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Home My WebLink AboutMiscellaneous - 140 BEACON HILL BOULEVARD 4/30/2018 140 BEACON HILL BLVD 2101045.B-0055-0000.0 ti 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: John and Daniel O'Connell Property Address: 140 Beacon Hill Blvd. Policy Number: FP5527659 Date/Cause of Loss: 3/25/2015, Water/Ice Dams File or Claim Number: 31651-W 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. Wade Anderson On this date I caused copies Notice res •f this s �t ce to be sent to the persons named above at the addresses indicated above by First Class MailVeand Ste ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 Date.......I..1 i, 1.,�I. OF NONr TOWN OF NORTH ANDOVER � � 9 PERMIT FOR GAS INSTALLATION This certifies that. . has permission for gas t stallation 4,ay �.�. ...... �.Q.,.j.. ..v inthe buildings of.................... N�.►tp.. ............................................................... at.:.......... �f �..l. orth Andover,Mass. ................................... '.�.............�... ...... Fee..Z�4..b..."....Lic. No.U. A....... '.:..1.. . ... ................................ ............: . ........ GAS INSPECTOR Check#� 9524 i ry 3 CITY 19110114 JOBSITE ADDRESS 140 Beacon Hill Blvd. OWNER'S NAME John B.O'Connell 1147 Boston rd.Haverhill MA.01835 TE 978-3-688-7524 FAX COMMERCIAL® EDUCATIONAL E] Q NEW: RENOVATION:O REPLACEMENT: PLANS SUBMITTED: YES® NOD APPLIANCES Z FLOORS BOILER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER ®=®= DRYER FIREPLACE FRYOLATOR FURNACE ®` GENERATOR GRILLE INFRARED HEATER 11 11 LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATERQ ROOM 1 SPACE HEATER ��[�� ®®� -- ROOF TOP UNIT TEST A UNIT HEATER 11 11 LLJ UNVENTED ROOM HEATER WATER HEATER ��(� OTHER �, ,�. ® ® _ e INSURANCE COVERAGE 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Q NO 0 LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY ® BOND 0 ti ONE ONLY: 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 PLUMBER-GASFITTER NAME John P.O'Connell I LICENSE# 16081 SIGNATURE 0 MGF® ® JGF® I® CORPORATION® PARTNERSHIP®# LLC®# COMPANY NAME: JP OConnnell P&H ADDRESS30 Pros ect St. Amesbu =ZIP 101913 TEL 978-420-8122 FAXI j CELL EMAIL JPOConnellPH ahoo,com V\1 (f I �w� e Y cERT1mar: OF LIABILITY INSURANCE T TTLTCER THIS CERTIFICATE IS 18SUE0 AS A MATTER OF INFORMATION Hathfas insurance Agency, Inc ONLY AND CONFERS NO RIGHT&, UPON THE CERTIFICATE H U)M TMS CERTIFICATE DOES NOT AMEND, EXTEND OR 200 Sutton Street, Suits 160 11 ALTER THE COVERAGE AFFORDEA BY THE POLICIES BELOW. North Andover.', MA 01845 979-688-5531 INSURERS AFFORDING COVERAGE NAIL# tN O John P. O'Connell WSURERA •••a.srm..r.Re.iwhr tau.n.c.oe�., 30 Prospect Street WSUIMRn AT»sWmry, MA 01913 WSMR C q�iER� I pi3jiT E,A F COVERAGES THE POLICIES OF IWSURAW.E UBTED SELOYV HAVE BEEN'tSSUED TO THE