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Home My WebLink AboutMiscellaneous - 10 DEWEY STREET 4/30/2018� � Q Claim # Advantage Claim Services Adjuster Assigned: Glenn Guarente 522 Chickering Road #B North Andover, MA 01845 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec. 3B To: Building Commissioner Board of Health or Inspector of Buildings Board of Selectmen Town Hall Town Hall North Andover, MA 01845 North Andover, MA Re: Insured: Joseph Buturlia Property address: 10 Dewey St. North Andover, MA 01845 Policy #: 1570959 Loss of: 2016/03/21 File or Claim No. AD 1986 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,_Ch _139_Sec._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. Glenn Guarente Title: Adjuster On this date, I caused copies of this notice to be sent to the persons named at the addresses indicated above by first class mail. 03-23-16 Signature and ate% 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, 3L, the POrmitapPlication form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and apprications shall be fded' bn the prescribed form. After a permit application has been accepted by an Inspector of Wires ' appointed pursuant to M. 01 c. 166, § 32, an electrical permit shall be issued to the, person, fmn or corporation stated on the permit application. Such entity shall be, responsible for the nOtificatiOn of completion of the work as required in M.G.L. c. 143, § 3L, Permits shLbe limited as to the time of.ongoing construction activity, and may bedeemed-bytheJnsnector-of-W.ires abandoned-and.invalid-ifhe--. or shchas determined tlia't the authorized work has not commenced or has not progressed during the, preceding 12 -month period. Upoa written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on thc� permit application. The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 20 10 and extended by Sections.74 and 75 of Chapter 23 8 of e the Acts of 2012. The purpose of thds act is to promotejob,growth and long-tenn economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certahrpermits -and licenses concerning theYse or development of real property. With limited exceptions, the Act automatically dxtends, for four years beyond its otherwise applicable, expiration date, any permit or approval tkit was "in effect or existence" during the qu'alifying period beginning on August 15,2008.and extending7thr ough August 15,2012. e 8—Permit/Date Closed: J?J/ —Ul -1 6 Note: Reapply for new permi)tx— 0 29 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... ............................. has permission to perform ... �� /-X I -F 4 A v-.�' /-:�09-111 .......... I ............................................................ wiring in the building of ... .................................................................. e ......... at . .......................... . North Andover, Mw Fee ... ... ...... /Lic. No"....&Z� Check # COMmonwealth of Afassachusetts Official Use Only Department of Fire services Pemut No. s BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked _ [Rev. 1/07] (leave blank APPLICATION FOR PERMIT 1'® PE All work to be performed in accordance with the Massachusetts sets ®c�tnC C��M4p��l�� tl�®R�! (PLEASE PRINT II�r11V OR TYPE ALL FORMATIO ( ), 5 7 CMR 12.00 City or Town oh NORTH ANDOVF � Date: � By this application the undersigned gives notice of his or her intention to peTo the rforin t�elect�rjcaietoof Wires: Location (Street & Number)described below. Owner or Tenant L"lr 7 /J h e J ,? .l i Owner's Address r Telephone No. Is this permit in conjunction 'th a building permit? �= Purpose of Building Yes NO ® (Check Appropriate Box) Mt Existing Service 1Q Utility Authorization No. Amps / A2 Volts Overhead 0 Und New Service A�'d ❑ No. of Meters Amps __Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: ,..."U . L r, .AiVs mom [etion of the followin table may be waived by the Ins ector of Wires. No. of Recessed Luminaires No. of Ceil: Sus No. of p. (Paddle) Fans Total No. of Luminaire OutletsTransformers KVA No, af:Elat Tubs Generators KYA. No. of Luminaires S Above �_ Kunming Pool d• o• o mergency ig g - No. of Receptacle Outlets nd. Batte Units No. of oil Burners No. of Switches F1 E A -LA -MS No., of ones ' No. of Gas Burners No. of Detection and No, of Ranges Total Imhatin Devices . No. of Air Cond. No. of Waste Disposers . Heat Pump Number Tons ns No. of Alerting Devices No. of Self -Contained . --�...... �...._ . .Contained No. of Dishwashers Detection/Alertin Devices . Space/Area Heating KW Local ❑ Municipal No. of Dryers Rea tin A hances Connection Other No. of Water KW g PP ' Security Systems: No. of No. of Devices or E uivalent Heaters rin No. of Data Wi Si s Ballasts. g; No. Hydromassage BathtubsNo. of Devices or E uivalent No, of Motors Total HP Telecommunications Wiring; OTHER: No. of Devices or E uivalent Estimated Value of flectrical Work: 3 pv oo Attach additional detail if desired, or as required by the Inspector of Wires t Work to Start: (When required by municipal policy.) b Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C RAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such c verage is in force, and has exhibited proof of same to the permit issuing office. ss CHECK ONE: INSURANCE BOND ❑ OTHER I certify, under the pains and enalties o .