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Home My WebLink AboutMiscellaneous - 141 STONECLEAVE ROAD 4/30/2018 141 STONECLEAVE ROAD 210/104.6-0136-0000.0 J BUTTERWORTH & O'TOOLE, INC. ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY claims@butterworthotoole.com SALEM,MA OFFICE DOVER,NH OFFICE P.O.BOX 8294 '�`�� P.O.BOX 734 SALEM,MAO 1971-8294 .• t«. DOVER,NH 03821-0734 TEL. (978)741-5731 TEL. (800)298-5330 FAX (978)740-9109 pR FAX (603)218-6760 REPLY TO: � REPLY TO: t;11`�l��NDRTH ANi�6V97K 10/04/2011 u DEPARTMENT -< FORM OF NOTICE OF CASUALTY LOSS TO BUILDING I UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B TO: Building Commissioner. or Board of Health or Inspector of Buildings Board of Selectmen City/Town Hall City/Town Hall ADDRESSES North Andover MA 01845 North Andover MA 01845 RE : Insured: Sylvia Sasso Address : 141 Stonecleave Road North Andover , MA 01845 Policy No. : HP 2436399 Loss of: 09/27/2011 Mold File or Claim No. : 17-1791 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, Ch. 139, Sec. 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. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. David Vincent Adjuster p- a Pie Commonwealth of Afass husettsU,t, I'.•relt Vin. Department of Public Sofct Oc"""cv S Fee Checked BOARD OF FIRE PREVENTION REGULA NS S27 CZAR 7200 3/90 ileavt blank) 'i APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Maesachusetu Electrical Code. S27 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date C- 3- SF'+ City or Town of IVP?TH Aytooy a To the Inspector of Wires: The undersigned applies for a permit to perform,the electrical work described below. Location (Street & Number) /ell STd NE C/L6,9 R& i4 D Neter or Tenant ID 19 YNNE G, Owner's Address SAME S7 f.,?S- -3 y4�o Is this permit in conjunction with a building permit: Yes ❑ No 0 (Check Appropriate Box) Purpose of Building Utility Authorization 110. Existing Service Amps / Volts O•ae:hcsd ❑ Undgrd ❑ No. of Meters _ Nev Service Amps / Volts Overhead ❑ Undgrd❑ Ito. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Installation of Alarm System No. of Lighting Outlets No. of Hot Tubs ' No. of Transformers Total KVA No. of Lighting Fixtures Above❑ In- 8 8 Swimming Pool grnd. grnd. ❑ Generators KVA No. of Receptacle outlets No. of Oil Burners No. of Emergency Lighting I Batter Units No. of Switch outlets No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No, of Ranges No. of Air Cond. tons Initiating Devices No. of Disposals No. of Puamps Total Total Tons KW No. of Sounding Devices No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local Municipal 1:1 ❑Other Connection No. of w No. of Water Heaters KW Si,nsf Ballasts Wirinol al; 1- / No. Hydro Massage Tubs No. of Motors Total HP lam/ OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES❑ NO ❑ I have submitted valid proof of same to this office. YES❑ NO If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER❑ (Please Specify) Estimated Value of Electrical Work $-276 e o Expiration Date Work to Start L- R-94PInspection Date Requested: Rough Final G-40-9,P Signed under the penalties of perjury: FIRM NAME A.D.T. SECURITY SYSTEMS NORTHEAST INC. LIC. No. 1231C Licensee -DONALD A BROOKS Signat a 10. 1231C Address 60 William Street, Wellesley, 8 s. TiL. No, 413-732-4400 Alt. Tel. No.617-431-5831 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial 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 S 3S 00 Signature of Owner or Agent r. N° Date.....//; . . tr/ f �apR7M 4 TOWN .Ow NORTH ANDOVER p PERMIT FOR WIRING SSMUSE� This certifies that .. "oT. S-e—c............ ?... ..s e .....� has permission to perform ........ .....a4z..m......... . CR wiring in the building of cT..l....U.................................................................p at.... .. ,........, t .VS......I.. ...:..... ,North Andover,Mase Fee....-?Yc cam. Lic.No.............. .