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HomeMy WebLinkAboutMiscellaneous - 108 STAGE COACH ROAD 4/30/2018 / 108 STAGE COACH ROAD 210/065.0-0158-0000.0 �L PO Box 55098 Boston,MA 02205-5098 617-951-0600 Form of Notice of Casualty 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: WILLIAM DUMONT and LESLIE DUMONT Property Address: 108 STAGE COACH RD.,N ANDOVER, MA Policy Number: HMA 0201353 Claim Number: BOS00050848 Date of Loss: 2/22/2015 Company: Safety Indemnity 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. Dane Iovino Claim Examiner 2/24/2015 Safety Insurance Company Y Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 •Phone: (6,1-7):951"0600 EXT 3533 Fax: (617) 535-5851 Email: DaneIovino@Safetylnsurance.com Safety Insurance Form of Notice of Casualty 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 i N ANDOVER, MA 01845 N ANDOVER, MA 01845 RE: Insured: WILLIAM DUMONT and LESLIE DUMONT Property Address: 108 STAGE COACH RD.,N ANDOVER, MA Policy Number: HMA 0201353 Claim Number: BOS00040364 Date of Loss: 11/18/2013 Company: Safety Indemnity 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, Chanter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chanter 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. Justin Murphy Claim Examiner 12/5/2013 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 5436 Fax: (617) 535-5869 Email: JustinMurphy@Safetylnsurance.com N2 •'1752 Date...... 40RTPf 01 -1 TOWN OF NORTH ANDOVER I" mw,--wow- PERMIT FOR WIRING 4 4 4 u u u 1% This certifies that ....-el.-..O. .......5n4........S.f'.-? ()........ .r.. ............ , has permission to perform ......... ............5.Y.5v " .......... wiring in the building of........ .......0..A.4wiJ ..................................... at.... 5.1.:.J. Af...Cc.)�4...OW ....... .L orth Andovel,.Mass. iCrR A Fee... .k. Lic.No./2,24C* .......... A�....... ELE C NSPECTOR C ti �?— WHITE:ApplicaoV/09/99CM4 .69Y: BulldingAe .I* pAlIfINK:Treasurer .. . MAP FORWARD 7 Office Use Only BF(�h1TB�ilJa Permit No. 116 Separtment of fiublic %fetg Occupancy A Fee Checked BOARD OF FIRIk PREVENTION REGULATIONS 527 CMR 12.00 Mo (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code. 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) pate 6/30/99 City or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below, Location (Street & Number) 108 STAGE COACH ROAD Owner or Tenant BILL DUMONT (978) 738-9781 Owner's Address Is this permit in conjunction with it building permit: Yes ❑ No ® (Check Appropriate Boz) Purpose of Building Utility Authorization No. Existing Service .Amps_I Volts Overhead ❑ Undgrnd ❑ No. of Meters r New Service Amps_J Volts Overhead ❑ Undgmd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of ltansformers Total INA No.of Lighting Fixtures Swimming Pool Above In- gmd. ❑ grnd. ❑ Generators KVA No.of Emergency Lighting No.of Receptacle Outlets No.of ON Burners Battery Units No.of Switch Outlets No.of Gas Burners FIRE ALARMS No.of Zones "r No.of Ranges No,of Air Cored, Tout No.of Detection and tons Initiating Devices i No.of Disposals No.of Heat Total Total Pumps Tons KW No.of Sounding Devices No.of Soft Contained No.of Dishwashers Space/Area Heating KW OstectbNSounding Devices No.of Dryers Heating Devices KW Local ❑ MCort�Cplon ❑Other No.of No.of Low Voltage No.of Water Heaters KW Signs Ballasts Wiring BURGLAR ALARM No. Hydro Massage Tube No.of Motors Total HP OTHER: INSURANCE COVERAGE:Pursuant to the requirements of Massachusetts genwW Laws I have a current Liability Insurance Policy including Completed Operations Coverage or Its substantial equivalent. YES G NO O 1 have submitted valid proof of same to the Office.YES O NO O it you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE O BOND. O OTHER O (Please Specify) (Expiration Oats) Estimated Value of Electrical Work i 579.00 Work to Start 6/29/99 Inspection Date Requested: Rough Final 7/2/99 Signed under the Penattles of perlury: 1 1 r FIRM NAME UC. NO. - -- Licensee nnnaltl A_ Rrnnk_s Signature LIC. NO. . 