Loading...
HomeMy WebLinkAboutMiscellaneous - 72 MILLPOND 4/30/2018J 0 0 Cn V D N b � o F N � gZ s� 0 PO Box 55098 Boston, MA 022055098 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: BONNIE ESTABROOKS Property Address: 72 MILLPOND, N ANDOVER, MA Policy Number: HMA 0356369 Claim Number: BOS00058150 Date of Loss: 2/15/2015 Company: Safety 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 313 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. Marc Chizauskas Claim Examiner 4/3/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3526 Fax: Email: MarcChizauskas@Safetylnsurance.com MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NO . ANDOVER , MA , Mass. Date 4/ —4,Z =19 �� Perrmit #_2©3 Building Location ;.2 MILLPOND Owner's Name d:!6 �QJC,S NO . ANDOVER , MA Type of Occupancy ' RES G New ® Renovation ❑ Replacement ❑ . Plans Submitted: Yes❑ ' No ❑ Installing Company Name CALLAHAN AIR CONDITIONING Check one: CertHicate ' Address 91 B -MONT STREET ❑ Corporation NO . ANDOVER, MA . 01845 ❑ Partnership Business Telephone 508-689-9233 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter JOSEPH KEVIN CALLAHAN INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142- Yes 42Yes R] No ❑ ' If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy Z1 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: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) In ove appricatlon are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit sued for this appllcati will b In plance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the neral law ey. Type of Ucense: Plumber gnatur o c nse L n a ar Gas fitter Title Masteref Ucense Number m-3440 City/Town Journeyman Ar't'f17y O N N rC W N N re Y ¢ vs U3 W ¢ w N tt O a c7 N ¢ F- `C >, = 4 f' < m W tu- y us O aLL1U .O C u¢r 4 i,- W .. 91.J < :. x ¢ I&A O Sar W V tW. N m = O = W C< s < W1u Us �W _W W �� 3 D C J V � Y SUB-aSMT. BASEMENT J ISTFLOOR 2ND FLOOR 3RD FLOOR I I ATH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name CALLAHAN AIR CONDITIONING Check one: CertHicate ' Address 91 B -MONT STREET ❑ Corporation NO . ANDOVER, MA . 01845 ❑ Partnership Business Telephone 508-689-9233 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter JOSEPH KEVIN CALLAHAN INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142- Yes 42Yes R] No ❑ ' If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy Z1 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: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) In ove appricatlon are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit sued for this appllcati will b In plance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the neral law ey. Type of Ucense: Plumber gnatur o c nse L n a ar Gas fitter Title Masteref Ucense Number m-3440 City/Town Journeyman Ar't'f17y O .•� Date.To 2032 ,NORTH TOWN OF NORTH ANDOVER A'< Oft a PERMIT FOR GAS INSTALLATION $ 9SSACMUSEt -e This certifies that .�.��!�/a..... w s permission for gas installation . 1�.'d{ .... . buildings of k ! P?.A ................. o �\?v �.�/'�h . ........... , North Andover, Mass. �. Lic,. No...�?!.`/. p .. ...... AS INSPECTOR CANARY: Building Dept. PINK: Treasurer GOLD: File 014t Cfommonwealt4 of Massarlluottts Department of Public Safety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only �J/ Permit No. Occupancy & Fee Checked 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to he performed in accordance with the Massachusetts Electrical Code. 527 CMR 12:00 (PLEASE PRINT IN INK OR Xy ff ALL INFORMA City or Town of _ The undersigned, applies Location (Street & Number) Owner or Tenant a permit to perform the 01-- r .' / r/ Date / 4 To the Inspector of Wires Owner's Address ✓ / 'c ---J is this permit in conjunction with a building permit: Yes 1:1No" IT (Check Appropriate Box) Purpose of Building�215Z2at4e-1j Utility Authorization No. _ Existing Service L 6 0 Amps LS'?J �za yyVolts Overhead L' 1 Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity / Location and Nature of Proposed Electrical Work C./ No. of Meters No. of Meters ,q s FEBr OTHER: B INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws - I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES O NO O : have submitted valid proof of same to this office. YES ❑ NO L1 If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE LJ BOND ❑ OTHER❑ (Please Specify) (Expiration Date) Estimated Value of Electrical Work $ Work to Start Signed FIRM Licenst Addres Inspection Date Requested: Rough Final —19 LIC. 'NO LIC. NO ._._ C_ r No. '7/`�J U. JVQ / Alt. Tel. No. 