Loading...
HomeMy WebLinkAboutMiscellaneous - 139 BEVERLY STREET 4/30/2018 / 139 BEVERLY STREET J 210/005.0-0040-0000.o J Commerce InsurancesM A&A sM The Commerce Insurance Company C� Citation Insurance Company SM SM Members of The Commerce Group,Inc." CLAIMS DEPT. 11 Gore Road,Webster,Massachusetts 01570 (508)949-1500 www.Commerceinsurance.com June 25, 2013 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: ROBERT COCHRANE f GLADYS COCHRANE Property Address: 139 BEVERLY ST Policy#: J16534 Date of Loss: 06/24/2013 Filet HCAV28-YNHV79 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. ELIZABETH BOTTIERI Telephone: (508)949-1500 Ext: 15284 Sr Claim Representative, Property Toll Free: 1-800-221-1605,Ext: 15284 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. June 25, 2013 CcmmCrc Companies ....COME GROW WITH us CIC 254 (Rev.4/95) MAIL M39 Official Use Only r Permit No. CJy € Occupancy&Fee Check BOARD OF FIRE PREVENTION REGULA �"ONS 527 CMR 12:00 APPLICATION FORPERM T TO ZRFORM ELECTRICAL WORK All work to be performed in accordance 'h the, Massachusetts Electrical Code 527 �Ri1 :CO (Please Print in ink or type all information) Date I v auc uraNca.avr Of n ca. Town of North Andover The undersigned applies for a permit to perform the �/elect'cal work escribed below. Location(Street&Number G ' � Owner or Tenant Owner's Address )J <2 Is this permit in conjunction with a building i�peermt�`/v Yes No 0 (Check Appropriate Box) Purpose of Building�j/ /iii b`l.�"`/`l Utility Authorization No. Existing Service Amps Voits Overhead 0 Undgmd 0 No.of Meters New Service Amps Volts Overhead 0 Undgmd 0 No.of Meters Number of Feeders and Ampacity. Location and Nature of Proposed Electrical Work //�� ` -—---Ll f./�LWvP1�/ /� I Total No.of Transformers KVA Date,,,1'o . ............... Generators KVA No.of Emergency Lighting Battery Units ,XORT" ��,«•° ;•�"o TOWN OF NORTH ANDOVER FIRE ALARMS No,of zone •" o� No.of Detection and o - �j° PERMIT FOR WIRING Inflating Devices • No.of Sounding Devices No.1 of Self Contained ,SSACMUS� Detection/Sounding Devices 0 Municipal 0 Other Local Connection This certifies that r .' Lowvonage ..�� ......:... r !:. .......................................................... Wiring has permission to perform ................................ wiringin the building of..... .. ...... .. ..................................................... ........ ... -- ",...................... .North Andover,Mass. NO Fee..,� .. ....... Lic.No. �...... 1...:v:............._ .. ���. ...:. r....................... r�by checldng the appropriate box. ELECTRICAL INSPECTOR Check # Final 5 G 6 0 LIC.NO. `Llcensee C,�/' �Si/gnature ` LIC.NO. �d- /Joo sy t�"U� J�l/� ��Gi ��1i�1 BAtt Tel.No. ��`l� %`��t� Address OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial 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) 0Location 13 �-- No. Date _ a304 NORTIy TOWN OF NORTH ANDOVER � N + i Certificate of Occupancy $ Eta Building/Frame Permit Fee $ SACMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �? 17678 �f Building Inspector' e. n TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED. SIGNATURE: Building Commissioner/inspector of Buildings Date , SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: DG15 DD b Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: If Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required LProvided R aired 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 ❑ On Site Disposal System 0 SE TION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT i 2.1 Owner of Record 6-<APYS ec C- Al+NC 1,Ai-24. Y S 7- Name(Print) Address for Service: C9 > �- Signature Telephone 2.2 Owner of Record: Name Print Address for Service: z c M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Vc'GaPO AL j, -1Y Ooa A All-z-- Licensed Construction Supervisor: O ZO9' O License Number A/,)Y Mn Address '-'F4 plc /may !il/3 D �1�f7jG Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name Registration Number Inn Address z Expiration Date Signature Telephone �• SECTION 4-WORKERS COMPENSATION(NLG.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.......0 SECTION 5 Description of Proposed Work check all a livable New Construction ❑ Existing Building 9" Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other Specify Lt/ Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be UFFICLAI USS`ONLY Completed by permit applicant 1. Building (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 0 o Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT T_ 1, as Owner/Authorized Agent of subject property Hereby authorizez�/ e� � to act on My behalf,in allmatters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby 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 ature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TWBERS 1 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIlVIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE North Andover Building Department i Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number 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. The debris will be disposed of in: AwAY i/Y MY T/Z�cr� (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector t Y BOAR OFl§UILbIN REG�'a'II LATIONS ;i k f !lLicense- CONSTRUCTION SUPERVISOR j I 020889 Birthdir /1948 EMreOk-:04/?5/2004 TK no.