12316 Bus.lel. No. CM3) 741-4008 Address 111 Morse Street. Norwood, MA Alt.Tel. No. pl)78-1131 -- OWNER'S INSURANCE WAIVER: I am aware that the Licensee doe@ not have the Insurunce coverage or Its substantial equivalent as re- quired by Massachusetts General Laws, and thni my signature on this permit spplk.auon waives this requirement. Owner Agent (Please chock one) 3 ,.. Telephone No. PERMIT FEE :35_00 (Signature of Owner or Agent) u.111qA5 ''����.�.�fti�"�.Yr r ..�".'L...•Z`�i1'•�,HA..Wr�+1.�-�I"� . 1ii�.�v �41-F.:.�rYfFt':a_my..+-�:-f.�� -+!' Location56�.CoACt� a No. la3 UJS Date 1 o 6ab } ;: of "O or;,tio TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ C E Foundation Permit Fee $ � s� s� ej Other Permit Fee U30UO ZS '. Sewer Connection Fee $ : d Water Connection Fee $ TOTAL $ wilding Inspector i ti Q 7612 Div. Public Works PER111V NO. ' � —S APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP KdO. LOT NO. 2 RECORD OF OWNERSHIP :DATE BOOK :PAGE ZONE SUB DIV. LOT NO. I 'LOCATION 108 STAGECOACH RD PURPOSE OF BUILDING INSTALLATION OF PALLET STOVE OWNER'S NAME SHUI LIANG, ZIA NO. OF STORIES & METAL sTNTERIOR CHIMNEY FLUE OWNER'S ADDRESS 108 STAGECOACH RD. , BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME 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 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 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COS PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. �71� EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED ANO APPROVED BY BUILDING INSPECTOR DATE FILED OCT, 2 9, 1994 &Q+�57 r UILDING INSPECTOR SIGNATURE O WNER OR HORIZED AGENT F E E ZSR" OWNERTEL.# 685 7369 PERMIT GRANTED CONTR.TEL.# CONTR.LIC.# H.I.C.# INSTALLED BY OWNER. BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY S;ORIEs I THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS I I RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE B l 2 13 CONCRETE BL K. PINE _ BRICK OR STONE HA 0 PIERS PLASTER — DRY WALL UNFIN. 3 BASEMENT 11 AREA FULL FIN. B M AREA _ 1/1 '/z l/. FIN. ATTIC AREA _ NO B M T FIRE PLACES _ HEAD ROOM _ MODERN KITCHEN _ r 4 WALLS II 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR POOR ADEQUATE _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.) _ GAMBREL MANSARD TOILET RM_ (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR 14 TILE DADO 6 FRAMING II 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM - STEEL BMS. 8 COLS, HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS '] NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd 11 NO HEATING Vr%0iv1.4 %J i %WO r 1.. 1111%_j 1r_1L_"1_nt 11v11 1v ........ rv.�.r . Permit (o g cos °` A building permit is required!or the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. Stove A. New X Used B. Typerradiant PELLET STOVE Circulating C. Manufacturer THELIN CO. INC. Lab. No. Name/Model No. THELTN 91 TURBO Collar size Dimensionsi Height 40" Length Width Chimney A. New Ezistingx B. Size(flue area) -4" C. Other appliances attached to flue(Number arid flue size) . D. Prefab(Manufacturer—name and type) _— E. Masonry/LinedKx Flue liner Z Unlined tYp•6 manutacturer F. Height(refer to diagrams) cap I IZ`r milt(. OVER, IC 3'Mlty o I,� �'r•1IN. Z' \` 1 Mlf�. n HEARTH CHIMNEY HEIGHT Hearth(non-combustible) A. Materials B. Sub-floor construction C. Minimum dimensions(refer to diagram) Clearances and Wail Protection(see stove installation clearances chart) A. Type of wall protection provided B. Clearances(refer to diagrams) i FIREPLACE CORNER WALL.CENTER 13 TECHNICAL DATA The 91 Turbo Vellet Stove The Gnome Pellet Stove Total watts while in operation: Total watts while in operation: Gear Motor......38 Gear Motor.......4 Air Fan......92 Air Fan & Exhaust Fan......50 Exhaust Fan......18 TOTAL...180 TOTAL....22 Specifications: Specifications: