HomeMy WebLinkAboutMiscellaneous - 61 WOODCREST DRIVE 4/30/2018N_
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Date....`. ...............................
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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that H (C- k_a Sim
............................................................................................................................
has permission to perform
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wiring in the building of......... .. ? -+-t.a...................................................................
at .......(.91........... d t> c3` CI S - —J): North Andover ass.
Fee . ` .."'........... Lic. No: 1!I...5...
Check # 'n
13294.
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— b \ Commonwealth olcc/��f'lq��
amaclutmiia Official Use Only
e all
a[Jeparlowd of -`ire �ervices Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEF), 27 CMR 12.00
(PLEASE PRINT IN INK OR TYPE A INF RMATION) Date: sJl�
City or Town of. �t/Of1il,� 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) t ,/ w s O-VS'
Owner or Tenant
Owner's Address
Telephone No.
Is this permit in conjunction with a building permit? Yes ❑ No 'ET (Check Appropriate Box)
Purpose of Building Utility Authorization No f
Existing Service 4� Amps LILP-/ �UOVolts Overhead ❑ Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:"
Completion ofthe following table mov be waived by the Inspector of Wires.
No. of Recessed Luminaires
No, of Ceil: Susp. (Paddle) Fans
No, of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑ In- F1o.
rnd. rnd.
o Emergency 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 um
Totals
Number
' ' """
ons
"""' ' '""
W
""""""""""'
o. ofSelf-Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances KW
ecurity Systems:*
No. of Devices or Equivalent
No. of Water
Heaters KW
o. o No. of
Si ns Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector gI'YI'ires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start:
2hS Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE OVERAGE: 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 coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
I certify, render the pains and penalties ofperjury, that t e inforrr{atyon on this application is true and complete.
FIRM NAME: 1f%1 Z. 5%� % c G + /1e 1, �fcj%/k:, 466 LIC. NO.: p�% ��� 7�-
Licensee: Signature LIC. NO.: ,;�7%
(Ifapplicable, enter "exempt" in the license number line.) Bus. Tel.
Address: Alt. Tel. No.:
*Per M.G.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) ❑ owner ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $
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Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
To: Building Commissioner or
Inspector of Buildings
1600 Osgood Street
North Andover, MA 01845
RE: Insured:
Property Address:
Policy Number:
Date/Cause of Loss:
File or Claim Number:
David & Lynda Roberts
61 Woodcrest Drive
HP3043842
2/15/2015, Water/Ice Dams
31186-W
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, location, policy number, date of loss and claim or
file number.
Wade Anderson
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.
S' nature and Date
ANDERSON ADJUSTMENT CO., INC.
50 Nashua Road, Suite 303
PO Box 1098
Londonderry, NH 03053
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
it Il j -
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Mass. Date t� --z• % 19 `�--� _ Permit # 761
Building Location/�/Da�� -d—Owner's Narrle I/,,
Type of Occupancy -
New 9 Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑
FIXTURES
Installing Company Namea_ZtZ f' el=o t (Z-
i,
Address 70�����m,
1_
Check one: Certificate
9 Corporation
❑ Partnership
Btasiness Telephone Z% I ❑Firm/Co.
Name of Licensed Plumber or Gas Fitter °-�
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ❑ No ❑
If 'you have checked yes, please indicate the type coverage by checking the appropriate box.
Miabiiity insurance policy ❑ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass.
GCneral Laws, and that my signature on this permit application walves this requirement.
L
of Owner or Owner's Agent
Check one:
Owner ❑ Agent ❑
I hereby cerlify that all of the details and information I have submitted (or entered) in the above application are true and accurate to the best of my knowledge and that all ):
and installations performed under the permit issued for this application will be in compliance wilh all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the
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i
Type of License: f
By —
I-] Ghunlwr
I 1 GasfiUrr -- --_
Tilly ��r%j�',,nler Signatur f I-ic ed Plluumbe---r/---u111'r Lias Fitter -
----- 'I_I Jrn,rneVrnan 1 ! DV -
City/Town License Number
APPROVED fOFF10E USE ONLY)
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Installing Company Namea_ZtZ f' el=o t (Z-
i,
Address 70�����m,
1_
Check one: Certificate
9 Corporation
❑ Partnership
Btasiness Telephone Z% I ❑Firm/Co.
Name of Licensed Plumber or Gas Fitter °-�
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ❑ No ❑
If 'you have checked yes, please indicate the type coverage by checking the appropriate box.
Miabiiity insurance policy ❑ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass.
GCneral Laws, and that my signature on this permit application walves this requirement.
L
of Owner or Owner's Agent
Check one:
Owner ❑ Agent ❑
I hereby cerlify that all of the details and information I have submitted (or entered) in the above application are true and accurate to the best of my knowledge and that all ):
and installations performed under the permit issued for this application will be in compliance wilh all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the
i
i
Type of License: f
By —
I-] Ghunlwr
I 1 GasfiUrr -- --_
Tilly ��r%j�',,nler Signatur f I-ic ed Plluumbe---r/---u111'r Lias Fitter -
----- 'I_I Jrn,rneVrnan 1 ! DV -
City/Town License Number
APPROVED fOFF10E USE ONLY)
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Date / .-".......I.......... .
13
,,pRTI, TOWN OF NORTH ANDOVER
py i«ac ,e,ti0
PERMIT FOR GAS INSTALLATION
This certifies that ! ........�......... .
has permission for gas installation. Via.'..:?.......'
....................
in the buildings of ................................
at 4<--4!-!?F .:�.................... North Andover, Mass.
c
Fee.-? ?...... Lic. No. �4� ?.... ... ...... ? ...... .
12/03/93 09:26 25.00 PAID GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
Date.4 !:..�44 .......
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
9
his certifies that ............
has permission for gas installation .............
in the buildings of ..1. ...........................
at f..`' ? , /North Andover, Mass.
Fee......... Lic. No.. 3 ��G.t��+!..........
G S INSPIECTOR
Check #
5439
1VIASSAaWSEITS UNIFORM AMICATON FOR PERNllT TO DO GAS FITTING
(Type or print)
NORTH ANDOVER, :MASSACHUSETTS
Date 743 /0
Building Locations �vU 7— Permit # 3
Amount $ 2
Owner's Name U ce- f --s
New ❑ Renovation ❑ Replacement Plans Submitted ❑
(Print or type) C e one: Certificate Installing Company
Name_ 1 �- V
Corp.
Address �k ❑ Partner.
Business Telephone C, 7 � f., � („ --113 F' '�i'� Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑V No ❑
If you have checked Yes, plea�indiatethe type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity ❑ Bond ❑
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.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
I hereby certify that all of the details and information i nave suDmittea dor enierea) in aoove appncanon are true anu accurate to Erie
best of my knowledge and that all plumbing work and in ations performed under Permit Issued for this pplication will be in
compliance with all pertinent provisions of the Mas chu its State Gas Cgode and C ter 142 of the eral Laws.
Im
)wn
IAPPROVED (OFFICE USE ONLY)
Signature of Licensed Pr Or Gas Fitte .
❑Plumber 0
❑ Gas Fitter Licerke i um er
aster
Journeyman
6TH. FLOOR
;7TH. FCOOR
(Print or type) C e one: Certificate Installing Company
Name_ 1 �- V
Corp.
Address �k ❑ Partner.
Business Telephone C, 7 � f., � („ --113 F' '�i'� Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑V No ❑
If you have checked Yes, plea�indiatethe type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity ❑ Bond ❑
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.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
I hereby certify that all of the details and information i nave suDmittea dor enierea) in aoove appncanon are true anu accurate to Erie
best of my knowledge and that all plumbing work and in ations performed under Permit Issued for this pplication will be in
compliance with all pertinent provisions of the Mas chu its State Gas Cgode and C ter 142 of the eral Laws.
Im
)wn
IAPPROVED (OFFICE USE ONLY)
Signature of Licensed Pr Or Gas Fitte .
❑Plumber 0
❑ Gas Fitter Licerke i um er
aster
Journeyman
3247
Date.. d ...`.... ........... .
NORTH TOWN OF NORTH ANDOVER
3 PERMIT FOR GAS INSTALLATION
N
..�j .\ 1
This certifies that ... ? ..: ' ....� ..Y .. ..................... .
has permission for gas installation .......................
t I the buildings of .. /,'c. !'..............................
at .. ..... ....... `'. `.... ?....{?! l• • • • • , North Andover, Mass.
/ 5. ;.
wee % ....... Lic. No..
. ... . - . ,.:..... .
GAS INSPECTOR r
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MW
Z--�
MAP _
4ASSAC CATON FOR PERMIT TO DO GAS F=NG
Date '�F-•2 (a 19,/ I
or print)
tvvxTH ANDOVER, MASSACHUSETTS
Building Locations ('� / / AJoO D Cit rS-7— AL Permit # Y 2
Amount S
Owner's Name ��(/•Q.. ��� �--�
New Renovation ❑ Replacement ❑ Plans Submitted ❑
(Print or type)
Name
Check one: Certificate Installing Company
❑ Corp.
Name of Licensed Plumber or Gas FitterGe— F
❑ Partner.
41
Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability, Insurance policy or it's substantial equivalent. Yes ❑ No ❑
If you have checked ves, please indicate_ the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity ❑ Bond ❑
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.
Check one:
Signature of Owner or Owner's Agent \ ', Owner ❑ Agent ❑
herebv certify that all of the details and information I have suhmirted (nr entered) in nhnve nnnlicnrinn are tnie 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 de and Chapter 142 of the General Laws.
By:
Tide
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
547 Plumber . 2G�.S�
❑ Gas Fitter (cense I umoer
❑ Master
Journeyman
�7T If FLO OR
(Print or type)
Name
Check one: Certificate Installing Company
❑ Corp.
Name of Licensed Plumber or Gas FitterGe— F
❑ Partner.
41
Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability, Insurance policy or it's substantial equivalent. Yes ❑ No ❑
If you have checked ves, please indicate_ the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity ❑ Bond ❑
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.
Check one:
Signature of Owner or Owner's Agent \ ', Owner ❑ Agent ❑
herebv certify that all of the details and information I have suhmirted (nr entered) in nhnve nnnlicnrinn are tnie 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 de and Chapter 142 of the General Laws.
By:
Tide
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
547 Plumber . 2G�.S�
❑ Gas Fitter (cense I umoer
❑ Master
Journeyman