(Specify P fperjury, that the information on his FIRM NAME: K� MC4Application is true and complete. _ Licensee./ VC. LIC. NO.: ®�2 �I s�n�0 Signatur (If applicable, enter exempt in thelice a nu b r li LIC. NO.: Address: ,�,q uyl?� e j' Q 011)(, Bus. Tel. No.: g 2 *Per M.G. c. 147, s. 57-61, security workrequires Department of Public Safety S°License: Lie. No. Alt. Tel. No.: OWNER'S INSURANCE WAIVER; I am aware that the Licensee does not have the liability required by law. By my signature below, I hereby waive this requirement. I am the (check one) [� owner coverage normally Owner/Agent Signature ❑owner's agent Telephone No. PERMIT FEE: $ 33'^ ELECTRICAL PERAUT NO.. INSPECTION REPORT: ELECTRICAL INSPECTOR - DOUG SMALL . ti 1. ROUGH INSPECTION: anicu —I j x-auea — t j Re -inspection requirecf ($50.00) - [ ] Inspectors' comments: 11 (Inspectors' Signature - no initials) Date d. ,�•u�ro r , �u.v�rr.e.�.tyly, r. y a.3ocu — t t .rauea —1 I Re -inspection required ($50.00) - [ ] Inspectors' comments: (inspectors' Signature - no initials) Date 3. UNDER GROUND INSPECTION: Passed — [ ] Failed — [ ] Re -inspection required ($50.00) Inspectors' comments: L. (Inspectors' Signature - no initials) Date !� I DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND ARE -INSPECTION OF $50.00 IS TO BE CHARGED. 1 ' The Commonwealth of Massachusetts Department of Industrial Accidents Office ofinvestigations 600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print I.e 'bl, Name (Business/ organization /Individual): AAG Address: ,�4 /l1ll p O P cti rPhone #: Mru an employer? Check the appropriate box: 1 • am a employer with r 4. ❑ I am a general contractor and I employees (full and/or —part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet ship and have no employees These sub_contractors have working for me in any capacity. workers' comp, insurance. [No workers' comp. insurance 5. required.] 3. ❑ I am a homeowner doing all work myself. [No workerscomp. insurance required.] t ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and the have no employees. [No workers' comp. insurance required ] *-AMY =scant that checks box 41 must also fill Out the section hero.., t tr showing their wc,k=' c^—n-a Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. EJ Building addition 10. ❑ Electrical repairs or additions ILEI Plumbing repairs or additions 12•[] Roof repairs 13.❑ Other =- omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance information. for my employees Below is the policy and job site Insurance Company Name: 2Z) Policy # or Self -ins. Lic. #: K 66P?— 6333 Expiration Date: Job Site Address: d City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance cArage verification. I do perjury that the information provided aboV6 iftrue and correct. Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License Issuing Authority (circle one): L Board of Health 2. Building Department 3. City/Town Clerk 6. Other Contact Person: 4. Electrical Inspector 5. PIumbing Inspector Phone #. Location er— e- I No. Date Xak I %ORTII A TOWN OF NORTH ANDOVER; Certificate of occupancy $ 8 Building/Frame Permit Fee $ Foundati6n Pepit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ A z �04& /Building Inspe6tor Div. Public Works i PER'Vf NO. 9T� APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. I,PAGE 1 MAP d,10. LOT NO. 2 RECORD OF OWNERSHIP iDATE (BOOK 'PAGE ZONE I SUB DIV. LOT NO. 0-4 LOCATION ,� PURPOSE OF BUILDING / e,eOd &JW OWNER'S NAME �! G NO. OF STORIES, SIZE Y _ OWNER'S ADDRESS jJ�(( //,�////JJ BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME✓I&Ve GA✓ SPAN --- DISTANCE TO NEAREST BUILDING,•/ DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES — SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION r IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING V ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED AAJV I A?9 SIGICATURB'OF OWNER OR AUTHORIZED AGENT frrJ�T - FEE PERMIT GRANTED 19 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST�6 -B ar, O� SSSSWW��/��/ r EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY V v1f U BUILDING INSPRCTOR OWNERTEL.