- 22297 Res�r��t��©0 � }; • THEODORE G VNp ' 27 PERRY AVE t ' NASHUA, NH 03060 ''" ?s Administrator TED'S HOME IMPROVEMENTS 27 PERRY AVENUE NASHUA, NH 03060 TELEPHONE (603) 889-4736 FAX(603) 889-7362 Gladys Cochrane 02/10/2004 139 Beverly Street N. Andover, MA. I will do the following work at the above address: ' - Remove all of the old'siding off the house - Install house rap around the house - Install new vinyl Certaintee Monogram Siding color Desert Tan - Install 6-pairs of dark brown shutters - Cover all doors, windows and facia trim in white - Remove all old siding from the premises For the total amount of$ 5,900.00, which includes labor and material. Payments are to be made in the following manner. $ 3,000.00 at the start of the job and final payment of$ 2,900.00 to be made at completion of job. Thank you, Home Owner Z)' Ise%`�" '`F tc Date ��� � c. Contractor Date �' ACORDM CERTIFICATE OF LIABILITY INSURANCE oiji6j2 0) PROD ER (603)883-1587 FAX (603)883-0997 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Foy surance Group - Nashua ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 350 M in St ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Nashua, NH 03060 I INSURERS AFFORDING COVERAGE NAIC# INSURED Ted Van Doorne dba INSURERA: Liberty Mutual Insurance 0046 Ted's Home Improvements INSURER B: 27 Perry Avenue INSURER C: Nashua, NH 03060 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTW ITHSTANDIN, ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONDATE IMMIDDIYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE ❑OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PROECT LOC J AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS' (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ • PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT .$ s ANY AUTOEA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC731S223886013 04/27/2003 04/27/2004 X WCSTATU- OTH- EMPLOYERS'LIABILITY IORY LIMITS A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? STATE OF NEW HAMPSHIRE E.L.DISEASE-EA EMPLOYEd$ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Home Improvement Contractor FOR INFORMATION PURPOSES ONLY. . . .VERIFICATION OF INSURANCE WILL BE ISSUED TO A SPECIFIC CERTIFICATE HOLDER UPON REQUEST OF THE INSURED. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NOOBLI OR LIABILITY OF ANY KIND UPON THE INSURER,ITS A NTS OR R NTATIV S. TO WHOM IT MAY CONCERN AUTHORIZED REPRESENTATIVE Simone Routhier CICO ACORD 25(2001/08) ©ACORD CORPORATION 1988 ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02919 Workers'Compensation,Insurance Affidavit Please Print i %min Name: Location: City Phone Fam a homeowner performing all work myself. 6 1 am a sole proprietor and have no one working in any capacity 1 am an employer providing.workers'compensation for my employees working on this job. Company name: s Address City: Phone# Insurance Co. Policv# Company name: Address City: Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a.copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. do herby certify under the pains and penalties of perjury that the information provided above is true and correct Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' 0 Building Dept ❑Check if immediate response is required Building Dept p Licensing Board E] Selectman's Office Contact person: Phone# 0 Health Department F1 Other FORM WORKMAN'S COMPENSATION NORTh TONM of Andover 0 „•., ,�. +',„r.., No.S60 lover, Mass., COCMIC HEWICEWICK ��S TED P? U BOARD OF HEALTH Food/Kitchen M Septic System BUILDING INSPECTOR PER IT T D THIS CERTIFIES THAT..... ........... .............(......... ........................ ... ............. Foundation has permission to erect..............................i......... buildings on ).43.9..... .. ................. Rough to be occupied as ... A...... ......***'*"*'*'**...... Chimney provided that the person accepting this pe I in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes By-Laws relating to the Inspection, Alteration and Construction of Buildings In the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES N 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION Rough ....................... Service .......................................................... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and.Approved by the Building Inspector. Burner Street No. SEE REVERSE SID Smoke Det. Location No. Date d NaRTM TOWN OF NORTH ANDOVER f 1 F 9 4L I Certificate of Occupancy $ +► °� tea.. � ;fg'••a°•tt�' Building/Frame Permit Fee $ S cHUS K , Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �3 Check # �� a 1 5 1 1 1 Building Inspect TOWN OF NORTH ANDOVER BUILDING DEPARTMENT PPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING UMDING PERMIT NUMBER: DATE ISSUED. rra :GNATURE: C _ Building Cominissioner/l o Buildin Date 3CTION I-SITE INFORMATION 1.1 Property Address: 1.2. Assessors Map and Parcel Number: iv Map Num e� Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: \. ning District Proposed Use Lot Area Frontage ft i BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Regilized Provided Water srpp> � .c.ao. sa) 1 S. Flood Zone Information: 1.8 Sew�a Disposal System yMI dic ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ ;CTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Owner of Record i v' Cocm"CA,/U F me(Print) Address for Service nature 71 Telephone Owner of Record: t ame Vrint Address for Service: M iature ' Telephone hone 9 CTION 3-CONSTRUCTION SERVICES Licensed Construction Supervisor: Not Applicable ❑ i ,nsed Construction Supervisor: License Number ress j Expiration Date j ature Telephone I I 2egistered Home Improvement Contractor Not Applicable ❑ SOO pany Name Registration Number ' I i 'ess r , i Expiration Date I cture Telephone Jr , SECTION 4-WORKERS COMPENSATION(NLG.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 a ucable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: v Gu ,O Z SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Completed by permit applicant f Y `r..v...1., ....kx`z.. .q u . 1. Building (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 1 SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENTT/OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize / to act on My alL in all matters relative o work authorized by this building permit application. Signature of Owder Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION i I, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name _ I Si Signature of Owner/A ent Date r NO. OF STORIES SIZE BASEMENT OR SLAB 1 SIZE OF FLOOR TIMBERS 1ST 2 3 I SPAN DTIvv1ENSIONS OF SILLS 1 DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS j HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHMINEY j IS BUILDING ON SOLID OR FILLED LAND I IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH Town of Andover No. iy /© o) 6 o"'-�- Lodover, Mass., /� QA COCHICHEWIC a\�,` 7 DRATED '9S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System a BUILDING INSPECTOR THIS CERTIFIES THAT........ .h, .......... ......................................................... Foundation G►► � VF e-fll 64. has permission to erect.....7F.AP. buildings on � ..../.......SC.1 �'............................... Rough ........... ............... ..................... . to be occupied as i41V .. �A /Q NUpl,conform Chimney . . . . . . . . . . . .. . . . . . .. .. . . . . . .................................................................... provided that the person accepting this permd shall in every to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. &-/5/to PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONS ARTS Rough C Service ....... .... .. .. .. ........................ ............. BUILDING INSPECTOR Final Occupancy Permit Required t0 Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT jo Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. • t HORr" Town of North Andover °,.��•�-.'h Building Department „ 27 Charles Street r North Andover, MA. 01.845 D. Robert Nicetta S4C St Building Commissioner (978) 688-9545 978 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE /0 ' a S- a 0 0 JOB LOCATION 9 z Number Street Address Map/lot "HOMEOWNER Nome Home Phone Work Phone PRESENT MAILING ADDRESS 13 ' / I City Town tate Zip Code The current exemption for"homeowners"was extended to include owner-0ccupied dwellings of two 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 108.3.5.1) DEFINITION OF HOMEWOWNER: 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 or two family dwelling,attached or detached structures ac- cessory 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.- The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner'certifies that he/she understands the Town of No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL