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HomeMy WebLinkAboutMiscellaneous - 161 HILLSIDE ROAD 4/30/2018 / 161 HILLSIDE ROAD 210/025.0-0047-0000.0 THEMOIIIIOLM DIIIDHAi,,IGROUP@ December 31, 2015 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B Building Commissioner, or Inspector of Buildings c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Board of Health or Board of Selectmen c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Fire Department or Arson Squad c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 RE: Our File No.: P1504772 Insured: LINDA BORLAND Address: 161 HILLSIDE ROAD, NORTH ANDOVER, MA Policy No.: H1216888A Loss Date: 05/01/2015 Loss Type: Building or Other Structure Damage A 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, Ch. 143, Sec. 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to my attention and include a reference to the captioned insured, location, policy number, loss date 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 the claim will be paid in our customary manner. Sincerely, Lorraine A. Peirce Sr. Property Claims Examiner 1-800-688-1825 x1139 NORFOLK&DEDHAM MUTUAL FIRE INSURANCE CO. 222 Ames Street,P.O.Box 9109,Dedham,MA 02027-9109 DORCHESTER MUTUAL INSURANCE CO. Telephone:(800)688-1825 FITCHBURG MUTUAL INSURANCE CO. o Fax:(781)329-1818 I Date. . . . . . ..14A .... .. NORTH TOWN OF NORTH ANDOVER O � D t - PERMIT FOR GAS INSTALLATION s �+ SSACHUS'- This certifies that /Mt alj'.�ullm? L . has permission for gas installation bO z-/J'0r� . . . . . . . . . . . . . in the buildings o /t����r�.�.k;�.�t�� Com__.!. . . . . . . . . . . . at , �.!` !�� - � �.1. �. . ., North Andover, Mass. Fee. lfLic. No.�/��3.. . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR � Check# v 4609 MASSACHUSEkTTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING j (Print or Type) - l !l)Pih. Mass. Date -Z P rtnit # 0 Building Location T ` Owner's Nam Q Type of Occupancy E�Sl -1-)CN Ti r- New ❑ Renovation ❑ Replacement 2--11 Plans Submitted: Yes❑ No ❑ y y s Z Q df y y U y Q: y W O = y W J y W H V m ►- S yl Z p W ~ < _ o r y y W Z V W y W < r C r S 0 H Z J r 2 r W Cr. O O > W r W J N W a W > x W G Z' < S _< i O O W O 1n1I F- {� O SUB-8SMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name �CjAE(Z T A . :�M MAT A 180 Check one: Certificate Address 3L O Corporation Al E 7 H U E fJ r11 ►a U l k q� ❑ Partnership Business Telephone &92 —9 17-7 ( 2-'Firm/Co. Name Of Licensed Plumber or Gas Filter "R0 8 E P T A• jA M M I T A r) INSURANCE COVERAGE: I have a current j bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.. Yes No O If you have checkedrtes, please indicate the type coverage by checking the appropriate box A liability insurance policy 0 Other type of indemnity O Bond O 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 C1 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 performed under the per i ued for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ner Laws. By T of License: C.� Plumber rt ure of Licensedu _. or Gas itter Title tter �atyRown Joumr License Number 93J� APPROVED O IC NLS t BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME E TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE GASINSPECTOR Lpcation��� No. �/3 Date �ORTM TOWN OF NORTH ANDOVER F? • • O9 Certificate of Occupancy $ t Building/Frame Permit Fee $ ♦ i s SSAC MUSEt Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ _b- — j/ Building Inspector 1 2 L x /98 ":a a-00 PAI" f- � � Div. Public Works I Location .` No. Date ,.aR,h TOWN OF NORTH ANDOVER F?O•�f`•o •,�Ow 09 Certificate of Occupancy $ C Building/Frame Permit Fee $ ;�'b�.T.O•I.r I.