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HomeMy WebLinkAboutMiscellaneous - 16 JETWOOD STREET 4/30/2018 f'IVIH ncNL I M VERMONT MUTUAL INSURANCE GROUP@ Lax89 STATE STREET-PO BOX 369 MONTPELIER,VERMONT 05601-0369 Claims 800-435-0397 Since 1'828 Property/Liability Claims Fax 802-229-7647 Auto Claims Fax 802-229-8941 E-Mail claim skvermontmutual.com March 31, 2015 NOTICE OF PAYMENT OF PROCEEDS UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 175, SECTION 97A. NOTICE OF CASUALTY LOSS UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 313 Town of North Andover Tax Collector/Building Department 36 Bartlet Street Andover MA 01810 RE: Insured: DANN R NICOLOSI &GEORGETTE NICOLOSI Claim No.: HC208646 Policy No.: H017036323 Date of Loss: 10-Feb-2015 Property Location: 16 JETWOOD STREET, NORTH ANDOVER, MA 018454112 Type of Loss: Ice/Snow To Whom It May Concern: A claim has been made involving loss or damage to real property of the above-captioned property loss location which may either exceed $5,000.00 or cause Massachusetts General Laws, Chapter 175, Section 97A, to be applicable. We have requested per the statutory requirements that the claimant provide us with any certificate of municipal liens from the collector of taxes of the city or town wherein the insured property is located. If any notice under Massachusetts General Laws, Chapter 175, Section 97A is appropriate, please direct it to the Claims Department and include a reference to the captioned insured, locations, policy number, date of loss and claim or file number. Additionally, the damage to the real property in question may exceed $1,000.00 and this letter constitutes notice pursuant to Massachusetts General Laws, Chapter 139, Section 3B. Thank you for your cooperation. VERMONT MUTUAL INSURANCE COMPANY-NORT'HE'RN SECURITY INSURANCE COMPANY,INC. GRANITE.MUTUAL INSURANCE COMPANY Date. . ./- `. ../G. . . ... . . • ,app Tly Of of TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �,SSACMUSEt / l This certifies that . . . . . . . . ...! ,. . . . . . . .. /. . . . . . . . . . has permission for gas installation G . . .`. . . . . . . . . in the buildings-of . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . i at . . . . . . . . �'-�--.- °: . . . '. . . . . . ., North Andover, Mass. Fee . . . . Lic. No.. . .;:. ,' .. . . . . . . . . . . GAS INSPE6TOR Check 4 71 07 MASSACHUSETTS UNIFORM APPLICATON FO., DERN Ur TO DO GAS FITTING (Type or print) Date - 1 b NORTH ANDOVER,MASSACHUSETTS Building Locations I4— I g .J _//OnC 5-T- Permit# l> Amount$ 6? A N N. i'1 Ind / Owner's Name �� New® Renovation ❑ Replacement ❑ Plans Submitted ❑ w z a U F w H z z H oa E• w x p O w F w w v, U w x w F z a [�• w G7 [- z H z Ex„ H C9 j H U a rn W w Q cx zo z o x x o x 3 c o Ix > SUB -BA SEM ENT BASEMENT Sal 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8.TH . FLOOR (Print or type) �� ��A Check one: Certificate Installing Company Name_ El-Corp. Address -u A UA Lt pi 3T 1:1Partner. tZZ 37Sg39� ussiness'Te ep one ® Firm/Co. ;;Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked Yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy59 Other type of indemnityE] Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ® Agent ❑ I hereby certify that all of the details and information I have submi d(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installat ons erformed uAdw l7eelmit Issued for this application will be in compliance with all pertinent provisions of the Massachus Sta eXGa a C pter 142 of the General Laws. By. Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber ((� City/Town ❑ Gas Fitter lcense um er ❑ Master APPROVED(OFFICE USE ONLY) ® Journeyman r The Commonwealth of Massachusetts Department o f Industrial Accidents Office of Investigations UV 600 Washington Street Boston, MA 02111 www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: �4 t, S Phone#: 17,51 Are you an employer?Check the appropriate box: • Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. EJ New construction 2.X.I am a sole proprietor or partner- listed on the attached sheet 1 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. F-1 Building addition [No workers' comp. insurance. . 5• ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.EZ Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑ Other ;Any applicant that checks box#1 must also fill out the section below sh.o%'in,-their worl-=1 compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the.name of the sub-contractors and their workers'comp.policy information. lam an employer that isproviding workers'compensation insurance for my employees. Below is the policy andjob site information. M Insurance Company Name: �a�rat l S• Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce fy nder the p 'ns and penalties of perjury that the information provided above is true and correct. Si afore: Phone#: e17d- �7S 4?9,V [Other only. Do not write in this area, to be completed..by city or town officiaL n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical InspectoEu son: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apart n eats and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department.of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business.or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. . The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-8 77-MASSA-FE Revised 5-26-05 Fax#617-727-7749 wwu,.mass.-gov/dia Date. !.,/ 0 �... . . . . OF AO DTH ` o� �' TOWN OF NORTH ANDOVER � .A 1 PERMIT FOR GAS INSTALLATION 5 SACMUSEtS This certifies that . . . . . . . . . . . . . . has permission for gas installation . . . "'. .. ... . . . . . . . . in the buildings of . . .t�! ( f.,t c ! . . . . . . . . . . . . . . . . . . . . at . .�� './f. . . :!y .(. - , North Andover, Mass. Fee. .4. '�`�Lic. Nol�`!.) GAS INSPECTOR Check# / 0 l 5875 MASSACHUSETTS UNIFORM APPLICATON FOR PERMrr TO DO GAS FITTING (Type or print) Date )-2-- 0 -7 NORTH ANDOVER,MASSACHUSETTS Building Locations e: / LU C), Permit# \ _ Amount$ tt\�,CCS 1 C ; Owner's Name New Renovation Replacement Plans Submitted E] v U O a cG C7 U w v, z Q a O C7 FW- z F= z x z w a w H U x a w d w > O O x a x O x w 3 o cd7 U c > q a H o SUB -BASEM ENT BASEM ENT / 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4 T H . F L O O R 5 T H . F L O O R 6 T H . F L O O R 7 T H . F L O O R 8 T H . F L O O R (Print or type) ��� �L C Check one: Certificate Installing Company Name Corp. Address H 457 ; O n f O ) C7 At n C 11 C('' � Partner. "55 Business Telephone o�7d� Z S � cp ® Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ Noo If you have checked}_es,please indicate the type coverage by checking the appropriate box. Liability insurance policy © Other type of indemnity 1:1 Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 13 Agent ❑ I hereby 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 perfor a under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State G s C and of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter D Plumber Title +� Lt City/Town [] Gas Fitter License Numoer Master APPROVED(OFFICE Use ONLY) [Et Journeyman o�Cc�0 eQ rxc s FORM U - LOT RELEASE FORM �_ �— `c3 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 iyAl /�� /1/Ce,_Odl PHONE 78 79fo 0087 LOCATION: Assessor's Map Number PARCEL_ SUBDIVISION LOT(S) STREET 16 j!;;7-k20zzz> ST. NUMBER_ ************************************OFFICIAL USE ONLY************************** **** RE MMENDATION$ O TO AGENTS: CONSERVATION ADMINIST ATOR DATE APPROVED DATE REJECTED S -0 COMMENTS" 21�tinc W1 CC not r►e,"4 50 TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR —DATE— Revised ATERevised 9197 jm r% 1-ci f..pr IG3 14Z /Sp 'r ARBA- �S 0 o c� I �2 /7D f r awrwNe rl a a 3cQI'm s I �, i-a�^i II I I I 31 r C—/ WOO Sj �CcT REFERENCE: DEED: REC.13K.41 PG.5 Al PLAN:016.3 TO:'7-kms F'jtZSr- l-LAt�o,vAL L3ArvKeAe, ;krLo'c_ir; THIS PLOT PLAN WASNOTMADEFROM I CERTIFY THAT THE BUILDING(S)SHOWN HEREON AN INSTRUMENT SURVEY AND IS FOR ARE LOCATED ON THE GROUND AS SHOWN AND THAT THEY THE PURPOSES OF THE BANK ONLY. CONFORM TO THE HORIZONTAL DIMENSIONAL REGULATIONS UNDER NO CIRCUMSTANCES ARE OFFSETS OF THE ZONING BYLAWS OF THE 1b-,rioF No(zTiS lla0ovc(` TO BE USED FOR ESTABLISHMENT OF AT THE TIME OF CONSTRUCTION OR ARE PROTECTED UNDER FENCES,WALLS,HEDGES,ETC. GENERAL LAWS CHAPTER 40A SECTION 7. I ALSO CERTIFY THAT THE DWELLING SHOWN IS NOT +�''. -" MORTGAGE INSPECTION PLAN LOCATED WITHIN A FLOOD HAZARD ZONE AS s° .:,','of LOCATED AT DELINEATED ON THE MAP OF COMMUNITY*2-S'>Oq8 ':���y 16-18 JETWOOD STREET NO' ' NORTH ANDOVER MA.,EFFECTIVE(o•2-5'3 rpll_ 4, �� THE FEDERAL EMERGENCY MANAGEMENT AGENCY. .Jj � t.. PREPARED FOR DA.�-rti1 Z• 1t I co mos� � o' 6Eo IZCvc Tj� .i cctC4 % SCALE I"=34' PE9Z. L 2c�o3 NORTH SHORE SURVEY CORP. DA E REG.PROFESSIONAL LAND SURVEYOR - r�ys.- 47 LINDEN STREET., - SALEM,MA #2043 S ' a TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: ic SIGNATURE: Building Commissioner/I for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 16 JETWOOD STREET 11 24 NORTH ANDOVER, MA 01845 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: R4 RESIDENTIAL 15,000 150 Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R red Provide Required Provided Re red Provided 30 30 15 40 30 30 1.7 Water Supply M.G.L.C.40.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public X Private ❑ Zone Outside Flood Zone X Municipal X On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record DANN R. NICOLOSI 16 JETWOOD STREET, NORTH ANDOVER, MA e(Print) Address for Service: H 978 794-8087 W 978 683-9669 i afore Telephone 2.2 Owner of Record: Name Print Address for Service: O Z rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ MICHAEL S. NICOLOSI Licensed Construction Supervisor: C.S.L. 077704 O License Number 18 JETWOOD STREET, NORTH ANDOVER, MA 01845 mn Address APRIL 4, 2004 978 686-7776 Expiration Date ic Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 Company Name rn Registration Number r Address r Z Expiration Date /1 Signature Telephone Y♦ 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.......❑ SECTION 5 Description of Proposed Work check aU a ticable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition X) Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ADDTTTON TO EXISTING RESIDENCE TO INCLUDE GARAGE, FAMILY ROOM, AND TWO BEDROOMS. SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee 55,000 Multi lier 2 Electrical (b) Estimated Total Cost of 5, 500 Construction 3 Plumbing 7, 500 Building Permit fee(a)x (b) 4 Mechanical HVAC 6, 500 5 Fire Protection 500 6 Total 1+2+3+4+5 75,000 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, DANN R. NICOLOSI as OwnerXV0M0tJf0M0Wbfsubjectproperty Hereby authorize MTrHApT, S. N T O T.O S T to act on My behalf, ' al matters ti to o rized by this building permit application. 5/2/03 Si nate er Date SECTIO OWNER/AUTHORIZED AGENT DECLARATION If I, DANN R. NI COLOS I as OwnerMtl�afXdXliXbf 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 / ,o / , /�/cvLoS� Pr t N me Si riuk4f Owner/ Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS Iff IGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Town of North Andover i a Building Department 27 Charles Street SSACHUSE� North Andover MA 01845 Tel: 978-688-9545 HOMEOWNER LICENSE EXEMPTION Please print. DATE ,� ,� JOB LOCATION /6 ,,/�r6yvo� �� �/2>!/A26,y!SK A �— Number NumbStreet Address Section of Town "HOMEOWNER 16 iw- 79'- Y-©$' p78 6,93—9(� 9 Number Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six 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 109.1.1) 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 to six family dwelling,attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official, a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) 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 pr edures and requirements and that he/she will comply with said procedures and require en HOMEOWNER'S SIGNATURE - APPROVAL OF BUILDING OFFICIAL Note:Three family dwelling 35,000 cubic feet, or larger,will be required to comply with State Building Code Section 127.0 Construction Control. 'FILE No.466 04/30 '03 12:16 ID:KHALSA DESIGN INC FAX:16178642086 PAGE 1 Pemnit Number REScheck Compliance Certificate Chocked By/Date Massachusetts Energy Code RES checkSotwam Version 3.5 Release 1 b Data filename:G:\D_nicolosi\energy calclenergy_zucolosixck TITLE:Addition to the Nicolosi Regidence CITY:North Andover STATE:Massachusetts HDD:6322 CONSTRUCTION TYPE: 1 or 2 Family,Detached HEATING SYSTEM TYPE:Other(Non-Electric Resistance) DATE:04/30/03 DATE OF PLANS:2126103 COMPANY INFORMATION: Khalsa Design,Inc. 700 Massachusetts Avenue Third Floor Cambridge,MA 02139 CON, LTANCE:Passes Maximum UA—389 Your Home UA=380 2.3%Better Titan Code(UA) Gros& Glaring Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling 1:Flat Ceiling or Scissor Truss 1200 38.0 0.0 36 Skylight 1:Vinyl Frame:Double Pane with Low-E 7 0.410 3 )exterior Wall 