�P : .............................................................. ELECTwcAL INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Location No. Date 3?0� "°"TM��oL TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ _ - 'Ss�cMusE` Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ pp Building Inspector f :>c .t PAID Div. Public Works PEWAIT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4J0. I LOT NO. 12 RECORD OF OWNERSHIP IDATE BOOK ;PAGE - ZONE SUB DIV. LOT NO. OCATION PURPOSE OF BUILDING 6'AIM /OWNER'S NAM O�ECL,C \ �v�,� NO. OF STORIES SIZES I C) t .� 1g L,,.OWNER'S ADDRESSVk:,;Af-A U. BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD ,,;BUILDER'S NAME .� O\ SPAN -- � DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES �O REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY BUILDING ALTERATIO IS BUILDING ON SOLID OR FILLED LAND LL BUILDING CONFORM TO REQUIREMENTS OF CODE C7 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 ST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM 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 AND APPROVEDBYBUILDING INSPECTOR X�z DATE ED MWILDING INSPKCTOR RE OF OWNER OR AUTHORIZED AGENT 1 F E Ems' OWNER TEL. PERMIT GRANTED TT CONTR.TEL.# �L! 19 CONTR.LIC.k H.I.C.# BUILDING RECORD 1 OCCUPANCY 12 i SINGLE FAMILYSTORIES 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 RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 ` CONCRETE BL'K. PINE BRICK OR STONE HARDWD PIERS PLASTER DRY WALL �. UNFIN. 3 BASEMENT I w AREA FULL FIN. B'M'TAREA _ y, 1/1 l/, FIN. ATTIC AREA _ NO B M T FIRE PLACES I HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS { CLAPBOARDS B 1 2 3 W DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDIU'D ASBESTOS SIDING COMMON _ VERT. SIDING ASPH. TILE _ I STUCCO ON MASONRY f' STUCCO ON FRAME I ` BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME �1 CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME +j SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13BATH FIXE i GAMBREL MANSARD TOILETRM. FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK ' SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 6 COLS. STEAM STEEL BMS. 6 COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS GAS 7 NO. OF ROOMS OIL T ELECTRIC i 1st 13rd I NO HEATIN 2nd G NORTH � � � Town of over Ir -A�211_. X1309 6 girt dower, Mass., 19 COC NIC NE WICK � AORATED S BOARD OF HEALTH Food/Kitchen Pr. KMIT T D Septic System Q O t. BUILDING INSPECTOR THISCERTIFIES THAT .........................................................................................:..................................................................... Foundation has permission to erect...... -.K.............. -0n .....:.1+1.........S7�'o ISI CC I��4. . .... ............... Rough �.`.x-.. .U.�...........z.2. -.lC................................................................ Chimney to be occupied as ...................................,1.. .. provided that the person accepting this permit shall in every respect conform to the terms of the,application on file in Final .Ithis 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EMPIRES IN 6 MONTHS Final UNLET CONSTRUCTION ST T� ELECTRICAL INSPECTOR Rough � Service B LDIN' INSPECTOR Final Occupancy. Permit Required to Occupy Building GAS INSPECTOR gh Display in a Conspicuous Place on the Premises Do Not Remove F na PY -- l No Lathing or Dry Wall To Be Done FIRE DEPARTMENT . Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. FORM U - VERIFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary a pprovals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ***************-**Applicant fills out this section***************** JL APPLICANT: o� `R ��1 Phone � Q LOCATION: Assessor' s Map Number Parcel Subdivision Lot(s) Street �,-7,C c��e.��- �.zN St. Number ************************Official Use Only************************ r a D RECO NDATIONS OF TOWN AGENTS: /,e � 1 Date Approved Co servatl Administrator Date Rejected f 40mments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector- ealth Date Rejected Date Approved Septic Inspector-Health .Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date Official Use Onty Permit No. .S.Sr�r�2f,S�77S Drams q(Pahl aqr -�i Occupancy&Fee Checked BOARD OF FIRE PREVENTION GULATIONS 527 CMR 12:00 APPLICATION FOR ERM TO PERFORM ELECTRICAL WORK All work to be pertormed in a rdan with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date S' 17- 01 To the Inspector of iffires: Town of North Andover ` The undersigned applies for a permit to perform the electrical work described below. '1 Location(Street&Number Owner or Tenant Owner's Address Is this permit in conjunction with a building permit Yes a No heck Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps . Voits Overhead 0 Undgmd 0 No.of Meters New Service Amps Voits Overhead 0 Undgmd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work cit a Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above 0 In u of Lighting Fodures Swimming Pool gmd a grrid I yrs KVA No.of Emergency lighting No of Receptacles Outlets No.of Oil Burners Battery Units h Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Dei ection and n es No of Air Cond Tons Initiating Devices Heat Total Total 1 No. Pu Tons KW No.of Sounding Devices No!of Self Contained S Area HeatingKW DetectiordSounding Devices I Municipal I Other Healing Devices. KW Local Confection No.of No.of Low Voltage Heaters KW Signs Baitases Wift Massacte Tuds No.of Motors Total HP COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Lava rrent Liability Insurance Policy including Completed Operations Coverage or its substantial equivaYES NO valid proof of same to the Office YES=NO - If you have checked YES please indicate the coverage by checking the appropriate box. BOND - OTHER - (Please Specify) (Expiration Date) Value of.Electrical Wor rt S /L—O f— Inspection Date Resquested Rough Final FfIV Penalties of perjury: UL v L.� LIC.NO. .e i -P-J l •-,ch Signature � LIC.NO. Zg us.Tel No. 78/ �c 3 f lXOrO� c •+c �j � AN Tel.No. ?7-3- !o t> StIRANCE WAIVER: I am aware that the Lic does not have the insurance coverage or its substantial equivalent as required by Massachusetts s.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE 5L (Signature of Owner or Agent) Official Use Only - Permit No. Pu6kaa�C#y —' Occupancy&Fee Checked BOARD OF FIRE PREVENTION R GULATIONS 527 CMR 12:00 APPLICATION FORERM! TO PERFORM ELECTRICAL WORK All work to be performed in a cordancb with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date S Tv uhc uwNca.aw of• uca. Town of North Andover The undersigned applies for a permit to perform 11 the electrical work described below.J Location(Street&Number ( J�k� R C,_U C_ Owner or Tenant : 4 U k-A Owner's Address Is this permit in conjunction with a building permit Yes 0 No heck Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Voits Overhead o Undgmd 0 No.of Meters New Service Amps Voits Overhead a Undgmd a No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work_ &^- 6' S p cr e5,r- ,s .,w 4 CA Total No.of Lighting Outlets No.of Hot fuse No.of Transformer; KVA Above 0 In 0 No.of Lighting Fbdures Swimming Pool gmd 0 gmd 0 Generators KVA No.of Emergency Lighting No of Receptacles Outlets No.of Oil Burners Ba#M Units No.-of Switch Outlets No of Gas Sumers FIRE ALARMS No.of Zone l Total No.of Detection and No.pf Ranges No of Air Cond Tons Initialing Devices Heat Total Total No.of Diposal No. Pumps Tons KW No_of Sounding Devices Nol of Self Contained No.of Dishwashers Space/Area Healing KW Detectior4ounding Devices 0 Municipal 0 Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equinaU.-ty NO • h v�m" valid proof of same to the Office YES=NO - If you have checked YES please indicate theerage by checldng the appropriate box. NSURANCE BOND - OTHER - (Please Specify) G DO (Expiration Date) Estimated Value of.Electrical Work$ D do Work to Start r-1 1.