91 49 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No.17 T4 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/99] 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: 11-24-09 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) 39 DAVIS STREET Owner or Tenant NICHOLAS PELLETIER Owner's Address SAME Telephone No978-886-2286 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building RESIDENCE Utility Authorization No. Existing Service Amps I Volts Overhead ❑ Undgrd ❑ New Service Amps' Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: J a A No. of Meters No. of Meters No. of Recessed Fixtures 6 No. of Ceil.-Susp. (Paddle) Fans No. of Tota Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures 3 Swimming Pool Above ❑ In-❑ d. gind. o. o mergency Lighting Battery Units No. of Receptacle Outlets 15 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 5 No. of Gas Burners 1 No. o Detection an Initiating Devices No. of Ranges 1 No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number Tons KW No. o Self -Contained Detection/AlertingDevices 4 No. of Dishwashers 1 Space/Area Heating KW Local 2 Cononnee El Other Ccttion No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydro massage Bathtubs No. of Motors Total HP o Wtquiv Telecommunications.ofDevices No. of Devices or Equivalent OTHER: REFEED TELEPHONE & CALE TV I INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licen- see provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certi- fies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. 1 cert, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: GEORGE PELLETIER Signature Address: 24 WOODHAVEN DRIVE ANDOVER.MA 01810 OWNER'S INSURANCE W VER: I am aware that the Licensee does not have the liab By my signature nbeJow waive this requirement. I am the (check one) ® owner Owner/Agent �% Signature Telephone No. LIC. NO.:36645E Bus. Tel. No.: Alt. Tel. No.: 978-475-2377 nsurance coverage normally required by law. owner's agent. PERMIT FEE: $ �� C1 -X-/ / Pte/ t, Date. �" : . �' ....... . WORTH pf of °� TOWN OF NORTH ANDOVER F D PERMIT FOR GAS INSTALLATION °•._ a This certifies that ......%- ?.`.--�....-? * . T....... . has permission for gas installation.. .? -r ,..�t:...... . in the buildings of .................. `...................... . atfff,-sem. `--.............. North Andover, Mass. Fee F? '.. Lic. No:. ti3 .. .......... �7 /f GAS 1NOE TOR Check # 6450 MASSACHUSETTS UNIFORM APPUCATON FOR PERNIlT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Logations 3 9 JDI T V ",S sr. Permit Amount S, Owner's Name New D Renovation D Replacement Plans Submitted ❑ w �a � ii �j U1 jt W - W F W w Q x a a w o A> z a w o� z H W W o > w F .a w o m z o o z z > W o o m SU B-BASEM ENT off. H o BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type)i Check one: Certificate Installing Company Name �� ✓chi G %7`/2=n to -t-11 Corp. Address Partner. Business I a ep one ci7,f 9'7 S �7 2g Firm/Co. Name of Licensed Plumber�or Gas Fitter 1ti/e`l1 yg-yyy ✓c�«ff 7N'z INSURANCE COVERAGE Check one: i 1 have a current liability Insurance, policy or it's substantial equivalent. Yes 2 No � If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy [0— Other type of indemnity 13 Bond 13 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 13 Agent 13 1 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 installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Title City/Town,. APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter [3—Plumber .202 3S Gas Fitter License Number Master UU-16urneyman