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HomeMy WebLinkAboutMiscellaneous - 128 RUSSETT LANE 4/30/2018 128 RUSSETT LANE / 2101103.0-0058-0000.0 ® MAPFRE The Commerce Insurance Companyw Citation Insurance Company'' Commerce " Gore Road,Webster,Massachusetts 01570 INSURANCE- 508.949.15001 www.commerceinsurance.com September 15, 2014 BUILDING COMMISSIONER or Board of Health or INSPECTOR OF BUILDINGS Board of Selectmen TOWN/CITY HALL Town/City Hall NORTH ANDOVER MA 01845 RE: Our Insured: KEIKO AKAHORI Property Address: 128 RUSSETT LN Policy#: XJ9199 Date of Loss: 02/18/2014 File#: JMRV37-CYYTM2 Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, 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 my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. LISA LEAHY Telephone: (508)949-1500 Ext: 15846 Sr Claim Representative, Property Toll Free: 1-800-221-1605,Ext: 15846 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above, by first class mail. September 15, 2014 Broken water pipe CIC 254 (Rev.4/95) MAIL 788 V 7 �r Date...�.1.... ... .. N°- HORT1, °t'"`°:•'"° TOWN OF NORTH ANDOVER r p PERMIT FOR WIRING �p SSACHU`�� 0 r This certifies that .............' has permission to perform-'- -�-�............................................................ wiring in the building of... ✓. ;n ........... ....'.' � .... ................................... .North Andover,Mass. co 14 � .......... � W, fELECTRICAL INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Office If..ewtr^ h The Commonwealth of Afassachusetts ` Department of Public Snfcty ' ocror.aty a f..o.eetaa _. y:. DOARD OF FIRE PREVE1I710N REGULMO NS S27 CMR 1200 3/90 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORIC An wwk se 16s petiorrned in aeeerdenc.%014Ih♦ 1-1 act schvstits Elicrrlcal Cede, S21 CMR 12:00 (PLEASE PRINT III INC OR TTPE ALL 111FORIMT1011) • Date. S- City or Town of 14'1'�Ol/�:-e Io the Inspector of Wires: Thi undersigned applies for a permit to perform the electrical work described below. Location (Street k I"ber))/ �c� /�USS��T U�-47_ Otter or Tenant Owner's Address • Is this permit in conjunction with a building permit: Yes ❑ No [� (Check Appropriate Box) Pvrpose of Building Utility Authorization 110. Existing Service Amps / Volts Overhead ❑ Undird❑ Ito. of Ileters-_ Bev Service Amps /_• Volts Overhead ❑ Undgrd❑ Ito. of deters Nuober of Feeders and Ampacity location and Nature of Froposedilectrical Work Q% Z`Je//I w No. of Lighting Outlets No. of clot Iubs Ito. of Iransformers Tota KvA jM No. of Lighting Fixtures Swimming Pool Above O In- ❑ grnd. grnd. Generators KVA No. of Receptacle Outlets Ito. of Emergency Lighting P Ito. of Oil Burners Battery Units Ito. of Switch Outlets No. of Cas Burners FIRE ALAPES Ito. of Zones No. of Ranges No. oftAirCond. Total Ito. of Detection and tons Initiating Devices Ito. of Disposals 110. of eatTotal Total Ito. of Sounding Devices PsIons KU . Ila. of Dishwashers Space/Ares lieating tlof Sel( Contained Detectioon Sounding Devices No. of Dryers liesting Devices KW local Muntclpal 1:1 D Other Connection ?to. of Water heaters KW No' of o. o Low Voltage r Slgns Ballasts Wiring Ito. liydro Massage Tubs No. bf Ilotors Total IIP / OI11ER: I1ISURAIICE COVERAGEt Pursuant to the requirements of Massachusetts General La%Js I have a current L abilit Insurance Policy Including Completed Operations Coverage or I a substantial equivalent. YESE) NO[] I have submitted valid proof of sane to this office. YES( NO UJ It you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE BOND ❑ 0111ER (Please Specify) Y xp tat on ate Estimated Value of Electrical Work S Work to Start Inspection Date Requestedt Rough Final f eir,,ed under the penalties of I•et j:•ryI F1RH NMIE /� L =fi- �C LTC. Ito. 14 57/q/�7— Licensee4/g"/Ib��5 1,CL5,Slgnaturev I ' Bus. Tel. Ito. 9 o - •� 9 3 oO �- Address /0-� �56"D ST 'A-1d. /�,fiDe�>e�2 i{7� O/.Pj!:�C- Alt. Tel. Ito. MIER'S INSURANCE WAIVER: I an aware that the Licensee does not have the insurance coverage oris sus stantlal equivalent as required by Ilatanchusetts General rws, ani Wat my signature on this peralt applitation valves this requirement. Owner Agent (Please check one) i Telephone Ito. PEPJIIT FEE S Signature of Owner or sent t Date. . . . . . . . . . . . . TOWN OF NORTH''ANDOVER ° PERMIT FOR PLUMBING SSACMUS� . '� This certifies that G .--. . . # usz� has permission to perform . . . ... . . . . . . . . . . . . . . . . . . . .!4/�`. . . . . . . . plumbing in the buildings of/./. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at .f�. ��. .,/ <...' %7?. . : ./.c. . . . , North Andover, Mass. e . ~PLUMBIN`6'INSPECT0R Check # 8270 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town:'Nodh Andover MA. Date: 10/27/2009 Permit# � a Building Location:_RussettLane �o1g Owners Name: Keiko Trust Type of Occupancy: Commercial o. Educational E. Industrial o Institutional 1-j Residential Lv ` New:L__.I Alteration:Fj Renovation:? Replacement: Plans Submitted: Yes No FIXTURES z 0 O Zz to N } V N z a Ix ? ~ z rn z a a U) z LU Q 0 rn x a aQ W 0 ~ "-' a � Y m � 0 o- x Q -J Q y 0 a� Q W O o W Z W 0 Z v a U. t�i v Ix— O o ~ x z a u- 3 0 Y a x W W W z rn i- 1— a a W ° Q O ~ 00 1 -J Q R a a a P I- SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 RD FLOOR 4 TH FLOOR 5 FLOOR 6 FLOOR 7 -FLOOR -i'FLOOR Check One Only Certificate# Installing Company Name: Joe Barbagallo - F1 Corporation Address: 110 Duncan Drive City/Town North Andove-� 1State: A `- MPartnership Business Tel: 978-375-3075 h Fax: _ Firm/Company 9623 Jose Barba alto Name of Licensed Plumber. r g �! LNSURANCE COVERAGE: [.have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes7No If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. 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 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 E-j Agent 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: / Plumber Sign ure of Licensed Plumber Master E City/Townl. Journeyman Ej License Number: 19623 APPROVED OFFICE USE ONLY Date. .l . Zh /�/. . 9225 NORTH TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSAGMUSE� This certifies that . . . .. has permission to perform . . . . . . . . . plumbing in the building of/. . P�I. .�� . . � d 0r, , , , . , , , , at. . �Z8. ./I U. e .G/1 forth Andover, Mass. Fee. 5,CU Lic. No.. �S. . . .. l7l�f_ PLUMBING INSPECTOR Check # MASSACHUSETTS UNIFORM APPUCATION FOR PERMIT TO DO PLUMBING City/Town: ,MA. Dater // Permit# Building Location:' LSV Owners Name46jkr A kd(.oz-i Type of Occupancy: Commercial❑ Educational❑ Industrial Institutional❑ Residential New:❑ Alteration:❑ Renovation:[jReplacement: Plans Submitted: Yes ❑ No FIXTURES DEDICATED Z SYSTEMS Lu z u, W Y V O W z {� h = l�/�l Au N z d W z Y N z a cas (n z O Q W U) = {A Q W z f- _W N G O H H O m in W f' ~ h } Q: _z v! O V d X = a as IL f Q H 0: a U. W O O OZ LL. W y J D Z D: O VW {t/y� a m m o c ° Uj Lu i Y g g o = � a oe a a a ~ o: v, W 3 3 3 o a 0 � 3 r✓ SUB BSMT. BASEMENT 1 FLOOR ' 2ND FLOOR ` 3RD FLOOR FLOOR 5 FLOOR FLOOR 7"FLOOR 8'"F OOR Q V Vi 9 W ;70rpgration ne