-O S Inspection Date Resquested Rough Final Signed under the Penalties of perjury: Q FIRM NAME rE ( tt '��' o`-�c fle_v`c '� LIC.NO. Licensee \nk LIZ Signature LIC.NO. z g 3 E `) us.Tel No. 1 QO k. 3 f 'O f O� ZOO ( ,— Address 'Go- U s� r aa� Alt Tel.No. 97 3- &f_-2 - Z7 7 G C OWNER'S INSURANCE WAIVER: !am aware that the Licdnses 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) JJ`` �U Telephone No. PERMIT FEE $ (Signature of Owner or Agent) Date.... ..................... °ft 6 6 -tee TOWN OF NORTH ANDOVER PERMIT FOR WIRING SgACHUS .,IfThis certifies that . ........................................................... ............................. t as permission t o perform f o rm -i ..................... wiring in the building of......... .............f............................. ....... .North Andover,Mass. Fee.................... Lic.No.............. ..... ............................... ELE IN........................ CMR Check it 5775 COMMONWEALTH OF MASSACHUSETTS OF ELECTRICIANS AS A REG JOURNEYMAN ELECTRICIA JOHN L STEENBRUGGEN 32 FAY ST WILMINGTON MA 01887-1807 Y 29573 E 07/31/07 SS3ES9 Na*hmQMs NangAllNftftti=l r i� �< • TOWN OF NORTU ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT'WAM WOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLIN BURDING PERMIT NUMB • DATE ISSUED //& ,4D SIGNATURE: Building Commissioned of Budding Date SECTION 1•SITE INFORMATION 1.1 Property AddtaL 1.2 Assemors Map andParW Nmmber: 0 W Saclea✓e fid _ v ✓ O. S Map Number Parat MM*w 13 Zoning Idannatioix 1.4 Property Dimeniass: Zona niattia use LA area M frorta 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Ted Provide Rmired ProvidedRemaired quired Provided 0 1,7 Water SapplyNKL(L.C.40. y4) 1.3. F1aod Zoarc 5dermrfioe I's saw Me t>ispaad System: P is 0 MAW p Zane odwerfoa?me 0 Mani*i 0 oaskampnd sydew 0 _J SECTION 2-PROPERTY OWNERSHIPIAUTHORM D AGENT rn1 2.1 Owoer of Reoord SvlvQ S1=0 N/ S= n�cleaye J�,! Address for Swire: /,, 0 7Zp —8 (o _- - S' Telephone 2 of Reco d: blame Print Address for Service: a M signshm Telephone M 4 SECTION 3-CONS1RUCJION SERVICES 3.1 Licensed Consoue ion Supenisor. Not Applicable ❑ Licensed Conwaction Supervise O LicceseNlrnlbcr Address Expini ion Date Signature Telephone r 3.2 Registered Home Imptc vemeat Contmdor Not Applicable Qf - ofl off' :Lbe Lib - C�»sfi'uchor� Con Name m l�� Schot, sfree� #�03 �yerel�Nom- Registratiaa Number r- Address (o/� X389 -3130 > Date S' re Te Location � .l •� No. Date HQRTIy TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ Building/Frame Permit Fee $ ,ss,�CMUSE ' Foundation Permit Fee $ Other Permit Fee $ eZ3 i TOTAL $ Check # n` 7 i j 18224 / 4 ( l Building Inspector > w S SECTION 4-WORKERS CO?CENSATION(nQL C I52 § 25c(6) Workers Compm n*n Insurance affidavit must be completed and submitted with this application. Fadure to provide this affidavit will result in the denial of the ismum of the building SimedaffidavitAttacited Yes......D No......D SECTION S Dacri 'oa of Proposed_. Work dreac New Consttuwou-D Existing Building Repairs) 0 Alterations(s) 0 Addition '0 Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work l k!h 1 •r e S/ L �• �• i lV umpsfCern =' �LL_ COSMucno�J SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be O I3SZtIN x� _ x Coryleted t ticant 1. Building (a) Building Permit Fee kc'SICIl� 0? $- . Multiplier 2 Electrical (b) Estimated Total Cost of -Construction 3 Plum ' Building Permit fee(a)x-(b) 4 Mechanical AC 5 Fire Protection 6 Total 1+2+3+4+5 CheckNumber SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT1, S Y l V 1 Q SQssO as Owner/Authorized Agent of subject propert, Hereby authorize i oy '014)7& 1-in a,-w&=hb" to act on . My Min I rgatt� k authorized by this building permit application. .S 6 •aoa� Nof Owner Date SEMON71i OWNERlAUTHORIZIrD AGENT DECLARATION I, as Owner/Authorized Agent of subject Properly Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of tiny knowledge and belief Piiiit 1. 