INSURED NAMM ABOVE FOR 7HE POLICY PERIOD INDICATED.NOTNRTNSTANDITtG ANY REQUIREIMEW.TEAM OR*CCONNDITION OF ANY CONTRACT OR OTHER DOCUWW MATH RESPEC"O V"CH THIS CERTIFICATE MAY BE ISSUED OR P AY PERTAIN,THE IMSURAWE AFFORDED BY-THE POLICIES DESCKWV HEREIN 1S.SUBJEOT TO ALL THE TERMS;EXCLUSIONT3 AND CONDITIONS OF SUCH POLICiM AGGREGATE LASTS SMVW MAY HAVE BEEN REDUCED BY PAID CLAWS- UR POLIYFAROBER oATEYA4�A �'i t L&M GENEF94L LLA=JW EACH OCCURRE"m ! Q.000 iCONJAERCIAL GENERAL 11ASM tT V PraNMS tEm qRaoml S CLAAGMADE FXJ OCCUR MEtiEIC�tAeti�#cerso+! 3 Z.000 A SCO060025001.457 11/05/13 11/05/14 000 tx`EIMURAL.AGGREGATE' % 1 00 GEML AGWtEGA-tE L IW Ar4kJR M PPIODUCT5.COW40P AGG S 5001900 P0 w j Loc AUT0MOME1d4Ad M c06TTT@E�EiNGLELQQT AWAUTO tf ) ALL ONMEDAUTOy XWLY i SCHEntk o~Altos iPv raory HS"AUTOS" BOFNLp tALAFiY M D&OWNEDAUTOS PASWE W GAMACE s tPacaadart illRfliEL4S9'LtT7 ALIM MM-Y-rA ACCW0V 4 N1YAlTITT aT?£RTHAW EAACC S AUTO ONLY AGG ! EXCESSAAWREYlA.UAEM dTY EACH 0Xt RTTfaVCls t =CM �CI.AdirSmm AGGREGATE a OIDUCTME Te VR)Rt:OMpENBATTIwlAra� EbPLOYEFt9 L.LA0+1" t ntr EL EACF4ACCKX iT K OffrxAuoE• E.L MSEASE-FA EMKOYE.6 p��,aartrbeunbn, SSEt�A lag=aSWL� COW* EL.o15EASE-POLIC+ I.Wr f OTHER D'ESCR�'tK3+YOFOPERA'T1O►el4FL.OC�ITtONBdt'EHiGtESt©LCLUSIE1At$AL10EDHPH1D0.+ @1T'ISPEGLALPFMVMOM CERTIFICATE HOLDER CANCELLATION TSHM"ANY OF THE ABOVEM OESL-RIPOLIC.MS BE CANICEU ED BF,FORE"THE EXFtie A City of North Andaver iATE Tw4tEcdF Tme L uvc mmax wLL ENDmm To w4_O mys wRrTTEN 120 Main Street "DICE r THEGEWWWATEIMWERHA WDTOTMELIFT.OUrrtA TO DOW .North Andover, MA 01.845 DA GsffTM OR LWMLITY We KW WON THE VOUR]3E ITS AGEWS OR REPRE5 4 mlmcw a �. ACOILn25(20MM) t�7 TION lose e, ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No TH S APPL CAT ON SERVES AS THE PERM T ❑ ❑ FEE: $ PERM T# PLAN 'REVIEW NOTES i f `S 3 i 6 ' i t i f V f s f i n v 9-COMMONWEALTH OF MASSACHUSETTS • • ° A Egg BOARD OF PLUMBERS AND GASF;ITTERS I 4 _I SSUEIS. THE FOLLOWING L INCE S� {� L'ICO S�b AS AJOURNEYMAN•f`L'UM JOHN:-P 0 CONNELL r' 'Z 30 PROSPECTST ._ __WSBURY MA 01913-1616 De Commonwealth ofMcassa0u3e``N — �e�rt�t�iea2t o�'.�ic�at�t�zt�Z.Acc�c�e�ts D,ffxce of-Invesfiguflovs ' 600 Washington Street . Roston,,HA 02111 wt��aas�.govfc�za - Wo rkexo'Coxnpewaiiou bsuance Affidavit:�n�c�e��Coxi�x°ac�o��/�lec�re�ezansl�'��nbex�� A-0-Ol pant orcnaat on Please. zn ) e bX Fame(Brzsinessforga&ationJinndtvidual): TO f1y\ A A)A . 0�t6'i 3Tu .Are yoIx an exuployer?Check me,approprzatebox-. Type of project(replxed): 1.Q T am a employer wifb �. Q T afn a genexal confractax and T €i. Q New c6usfradioli f �,{employees(iSzT�and(oxpart Eimer T have nedtka sub-contxacf s 7, Q Remodeag 2.Imo►S am.a gala propxietor ox parEn ex listed on tha attached sheet.