HomeMy WebLinkAboutMiscellaneous - 153 MILL ROAD 4/30/2018 I
153 MILL ROAD
210/107.C-0080-0000.0
1
PO Box 55098
Boston,MA 022055098
617-951-0600
: ►� NK
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
NO ANDOVER, MA 01845 NO ANDOVER, MA 01845
RE: Insured: SUI THU and MUOI TRUONG
Property Address: 153 MILL RD,NO ANDOVER, MA
Policy Number: HMA 0213306
Claim Number: BOS00050555
Date of Loss: 2/20/2015
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.
Pat O'Sullivan Claim Examiner 2/23/2015
Safety Insurance Company
Homeowners Claims Unit
P. O. Box 55098
Boston, MA 02205-5098
Phone: (6.17)951-0,600 EXT_3549. .
Fax: (617) 531-8823 -
Email PatO'Sullivan@Safetylnsurance com
-6448 Dater .z''' ? ........
NORTH TOWN OF NORTH ANDOVER
n
PERMIT FOR GAS INSTALLATION
N 9
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4SSACHUSES ,
i This certifies that . . ..
. . ... . . . . . . . . . . . .
has permission for gas installation.: L-4: . . . .. . . . ... .
in the buildings of . . . . �. . . . . .. ../. . .. .. x
at /�," Vit:: .n .. North Andover, Mass.
Fee.:-. . . . . . Lic. No -7P5'. . . . . .... ...� . . . . . . . . . .
GAS INSPECTOR
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
1 >
MASSACHUSETTS UNFORM APPLICATON FOR PCRNIIT TO DO GAS FITTING
iType or print) Date
NORTH ANDOVER,
MASSACHUSETTS
Building Locations / /'i e/ J L �' Permit 9 y��
Amount S ��
Owner's Name
New Renovation ❑ Replacement ❑ P s Submitted ❑
n j n
n n n n J Z n _
Z J -, :. Z Z Z ::i
�t lJl
BASE .vi ENT
I S T. F L O O R
2:Y D . FLOAR
3 R D . F L O O R
Try FLO G It
5-r ii . FL0UR
6T 1i . FLOOR l
7"r5 . FL00It
3"r If . F1, 00 R
(Print or type) J Check one: Certificate Installin,,Companv
dame /2Efl I C /1 fJAl E d ❑ Corp.
Address ❑ Partner.
Business Telep one ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSUI,ANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No
Ifvou have checked ves, please indicate the type coverage by checking the appropriate box.
Liability insurance policy ❑ Other type of indemnityF7Bond ❑
Owners Insurance Waiver: [am ware that[he licensee does not have the insurance coverage required by Chapter 142 of the
ivtass. GeneraGa and si Lure on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner Agent ❑
herebv certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions ofthe Mass setts tate Ga�S G6d rid ws.
Bv: Signature of Licen d Plumber Or Gas Fitter
Title ❑ PI tuber a 9 9
Citv_iTown l "us Fitter (cense wumoer
❑ Master
APPROVED(()Eric;: u5F nru"v) umevman
Location
.` No. `7 93 Date
Date Location-
-30 '�Y
t
�ORTM TOWN OF NORTH ANDOVER
_ F 9
1 i ; ; Certificate of Occupancy $
- �,SSACMUS t� Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ 3�
Check #
P
Y r
l
17418 �.� �--�-�
Building Inspector
�~ TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ..yyyy
BUILDING PERMIT NUMBER: 11-7DATEISSUED:
7
SIGNATURE: l L
Building Co ssioner/I or of Buildings Date
SECTION 1-SITE INFORMATION
1.1 Property Address: ' 1.2 Assessors Map and Parcel Number:
®o g
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
I
I \v\
Zonin District Proposed Use Lot Areas Fronta e ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required Provided Required Provided
1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: YeS ILIO �
2.1 Owner of Record
al
, , T C--�%�� /xv/Z1 RD ,ri
Name(Print) Address for6S^errvice: p
Signator Telephone
1.2 Owner of Record: �.
i
Nagle Print Address for Service:
Signature Telephone
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable
Licensed Construction Supervisor:
License Number
Address
Expiration Date
Signature Telephone r
3.2 Regiltered Home Improvement Contractor Not Applicable ❑
Company Name
Registration Number r
Address r
Expiration Date
Signature Telephone
SECTION 4-WORKERS COMPENSATION(M.G.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 applicable)
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be � �, {}FFI
CIAY,USE"UNLY�NTMI�
Completed b rmit a ltcant n „ "�
_.,
011
1. Building (a) Building Permit Fee
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 Plumbing Building Permit fee(a)X(b) 2L
4 Mechanical HVAC C.�
5 Fire Protection
6 Total 1+2+3+4+5 Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf,in all tte s r v o work authorized by this building permit application.
