HomeMy WebLinkAboutMiscellaneous - 10-12 WILEY COURT 4/30/2018■ono r Phone: 978-632-2660 JAMES A. TRUDEAU Adjustment Service Inc. P. O. BOX 7 Fax: 978-632-2662 Gardner, MA 01440 claimsAtrudeauadi.com Notice of Casualty Loss of Building Under Massachusetts General Laws, Chapter 139, Section 3B February 19, 2015 uilding Inspector 1.20 Main Street North Andover, MA 01845 Board of Health 120 Main Street North Andover, MA 01845 Fire Department Dept. of .Records 124 Main Street North Andover, MA 01845 Insured: Lisa Vayanos Loss Location: 10-12 Wiley Court, North Andover, MA 01845 Insurance Company: Preferred Mutual Insurance Co. Policy No.: PHOO100543874 Date of Loss: February 18, 2015 File Number: 15-12819 Claim Number: 15104304 Type of Loss: Ice Dam 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 writer and include a reference to the captioned insured, location, policy number, date of loss, and file or claim number. On this date, I cause copies of this notice to be sent to the person(s) named above at the address indicated by first class mail. Sincerely, Joshua M. Trudeau Claims Adjuster Date .lql !.!-/AG ....... 40 TOWN OF NORTH ANDOVER • - PERMIT FOR GAS. INSTALLATION' ♦ 'a 5 �7S SACMUSESS This certifies that .. ... ........ /" P . ........ . has permission for gas installation ................. in the buildings of .. ��.<� .!: �� �.G..`.......... • . • ..... at .......... North Andover, Mass. Fee...39, Lic. No.../ ?. 7.yl. .................. GASINSPECTOR Check # 3 Y 6649 MASSACHUSEM UNIFORM APPUCATON FOR PERMIT TO DO GAS FMING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Loqations /0 6V Paul,-Va�ravto-5 Owner's Name New ❑ Renovation ❑ Replacement Ef Date - l �` &o X Permit # ' A ount $ Plans Submitted ❑ (Print or type) , rr Name LAA C.I le, Pfit) m-NV1(,� I.-, ) I cA A Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company ❑ Corp. ❑ Partner. Finn/Co. INSURANCE COVERAGE I have a current liability Insurance, policy or it's substantial equivalent. Chec on If you have checked Yes, please indicate the type coverage by checking the appropriate box. Yes Liability insurance policy M Other type of indemnity EDBond No❑ 13 Owner's Insurance Waiver. I,= 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. Signature of Owner or Owner's Agent Check one: Owner 13 Agent 13t hereby certify that all of the details and information I have submitted (or entered) in above appiication are true and accurate to the best of my knowledge and that all plumbing work and installations performed unde Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S as �e;7CCh�ptey1 ss of the General l .awc By: Title City/Town, APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber Z ❑ Gas Fitter Ucense Number IM Master Journeyman Location No. Date'��� TOWN OF NORTH ANDOVER ti. TOTAL Check # 10 �l �•1. f �, —Building Inspectgt ` Certificate of Occupancy $ ��s',••°''t�' sac Must Building/Frame /Frame Permit Fee $ 9 Foundation Permit Fee $ Other Permit Fee $ ti. TOTAL Check # 10 �l �•1. f �, —Building Inspectgt 1.1 Property Address: A -a (,t ae c misioric ulstrict: Yes No 1.2 Assessors Map and Parcel oae) Map Number Number: /, Parcel Number o. D r -Q /` (✓t / A { f Signature V Telephone 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Signature Telephone Front Yard Side Yard Rear Yard Required Provide Required Provided Rapired Provided License Number Expiration Date 3.2 Registered Home Improvement Contractor 1.7 Water Supply M.G L.C.40. 54) Public ❑ Private ❑ Zone 1.5. Flood Zone Information: Outside FI e ❑ 1.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System ❑ SECTION 2 -PROPERTY OWNERSHIP UTHORIZED AGENT misioric ulstrict: Yes No 2.1 Owner of Record t/ia U j 1� �4 )o -5 Name 4 C7-/ Address for Service Signature V Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Addrtss Signat4re Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Si nature Telephone M M X ic z O v m O z M 90 O mn r v M r r z G) SECTION 4 - WORKERS COMPENSATION (M.G.L. 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 ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition 11 Other ❑ Specify Brief Description of Proposed Work: ro4 Q( V1 2.e VY10 ve (pa r-4 or 4 h Q roo . CL W U-) © A P - SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL..USE ONLY 1. Building (a) Building Permit Fee Multi lier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) °s 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OR CONTRACTOR APPLIES FOR BUILDING PERMIT OWNERS AGENT Og� �/ V Q (Q n 0 S as Owner/ uthorized Agent f subject property Hereby authorize 9?,9 M D s 120 a f/ r7 q 0 /1 4 P ?