Only Certificate Installing Company Name: �jj o (J Address: a eCit) ---I S " tate: (� E]Partnership Business Tel: Y'. - A �c Fax: 3 El Firm/Company Name of Licensed Plumber: �� INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes❑ No❑ If you have checked Yes,please indica a type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond o d ❑ 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 ❑ Agent I hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing workand 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 Raster� se: Title tuber Sign re Df Licensed Plumber City/Town APPROVED OFFICE USE ONL ❑Joumeyman License Number:_ `� r X, 4 y:p 47r., E3ENJI��i1tN;;J©HN ADAMS 25 Sherbook%reet> TY!j9-b pro;:VIA�J1b7 ' r M2ster`Plumber 7 r x"004273 p" 179£3.-M 05101/2012SPri��NE, Ezplratln J: ,l fr 1' u• 1 { Form 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: Keiko Akahori Property Address: 128 Russett Lane Policy Number: XJ9199 Date/Cause of Loss: 6/6/2012, Water Damage/Pipe Leak File or Claim Number: 26638-J 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. Jim Taylor 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. Signa re a ate ANDERSON ADJUSTME CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 J, ;J u Date.......:..'....... / Of M°DTM 1ti ' TOWN OF NORTH ANDOVER PERMIT FOR WIRING ACMUS� This certifies that<— DC7.- _ � � ........................................ >{ k�iBDRA)MENT....... .................. -........:.-..... .. wiring in the building of."...... ..................... . :r =. ,North Andover,Mass. /,NORTH ANDOVE Fee PAS UR•ER-U LUTOW--3/1........... �] ELECTRICALINSPECTOR `� L� (0o, A1C, °o WHITE:Applicant CANARY: Building Dept. PINK:Treasurer i The Commonwealth o Mass "" °" °°)' f ach etts 3;Perate So. �Sd� Department of Public Safety .' occupancy b Fee Check" BOARD OF FIRE PREVENTION REGULATIONS SZT CMR 1x00 3/90 (I eavi.blank) APPLICATION FOR PERMIT TO. PERFORM ELECTRICAL WORK All work to be performed In.aeeordance with the Massachusetts E]eetrkal Code. 527 CMR 12:00 (PLEASE PRINT ZH IHIC OR HYPE��®RHATZON) Date1City or Tots of _ p,� To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street &-�Nt�mm-ber) Owner or Tenant Owner's Address 25 A}-M Z-5 Is this permit in conjunction with a building permit: Yes ❑ No g (Check Appropriate Box) Purpose of Building 9—es (day, 175--1 Utility AuthoriZati3On NO. Existing K:rvice �0 ..raps i 2 t_ C_)volts Overhead ❑ ,Undgrdg .No. of Meters New Service Amps / Volts ; Overhead ❑ Und' d❑ No. of Meters Number of Feeders and Ampacity 15 Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Piot Tubs No. of Transformers Tota No. of Lighting FixturesrVA Swimming Pool Above In 8Tnd• ❑ grnd.' ❑ Generators ZVA No, of Receptacle Outlets No. of Oil Burners NoBat. of Emergency Lighting tery Units No, of Snitch Outlets No. of Cas Burners FIRE ALARMS No. of'Zones No. of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No. of Heat Total Total s T RW No. of Sounding Devices.. No. of Dishwashers Space/Area Heating Iai No. of Self Contained Detection/Sounding Devices' t No. of Dryers Heating Devices Y3J Local Municipal E] ❑ConnectionOther No. of Water Heaters ' of Ballasts Low Voltage _Wiring No. Rydro Massage Tabs No. of Motors Total HP O'11fPR: oeo fen4 ,,ems INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts'Ceneral Laws I have a current Liabilit Insurance Policy including.Completed; equivalent. YES❑ NO 8 I have submitted valid pr000f'sameOtorthisat noffice. YES❑verage or itsNO,[]substantial If you have checked YES, please indicate the type of coverage by checking the appropriate box.. IN SURANCE k BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work $ ration ace Work to StarF19 Inspection Date Requested: Rough 8 Final Signed under the penalties of perjury: FIRM NAME .