Height......40" Height......34" Diameter......16" Diameter......13" Door Opening......14"x10" Door Opening......8"x10" Rear Vent Diam....... 3" Rear Vent Diameter......3" Rear Vent distance from floor O.0.......141/4" Rear Vent Distance from floor O.0.......13" Pellet Capacity......35# Pellet Capacity......28 lb. Heating Capacity......800-2000 sq. ft. Heating Capacity......500-800- sq. ft. INSTALLATION (Copy of UL Label) CONTACT YOUR LOCAL BUILDING OR FIRE OFFICIALS ABOUT CONTACT YOUR LOCAL BUILDING OR FIRE OFFICIALS ABOUT RESTRICTIONS AND INSTALLATION INSPECTION IN YOUR AREA RESTRICTIONS AND INSTALLATION INSPECTION IN YOUR AREA Approved for Mobile Home Installation Pursuant to(UM)84-HUD LISTED ROOM HEATERS,SOLID FUELTYPE NORTHWEST TESTING LASS,INC. Manufactured By: Also Suitable for Mobile Home Installation Pursuant to(UM)84-HUD Portland,Oregon THELIN PELLET HEATER CO. rn I.C.B.O.TL-1128,AA-591 P.O.Box 847 QQlf�.11� Itf1EA5URE1NEIJT Manufactured by: NVLAP LAB CODE 0244 Nevada City,CA 95959 CORPORATION THELIN 1315 S.Central Unit C P.O.Box 847 •`war ar CONTROL NO. Kent,WA 98032 Nevada City,CA 95959 �g�$ LISTED FIREPLACE STOVES. MODEL: "Thelin'• "PREVENT HOUSE FIRE" SERIAL NO. [� ROOM HEATERS, TESTED TO: UL 737,UL 148283 Install and use only in accordance with 6�4roa�E°d SOLID FUEL TYPE. TEST DATE: October 13,1987 manufacturer's installation and operating MODEL: Little Gnome ® REPORT NO. 308879 instructions and your local building codes. TESTED TO: UL 1482 "PREVENT HOUSE FIRES" TYPE OF FUEL: Pelletized Wood Only CAUTION: Special methods are required TEST DATE: November,1990 when passing chimney through a wall or REPORT NO. 90008 Install and use only in accordance with WARNING: (MOBILE HOME)An outside ceiling,refer to local building codes.Do TYPE OF FUEL: Pellet Fuel Only manufacturer's installation and operating air inlet must be provided for combustion, not pass chimney connector through a DATE OF MFG: instructions and our local buildin codes. combustible surface.Do not connect this y g and be unrestricted while unit is in use.Do unit to a chimney flue serving another ELECTRICAL RATING: CAUTION: Special methods are required not install appliance in a sleeping room. appliance. 115 VAC .25 Amps 60 Hz when passing chimney through a Well or The structural integrity of the mobile home WARNING: (MOBILE HOME)An outside DANGER: Risk of electrical shock.Dis. Ceiling,refer to local building codes.Do floor,walls and ceilinglroof must be main. air inlet must be provided for combustion, connect power before servicing unit.Do not pass chimney connector through a tained. and be unrestricted while unit is in use. not route power cord beneath heater. combustible surface.Do not connect this Electrical Rating: Do not install appliance in a sleeping This pellet fired appliance has been test. unit to a Chimney flue serving another ap- 115 VAC, 3 Amps, 60 Hz. room. The structural integrity of the ed and listed for use in manufactured mobile home floor,walls and ceiling/roof homes in accordance with Oregon Admin. p0 nce. DANGER: Risk of electrical shock.Dis- must be maintained. Istrative Rules 814.23.900 through 814.23.909. NOTE: Replace glass only with 5mm ce- connect power before servicing unit.DO NOTE: Replace glass only with 5mm OPTIONAL COMPONENTS:Use listed pel. ramic. NOT route power cord beneath heater. Ceramic,or NEOCERAM. let vent only. Minimum Clearances to Combustible Materials(in Inches) Minimum Clearances to Combustible Materials(in Inches) BACKWALL ADIACENTWALL BACKWALL BACKWALL ADJACENT WALLFloor protector must be p D ? p g - 4 318" mc1mulin. thickness non, eS° 0 6 y STOVE valent,exte ding be aterial r equi 9 4 4 E STOVE �r0`f E E E 6 STOVE �i)�f f 4 FRONT neath heater and to the front/sides/rear as indi. STOVE FLOOA PROTECTOR cared. HORIZONTAL VERTICAL STARTING INSTRUCTIONS: TO SHUT OFF: • Place small handful of pellets in burner. Dimension Turn control tofenh sition. Turn