2x4 w/R14:Wood Frame, 16"o.c. 2064 14.0 OA 135 All Windows:Vinyl Frame:Double Pane with Low-E 255 0.380 97 Garage&&lain Door:Solid 60 0.250 15 To Deck:Glass 40 0.270 11 Basement Wali 1:Solid Concrete or Masonry 792 0.0 14.0 46 Wall height:9.0' Depth below grade:7.0' lmIatioD depth:7.0' Fust Floor over Basement: All-Wood Joist/Tntss:Over Unconditioned Space 600 30.0 0.0 20 Second Floor over Garage: All-Wood Joist/Truss:Ovcr Unconditioned Space S03 30.0 0.0 17 COMFLTANCE STATEMENT: The proposed building desip described here is consistent with the building plans,specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in RES checkVersion 3.5 Release 1 b (formerly N ECchecg and to comply with the mandatory requirements listed in the RES checkInspection Checklist FkE No.466 04130 '03 12:17 ID:KHALSA DESIGN INC FAX:16178642086 PAGE 2 I ' The heating load for this building,and the cooling load if appropriate,has been determined using the applicable Standdrd Design Conditions found W the Code. The HVAC equipment sclecWd to heat or cool tic building shrill be no greater than 125%of the design load as specified' 'ons OCMR 1310 and J4.4. BuilderlDesiper „_ Date AcORv_ CERTIFICATE OF LIABILITY INSURANCE DATFWOD" PRODUCER JONATHAN M SAMEL,CIC LIA THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND SAMEL INSURANCE AGENCY,INC. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 15 CENTRAL STREET DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ANDOVER MA 01810 COMPANIES AFFORDING COVERAGE INSURED COMPANY A: ZURICH INSURANCE GROUP L'ITALIEN&SONS CONSTRUCTION CORP COMPANY B: 236 PLEASANT ST. METHUEN MA 01844 CCMPAPIY C: COMPANY D: OVERAQFS COMPANY E: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING 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 C9NDIT1DNS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED 13Y PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POIJCY EFFECTIVE POUCY EXPIRATION LIMITS GENERAL LLaBILITY j - -- - - EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL,LIABILITY i SCP*4 -1580301 DEC.3 3 02 DEC 3 Q 3 FIRE DAMAGE(Anyone Fire) S 60,000 CLAIMS MADEa OCCUR MED.EXP(Any One Person) $ A PERSONAL i3 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/013 AGG. S 1,000,000 POLICY PROJECTLl LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO SCP40580301 DEC 3 02 DEC 3 0 (Eaaccident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY A X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY S X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY I AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESS LIABILITY EACH OCCURRENCE $ 1,000,000 A X1 OCCUR El CLAIMS MADE SCP4 0 5 8 0 3 01 DEC 3 02 DEC 3 0 3 AGGREGATE $ 1,000,000 5 DEDUCTIBLE - S RETENTION S S WORKERS COMPENSATION AND WC srATu OTHER EMPLOYERS'LIABILITY A SCP40580301 DEC 3 02 DEC 3 03 El.EACHA°c'DEN-_ ` 100:000 E.L.DISEASE-EA EMPLOYEE S 100,000 OTHER: E.L.DISEASE-POLICY LIMIT S 600,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE MicheaL NicolOSl EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 GAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT 18 Je twood', Street FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE N. Andover, MA 01845 INSURER,IT,'S AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Attention: ACORD 26-S(7/97) Certificate# 4274 Jonathan M. Samel 38876-MA, 359712-NH y 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 c11, S150A. The debris will be disposed of in: WOOD WASTE 85 Boston Street, Everett, MA 02149 (Location of Facility) Si ature of Permit Applicant -2 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building inspector ANESTIS METAL CORP. Haulers • Buyers of • , • Metals 40 Bennett Street Somerville, MA 02143 (617)666-3405 (617)666-3406 CD (-Y)CAj G) ca > o CD U � � r LL \ �\_kw\ Ove ,fir, S �o,t(: Q r'Sot WaSk G� S � ?)OS�o,\ sf CI L N N D L � U (/) 3 LL Suppliers of Load Lugger Boxes • Roll-off Containers Trailer Bodys 9 Hydraulic Tailgate Pickups ADDITION TO NICOLOSI RESIDENCE ARCHITECT TKG KHALSA DESIGN INC. _ 0000000000000000 700 MASS AVE.CAMBRIDGE,17-8.02179 TELEPHONE Fl617464-9662 FAX 617-e64-2096 wo 19 , °- f1 Key Plan: Lj - ? Job ij i D2wn By Checked By '�. Date:226103 Revisions i Scale: IcN ADDITION-TO NICOLOSI RESIDENCE nxc cr ® . 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