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HomeMy WebLinkAboutMiscellaneous -Lot 1 71 Empire DriveForm 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: Mary Lietz 71 Empire Drive H P3015467 12/16/2013, Water/Ice Dam 28832-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. /% /), Siana"ture and Date ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 rNew: ASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING IJ�C City/Town.^ MA. Date: IF • 3— 0 ' Permit# :__ Owners Name: b�. y: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential &� tion: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ Non Installing Company Name: e� y,� %� Address: A0.6"" t 101 City/Town: Business Tel: f` ��} •3 7(r {� t�j Fax: FIXTURES Date. Y. -. 31. 1.... . TOWN OF NORTH ANDOVER PFRUIT FnA PI IIMRINr This certifies that . &q tv, S4— ... R° ° P. has permission to perform .. . �4 W-,—. f4k! -� .............. plumbing in the buildings of - -0 e (. MA_0� - 04.0 (-0hCE 1_ -CC .. . at ..J%-� .... , No h Andover, Mass. Fee .! 2. c 5CLic. No. J.Ca�Y� . ......10 w. ............ . Check # i . 1? z v IMOUKANCE COVERAGE: 1 have a current liarinsuran ce policy or its sL If you have checked Yes, please indicate the type �•��'ng�ne`appropriate box below. A liability insurance policy* �j Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee doesnot 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 Si nature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information 1 have submitted (or entered) regarding this application are trop and rr..r fnbest-if—my c Knowledge and that all plumbing work and In stallations performed underthe permit issued for this application will e n compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 1pe pof ermit General Laws. a ~.a.,, to the all o, my Type of License: Title ✓ Plumber Signature of Licensed Plumber Ditylrown ster 4PPROVED (OFFICE USE ONLY) ❑Journeyman License Number: 3 0 7765 Date ... ..... l �......... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..��!' �... �.`. ��...................... . has permission for gas installation .. ` t cw.L?-........... in the buildings of ....().ac.(�\ 0.6 C. L.(-.( ; ..... . at ........�GOAS dove,,Mass. Fee.luU �o. Lic. No..l,Q3.`F�... . INSPECTOR Check # 1 4 2Z-0 FIXTI IRFC w wN Wuj Z MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: ii=6(A ( MA. Date: ' Permit# Building Location:_ Owners Name: ©rte VYVI�,,�_ LLC - Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential $ New: T Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTI IRFC w wN Wuj Z C0 IX I. Q m3: N o: W Cl) W U0 0 CO) = H = w W Z I- O 4 Z -J>- C W CO3nwix 1X 0 IX 0 1- D > tq CO)LU ¢ Lu V Z Cl) Ca O OF a O ~QQ w W X LL W H R z W} Q W W Z O � W N Z H N = 0 Z -1 W O LL lJj F= w ❑ H W W U❑❑ C7 t7 Lu 2 m> 0 LU 0 Z 0 W Z Z W a F- LL 2 0 IL H > > > 0 SUB BSMT. BASEMENT 1 5T FLOOR -fu--FLOOR 3 FLOOR 4 FLOOR -i'FLOOR 6Tm FLOOR 7 FLOOR 8 TmFLOOR Installing Company Name: /�4 Iflo6 � ®f Check One Only Certificate # ��1 Address: ko,'&V i Zyl City/Town: State: WA— t9-Corporation1�0 6 ❑ Partnership Business Tel: !1213 1Y Fax:�'�Sy5��t -'tl1'1 I ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: $'�" Cj4 INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 Yes [9 No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy B Other type of indemnity [-I 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 Signature of Owner or Owner's Agent Owner El Agent E] 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. By Type of License: M'Plumber Title ❑ Gas Fitter Signa ure of Licensed Plumber/Gas Fitter EiMaster Citylrown ❑Journeyman License Number: APPROVED OFFICE USE ONLY ElLP Installer ii 0271 Date .... 2 ..... KI ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ...... r>.Z'r .... ............................................................... ....................................................... has permission to perform k. .... . ....... . . ......... .......... wiring in the building of ....... ef:..e ........ /. k.-27 < >.. enr ..................... ;F'� . ..... 71. .". -.�).PAorth over, mass. Fee .�37YP ...... Lic. ...... ...... ............ E[ ecrRt P CTOR Check # Z 70 I k, Commonwealth of Massachusetts' Official Use only Department of Fire Services Permit No. to Z ZZ BOARD OF FIRE PREVENTION REGULATIONS APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK -All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 11 (PLEASE PRINT IN INK OR TYPE ALI. INFORM TION) Date: a- a -a City or Town of: To the Inspector of Wires: By this application the undersigned gives notice of his or her inkention to perform the electrical work described below. Location (Street & Number) A/ 2 T d ..,- r ti 4: Owner or Tenant &LS , Telephone N Owner's Address 7' -7 w J . 2-1_-/G Sf A- e fvl 7 Is this permit in conjunction with a building pc�[:1mit rrmit? Yes Qo Building Per # Purpose of Building i „ - G-, 2 �r '1Utility Authorization No. . Existing Service Amp / Volts Overhead [-]Undgrd [:].No. of Meters New Service 26,l/ Amps >`w / Z k (Wolts. Overhead ❑ Undgrd ©No. of Meters Number of Feeders and Ainpacity 115 31 r70 Location and Nature of Proposed Electrical Work:ti,,� Completion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans o. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above r-1 In- ❑ rnd. grnd. o. of 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 Initiatin Devices . No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers p Heat Pump Totals: Number Tons ................. KW ........... No. of elf -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW p g Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: INSURANCE 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 equivalent. The undersigned certifies that such c�=E] -n force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OTHER ❑ (Specify) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: C% 2- f -l` 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. Current Insurance certificate must be on file in our office and affidavit must FIRM NAME: 4 . /u /." , /// A0111! e - Licensee: _w (If applicable, ent, Address: OWNERTS INS required by law. Owner/Agent Signature _ be filled out with each application. ,LIC. NO.:A f 17-3� LIC. NO.: Signature /&,.� r - ✓"exempt" in the license number line) Bus. Tel. No.: TRANCs.-" .5 ;1— z,/1/- Alt. Tel. No.: E WAIVaware that the seedoes not have the�liability insurance coverage normally By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Telephone No. I PERMIT FEE: $ YU ELECTRICAL PERMIT NO. INSPECTION REPORT: ELECTRICAL INSPECTOR - DOUG SMALL 1. ROUGH INSPECTION: Passed — Failed — [ J Re -inspection required ($50.00) - [ ] Inspectors' comments: (Inspectors' Signature no initi ) Date 0 2. FINAL INSPECTION: Passed —1K Failed — [ ] Re -inspection required ($50.00) - [ ] inspectors' comments: (Inspectors' Signatur noin' ial } Date M 3. UNDER GROUND INSPECTION: i Passed — [ ) Failed — [ ] Re -inspection required ($50.00) - I Inspectors' comments: (Inspectors' Signature - no initials) Date 4. INSPECTION — SERVICE: DATE CALLED NATIONAL GRID: `— NAME: Passed — 9Failed — [ ] Re -inspection required ($50.00) - [ ] Inspectors' comments: IL VKL (Inspectors' Signature - no initials) Date 5. INSPECTION - OTIIER: Passed — [ ) Failed — [ J Re -inspection required ($50.00) -1 J Inspectors' comments: (Inspectors' Signature - no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE -INSPECTION OF $50.00 IS TO BE CHARGED.