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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 i o • i ^i 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. - o M .� M X : 0� . oOc"Z-) 455 -- _= i I � � l i Ali i 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 . i 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 P g 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 r F er s a au .. r uctMnalAssemblyIs ®ns Xv PAT-10VCAORT Mll' 'odel. -,N,t,z,�-.----"PC1020 �Jr 697o,68767 0 Attached r! i — �� a � ' I�I I �1 I I I'�• o e 1 ,I a • E � e� SEoa G o 1ARR ' 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.