✓t CONTR. TEL. # CONTR. I H.I.C. # BUILDING RECORD ' 1 OCCUPANCY 12 SINGLE FAMILY S-0 IES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH d 1 2 I3 PINEHARD PLASTER CONCRETE CONCRETE BL'K. BRICK OR STONE PIERS DRY W DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA '/ 1/1 '/ FIN. ATTIC AREA _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 �_ 3 _ _ DROP SIDING WOOD SHINGLES CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ HARMWID COMMCN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR BRICK ON FRAME I_ CONC. OR CINDER BILK. WIRING STONE ON MASONRY _ STONE ON FRAME SUPERIOR I�POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I A IP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ Isr 13rd ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CN � d x O A a v ucu O w E v C/)w w X z z a W_ O O g2 U � G w w � p w m C w a o u P GO u U a , W p u2 y cn � w a O U p c4 in G u: z w a a w v c c0 o 2 v L V) v O p cn go uj 0 z .. O d C ;;C O C V O � L C �• ca O C R o V V C. C R R Q L H Ea o a y. H E c m co.. .00 c a �• N m L om 3 co CC.1 A cmJ C C � mo a H W OC V y C-7� N m CDttE CD C3 'y o ?� \ cc � c o 0. = m 3 0 N m W = d C _ .0co O C M O.= E -o o CD _o p m C_ O d O.0 m = o CA y a,m J 0 m A.11 CD O E /Mco L Ii O CD Z O y O � co p� ICco M:2 O — Ln co m m L- H0 co G. f+ = O � CD L m O Q CL via O Cc CA Z CD V y C s 'C C CO) is I Date. . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... ................... has permission for gas installation .14 ................... in the buildings of ... i .................................. at ............... North Andover, Mass. Fee. Lic. No.. . ? .... ... ...... (6AS INSPECTOR Check # 4�r '7 6:' 3 0 -1 MASSACHUSETTS UNIFORM ANt'UCATIDN FOR PtRMI 1 1 V UV (iASFITTING (Print or Type) ' G f Mass. Date /0' 6t ` 1 � Permit # b z-3 Building Location Lv Owner's Namelc r//42 arllcz J)0 e (� fill/' / &l Type of Occupancy e,5j 7 N 7r r -I L New ❑ Renovation ❑ Replacement Plans SubnSit; Yes❑ No ❑ installing Company Name 1Z T A `gym mA Tri X 0 Check one: Certficate Address 30 0oA C H ih A_ ►y &Nf . ❑ Corporation Me T H U e fel 01 rl U( ?q y ❑ Partnership Business Telephone /,9 gZ — 9 17-7 f p�rrm/Co. Name of Licensed Plumber or Gas Fitter '� o 8 E T A `J A M m H i A,f?r � INSURANCE COVERAGE: I have a current f bil)ty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ It you have checked Les, please indicate the type coverage by checking the appropriate box A liability insurance policy / 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 above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the pe ed for this application ' ;inmpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ner laws. By T of License: �116Z Plumber n urb of Licensedu _. orr Title tter er license Number 9333 City/Town Journeyman i i installing Company Name 1Z T A `gym mA Tri X 0 Check one: Certficate Address 30 0oA C H ih A_ ►y &Nf . ❑ Corporation Me T H U e fel 01 rl U( ?q y ❑ Partnership Business Telephone /,9 gZ — 9 17-7 f p�rrm/Co. Name of Licensed Plumber or Gas Fitter '� o 8 E T A `J A M m H i A,f?r � INSURANCE COVERAGE: I have a current f bil)ty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ It you have checked Les, please indicate the type coverage by checking the appropriate box A liability insurance policy / 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 above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the pe ed for this application ' ;inmpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ner laws. By T of License: �116Z Plumber n urb of Licensedu _. orr Title tter er license Number 9333 City/Town Journeyman sbI v v Date.. TOWN OF NORTH ANDOVER 0 PERMIT FOR GAS INSTALLATION SSACHU This certifies that .......... has permission for gas installation ............................ in the buildings of ... . ................................. at /Q ... � ... North Andover, Mass. Fee-��. . .'. Lic. �0. S INSPE 5OR Check # 4 9 7 (-� y� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTONG omm or Type viMass. Datk:L�ZC� Permit (a Sutlding '� Owner's Namp id�/i' Type of Occupancy New ❑ SUS—SSMT. .rte BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 8TH FLOOR 7TH FLOOR STET FLOOR Renovation ❑ Replacement Plans Sul rb X W Z df C . to W C W O V NCX ai r Y A yWj Z O W W~ < C O W < m il �+ W OC I - < ti J W Y < C '= W .J• O a Z G U. 2 < 1 C O O d V C > C 6 O •:. 11 i1 Bud ness Telephone_ 04/-- Name of Ucensed Plumber or Chas Fitter c. Check one: O Corporation ❑ Partnership /CO. Yes❑ No ❑ Certilicate INSURANCE COVERAGE: I have a current ability insurance policy or ftsubstwtial equivalent which meets the requirements of MGL Ch. 142. Yes &r No O If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy 0 Other type of Indemnity O Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not Imve the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waMes this requirement. Check one: Owner❑ Agent O Signature of Owner or Owner's Agent i hereby certify that all of the details and information I have submitted (or entered) in above application are true and wwrate to the best of my knowledge and that all plumbing worn and Wa taliationa performed under the pe ed for this application be in compliance with all pertinent provisions of the Massachusetts State Lias Code and Chapter 142 of Laws. gy Tkooense:er re _ or itter Uoese Number/Town yman 0 x �O s fi 1 � � a � e s � r i � O z � O O � 9 w � O „ � A O O D O . O O � � s ,s a a D