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HOLLOWELL JAMES CHAPTER 139 LETTER CRAW.PDF
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Crawford
Crawford & Company
1001 Summit Blvd
Atlanta, GA 30319
Phone 877-346-0300
4/4/2015
Inspector of Buildings
1600 Osgood Street
North Andover, MA 01845
Re: Insured: James Hollowell
Claim Number: 033566720
Policy Number: 94146400002
Our File: 6776-2589081
Date of Loss: 2/18/2015
Type of Loss: Ice Damming
Location of Loss: 10 Greenwood East Ln
North Andover, MA 01845
To Whom It May Concern:
A claim has been made through Arbella Mutual Insurance Company which involves loss, damage, or destruction
of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter
143, Section 6, to be applicable.
If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate, please direct it to the
attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number.
Very truly yours,
James Warren
Crawford & Company
CC: City/Town Fire Dept, City/Town Health Dept
Location 1,9 &,-,e e-, vWV0d
No. 1, -;� Date
,%OWTPI
TOWN OF NORTH ANDOVER
Certificate of Occupancy
$
CHU
Building/Frame Permit Fee
$ 3511/
Foundation Perffiit Fee
$
Other Permit Fee
$
C//
TOTAL
$
-?() �6
Check #
147 �7
Building Inspector
Location &g�,
No. Date
k0*Tjj TOWN OF NORTH ANDOVER
0.
Certificate of Occupancy $
'A
CMU Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # .21? �6
14727
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
TWs,Secho:for: (?iixxai i3se`Oai , .. :.
BUILDING PERMIT NUMBER:
DATE ISSUED.-
SSUED:SIGNATURE
SIGNATURE
Building Comrnissioner/I for of Buildings Date
I SECTION 1- SITE INFORMATION I
1.1 Property .Address:
3.1 Licensed Construction Supervisor:
r
Licensed Construction Supervisor:
Address
Signature Telephone
1.2 Assessors Map and Parcel Number:
License Number
Expiration Date
G1k da7j Le OoaBv�
Not Applicable 0
Company Name
Registration Number
Address
Map Number Parcel Number
Signature _ Telephone
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning District Proposed Use
Lot Area (so Frontage (ft) .
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Reqwred
Provided
Required
Provided
1.7 Water Supply :M.G.L.C.40. 54) 1.5. Flood Zone Information:
1.8 Sewerage Disposal System:
Public 0 Private 0 Zone
outside Flood Zone ❑
Municipal 0 On Site Disposal System
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
110 Y
i (y�7 {- /i
`
S O �
1 i� V S-GG�^ W o+ •�5 t�P� dLt.
Name (Print) �
Address for Service
479 05--91K0
Signa 011Telephone
2.2 Owner of Record:
1{.�}
/�/► I
//��
Name Pnn &0_0
Address for Service:
Si na Tele hone
SECTION 3r CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
r
Licensed Construction Supervisor:
Address
Signature Telephone
Not Applicable 0
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable 0
Company Name
Registration Number
Address
Expiration Date
Signature _ Telephone
SECTION 4 - WORKERS COMPENSATION (M.G.I. C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes ....:..❑ No ....... 0
SECTION 5 Description of Proposed Work check aU applicable)
New Construction ❑
Existing Building ❑
Repair(s)
❑
Alterations(s) 0
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other
❑ Specify
Brief Description of Proposed Work:
4,1 'fit+ o l.' V e d
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to bero,O
Completed b permit applicant
CIAL
',��
USE Ni;Y
I . Building
b 6
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) X (b)
4 Mechanical HVAC
5 Fire Protection
6 Total (1+2+3+4+5)
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, as Owner/Authorized Agent of subject
property
Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Name
Si"aturewner/A ent Date
NES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1ST 2 NU 3 RD
SPAN
DIMENSIONS OF SILLS
DU\, ENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CFMVINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
Iti r e4v\ Ict.
FORM - U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve the
applicant and or landowner from compliance with any applicable requirements..
.........................................�.1.�.`.f...i.'...........................
APPLICANT r m c. Q �' F --J � 0 �(a N awtVt PHONE �if' KA 5 - 6 MA
ASSESSORS MAP NUMBER D � 8 . C LOT NUMBER onnQ, C
SUBDIVISION LOT NUMBER
STREET G, uv% w ee) 1�_s4" L y► c STREET NUMBER O
OFFICIAL USE ONLY
RECOMMENDATIONS OF TOWN AGENTS
u U�- DATE APPROVED
1,CCO SERVATION AD STRATOR
DATE REJECTED
CONB4ENTS
TOWN PLANNER
COMMENT'S
FOOD INSPECTOR - HEALTH
SEPTIC INSPECTOR - HEALTH
CONIIvIENTS
PUBLIC WORKS — SEWER / WATER CONNECTIONS
DRIVEWAY PERNIIT
FIRE DEPARTNIENT
CONINIENTS
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
RECEIVED BY BUILDING INSPECTOR DATE
MORTGAGE'INSPECTION PLOT PLAN
• NORTHERN ASSOCIATES, INC.
