HomeMy WebLinkAboutMiscellaneous - 55 EQUESTRIAN DRIVE 4/30/2018 (2) 55 EQUESTRIAN DRIVE
2101105.D-0148-0000.0
FL
fRq
April 28,2015
Building Commissioner/Inspection Services
120 Main Street
North Andover, MA 01845
NOTICE OF CASUALTY LOSS UNDER MASSACHUSETTS
GENERAL LAWS,CHAPTER 139,SECTION 3B
RE: Insured: Shawn&Norah Slattery
Claim No.: HC211964
Policy No.: H017095057
SCS No.: MA01883
Date of Loss: 3/5/2015
Property Location: 55 Equestrian Dr,North Andover,MA 01845-3352
Type of Loss: Ice Dam
Ladies and Gentlemen:
A claim has been made involving loss, damage or destruction of the above-captioned property which
may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6, to be
applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate,
please direct it to the attention of the writer and include a reference to the captioned insured, locations,
policy number,date of loss and claim or file number.
Thank you for your cooperation.
Sincerely,
Troy Pritchard
cell(954)328-9995
fax(954)337-6108
2600 McCormick Dr.,Ste.110 Clearwater,FL 33759
Telephone(727)442-4900 Fax(727)442-4933
Date......! �(.A �
rtORTl1
?°;<;�``°.:•�"°°� TOWN OF NORTH ANDOVER
o
PERMIT FOR WIRING
�Ss�cMusE�
This certifies that ..........J„n,�c t...:�........�.....��U..............................
has permission to perform ........ .:. r r "� � {��c
wiring in the building of....... _....:.:. .. .. :.... ............................................
at
Fee.....�.vv...�.... .A...:.�
.............................................
. 1orth Andover,Mass.
..... ........... Lic.No.�... � '-v... ......
? ELECTRicAL INSkc-roR
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
DOARD OP r)RE PAA- L'N11UN RYGUL&n0NS:S27.CMR 92.00-�3190 11ssw t.taak>
<.ap�t�tCariory FOR PERMIT TO PERFORM ELE1'R}C,nL. WORK
Aft»...4 e-►. r.rl.....»J h......�...ss rrM.I.♦ M..++�nwe+v Claa.rl�►1 GWs. Oa! CNR I-C.00
(imr-ASN PRINT YN INK OR TnE AT.T. TNFnvwA�rTAW)
City or Town of 0 . r ---,----
_ _-•tet? �✓�/1 To tho Inspector of uirast
tho,undcrsinnod applies for a perait to Peecrform the eleotrierl work dasc iDod Lalow.
;Location �Strner. A, MinnhQr�)C
'4Ovner or.Tenant_ - t1
Owner Is liddress
x• this ,parnie Rn eonSurtetion with a bui),Ji11$ y44Uirra Ye.a ❑ ?10 ® (Cheek ApproprLaus Nox)
Purpose of -Building Utilit Ardthor
. yI dation N0.
Exiafing Service Apps / Molts Ovorhtada❑2 Undgrd❑
No. of Meters
New Bovie Amps/ __Volt*, 94etth6hd ❑ Undgrd❑ No. of Hetere
Number of reeders and Anpacity,
Location and Nature of Proposed Electrical
_Jr c
No. of Lighting Outlets No. _^t Tubs No. of Xeansforc,ers Total
1NA
No. of Lighting Fixtures ,�Skim�teg fool Above
gnerators KVA
No. of Receptacle Outlets __No. dr Oil Burp" No. of Emergency Lighting
Batter Unita
No. of Switch Outlets. No. of Gas Burners FIRE ALARMS . No. of Zones
No. of Ranges iNo. of AL �'on Total No. of Detection and
tons Initiating Devices
No. of Disposals No. ofUZAts Total Total No. of Sounding Devices
No. of Dish%�ashcrs SpaceAUrea xteating KW No. of Selff Contained
Detection/Sounding Devices
No. of Dryers Keating Devices KW Local.❑Municipal ❑Other
Connection
No. of Water Heathrs KW No, of
Ballasts LOW
W Volta&*
No. Hydro Massage. TuYs No. of liotors Total 1{P
OTIUER:
r
4
INSURANCE COVERAGEi Pursuant to the requirements of Massachusetts General Laws
I have a current LiabilitX Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YES❑ NO 0 I have submitted valid proof of same to this office. YES❑ NO [:3
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE Lei BOND ❑ OTHER ❑ (Plcnse Specify) ig— 00
Estimated Value of Electrical Work $-(5 G xpirac on ate
Work to Start — Inspection Data Requested, Rough FSnal s�
Signed under the penalties of perjury:
FIRM NAME �ahl?
LIC. NO.19
:_:Licensee a �' Signature r* LIC. NO.G' l�� y
dress ,n':. 3S - a 13--Bus. zcl. No.
Alt. Tel. No.
OWNER'S INSURANCE WAIVER; I am aware that the Licensee does not have the insurance coverage or its au -
'stantial equivalent as required by Massachusetts Gcneral aWs, and that toy signature on this permit
:application waives this requirement. Owner Agent (Please check one)
Telephone No.
SLnnature of Ow.1ar or Agent) PERPIIT FEE S --