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HomeMy WebLinkAboutMiscellaneous - Exception (137)APO Box 55098 Boston, MA 022055098 617-951-0600 WASIr- Form of Notice of Casualtv 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: SCOTT BERMAN and MARCIA BERMAN Property Address: 70 FARRWOOD AVE #10, N ANDOVER, MA Policy Number: HMA 0136267 Claim Number: BOS00053376 Date of Loss.: 3/4/2015 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 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. Connor Donovan Claim Examiner 3/5/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3298 Fax: (617) 603-4926 Email: Connorponovan@Safetylnsurance.com Date... /.`/.�4 ....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .... , ! � . (. k .'...... I ) I .. (f ............. . has permission for gas installation ... P. .................... in the buildings of ....;. ..................... . at ... ? A.: ? . ! ...E .!a P.F ! ..... . , North Andover, Mass. Fee.. ... Lic. No.. S5 ? ::... ..r.� ..: r�..-% ...... GAS INSPECTOR Check # c- % f 72,6 MASSACHUSETTS UN [FoRMAPPLICATON FOR PERMIT TO DO GAS FrrmG (Type or print) NORTH ANDOVER, MASSACHUSETTS Date J e.cl • Building Locations � R- cZ W© P i Permit # L- t Y $ Owner's Name oust l�� 1 �y ev New ❑ Renovation Replacement Plans Submitted (Print or Name of Licensed Plumber or Gas Fitter 7) 271 j . i\ 1 lJ e k one: Certificate Installing Company Corp. 11 Partner. aTiirm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes [B' No13 If you have checked Yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy [3 Other type of indemnity Bond 13 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. M A n I hereby certify that all of the details and information I have submitted (or entered) in above best of my knowledge and that all plumbing work and in ons perfo ed under Permit compliance with all pertinent provisions of the Massac setts tate G;Rdwid Chaffer 1 City/Town APPROVED (OFRCE USE ONLY) Signature of; Plumber Gas Fitter 13Master Journeyman sed Plumber Or Gas Fitter icense Number n are true and accurate to the this application will be in General Laws. . � w � v C O GO O w a OOcc z a w x W w ` a z L p a w c " w z �-• Q W z a � z w y m zz a` � �' H SUB-BASEM ENT _ ' C > a e0. � 6. 6. w p BASEM ENT + 1ST. FLO OR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR S.TH. FLOOR (Print or Name of Licensed Plumber or Gas Fitter 7) 271 j . i\ 1 lJ e k one: Certificate Installing Company Corp. 11 Partner. aTiirm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes [B' No13 If you have checked Yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy [3 Other type of indemnity Bond 13 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. M A n I hereby certify that all of the details and information I have submitted (or entered) in above best of my knowledge and that all plumbing work and in ons perfo ed under Permit compliance with all pertinent provisions of the Massac setts tate G;Rdwid Chaffer 1 City/Town APPROVED (OFRCE USE ONLY) Signature of; Plumber Gas Fitter 13Master Journeyman sed Plumber Or Gas Fitter icense Number n are true and accurate to the this application will be in General Laws. . Date.. TOWN OF NORTH ANDOVER O04 p PERMIT FOR PLUMBING This certifies that .... !/.. ! ....... F�- .................. has permission to perform ..... H . ....................... plumbing in the buildings of .....,7 .............. at ... 711.' .7. North Andover, Mass. Fee. ..24'.... Lic. No....5i... ...... ....... /PLUMBING INSPECTOR Check # r, - U L) I 0 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or per) NORTH ANDOVER, MASSACHUSETTS Building Owner >-'/ J- '�- j AJ i New ❑ , . Renovation ❑ d2 woo j Replacement Date S 7 / . Permit # C tT Amount Plans Submitted -Yes ❑ No ❑ (i -rat or type) g Name .