-Diaz � LIC. No._/ Licensee Signature' ;Q /f� SIC. NO. Address_ /%-77Q2 S% �isvct/ /Y�� Buspel. No.1- OWNER'S INSURANCE WAIVER: I am aware that the Licensee does`not have Alt.the Tel. insurance cove/ ge or i is suD/� stantial equivalent as required by Massachusetts.General.Laws; and that.my signature on this permit application waives this requirement. Owner Agent.::;.: (Pleasecheck'one) Telephone:No PERMIT FEE S j� 0 Signature of Owner or Agent _ c N2 i 6 5 Date...E,A..� ........... f ,aORTM, TOWN OF NORTH ANDOVER I. PERMIT FOR WIRING cmusE� + This certifies that ..... :.......... ............. .... ..... ................. .... has permission to perform ..., :�..%. ...........�. ................ ........;................. wiring in the building f, ......1. :-5:—',1�+ � :4...................... at..1:.'L /�,�• �C/-�'-E! t ...................... .North Andover,Mass. e-61- , Fee. ...�.. Lic.No!�.7�........................................................... ELECTRICAL INSPECTOR 08/03/98 12:49 25.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer \ Office Use ON t�1�jP �IImmII1TIUPc�l# Dffi ��LhuSP Permit No. 32Ilurtatrnt of 13ubHr J%1_ &9 Occupancy b Fee Checked lug BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 30 pea"olanl0 APPLICATION FOR PERMIT TO PERFORM! ELECTRICAL WORK -All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 1200 I (PL=EASE PRINT IN INK C)RWE ALL INFORMATION) Date 9 " -3z' - City or Town of e) 7�t l L� To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) /2 &- 2u•ssC-7-7— X 4-- f-- - Owner or Tenant A"`^""e S V3 I A 1 WS le i Owner's Address / Is this permit in conjunction with/a building permit: Yes C No 13 (Check Appropriate Box) Purpose of Building 5 'a `'�C {- Utility Authorization No. Existing Service 2cl'O Amps 12-0 1 2,410 `,/olts Overhead ❑ Undgrnd Lel/ No. of Meters New Service Amps_J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Eiectrical Work ��x CrA-J►4T e C� /�y �vt�r✓v�sS � ,3�2oS . �si. N�. of Ugnting Outlets I No. of Hot Tubs I No. of Transformers T°tat KVA Na. of Lighting Fixtures ( Swimming Pool Above crnC. `I In-grad. (— I Generators KVA • -r-- No. c - =mergency Lighting No. of Receotacie Outlets I No. of C.: Burners Sattery Units No. of Switch Outlets I No. of Gas Burners ( FIRE A:ARMS No. of Zones No. of Ranges No. of Air Cone. Total No. of Detec*ion and tons Initiating Devices No. of Dieoosals I No.of Heat Total Total Pumps Tons ICN No. o`. Soundinc Devices No. of Self Con.amed No. of D!shwasners ( Space/Area Heating KW Detection/Souncinc Devices No. of Dryers I Heating Devices KW Local ❑ Municipal L7Other Connectior. No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors TotalHP �1 OTHER: f vK E 0-6'fin A- 4 rnC e.P,4 Na S %a' I t>1 C e tR Cs_2ou.�_�) '1'C e (I�2 tt�.