- ship and`7�avena.employees These snb-oontractoxsh6.ve 8. Q Demolition g forme iv any capacity. workers'comp.insurance. wor7gY Q Building addition WO work-G&cow.insurance �. Q�e are a corp oration and its '10.j Llecfricalxepairs oxadclitions xegakod.] officers Dave exercisedtheir 3.Q X am a homeowner doing all work :d&of exemption pexMGL 11=Q 1'lumbingxepairs or additions myself.UfO workers'comp. c.152,§1(4),audwohaven.o 12F]PDofxelpaixs insuranc�recluixsd.�i employees..[NOworkexs' 13,1 Other comp,i=ancaxog*ed.] e uya�plic tbacchecksbox ymusealso fM6Ttitlzeseg6oubel6wshov&gthckyozkers'compeasaf[onpolioyinrorrnation. 1IlomeoxnerswhosnbvniithisaMdavitindicating€ oe 6.'redoingallworgandthenXmoutgidecontractorsmustsulmitanew, idaviiinaicatffi siich. Coniracforsi7iatche�kthisbo mxstaffached uxadditionalsheetshowingfbenamaofthesut�confracforsandtfieirworkers'comp.policY. ounmon. tcrrz crit ein foyeN tAid is p�ov!dlllg woylrelsI cornpetasatFon arzsr�ra ce fa any er �oyees Below i �hepoliey ccr djah 4fe infa��rtatiort . ?n,smance Company Name:. Rolicy#ox�e�vis.J�ic.#: Expiratlon�ate: .. . lab Site-Addxess: City/Sate/dip: -Atfach a copy az f ewoxkerg'comp ensation poizey declaration page(showing-tlte policy mmnber and expixavon date). Failure to secures covexage as xegr&Gduudor Section 25A ofMGT,0.152 can lead to the imp I)S iov.of eriminalVenalties Of fine uR to$1,500.00 avd(ax one�yeax imprisonment,as well as ciMtpenalties in the fozm.ofa STOP!WORT,ORDER.avid a ane ofupto$250.00 a dap agavasttheviolator. 13e,advised that a copy ofthic sfateMentnaybe fozwardedto the Office-Of xnvestiguffom ofthe DTA fox ismance,coverage vexification. •l'do lZereby rt fy de tree iZd reiz aXti O trialAie inf0.rmatio�l,jlYOYideCru�oYe IS true ail[ COrrL'Ct, - S3 attire: Dete- 'lzotta Oficial use oIlly. vo riot write in this area,to be coivIeted by cO Orlo=offfciaZ City or Town: Bexmx ITIcense 0 SssWng.A nthorxty(circle one): 1.Board of Health 2.BuzlcY Pepafraneut 3.CityMom Clary 4.�leotrzcaXPnspeetor 5.P°lucabSug]fnspecto� f.Outer - r - Information and Instructions MassacbusefEs General Laws chapter 152 xequiras alt employera to provide woxkexs'compensafiio fox ei�employees. 1'ur9aantt0flisstafate,an e��•ployeeis dei"ined as",..ever personzu the se�vzce of anoffiax ander any o6traet of'•hixe,. express ox•LOA oral oxwxiften." .fin erTloye b defned as"an kdividaal,partnorsbip,assoczafiom,coxpoxation or other legal extify,or any two ox more of the foregoing engaged in ajoiut enterprise,and ineluding the legalxepxesentatives ofa'deceased alnloex,.or Erie receiver ortYrisfee of an individual par�nership,assn dation.ox other legal entity,employing employees, ITowevex the Mm-er ofa dwellinghousehaviugnotmoxethauthxeeapartments andvrT�aresides there n,orthe occupant Eve dwelling house of anather who employs persons to do mdntenauce,eonsitaction ov repair work ort such dwelffig house or onthe grounds orbuildiug appuenanttliexeto shatlnotbecause ofsuclr e�nploymenfbe deemedto