( J d �'� D lT' f (� `� Check one: Ce�rti�fiioate � 1� 0 -Corp. Address � C, - S'^ r y 0 Partner. Business Telephone Name of Licensed Plumber: _ y i -A (cJ Inscnance Co oe• Indicate the type of insurance coverage by checking a bor. Lim' izimance Pow Q-- other type of kdenn 4 ❑ Bond El Insurance Dt►aiver. L the undersigned, have been made aware that the licensee of this application does not have arty one of the above three insurance Signawe Owner ❑Agent❑ I hereby c=* that all of the details and information I have submitted(or entered) in a best of knowledge tion are true and accurate to the my edge and that all plumbing work d ' tions der P Is ' compliance with all pertinent provisions of the Mas State a this application will be in 8 de,aa s 1 of the General Laws. Type of Plumbing LicV= own ease urn �r 2Master jam" Journeyman ❑ OVED (OFRMUSE ONLY Lv,� r Date ..A -110C . --7 ....... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that... �G`z.............. has permission for gas installation ...... ............. . in the buildings of ..... ............. at;(' . 'r! :t, North Andover, Mass. Lic. No... ! . ".0 Check # 13 {. `U : J GAS INSPECTOR J MASSACHUSETTS UNNUIRM APPUCATON FOR PERNIIT TO DO GAS FITTING (Type or print) Date /d Z U NORTH ANDOVER, MASSACHUSETTS Building Locations 7 d -y --e SU 1f7L11 ,S'- t Permit # / Amount $ Owner's Name C k 4l 2 5 /< -e New Renovation Replacement Ur Plans Submitted (Print or type) /f j '� / Che k one: Certificate Installing Company Name , v �1 ' 5 /. -" ten- •e k0d- C/I Corp. Address S F(j-,- � -yT � U- 1h4-;iU U -P 2 .�y� Partner. Business Telephone Cl 79:/,-�n irm/Co. Name of Licensed Plumber or Gas Fitter jrj Lj Vo -Ile -et, r INSURANCE COVERAGE Check one: 1 have a current liability Insurance policy or it's substantial equivalent. Yes Or No� If you have checked ves, please in icate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 13 Bond 13 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 13 Agent 13 I hPrnhv rorfi Ai tti n+ X11 ..F♦he aeF�:1...... ,1 :.. C__�_. � �___ - - - - --»- �• �••�•• • ••��� auum 'u kui cnrcrcu) in aoove application are true and accurate to the best of my knowledge and that all plumbing work and installations e�rfjrmed under Permit Issued forINS application will be in compliance with all pertinent provisions of the Massachusetts Stato<30 Code add Chanter 14i21nf the 2prai 1 .— Title City/Town (APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber n ?� Gas Fitter License um er U -master Journeyman a o= o z a W d z w d° a a° > d Cw7 [w- z F z x W w Cw7 °L > w x a z w > -< x H Q >- a m m z O z a x o x 3 a° a> a H o SU B-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7 T H. F L O O R STH. FLOOR (Print or type) /f j '� / Che k one: Certificate Installing Company Name , v �1 ' 5 /. -" ten- •e k0d- C/I Corp. Address S F(j-,- � -yT � U- 1h4-;iU U -P 2 .�y� Partner. Business Telephone Cl 79:/,-�n irm/Co. Name of Licensed Plumber or Gas Fitter jrj Lj Vo -Ile -et, r INSURANCE COVERAGE Check one: 1 have a current liability Insurance policy or it's substantial equivalent. Yes Or No� If you have checked ves, please in icate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 13 Bond 13 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 13 Agent 13 I hPrnhv rorfi Ai tti n+ X11 ..F♦he aeF�:1...... ,1 :.. C__�_. � �___ - - - - --»- �• �••�•• • ••��� auum 'u kui cnrcrcu) in aoove application are true and accurate to the best of my knowledge and that all plumbing work and installations e�rfjrmed under Permit Issued forINS application will be in compliance with all pertinent provisions of the Massachusetts Stato<30 Code add Chanter 14i21nf the 2prai 1 .— Title City/Town (APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber n ?� Gas Fitter License um er U -master Journeyman TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ...................................... has permission for gas installation ...... in the buildings of ... ..... ............. at .............................. North Andover, Mass. Fee! ........ Lic. No..24:..fit........ ..... Y GAS INSPEcTQA Check �i - - , rmro v MASSACHUSETTS UNIFORM :APPLICATION FOR PERMIT TO DO GAS FITTING �lr - I�n��V Lx -MA. Date: 4:z2� �� Permit# , �)� City(fown ^ , IBuilding Location:? <S ���r�Jav� -:5-T Owners NameA%r \�Q�� V rQen Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: gt Replacement: ® Plans Submitted: Yes ❑ No �i - - , rmro v 1 / 1 1 11 / / 1 1 1 • 1 1 1 / 1 1 1 11 No OWN W=0WW=WWM===WW No= =Now= nnnnnnnnnNow NOON -' �on •..