5 6 •��5— Signa o Owned ent Date ATO.OnTORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TZMERS 1 2 NO 3 SPAN DRA]MIONS OF-SILLS DIM MSIONS OF POSTS DAgNSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHD44EY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS:LINE 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 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 c 11, S 150 A. The debris will be disposed of in: (Location of Facility) ` d Sigrfature 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 ` f NORTH TOWN OF NORTH ANDOVER • , ° "" "� OFFICE OF A BUILDING DEPARTMENT 400 Osgood Street North Andover,Massachusetts 01845 1S1AClWst� D. Robert Nicetta, Telephone(978)688-95454 Building Commissioner Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: JOB LOCATION: I�� Sf�r�ecleave neo{, �o�,a Number Street Address Map/Lot HOMEOWNER 500a 5256'0 �� 1f F0 osg1 CIA& Df 02o� Name Home Phone Work Phone PRESENT MAILING ADDRESS ID 51MIrclea ve_ ,k/. 471dove✓ (21ed City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to 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 HOMEOWNER 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 structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances 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 North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFI AL 131LV21)OF APPEALS OX8'9541 CONSFIRVATION 6980530 11EALI][6SR-9540 PLANN1\6 ORR OS35 Of V40RTH Andover TONM No. 4 ?0 C, 0 LAover, ST Mass. , ks Af COCHICHEW CK 0R ATE D BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT..., .............:�.46............ ...................... BUILDING INSPECTOR PERMIT T D Foundation has permission to erect................................. ..... buildings on ... Rough ..... ... . . . ......... .. ..... ...... ..... .... . . ..... to be occupied asol-1111::11111A.dwolei-r. respect conform..to t.h.9..terms..of..the app.application..o.n..file in Chimney h s 11111& ....................... provided that the person accepting the permit shall werys Final this office, and to the provisions of Codes and 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCT STARTS ELECTRICAL INSPECTOR "'Ur Rough .................................................... ................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Promises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. BUTTERWORTH & O'T OGLE, INC. P.O.BOX 0734 DOVER,NH 03821-0734 ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY TELEPHONE(603)969-0040 j r-' FAX(603)21&6760 REC a F' MAR - 12011 February 7, 2011 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASSACHUSETTS GENERAL LAW, CH. 139, SEC. 313 TO: Building Commissioner or Board or Health or Inspector of Buildings Board of Selectman ADDRESSES City/Town Hall City/Town Hall North Andover, MA 01845 North Andover, MA 01845 RE: Insured: Sylvia Sasso Address: 141 Stonecleave Road North Andover, MA 01845 Policy No.: HP2436399 05 Loss of: February 3, 2011 File No.: 16-0239 Origin: Water damage / 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 Law Chanter 143. Section 6 to be applicable. If any notice under Mass. Gen Law Chanter 139, Sec. 3B is appropriate, please direct it to the attention of the writer below and include a reference to the captioned insured, location, policy number, date of loss and file/claim number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. Thank You, Robert L. Smith, Jr. Adjuster BUTTERWORTH & O'TOOLE, INC. P.O.BOX 8294 SALEM,MA 01971-8294 ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY TELEPHONE(978)741-5731 FAX 978 740_,-VO February 25, 2011 r�rti 0 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASSACHUSETTS GENERAL LAW, CH. 139, SEC.3B TO: Building Commissioner or Board or Health or Inspector of Buildings Board of Selectman ADDRESSES City/Town Hall City/Town Hall North Andover, MA 01845 North Andover, MA 01845 RE. Insured: Sylvia Sasso Address: 141 Stonecleave Road North Andover, MA 01845 Policy No.: HP2436399 Loss of: February 15, 2011 File No.: 17-0535 Origin: Water/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 Law Chapter 1�Section 6 to be applicable. If any notice under Mass. Gen Law Chapter 139, Sec. 36 is appropriate, please direct it to the attention of the writer below and include a reference to the captioned insured, location, policy number, date of loss and file/claim number. If no reply is received from your office within ten days,we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. Thank You, David Vincent,AIC Adjuster