be an employer:" MQL chaptex 152,§25C(6)also states that"everysfate or Total XZeensiug agency sl�alX t�zthltold theissuaxtce or renewal of a license ax pexutit to operate a business or to constrnet buildings in tka commonweal&for arty applicatzt who Teas ltot pro dated-acceptable evidence of com-pliaxaee path Me insurance coverage xectnixed;' Additionally,Ma chapter 152,§25C(7)stafes,W0 ither the cornmonwealtlz nor any ofits political subdzv'sions shall enterinfo any confractfor thaperformance ofrobRoworkuufil acceptable evidence of coMpliaucewith the insurance requirements offbis chaptexbave beextpresenfedfathe eonfractingatrthority" Applicants . ' • Please out the workers'0 ,V msalion afdae completely,by checking tfie boxes that apply to your situation and,iE necessary,sapplysub-confracfox{s)name(s),addresses)and�ltona numbers)along with their cez€if(eate(s)ox insurance. ZiinitedLiabilityeompanies(LLC)oxLfialtdLia Mtypartnexships(LLI')withzto employees otliexthatzthe xmmbers oxpartners,arenotrequiredto canyworkers'compamation.iasuxance. Ian Lp,CoxLTp doeshave ezMloyees,apolicyh=quired. Be advisedthaffbisafdavitmaybe,sabmitfedtoflaDogartmentof 7udustiial Accit9an for confusnation of insurance coverage. Also be sure to sigrt and date tTie of ffavi: The afr davitsltorrM beretuxnedtothe cityortovathattheapplicationfoxthepezmitoxlioenseisbeingrequesfed,xto thel7epaxtmentof 7ndastrialAcoldenfs. ShouldyouhavamygyestionsregaxdLgtlzelaw oxiiyoriaxexeclazreclfaabfakay,orJsexs' compensationpolicy,pleasecalltheTapaxfluentafthemuuberlistedbelow Self-ju xedcompaniesshouldo textheir self ittsurarlce license number o:q the appropriate line. City or Town Offlezals 'lease be sure that the affidavit is complete andpxinted legibly: The Depatment has pxovided a space at the bottom oz the ailxdavitforyou to m out in the event the Office of Snvesfigatlons has to contactyouregarding the applicant, pleasebesurefazi]littthepemiif/Iicensenumbexvrhichwillbeused asaxezemuconumber, kaddition,auappltcant thatmust submitmultlple pexmifi/license applsca iom iii any given year,need only submit one amdavit indicating cwent policy inz"onuation(Xnemssary)and under'%b Site Address"the applicant shouldwxife"all locations in (city or town)" copyoitheaffidavit thathasbeenofciallysfainpedoxmarkedbythecityoxfowumaybepxovidedtotha applicant as 19 year. Where ahome owner or citizenis obtafigngalicense ox,pexmitnotxelafed to anybusiness or commercial venture clog license oxpexmit to bran leaves etc)said p ersoxt is XOTXequired to eolnplete this affidavit. Tile Office of Xnvestigationg,would lime to thanleyou iu advance for vont•coopexafka and should you have any questions, please do no%hesitate to give us a call. `i'he-Depaxtment's address,telephone and fax number, Tho CQ 4x1t atf t o II � Sarhu De axi=t Q�Udu P ialAcczdwita f ace o�'A Mggq#0jM 600 Wu gtQa 8txe t