HomeMy WebLinkAboutMiscellaneous - 634 CHICKERING ROAD 4/30/2018 334 CHICKERING ROAD
210/08300
3-0000.0
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
I�
RE: Insured: Audrey Goldstein
Property Address: 634 Chickering Road
Policy Number: HP2229326
Date/Cause of Loss: 2/9/2015, Water/Ice Dam
File or Claim Number: 31015-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.
ignature and Date
ANDERSON ADJUSTMENT CO., INC.
50 Nashua Road, Suite 303
PO Box 1098
Londonderry, NH 03053
R Date........ .......
y Ot NO RT"1�O
a? TOWN OF NORTH ANDOVER
' PERMIT FOR WIRING
SSACNUS�
This certifies that ... ..7..............`J...... ...�................. ................................
has permission to perform ................/'.�.1 ... .....................................
wiring in the building of.
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. j� ..........,f� lNorth Andover,Mass.,
Fee. r,J C Lic.No. ..........r/ .
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ELECTRICAL INSPECTOR
All
,eck # J
-, U �
-` The Commonwealth o¢ Massachuletts � u
q IMMEM 0 d Permit No. "
;1 Department of Public Safe/527CMR
�r Occupancy& Fee Checked
BOARD OF FIRE PREVENTION REGULATI S 12:00 3/90 (leave blank)
APPLICATION FOR PERMIT TFORM ELECTRICAL WORK
All work to be performed in accordance wit the Massachusetts Electrical Code,527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date January 27 , 2004
N. Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location(Street&Number) 634 Chickering Road
Owner or Tenant Brookside Condo Association
Owner's Address Property Management of Andover P.O. Box 488 Andover, MA 01810
( 978 )683-4101
Is this permit in conjunction with a building permit: Yes ❑ No El (Check Appropriate Box)
Purpose of Building Residential Utility Authorization No.
Existing Service Amps / Volts 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 Lighting retrofit; outside front and back
fixtures
Total
No.of Lighting Outlets No.of Hot Tubs No.of Transformers KVA
Above In-
No.of Lighting Fixtures 58 Swimming Pool grnd. ❑ grnd. ❑ Generators KVA
No.
No.of Receptacle Outlets No.of Oil Burners Battof Emergency Lighting
Bery Units
No.of Switch Outlets No.of Gas burners FIRE ALARMS No.of Zones
Total No.of Detection and
No.of Ranges No.of Air Cond. tons Initiating Devices
Disposals No.of Heat Total Total
No.of No.of Sounding Pumps Tons KW 9 Devices
No.of Self Contained
No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices
Municipal
No.of Dryers Heating Devices KW Local❑ Connection[]Other
No.of No.of Low Voltage
No.of Water Heaters KW Signs Ballasts Wiring
No.Hydro Massage Tubs No.of Motors Total HP
OTHER:
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 ® NO ❑
I have submitted valid proof of same to this office. YES ® NO ❑.
If you have checked YES,please indicate the type of coverage by checking the appropriate box.'
INSURANCE 0 BOND❑ OTHER❑ (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work$
Work to Start Inspection Date Required: Rough Final
Signed under the penalties of perjury:
FIRM NAME CROWE & SONS ELECTRICAL CORP. LIC.NO.17168A
Licensee JAMES B. CROWE Signature LIC. NO.1716 8A
Bus.Tel.No. 978) 453-6�—
Address 543 MIDDLESEX STREET, LOWEL , MA 01851 Aft.Tel No. 978 —
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage or its substantial equivalent as
required by Massachusetts General Laws,and that my signature on this permit application waives this requirement.
Owner ❑ Agent ❑ (Please check one)
Telephone No. PERMIT FEE$ 85 , 00
(Sianature of Owner or Aoent)