-nnnM=nnnnnnn NO OWN �11M!11111 � Installing Company Name. Y SN » -' � I Address:� 0+A°rrtr��s� '3"t City/Town:—c,5 State Business Tel: roits LA�� "til Name of Licensed Plumber/Gas Fitter: Fax: tC SC [� Corporation ❑ Partnership ❑ Firm/Company INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes X No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 9 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Si nature of Owner or Owner's Agent By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By ®Plumber ❑ Gas Fitter Signature of Licensed Plumber/Gas Fitter Title [ Master ��++ City[Town ❑Journeyman License Number:��OZ.� APPROVED (OFFICE USE ONLY) ❑ LP Installer � aL/ Date ......Y. .....<........ I'* ``°'•_."�,� TOWN OF NORTH ANDOVER �,,��, p PERMIT FOR WIRING i i�:� i lam' a �SSACMUgf � � I � � This certifies that .`.:.... G � l.................A............................................ � "`.. has permission to perform ..... ........................................ wiring in the b 'lding of ........ �,,k l%..,..... ................................... ........ LrA dover Mass. Fee. �- .-J.:......... Lic. No.�/Zz ��1....................................................... ELECTRICAL INSPECTOR Check # ✓ D , U Commonwealth of # Department of I BOARD OF FIRE PREVE voAPPLICATION FORPERMIT All work to be performed in accordance 'th the (PLEASE PRINT IN INK OR TYPE ALL INFORMATIO City or Town of. North Andover By this application the undersigned gives notice of his or hV i en Location (Street & Number) 70 Farrwood Ave Apt 7 Owner or Tenant Mike Stri Owner's Address 70 Farrwood Ave Apt 7 North Is this permit in conjunction with a building permit? Purpose of Building residential ssachusetts Official Use 9 y 4r I-tN Permit no. 1 Services 7 Occupancy and Fee Checked ION REGULATIONS [Rev. 11/991 (leave blank) PERFORM ELECTRICAL WORK husetts Electrical Code (MEC),527 CMR 12.00 Date: 3.23.2004 to perform electricaYwor�CrdetcNre below. Telephone No. 1-617-799-4992 MA 01845 Yes [—] No [X] (Check Appropriate Box) Utility Authorization No. Existing Service Amps / Overhead [—] Undgrd 7 New Service Amps / Overhead F] Undgrd Number of Feeders and Ampacity No of Meters No of Meters Location and Nature of Proposed Electrical Work: install 20A outlet behind stove for igniter; replace 2 reg outlets in kitchen with GFCI outlets No. of Recessed Fixtures No. of eil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above In- No. of Emergency Lighting grnd. rnd Batter Unifs No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones 3 No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No of Air Cond. No of Alerting Devices No. of Waste Disposers Heat Pump Number Tons KW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers space/Area HeatingKWoca MunicipalOther 1:1Connection � No. o Dryers Heating pp icances KW Security Systems: No. of I3evices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters I Signs Ballasts No. of Devices of Equivalent No. of Hydromassage Bathtubs No of Motors Telecommunications Wirin� Total HP No. of Devices of E uivat ren OTHER: Att h addi •oral detail i` a fired, .or s re fired b the lnspec r n ares. INSURANCE COVERAGE: Unless waived by the owner, no permit for `ie per{'ormance cSf`le�ectricai wografc ma� issue unf"erdt ie 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. 'HECK ONE: [j�] INSURANCE ❑ BOND[] OTHER (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME Power Wiring & Emergency Response, Inc. LIC. NO.: A17354 Licensee: Stephen Decker Signature LIC. NO.: (If applicable enter "exempt" in the license number line) Bus. Tel. No.: 1-800-418-3221 Address: 44 Stedman St, Unit 2, Lowell, MA 01851 Alt. Tel. 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 (chec on) ownero�ner's agent. Owner/Agent 25.00 PERMIT FEE r � Location No.-si= �r/ Date NORT11 TOWN OF NORTH ANDOVER OL 4� °>> Certificate of Occupancy $ Building/Frame /Frame Permit Fee $ a s,+cMusa 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 4� S 2 Building Inspector