630 TURNPIKE STREET NORTH AMD7,1ER MA (508) 975-7117
JAtME-S At BONA kJ.
MORTGAGOR H 0I--ee)WS_f _ I DEED REF_2P_U0__PG. 2?�8
ADDRESS OF PRINCIPLE BUILDING PLAN REF, t.10 .-1440
1D C-` 1✓ I �,. inn r:) '.- t -1`I ; DATE OF INSPECTION:
A�Jolvefe_ MA:
�crt"
3
a 8.-A=60.00
!✓ 0 T Z
o
25000
SF t
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C McSrivu r
NOTE: This mortgage Inspection was prepared:
spedficaly for mortgage purposes and Is not to be rolled
upon as a survey. Northern Associates, Inc. accepts no
responslbllity for damages resulting from said reliance by
anyone other than the told mortgagee and Its assigns In
connection with. Its proposed mortgage financing .to said
morigagCY.
CERTIFICATION TO:.
This mortgappa Inspection was prepared In acwrdance
with the Tachnlcal Standards for Mortgage Loan
Inspections as adopted by the Massachusetts Association'
of Land Surveyors and CM Engineers, Inc,
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1 FURTHER STATE THAT IN MY PROFESSIONAL
OPINION the principle strvctum/s and accessory
outbuildings, CONFORM
with ft setback requirements of the local zoning
ordrwlces, and that there ars no encroachments of major
Improvements either way across property fines except as
shoo rt. pANEL #sG�v 9 8- 00 6 C
ALM ,
0 t.. Progeny is not in a Flood Hazard Area' : DATE t G -.2 -
0 2. Property Is in a Flood Hazard Area.
0 3. Information Is Insufficient to determine Flood Hazard.
Flood Hazard determined from latest Federal Flood
Inwrance Rate Map P&WI
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N 2223 Date..
AORTH
TOWN OF NORTH ANDOVER
0
0 PERMIT FOR WIRING
This certifies thaC��-,-7 . . ..................
............ . .......................
has permission to perform .....
7\viring in the building of ....
... ................ .............. ...................................
at............... 1-4 ...................................................... .... orth Andover, Mass.
Feie:��,.. I ......... Lic. No . ............. r .......................
. ..............
E�LiECMICAL INSPECMR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
�\ O::tee Use Only
The Commonwealth of Massachusetts
IV
Department of Public Safety Permit No.
BOARD OF FIRE PREVEN11ON REGULATIONS S27 CMR 1200 3/90 OccmpaM) b Fee QMckea-
(leave blank)
APPLICATIONl woork�FperfordORmP`ERoMIT TOdance withe PERFORM MassachusettsElecCode.trical TRIC�AL WORK
(PLEASE PRINT IN INR OR TYPE ALL INFORMATION) Date -3-13 _60
City or Town of �/pXA,0e1/C2 To the Injpector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) LD &LOOLY S7_ 6'91VC
Owner or Tenant /_� //A
Owner's Address
Is this permit in conjunction with a building permit: Yes ❑
Purpose of Building Utility Authorization NO.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service Asps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Amoacity
Location and Nature of Proposed Electrical Work A4e 60
L/
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers Total
KVA
No. of Lighting Fixtures
Swimming Pool Above In-
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
Initiating Devices
No..,of.Sounding..Devices
No. of Self Contained
Detection/Sounding Devices
Local ❑ Municipal ❑ Other
Connection
No. of Ranges _
No. of Air Cond. Total �..
tons
No': of'Disposals
No. of Heat Total Total
PUMPS Tons KW
No. of -Dishwashers
Space/Area Heating KW
No. of Dryers
4
Heating Devices KW
No. of Water Heaters
Signs 1of No. of Ballasts
LowWirVoltage
ng
No. Hydro Massage Tubs
No. of Motors Total HP
INSURANCE COVERAGE: Pgrsuant to the requirements of Massachusetts General Laws
I have a current Lia ty Insurance Policy including Completed Operations Coverage or it stantial
equivalent. YES NO U I have submitted valid proof of same to this office. YES NO ❑
If you have chec YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE BOND ❑ OTHER ❑ (Please Specify) /a -3) 0
at
Estimated Value of Electrical Work $ Expiration e
Work to Start Inspection Date Requested: QRough Final
Signed under the pen lties of perjury: FO Stc6C9/T s7:" 1046A.ItSgwer
FIRM NAME �rC CI-
IrAv Car,LIC. N0.
Licensee �`/C .(f�� 061156-571 Signature LIC. N0.
Addressus. Tel. No.
Alt. Tel. No. U
OWNER'S INSURANCE WAIVER: I am aware that the Lice see does not have the insurance coverage or its sub-
s-tantial 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 $
Signature of Owner or Agent