knob off. Installation Clearance A B C D E po • Light pellets witapproved fire starter. Residential Standard Horizontal 4 4 7,5 4 7.5 When burning well.set knob to desired setting. Residential Standard Vertical 2 4 7.5 2 7,5 Mobile Home Standard Horizontal 4 4 7.5 4 7.5 Mobile Home Standard Vertical 2 4 7.5 2 7.5 CAUTION Alcove Standard Horizontal 4 4 N/A 4 7.5 Alcove Standard Vertical 2 4 N/A 2 7.5 HOT WHILE IN OPERATION.DO NOT TOUCH. KEEP CHIMNEY 8 CONNECTOR:3"or 4"diameter pellet vent connector pipe with listed CHILDREN, CLO-THING, AND FURNITURE AWAY. CONTACT MAY CAUSE SKIN BURNS. SEE NAME— factory-built chimney(Mobile Home must beequipped with a spark arrestor).4"max• imum flue collar.Floor protector optional(Required combustible floor). 10 PLATE AND INSTRUCTIONS. Made in U.S.A. DO NOT REMOVE THIS LABEL THELIN moo. zNo. 12400 Loma Rica Drive 0 Grass Valley, California 95945 0 (916) 273-1976 The THELIN CO . INC. Pellet Burning Stoves WN u, Via' _ s " Y Eby hY*� r v Y W THE GNOME THE 91 TURBO America's cleanest burning pellet heater with Thelin Co. Inc.'s answer to clean burning, automatic 12V back up or 12V power. The super efficient home heating. This incredi- incredible little Gnome pellet heater weighs ble stove burns clean, safe, easy to handle less than 80 lbs. and will burn for over 20 wood pellets made from wood waste and hours on a single load of pellets. Ideal for agricultural residue.Available with chrome one room, mobile home or small space or gold rings, door and top. heating needs. Town of North Andover BUILDING DEPARTMENT _S Homeowner License Exemption (Please print ) ' DATE JOB LOCATION och Number Street Address Section of town "HO,IEO�dNER" AC) t LI40�, Name Home Phone Work Phone PRES'E' T \AILING ADDRESS State Zip P code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license , provided that the owner acts as supervisor . (State Building Code , Section 109 . 1 . 1 ) DEFINITION OF HOHEOWNER: Person(s ) who owns a parcel of land on which he/she resides or intends to reside , on which there is , or is intended to be , a one to six family dwell- ing , attached or detached structures accessory to such use and/or farm structures . A person who constructs more than one home in a two-year period shall not be considered a homeowner . Such "homeowner" shall submit to the Building Official , on a form acceptable to the Bulding Official , that he/she shall be responsible for all such work performed under the building permit . (Section 109 . 1 . 1 ) Thi undersigned "homeowner" assumes responsibility for compliance with the State ;Juilding Code and other applicable codes , by-laws , rules and regulations . he undersigned "homeowner" certifies that he/she understands the 'Town of :\'orth Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and _equirements . SIGNATURE '. PROVAL OF BUILDING OFFICIAL `;ote : Three family dwellings 35 ,000 cubic feet , or larger , will be required to comply with State Building Code Section 127 .0 , Construction . Control . y_ gad � W.STS C- l R=' 1 FORM U TOWN OF NORTH ANDOVER LOT RELEASE FORM SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) 44 PERMANENT ADDRESS ASSIGNED BY D.P.W. STREET jD Sfa1,� P _�7c1 h APPLICANT Jo yea l) A - Z)r may-la)-0 PHONE ��Of� DATE OF APPLICATION March I _ LU TOWN USE BELOW THIS LUNE PLANNING BOARD DATE' APPROVED TOWN PLANNER DATE REJECTED CONSERVATION COMMISSION DATE A 11110 V E 1) CC'NSERVATION AINHIN. DATE REJECTED BOARD OF HEALTH DATE APPROVED 3 HEALTH-8A,NI'fARIAtr DATE REJECTED %C l c1,c DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT SEWER/WATER CONNECTIONS FIRE DEPT. RECEIVED BY BUILDING INSPECTION DATE This form shall .be signed by the agents of the Planning and Health Hoards, the Censel-vation 'Commission prior to the issuance of any building permits for the subject lot. . This form shall not releive the applicant from the comp.liance., of any applicable Town requirement or Bylaw.