� cMustt Foundation Permit Fee $ Other Permit Fee $ a Sewer Connection Fee $ Water Connection Fee $ TOTAL $ /� oe �p � Building Inspector 09/25/98 11:3S 25./W OATT Div. Public Works ;rte PERMIT NO. AI'1'LICA'TION i•OR PERMIT `TO 13UILI)* ******NORTH ANDOVER, MA M%P NO, L___--D ^� I.UI'.N/). �, 2. HuoRDOFOWNL.RSlllh DATE BOOK PACE ZONE SIIBDIV. 1.01 NO. I I.O( A]ION �� /� / s'�� ! v f'11R1'(>SE(k=81111 DING OWNER'S NAME �(� !' 7SCJ 0 NO.LM SFOR IES lZE OWNER'S ADDRESS BASEMENr OR SLAB ARCI III ECI'S NAME SIZE OF FLOOR TIMBERS I 2 3 Bl III DER'S NAME SPAN DISIANCI:TONEARES'I BUILDING, DIMENSIONS OFSILLS DIS FANCEIROM S'IREF I' / DIMENSIONS 01:POS IS DISTANCE FROM LOT LINES-SIDES (D REAR DIMENSIONS OF GIRDERS AREA OF LOT FRONTAGE IIEIGIrr OF FOUNDATION THICKNESS IS BIIILDINGNL-'W SIZEOI IOOfIING X IS BIIII.DING ADDI IION MAI ERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR Flt LED LAND 14'11.1.BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED I'O TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING C(NJNECI ED TOl'OWN SEWER it IS BUILDING CONNECT ED TO NAIURAL GAS LINE J-IS'UlICTIONS 3. PROPER'n'INFORMATION LAND COSI' ESI'.BLrx;.COST ��4' PAGE I FILI.Ot I r SECTIONS 1-3 EST.BLDG.COS F PER SQ. FT. ESI.Bit)(;.COS I PER ROOM EI ECTRIC MEI ERS MUS'('BE ON OtrrSIDE OF BUILDING SEPTIC PERMIT NO. Al-1 ACL IED GARAGES MUST CONFORM rOSTATE FIREREGILA IRNIS a. APPROVED BY: PLANS MUSK BE FILED AND APPROVED BY BUILDING INSPLCrOt B111H)ING INSPECTOR DA It:FILED �S /1 s - g� OWNERS TEI.a 7� C(NTR.TEI a c(NrrR.11(a I I IRI:OF OWNER OR ALI I I 10HI711)AGLNT u.l.ca F11 1'I RMITGRAN 11.1) 19 r �I TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units...or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along wit other equirements. Esyost d' CdZJ Type of Work: Address of Work Owner Name: (4-) Date of Permit Application: C—A I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Pemit No. Job under $1,000 Date Building not owner-occupied _Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND LINER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date C-4wAfaete44ame R - OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: ►�� Date Owner Name 9 45 2. Date k... ... ...... a.... NOR7►1 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SSACMUS� This certifies that .........P.. ............ � . ............................................................... has permission to perform /, /�. �df�t ``r wiring in the building of ASI! �r <� f' at..d.G............... ...... .............n..,North Andover,Mass. Fee.Zti: Lic.NQA �Plz?. P�. ELECTRICAL INSPECTOR • Check # Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. �I BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked [Rev. 1/071 Qeave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WO All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 RK (PLEASE PRINT IN INK OR TYPE ALL INFORA"TIOA9 Date: � — F--`U City or Town of: NORTH ANDOVER By this application the undersigned —int,- - 93 To the Inspector of Wires: gn ves notice of his or her n 'on to perfo the electrical work described below. Location(Street&Number) �pl — `S p Owner or Tenant /1 Owner's Address Telephone No. s.l�.z -� Is this permit in conjunction with a building permit? Yes i ❑ No Check Appropriate Box) Purpose of Building__ yX / ��.,,� �� U9��z ' ation No. E�sting Service /�U Amps /�� l z yG Volts Overhead ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: < 17 Cam lesion o the ollowin table may be waiv;o ,,,en ector of Wires. No�ofRe�cessed Luminaires No,of Ceil.-Susp.(Paddle)Fans 0.ofotal. No.of Luminaire Outlets TransformersVA No.of Hot TubsGeneratorsVA No.of Luminaires Swimming Pool ove In- o.o mergeng d• � d. � Butte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.Of Detection and No.of N Ranges Initiatin Devices g o.