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 $ /W�l (Signature of. Owner or Agent) k 4f 9(1: TOTAL No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA AboveIn- No. of Lighting Fixtures SwimmingPool rnd. ❑ rnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets '-No' of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of Ranges No. of Air Conditioners Tons Initiating Devices of Sounding Devices. No. of Self Contained Detection/Sounding Devices Municipal Local❑ Connection ❑Other No. of Disposals Heat Total TotalNo. No. of Pumps Tons KW No. of Dishwashers Space/Area Heatingyr K No. of Dryers Heating Devices KW No. of No. of Low Voltage _ No. of Water Heaters KW Signs Ballasts Wiring a No. Hydro Massage Tubs No. of Motors Total HP Ell ky' ,q s FEBr OTHER: B INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws - I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES O NO O : have submitted valid proof of same to this office. YES ❑ NO L1 If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE LJ BOND ❑ OTHER❑ (Please Specify) (Expiration Date) Estimated Value of Electrical Work $ Work to Start Signed FIRM Licenst Addres Inspection Date Requested: Rough Final —19 LIC. 'NO LIC. NO ._._ C_ r No. '7/`�J U. JVQ / Alt. Tel. No. 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 $ /W�l (Signature of. Owner or Agent) k 4f 9(1: F Tri 2842 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ ....... . .................. has permission to perform ......... ............. 9. 'fX. wiring in the building of ........Le. at ....... 7A J .4.4j.k.100 .V....... .... .......................... . North Andover, Mass. Feej&�. 0').... Lic. No ............................................................................. ELECTRICAL INSPECTOR CA 9,06V^ 11:59 15.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File .A MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTIN1G t (Print or Type) NORTH ANDOVER Mass. Date _ t`3uilding Location /iii ��� Gl? Permit # Owners Name/fit, r, ; e *�S'��� ,�f_ New T Renovation Replacement L] Plans Submitted] r u (Print or Type) ) Check one: Certificate Installing Company Name �,�1� �,p / Q Corp. Address /GJ,p�./ f ��, , �Partner. --� Firm/Co. Business Telephone: Name of Licensed Plumber or Gas Insurance Coverage: Indica--e ,ype of insurance coverage by checking the appropriate box: Liability insurance policy tom: vt^er type of indemnity t�] Bor.d Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner = Agent Q I he:cby certify thst aU of the details and ittfotmation I hare submitted (cat entered) in &L -ave application are true and accurate to the best of my knowted;e and Mat sU plumbing want and instaLtatioos ;e:•"orae: undo fterrait juumd for this appiicatiaa wdi be in compiianoe with all ,xsttacat provisions of L4e Massachusetts Slate Cas Calc and C:La7tc :<-" cf L!la Ge-t=ni Laws. ' By T`_'P= LICZNGE Plumber " Tit?e 1 Gas�.fttter Signature of L cense �.., ,t. Mas ter P2ulttb�r o G�`�fitter C ter/ cwn: Journeyman =47:7e> APPROVED (OFFICE USE ONLY) License Number w _ 1c ' us m ( I V L2 �' ~ Cs UA = ul S CM 0 < W W d C W 4 alG W d uuj V W Q W U. < W} G W - i < 4 O O W O W F- I< I sva—as;., BASEME:i T 'I ST FLOOR 'I i I I L I I 1► i i f I I I I{ ! I I I I j 2`[D FLOOR { t 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7T){ FLOOR STH FLOOR I I I I I ( I I ( I (Print or Type) ) Check one: Certificate Installing Company Name �,�1� �,p / Q Corp. Address /GJ,p�./ f ��, , �Partner. --� Firm/Co. Business Telephone: Name of Licensed Plumber or Gas Insurance Coverage: Indica--e ,ype of insurance coverage by checking the appropriate box: Liability insurance policy tom: vt^er type of indemnity t�] Bor.d Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner = Agent Q I he:cby certify thst aU of the details and ittfotmation I hare submitted (cat entered) in &L -ave application are true and accurate to the best of my knowted;e and Mat sU plumbing want and instaLtatioos ;e:•"orae: undo fterrait juumd for this appiicatiaa wdi be in compiianoe with all ,xsttacat provisions of L4e Massachusetts Slate Cas Calc and C:La7tc :<-" cf L!la Ge-t=ni Laws. ' By T`_'P= LICZNGE Plumber " Tit?e 1 Gas�.fttter Signature of L cense �.., ,t. Mas ter P2ulttb�r o G�`�fitter C ter/ cwn: Journeyman =47:7e> APPROVED (OFFICE USE ONLY) License Number 2068 0 �RT k Date ..... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ...... r <ZI-419 L r A�/ ....... — has permission for gas installati ..... in the buildings of ... ......... at .:'!''q.... ...... .. ....... North Andover, MJ Fee. Lic. No. f 7-4 . .......................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File