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Address � G S 1�r'�./�-✓lip �T Title of Fiae Page of
Date File Open: Date file closed:
Doc Document/Action Title Date of Refer to other Purpose of DocumWe nt/Action and notes
action Document/ document/
Num. Action De artment
Board of Appeals - Board of Health - Planaing Board - Conservation Commission - Building Department
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Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
TO: Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectmen
Town o4 N. Andovex ) ( Town o{ N. Andover
N. Andomt, J ( n .oven, 5
addresses
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RE: Insured: Witbun H. Suhnham S.tud.i.od S
Property address: 60 A�shtand Sxheet
N. Andover, �4A 01845
Policy No. 7277503
Loss of Dece.mben 28 1984
File or Claim No. W 2655
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, CH. 139, SEC. 3B
is appropriate please direct it to the attention of the writer and include a reference to the
captioned insured, location, policy number, date of loss and claim or file number.
Hautd P. Hunteh, AdJuatex
Title:
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.
PATRICK.I DONOVAN ASSOC212 518 5
�
P. Q. Box 489 A4��!y -
Signature and date
Wakefield.. NAA 01880
245-5540
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lugThe Commonwealth of Massachusetts Permallo. Office use OMy
Department of Public Safety Occupancy 6Fee Checked Q
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12A0 390 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code,627 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) DATE 3/A9/9�'"
Ciryor Town of Na gr'k A w Do VAR To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location(Street&Number)
Owner or Tenant A M 1,6:,C_ L tJ
Owner's Address 5A M c
is this permit in conjunction with a building permit: ' '' ❑ Yes' O No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead ❑ Undgrd '❑ No.of Meters
New Service A'mps•' Volts` 'Overhead , E3 Undgrd .O No.of Meters
Number of Feeders and Ampacity -
Location and Nature of Proposed Electrical Work R6PLA<< 13A44AS 7" A R -
A.
/L/ASS ELEcr-fc't �'ETR�i-� T PRO<oR F),"
No.of Lighting Outlets No,of Hot Tubs No.of Transformers Total
KVA
No,of Lighting Fixtures Swimming Pool Above In- Generators KVA
gmd. ❑ grind.
❑
No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting
Battery Units
No.of Switch Outlets No.of Gas Burners FIRE ALARMS No.of Zones
Total No,of Detection and
No,of Ranges hto.of Air Cond. Tons Initiating Devices
Heat Total Total No.of Sounding Devices
No.of Disposals No.of Pumos Tons KWNo,of Soft Contained
No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices
Local 13 Municipal Other
No.of Dryers Heating Devices KW Connection
No.of Water Heaters KW Sons Ballasts of Low Voltage Wiring
No. Hydro Massage Tubs No,of Motors Total HP
OTHER: �4 G
��f � ST --- - -
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INSURANCE COVERAGE:Pursuant to the requirements of Massachusetts General Laws.I have a current Liability Insurance Policy including
Completed Operations Coverage or its substantial equivalent.YES 0 NO O I have submitted valid proof of same to this office. YES X NO O
If you have checked YES,please indicate the type of coverage by checking the appropriate box.
INSURANCE 19 BOND 0 OTHER 0 '(Please Specify) ///4r
Estimated Value of Electrical Work$ (Expiration Date)
Work to Start Inspection Date Requested: Rough Final y�/al 9j—
Signed under the penalties of perjury
FIRMNAME4/N 41WF Gr46CT)?j AC_ CO, LIC. NOA/o4,s9
Licensee l7AtJi?) Signature LIC. NO.
Address /a GA`4-owl,' t4//4 L RD - SALEM , MA. Bus.Tel. NoXOr-9Y/ Alt.Tel.No.&/17--SYP/ A
OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by
a Massachusetts General Laws,and that my signature on this permit application waives this requirement. . Owner Agent (Please check one)
Telephone No. PERMIT FEE$
(Signature of Z37wner or gent
a
Date......L�... ........ ... ..
rIORTM
TOWN OF NORTH ANDOVER
o41 PERMIT FOR WIRING
SS4 uSES r
This certifies that ............................,. :.............
has permission to perform .......... f r
r
wiring in the building of......,1 .........ti........!. ,..L ...............................
at...................... 1,/�i J,,-�f ...... North Andover Mass.:.
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Fee...1112cl. - Lic.No.. �t.. ,,� ..........
ELECTRICAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File