Si e of Ov4Ler Date i
CTION 7b OWNER/AUTHORIZED AGENT DECLARATION
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
Si ature of Owner/A ent Date
NO.OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 2ND RD
3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS r
DIMENSIONS OF GIRDERS
s
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
FORM U v LOT RELEASE FORM
J
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION***********************
APPLICANT ! / ' �l� PHONE64�Q'� /
LOCATION: Assessor's Map Number PARCELO
SUBDIVISION LOT (S)
STREET l L_ ?!C ST. NUMBER�j�
******* ********************************OFFICIAL'USE
REC MENDATIONS OF TOWN AGENTS:
CONSERVATION ADMIN IS TOR DATE APPROVED 6
DATE REJECTED
�_( " se�
COMMENTS I.7 a� 7 00 ��„�, D�bpo tire �o� a'+�0.I/ (r�.mcecr�¢. A
C 1'nJ6M9A owner -D cease-
TOWN
ease TOWN PLANNER _ DATE APPROVED
DATE REJECTED
0
COMMENTS
FOOD INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED
COMMENTS
0
PUBLIC WORKS -SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 jm
LOCATED IN : ,1VDEED BK. lltO
BUYER : S' / V. 7%�!a /`� U �OcJnlc; PLAN NO.�3 ¢
SCALE : / "-`�� ' _ BK. PG.
DATE INV. NO. ?3 7
1
1 .2/U•OBJ' '
41 �zs. -
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and its title insurers: I hereby certify that I have examined the
premises and that all buildings are located on the ground as shown, and that they do ( ) conform to the zoning by laws
when constructed- I Also certify that this property is (WOf-) located in thh flood hazard area.
NOTE: This certification is based on the survey markers of others, .and does not represent an actual survey. For
mortgage purposes only.
Z i- NoR rHs rA i? JEFF
LA ND SURVEY HoFNiI>,fdl�
SER VICES
f
11THE TANNERY" - SU/TE 73 �-
P.O. Sox 131 5
NEwsuRYPO/2T, MA O 1 950
f TEL ./9781 465-2940
FAX: 79781 465-71717EMAIL : N0RTH97AR01 950`A0L.00A7 .
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ttgR%Ft
Town of North Andover 0��`,�ro
Building Department
27 Charles Street ra �"
�Q
North Andover MA. 01845
�SsHCN14SE4
D. Robert Nicetta
Building Commissioner
(978) 688-9545
(978) 688-9542.Fax
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE
JOB LOCATION Z,�� /� �Q� 7. C/
Number Street Address Map/lot
-HOMEOWNER
Name Home Phone Work Phone
PRESENT MAILING ADDRESS
City Town State Zip Code
The current exemption for"homedwners"was extended to include owner-occupied 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 sponsibility for compliance with the State Building Code and other
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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
V
APPROVAL OF BUILDING OFFICIAL
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F er s a au ..
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uctMnalAssemblyIs ®ns
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PAT-10VCAORT
Mll' 'odel. -,N,t,z,�-.----"PC1020 �Jr 697o,68767 0
Attached
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' World's lending Malcei
of Storage Buildhigso
CAUTION:SOME PARTS HAVE SHARP EDGES.CARE
MUST BE TAKEN WHEN HANDLING THE VARIOUS PIECES
TO AVOID A MISHAP.FOR SAFETY SAKE,PLEASE READ
SAFETY INFORMATION PROVIDED IN THIS MANUAL
705120397 BEFORE BEGINNING CONSTRUCTION.WEAR GLOVES
UNIT DIMENSIONS "Size rounded off to the nearest foot tWHEN HANDLIING METAL PARTS.
Exterior Dimensions Interior Dimensions
Approx. Foundation Storage Area (Roof Edge to Roof Edge) (Wall to Facia)
Size Size Sq.Ft. Cu. Ft. Width Depth Height Width Depth Height
10'x 20' 123"x 249" 197 1692 120 3/4" 240 1/4" 106 1/2" 119" 238" 102"
XAORTH
TO" of . , over
O M
No.
_ LAK 1 lover, Mass.,o
COCMICHEWICK
ADRATE D
S U BOARD OF HEALTH
PERMIT . T D Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT........> .V. v
•
...............................................................................�......................
� Foundation
has permission to erect....... ..... �4..... buildings on .....�.� ........j"� 11
.................................... Rough
to be occupied as.... S&A Im..................................4.................CA..................pbvkT.....Roo A Chimne..................................... y
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Lawselating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. /O, Q ) 8� O w PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
ELECTRICALINSPECTOR
UNLESS CONSTRUCTION STIRTS C Rough
��..�..... Service
..... . . ...... ....... ............:.
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises Rough— 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 SIDE Smoke Det.