/ /7 -Jt n'<? L %G to act on My behal�f,,, in all matters relative to w rk authorized by this building permit appli ion. .Cq . (T'*h e�� �g Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject roperty eby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and ' f Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DUv ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHINMY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE r, CA m m x CO) CO) EPmm C= y C � CA Cl) n Z y o 06 C, go � O CL F y a� v CDCL O CT d CD CD o CD C CD co) av y O CD I I co E� =r =H`Q ON EL. 0 CEL - 2 C gr -a .► d =r a POOH O IE mGo �O Zi n ?=- ay RAM=: a O O O ti Oa o H m� _ CL C IE ccm ti y _ C O m oo �m o H � CD _ � O m CD CA 0 CD d ME G �• = m CA C) T T m CO2 2 z 0 y 0 `� 'v °�' G w Crl 0 O ro r CL to O ro b o O x v 0 c RAMOS ROOFING AND PAINTAING, LLC. *ROOF •VINYL SIDING *WINDOWS REPLACEMENT 30-32 Spruce Street. Lawrence, MA 01841 Phone (978) 681-1577 or (978) 420-2458 ABBREVIATED FORM OF AGREEMENT BETWEEN CONTRACTOR AND OWNER Agreement Made as of the 4h days of August, 2005 Between the contractor: (Name and address) And the Owner: (Name and address) Ramos Roofing and Painting LLC. 30 Spruce Street. Lawrence, MA 01841 Paul Vayanos 12 Wiley Ct. North Andover, MA. The project is: 12 Wiley Ct. North Andover, MA. (Name and location) The Contractor and the Owner agree as set below. The word of the Contract • Apply a new roof up and over.(Shingles, Arq. Dual brown) • Remove one part of the shingles in the back size of the house and apply new shingles. • Apply Drip Edge around of the building. • Apply Ice & Water shield. • Apply black paper 15 lbs. • Including thrash service and city permit. • Remove old TV antennas. • Tie around chimneys after new roof is applied. The contract Sum is based upon the following alternates, if any, which are described in the Contract document are herby accepted by the Owner: Unit prices, are as follow: Materials cost: $ 2,500.00deposit Cost of job: $ 2,100.00 due on the completion of the work. Total $ 4,600.00 This work should be done in 4 days or less, depending of weather conditions. This agreement entered into as of the day and year written above. ➢ 10 years of warrantee ➢ Full insurance Contractor: Ramos Roofing And Painting (SIGNATURE) DATE Owner: Paul Vayanos DATE 08/04/2005 13:51 FAI 978 640 0611 WILKENS INSURANCE AGENCY X1001 AM CERTIFICATE OF LIAEiL PRODUCER (978 551-8770 FAX (978)640-0611 Wilkens Insurance Agency Tewksbury Insurance Agency LLC 170 Main St Suite 103 Tewksbury, MA 01976 INSURED GO Victor DBA: Ramos Roofing 32 Spruce Lawrence, MA 01841 ITY INSURANCE DATE /2� ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIL 9 INGURIii-7 Sgvereign Excess IN3URFRe: National Grange Mutual 14788 lxs~cc AIM Mutual Insurance INSURER D: I — ;HSUFIFR E ' .uvemmoca _ THE POLICIES OF INSURANCL LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE PI ANY RGROUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENC WITH RESPECT TO WHIC MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES 0MR19ED HEREIN I$ SUBJECT TO ALL THE TER POLICIES. AGGREGATE LIMITS SHOWN MAY RAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF WGURAWS POLICY NUMBER P FEmng POLICY WI*ATIOA aiNGRAL UABILRY 491F002610 06/06/2005 06/06/2006 X �:OerJGRC 4 (%ENEUAL LIASILRY CL►ILW MADE Q OCCUR A GENY AGGREGATE LIMIT APPLIES PER. y POLICY IAC AUTOMOBILEl.MLITY M9M134a6 10/10 2004 10/10/2005 ANY AUTO ALL OWNED AUTOS B X SCHEDULED AUTOS HIRED AUY03 NOR-OWNSD AUT09 CAkA" U,ASRJTY ANY AUTO Sl(CL•3S/'JMSRBLLA LIABILITY DOCCUR 0 CLAM MADE 1 DE.,UCTGLE 1wordaiRSCOMKWSATIONAND EMPLOYERS LIABILITY C ANT PROPRIETORWARTNERJEXECUTPIS, OFFICiRTAEAW R ESCLUDEDT BY INDORSEMENT Paul Vayanos City of N.Andover 12 Wiley Ct. N.Andover. MA 02845 AGORD 26 (2001108) FAX: (978)681-1577 ILICY PERIOD INDICATED, NOTWITHSTANDING H THIS CERTIFICATE MAY BE ISSUED OR 48, EXCLUSIONS AND CONDITIONS OF SUCH LIMITS EAGM OCCURRENCE S D r. To REHM S NED ErP (My — P"Qn) S PENIAL&ADVI14URY S GENEFALAmFmATE S KtOOUCTS-COMPrOPAGG S COA;BINED bING.E LIMIT $ (12 armory BODILYINJURY b CAW pan:on) S (�aYa�nt)� PROPOM DAMAG6 S (Por accttmt) AUTO ONLY - EA ACCIDENT S OTHER THAN FA ACC b AUTO ONLY: AOO $ EACH OCCURRENCR% S AGOREGATE S 5 S S DTI+ E.L. EACH ACCIDENT $ 10010 E.L. OISFASE - EA EMPLOYN S 100A0( F-L.cmASE•POLiCYLIMrr S S001000 SHOULD ANY OF THE ABOVE OE3MEED POUCIES BE CANCELLED 29FORS THE EXPIRATION D&TETWEMOC, THE fSSU1NGINSURER WLLENGCAVORTOMAIL 10 Y8 TTEN NOTICE TO TNR CERTIFICATE woi ER NAMED TO THE LEFT, AIWRE T %. SUCH NOTICWHALL IMPOSE MCCRUGATIM OR LIJARIL Y fy :, , QA ORD CORPORATION 1988 1�0 ;um O O mN�cn n X O 9' 8 S c C', z G1,L a o 0 70 a S Z D < ao GZi z N N N NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date