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat PSP umber Tons KW o.of Self-Contained Totals: - `" Detection/Ale ' Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ OtherNo,of Dryers Heating Appliances K.W Security Systems:Connection No.of Water o of No.of Devices or E uivalent Heaters K' 0.of Data Wiring: Si s Ballasts . No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total Hp Telecommunications Wiring: OTHER: No.of Devices or E uivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: Work to Start —`(� (When required by municipal policy.) Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation"coverage or its substantial equivalent The undersigned certifies that such coverageforce, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER I certify ❑ .(Specify:) under the pains and penalties o perjury,that the information on this application is true and complete. _ FIRM NAME: Licensee: Si LIC.NO.: J�',33 1 /'T gnatur LIC.NCO..: (If applicable, ter"exempt"in the license number line.) _ Address: Bus.Tet K0.:�3 *Per M.G.L c. 147,s.57-61,security work requires D Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that Licensee Goes no have tbe1i ab II Lic.No. required by Iaw. B m signature y q liability insurance coverage normally BY y gnature below,I hereby waive this requirement. I am the(check one) ❑owner ❑ owner's agent Owner/Agent Signature Telephone No. PERMIT �1 The Comrnonwezith ofAyassachusetts �1 Department q f 1ndusVal_,accidents Office of fylvestigations 600 Washington Street Boston, AL4 02,711 Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Ao�bcant Information Please Print Lec biv Name(Business/Organization/indivi dual): Address: City/State/Zip: Phone#: FJAYOu an employer? Check the appropriate box: I am a employer with 4. ❑ I am a oeraType of project(required):and . employees(full andlorpurt-time).* have hired the sub-concontractors 6• ❑New construction . an a sole proprietor or partner_ listed on the attached sheet t �• ❑Remodeling ship and have no employees These mob-contractors have working for me in any capacity, workers tom .ins g' ❑Demolition P insurance. [No workers' comp. insurance 5. ❑ We are a c 9• Buil orporaiion and its ❑ �addition required) officers have exercised their 10.[1 Electrical repairs or additions Myself [No workers'comp. c. 3•❑ I am a homeowner doing all work right of 152 1 option per MGL 11.[]Plumbing repairs or additions �** to e„ (4),and we have no 12•❑Roof repairs insurance required.] t em P Ye�s. [No workers comp.insurance required_] 13•❑ Other =.ny applicant that checks. box i!1 Must allso a-c !the se, eon b—ow shox .t _ Homeowners who submit this affidavit indicating the; 2-doing aL'work-'and thmhire outside conaYctc;�inst s¢bmi�a new affidavit indicating such. ''Contractors that ch=k this box must attached an additional sheet showing the name of the sub conuactocs and their workers'comp•peu� information. a►n an employer that is providing workers'compensation i information. nsurance for my employees' Below is the policy and job site Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: Attach a copy of the workers' compensation policy declaration page(showingCity/StateiZip: Failure to secure coverage as required under Section 25A of MGL c. 152can to thethe impositionnumberolicy andand expiration date). fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form oSTOP WORK ORDER nand of�e 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 terrify under the pains and pantries of perjury thrrr the information provided above is true and correct Sisnatur!: Phone#: FFOther only. Do not write in this area, to be completed by citj,or town OffiC iaL Town: Permit/License# ority(circle one): I. Health 2.Buildin- Department 3. City/TOwn Clerk 4.EiectricaI Inspector S.plumbing b Inspector son: Phone�: