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HomeMy WebLinkAboutMiscellaneous - 71 PADDOCK LANE 4/30/2018N O O v v 0 0 0 0 PO Box 55098 Boston, MA 02205-5098 617-951-0600 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 Selectman City Hall City Hall N ANDOVER, MA 01845 N ANDOVER, MA 01845 RE: Insured: JOIIIvT S FOTu'rIY and PATRICIA K FOUHY Property Address: 71 PADDOCK LANE, N ANDOVER, MA Policy Number: HMA 0291266 Claim Number: BOS00051438 Date of Loss: 2/23/2015 Company: Safety Indemnity Insurance Company 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, 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 number. Lindsey Hodgens Claim Examiner 2/24/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3418 Fax: (617) 603-4914 Email: LindseyHodgens@Safetylnsurance.com u E Lf11MMUnWrUJt4Uf 4 iaSSa 4U9k##n Mepartment of Public _*aft41 BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only �) Permit No. (d Occupancy & Fee Checked 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM tf1ELECTRICAL ooWORK All work to be performed in accordance with (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date It KI (M* or Town of NORTH ANnOVF.R To the Inspector of tres: The udersigned applies for a permit to Location (Street & Number) Owner or Tenant Owner's Address Cel the electrical work described below. Is this permit in conjunction with a building permit: Yes �Y.1 No El (Check Appropriate Box) Purpose of Building �i%Sc� r_A& reY &.17 L(_ c%,y Utility Authorization No Existing Service Amps _J Volts Overhead ❑ Undgrnd ❑ New Service Amps Volts Overhead ❑ Undgrnd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work -,/—AJ., N Total No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA Above In - No. of Lighting Fixtures ( Swimming Pool grnd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners I Battery Units No. of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of Ranges No. of Air Cond. tons Initiating Devices Heat Total Total .No. of Disposals No.of Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Local Municipal ❑Other ❑ Connection No. of Dryers Heating Devices KV/ No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs I 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 the Office. YES 3:�f NO _ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE L� BONO = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work 5 _ Work to Start Signed under the Penalties of perjury' FIRM NAME —12& Inspection Date Requested: Rough L/_S C Final LIC. NO. ' rice LIC. NO. Licensee _ � 44j!Jn—� yb/7///_7"Y Signature r N,w( ,l - g _ ` '% / p IBus. Tel. No. Address �/ -2 � lJ J [T�`�y `-�% ,/�UN 411"f✓ Alt. Tel. No. OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement.O r �nt (Please check one) 70 g Telephone No. PERMIT FEE 5 (Signature of Owner or Agent) x-6565 C, _!LN- Date ...... ZA0 2 044 NORTF, TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that ... ... ...... .......................... T.O., ...... (�..( .......................................... has permission to perform ........ .... .... wiring in the building of ... 7). 0........ Fvf-h. 1/ ...................................... at ....... 7� ..... f. ... c ..................... ,North Andover, Mass. Fee..L7610 ............ Lic. No. . ............................................................... ELECTRICAL INSPECTOR O 111/97 14 1 q 40.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer if CkfL-1 &4 = The Commonwealth of Massachusetts O:iicc Use only r Department of Public Safety Pa rr. is Xo: Occupancy 6 Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 3/90 heave blank) _ ) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance With the Massachusetts Electrical Code. 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date City or Town ofAll,.) eh To the Inspector of Wires: The undersigned applies for ra� permit to perform the electrical work described below. P6Location (Street & Number) l /' 6 d Gf U G j� L A, Owner or Tenant 7 L7 /Z I/ f7 Owner's Address /, /7 - Is this permit in conjunction with a building permit: Yes ❑ No D (Check Appropriate Box) Purpose of Building �(O u 5 -e- Utility Authorization NO Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity. No. of Meters No. of Meters v Location and Nature of Proposed Electrical Work �O ':!r A, 5 �/��L., / •—� 3 6)� �((] G If k u..t J -{ /— A G U rv"-f U It e) A'h !AA -at -ehW"f z.4 ;a 0 76 PqL,� No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Above1:1In- ❑ Swimming Pool grnd. grnd. Generators KVA 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 of Detection and Devices of Sounding Devices No. of Self Contained Detection/Sounding Devices Local E] Municipal❑ Other Connection No. of Ranges TotalNo. No. of Air Cond. tons 2 12—Initiating No. of Disposals No. of pumps Total Total Tons KWNo. No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices KW No. of Water Heaters KW No, of No. of Signs Ballasts Low Voltage 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 Eg" NO ❑ If you have checked YES,splease indicate the type of coverage by checking the appropriate box. INSURANCE R BOND ❑ OTHER ❑ (Please Specify) P/- e F�' / F 2�1 /% t/ f C.( /3 1— (Expiration on Date Estimated Value of Electrical Work S �/- Work to Start S-- /4 3 7 Inspection Date Requested: Rough Signed under the penalties of perjury: FIRM NAME Final ,�-- 1 % — / LIC. NO. Licensee Cr- e F d e h yep f Signature ,d,r -jN �hj 1444 LIC. NO. / �{ Address /�J/ SAi�4`Y�a� ,S� Li4GvhtiyC_2 1�i/,�-_SSG/,pk/ Bus. Tel. No.,j'DhG�3rr•5// Alt. Tel. No. 5 4h --t- OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) T . � c,� Signature of Owner or Agent Telephone No. PERMIT FEE S O REMARKS BY ELECTRICIAN: Z o o ° Z m E E N O N O N Z W a V REMARKS BY ELECTRICIAN: Date. A/1- - TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... .............. has permission to perform wiring in the building of ......... .............................. at .... />;�.e �.. ................. .North Andover, Mass. ig- Fee.A$r .. . ...... Lic. NoPT4.94.E ........................................................... ELECTRICAL INSPECTOR 0-k*1&tv3 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer U1 use i m "Ov Ul --K D' VER--MASSAqH e _LUSETTS. /* 'M At record'' Mr.[ 0�:'Rk"d' on N. �W 01iform for U80 by locI• he SVst . em Pumping Record mus; b eq:submitted . 0 1Oc yt 19fW'Soard of Health r0thaW XTO horil Y, — ------------------ A;_Fa.c111tyJnfQrr tion DEC 0 7 2007 ,rW en filling out System L6c-atJon:'-. T(jAvtiv, F4ORTH ANDOVER .'•,u v HEA)eTy DEPRT ENT only the W k8Y ACOMS to move your ........... State zip P ksy %,vj0!qA .System0 wner:, 0i (If different fj— ------------ State F. Telephone NUmber 8vpord,*. iai- um o 4z 1, fte antItY Pumped: -------- Gallons Cass ypq 9 P0,01(s) Septic Tank - Tight Tank F. .,.Other Efflueht T66'F ter"pipsent? Yes J�o' If yes, was it cleaned?❑yes No 400e Z. Limped B C.) ...jL n W dlopmd:.. ttp:/Av' W'�4. m a h 'A .,ale� ppp.rQ,v.a)slt5forms.,htm#inspect A ,Vehicle Ucen#,-Number SYCBm Pumping Record , Pa;e I I Location � No. - Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ r Other Permit Fee $ 7 U ti ", �., Sewer, Connection Fee $ Water Connection Fee $ FC3 !� �iTAL $ %D c� Building Inspector Div. Public Works L:7 _ a � � Y � � 0 W o .�• N �. 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O y Q C I Ccm O•— y Q 'O y CD • m m O `O O r � m i Cc O d fi �4 O C O V 'fl CL 0 CD C Z CD 42 CL V H .O C C •— C cc The Commonwealth of Massachusetts pr rrit No: O:i ice lsr only Department of Public Safety Occupancy S Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12-00 3/90 (leave blank) 3 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Massachuserts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date/ C, -- '� e/- C/4 City or Town of U0 k f bi 4 Aj a a Ll t I;- To the Inspector of Wires: The undersigned applies form permit to perform the electrical work described`beloow. 7-9'" j G Location (Street & Number) / / IP 14 c{Ae1 O G j 1 L d ry t �'{ �.- `f l� / / Owner or Tenant %G 14 /V F p Owner's Address S A 04.? Is this permit in conjunction with a building permit: Yes ❑ No D (Check Appropriate Box) Purpose of Building jj a;,i 6 -e. Utility Authorization NO Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work Irv+ s-; ,l, , ic>r G ; L rqf A, ci- 1 No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures AboveIn- Swimming Pool grnd. ❑ grnd. ❑ Generators KVA 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 No. of Detection and Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local ❑ Municipal ❑Other Connection No. of Ranges No. of Air Cond, Total tonsInitiating No. of Disposals No. of pumps Total Total Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices KW No. of Water Heaters KW No, of No. of Signs Ballasts Low Voltage 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 [F" NO E] I have submitted valid proof of same to this office. YES[jLY NO If you have checked YES,,please indicate the type of coverage by checking the appropriate box. INSURANCE BOND ❑ OTHER ❑ (Please Specify) FP fe e ii /d t: d MK y1)1— 7 7 OE pkrat on Date Estimated Value of Electrical Work $ 5 0 Work to Start% o— 10 , y� Inspection Date Requested: Rough inal /Of� Signed under the penalties of perjury: FIRM NAME LIC. NO. Licensee &,eyir d -f /'1 L tjMA -ar 4 Signature gt" jr T_,Ae: LIC. NO. f f" i�/ 2l/ � Address `//� -y v �# _� -t 4-A ft, ` r w c t c,/l Y/ Bus. Tel. No. f"u PLS ft f-// Alt. Tel. No, 014NERIS INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial 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 S Signature of Owner or Agent REMARKS BY ELECTRICIAN: Z c O O Z a N E E d O O in Z w N a u REMARKS BY ELECTRICIAN: N '% T3 1.- 544 Date ..... TOWN OF NORTH ANDOVER Mow PERMIT FOR WIRING This certifies that ........... .. ..... has permission to perform ....... .. ..... ................. wiring in the building of ...............I .... . ........ orth Andover,* 'Mass. Fee. .... Lic. No6w..,6 .............. .. ...................... ELECTRICAL NspEcrOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer The Commonweatih of Massachusetts a`r`•' a" Deportment of Public &fay ••••`` '�._ S 80ARD OF FIRE PREM'nom REGtJIJITtONS SZ7 CM 4erp.et it.* QW411" � A 1200 3190 flu.. sua.>,) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK M Work ar k j who ld is aetardaaot aft &4 Kouaeil.rew Marka Cale. Sly CMR I2. -W cuzos run w nm ox =z ars neo ��- � Date_ City 0= ?off of a •.� To the Inspector t Sures! me ondesstp►ed appltss for a petsit to riots the sisetAcsl Work described below. Lecatieo (Sheet -4 losteber) ( � owur Or ZitOatlt 1 U f . Baler's Address rn L this petsit to ooa)uettioa VLW a buLldLaS pereLt: Yu llltpots o! sail ❑ xO 10(CheckAppropriate ltos) lity Aetborisation W. —•�•r`� / :golfs OratBud ❑ ikasrd ❑ No. of !fetors �� -----.gyp! Volta Ovesosad ❑ undpsd ❑ No. of meters��_ ilaobor of peaders raeatiea WA asawe of Proposed sleetricil Work Ti= 4 j/, Z - IIs. e! Llsbtlus Ootleis- Ib. of Not Tube YO. Of Zransforeers Ifo. et Liplrtini >limtvres toolSend. ❑ d. ❑ 1CYA "rotors No. of Sseeptaele Outlets No. of all Burnese . XTA tb. of Dssr�alep ipbt >satte ts 14. of 911 tcb Aulats no. of Gas ltnrusss �� of a arta ALAut4 No. of Zonas Ifo. of Air toad, La toau No. of Detaetion alnd No. of Disposals no. of is total total Ioittatint Devices -..... .� NO. o! Dtshu+a.bsraE No. Of Sounding Devices Ili. Space/Ark Watlog tai bo. of Sei CootsLaed DeteetLoo SoundL4 Davies: of Dr7ets Heat"S Deeiesa amict"l❑Otber Load ❑ Conu !L--69 Water BoatersxW • e o. o Eallasts t Low rolta e %. dto Ilasasp 3bbs No. of Notors Total up C®ts Dt=== MVAM Aara"At to the requisiments of itsuach I baro a Current Lisbili ite untts Viral Lave �aivoleut. 1 Ia+uranee Po y 3aDelud19 Covpl.ted slit you have e � 1 dw w4ltted trolid pteot of sats it otttions �t' a=e or its D��1 . pisses tadiCaee tba ti►pa o! edreespgig YES S*ARM grnn ❑ oz»e ❑ (Please Spec 'tee &WroarLa��box. Isolated '""a of Slaetrioal Work S W=t to Start tfttiy • IMSSvs. -- iospeetion Date Asqusstadr j�yu Sd.i'der the Pauaitias of per uiiwar;1 Final �� xo.�.�.3 Sisnatur. _ Tel i! _� S � S : t Vl4 2 k oware,tbat the Liesnsa it. Zel. no. t+uttal �Lraiaat as sa ap�ltsa wtws chis ~ oaebweeta Cet�00 the 1"Ura4a Cover 7uireneat. aia Or ts. w'11et' Aleut (these ebac!)isaalture en tbts petsit saato:a 0 r or One Telephone xo. 11' 33G .Date......*.. ..(../. ..X ' .. HORTM 0 A SAcMUSEt TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.....0..?.N.r/liS.........PRC...4� =.tC ........................... ....................... has permission to perform ............+(........�t.�44- ..................... wiring in the building of ......... ....... �..Q.11.Ast....................................................... at ..... ..1.......Qx�.ajd,k... ..................... ,North Andover, Mass. i Fee ....fS.'v...... Lic. No. tT.............................................................. $ � ELECTRICAL INSPECTOR l=ee f 3 WHITE: Applicant CANARY: Building Dept. PIFT Treasurer mi??/% 09:05 15.00 PAI N23 Date....... .................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..................................................................... ...... ....... 4, has permission to perform ............................... I ............... ........................ wiring in the building of....... ................... ............ ................................... at........................... r....................... ................. -, North Andover, Mass. Fee..... ................. Lic. ..... ....... I ...... .......................... ...................... ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer JJaParEntarz� a�,Tira Jarvtc�i I. Permit No_ BOARD OF FIRE PREVEiUTION REGULATIONS Occupancy and Fed Clieciced [Rear. I I/99J . (leave blank) —� .AP PLIGAi iU I�: FOPS PLRMIT.T0 PE FO M EL AIC work to be perfornied in accordance with the iy1 issaehusetts Glcarieal eod� c,�E� TRi�Cq O W Q 52.7 CRK (PLCflSLP1Z11VTI OR ZY1'G :lLL INFOR�bf:•l TIC ' •.;` . llatt : City Town o — n—d By this applicatlie un rsignedgives cc of lIi a f�cr intentiau to perform the To tile- lectri Inspector1 work- described below, Location (Street It. Yuxilber)' Otivner or Tenant —r— Owner's Address Is t11is permit it, conjunctioti Ivith n building permit? Purpose of I3uildittg TciepllonejNo.Q`x? Yes ❑u i`io M(Cliccl,AppropriateBoz) Utility Authorization iYo_ ExistingSciyicc Amps. / lrolcs Ovcrllcad ❑ Undgrd ❑ No_ of Metcrs - NiLs Scrricc Amps / Volts 0v crilc ld ❑ Undgrd ❑ No_ OfMeters.' N;uinber of Feeders 2IIt1. Arnpacity s Lbcation and :`Nature of -Proposed Electrical work: Cu"Inletiarr ofthe !ollowitrt?table may be naircrl by the Insncrrar oi- wire,_ No_ of Recessed: Fixtures Na_ of Ceil: Susp. (Paddle) Falls !yo• - •Total 1 rV_-_,_ No. oCLigliting Outlets ING- of Li;hting Fixtures .N, o. of Receptacle Outlets 10. Of S wit cil es No. of Ranges No_ of Waste Disposers No_ ofDisli�vnsliers No. o f Dryers I`1o_ of Yater q Heaters K ,NO. Hydroninssaye Batlitubs OTHER: No. of Ilot Tolls . A "113+urincrs KV.k Generators e Swin2mina Pool��gn 111- Q °rnd_ Q t o, a1 merbeuc_ t�ti[u1g . Battery Units No. of Oil Burners FIRE ALARI),IS INo_ of Zones No. of Gas Burners II`No, of Detection and Initiating Devices NO. of Air Cond. Total INo• I Tons oCAlerting Devices Tatars• � Y—i_ SpacclArea Heating KAY Heating. Appliances KW o. No. of Motors Ilio. of Ballasts Total HP I•to. of Sell=Corltnined - Detection/Alertina Devices Local Q tl•Iunicipal Connection Q Other Security S vste:ns: No. of Devices or Ecruivalent Data 1Ytriug: i Io. of Ueliccs or EauivaIent rclecoMnluIlit:jtions ";irirl°: 1`10_ of Devices or Eauivatent Mach additional detail if desired, or as required by the Inspector of Wires Ii1SUR NCE COVERAGE. 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 eaui,-a1c:1,• TIie undersigned certifies that such coverage is in force, and has esliibited proof ofsame to the permit issuima of ice. CHECK ONE: INSURANCE fZ BOND ❑ 0"I•I•IL-R ❑ (Specify.) Estiniated Value ofEIectrical Workoo 71-IP—I IDDaic) Work- �35a. (tiVIien required by municipal palic}•.) 0° = ' Inspections to be requested in accordance with MEC Rule 10, and'[fuan comp" lotion_ J I cerrifj•, fill der the pants 11111 peualtics of perjar), that t/te infortnatiorr on this applicatiotr rue and complete_ FIIZI[ i�:�t1[E: �irersd SeCtlri Alarms /44 LIC. i>0.: A t7O30 nsee: LiceRrd Hr�ne, Signature v (/f appiicable• enter �ranpl in /lie liccnse nrunber !hm) LIC_ N O" E 1%4-3 Address: 937 R.Web.s}ef 5. 2"A �i. Mnr,_ teid MA 02050 13 us. Tcl_IN. o.:781.31q•1475 (D NV NL ER'S IL 1SUR- NCE WAiVER.- Lam aware (lint the Lice,2s= doe.: ;lot /tave the liabiiilyAlr-Tnce colea_o e3 nna�y reauircd by Iu ,v• Br my signziturc- below, I hcrehr wain c this reouircmcat I nIR t11C (CIICC:� one; ns owner Owucr/Al =t. Q owner's a_eat: Signature 'r e!cphone 1'u_ P%=li~iIfIT