$ INSURANCE COVERAGE: Pursuant to the requirer-•ents of Massachusetts general Laws 1 have a current Liabillty Insurance Policy includin Complete Operations Coverage or its subsea-tial equivalent. YES M,-NO ❑ 1 have submitted valid proof of same to the Office. YES NO ❑ If you have checked YES, prease indicate the type of coverage by Checking the apprtzriate box. INSURANCE aY- OND ❑ OTHER ❑ (Please Specify) (Expiration Date) Estimated Value of Electrical Work S Work to Stag inspection Date Requested: Rough Final e `S- Signed under the Penalties of perjury:, FIRM NAME t�' II t►�A"t, 3' ' '422 L'%4 Z 2 4 �C LIC. NO. Licensee W'r it I' ►q-�� J'- 77!t signature - o LIC. NO. �i l,^-q I N h v j/i/) �i/ u .Tet. No. Address, Z7 Cit o4✓-i*-S rl ' " Att.Te..No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does net have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please Cheek one) Telephone No. PSRMrr FEE S (Signature of Owner or Agent) • x•13565 P 186 6u2 091 US Postal Service 'Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sent to Street&Number Post office,State,&ZIP Code Postage s Certified Fee () Special Delivery Fee t Restricted Delivery Fee LO Return Receipt Showing to '�� Whom&Date Delivered a Return Receipt Showing to Wham, Q Date,&Addressee's Address O TOTAL Postage&Fees 0o V) Postmark or Date E F LL Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1.If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service y window or hand it to your rural carrier(no extra charge). m 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the ami return address of the article,date,detach,and retain the receipt,and mail the article. LO 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article , 'a RETURN RECEIPT REQUESTED adjacent to the number. { Q 4. Ii you want delivery restricted to the addressee, or to an authorized agent of the O O addressee,endorse RESTRICTED DELIVERY on the front of the article. Go 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. ti 6. Save this receipt and present it if you make an inquiry. a ai SENDER: I also wish to receive the v ■Complete items 1 and/or 2 for additional services. 6 ■Complete items 3,4a,and 4b. following services(for an 4) ■Print your name and address on the reverse of this form so that we can return this extra fee): 0 card to you. ai > ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address d permit. d d ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N ■The Return Receipt will show to whom the article was delivered and the date C delivered. Consult postmaster for fee. v 3.Article Addressed to: 4a.Article Number d C E � 4b.Service Type d v /a > ❑ Registered ❑ Certified e ❑ F Mail ❑ Insured U, ¢ � �/ Retum Receipt for Merchandise ❑ COD 7.Date 7fve z = 5,Received By:(Print Name) S.Addressee's ddress(Only if requested and fee is paid) r t- g 6.Signatur ' (Addre ee or Age ) a� PS Form 3811, December 1994 102595-97-B-0179 Domestic Return Receipt First-Class Mail UNITED STATES POSTAL SERVICE Postage&Fees Paid LISPS Permit No.G-10 • Print your name, address, and ZIP Code in this box • !North Andover Building Dept 27 Charles Street Forth Andover rVIA 01845 I Town of North Andover NORTH , OFFICE OF 3?0`ttiOL COMMUNITY DEVELOPMENT AND SERVICES A 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT SSACHUSE Director (978)688-9531 May 3, 1999 Fax(978)688-9542 Ms. Helen Winiski 128 Rusett Lane North Andover MA 01845 Re: Service Repair Problem Dear Ms. Winiski: I met with Mr. Brian Hart from Mass. Electric on Monday April 26, 1999 at 9:00 A.M. As far as we can tell you own from the hand hole to your home. This means you must select an electrician to repair this immediately. Please have your electrician file an application permit and notif/ me when the work is complete for an inspection. Thank you for your cooperation in this matter. ry truly yours. James DeCola, Electrical Inspector Return Receipt Requested 186 642 091 JD/jm BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-95.-,,) PLANNING 688-9535