HomeMy WebLinkAboutMiscellaneous - 180 LANCASTER ROAD 4/30/2018 (2)eo
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PO Box 55098
Boston, AAA 02205-5098
617-951-0600
SIR -
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
NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845
RE: . Insured:
_JOEL. MYERSON:and KIMBERLY MYERSON
Property Address:
180 LANCASTER RD, NORTH ANDOVER, MA
Policy Number:
HMA 0278286
Claim Number:
BOS00052933
Date of Loss:
2/22/2015
Company:
Safety Property and Casualty 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 lossand claim number.
Pam McPherson Claim Examiner 3/4/2015
Safety Insurance Company
Homeowners Claims Unit
P. O. Box 55098
Boston, MA 02205-5098
Phone: (617) 951-0600 EXT 3521
Fax: (617) 531-2741
Email: PamMcPherson@Safetylnsurance.com
Date.. � . /' .. . '.
HORT/I
pya „ao ,s 1ti0-
TOWN OF NORTH ANDOVER DOVER
PERMIT FOR GAS INSTALLATION
This certifies that .. C: �..:' ..... r.�. ��
has permission for gas installation
in the buildings of/. ..........................
tL� . f Ori
at . ��..,�..�� .r :- <-�-. �!. .., North Andover, Mass.
Fee 6 /. 6 . Lic. No: Z,, ate".. . c 1 .-....... .
GAS INSPEGTOF'
Check #'
7076
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
L - A-jUb0 U C A— Mass. Date / 20 _!Ll Permit # �10
Building Location 196 I-AA)rnier's Name / f yAr/Z SQ
Type of Occupancy R
New ❑ Renovation ❑ R(iilacetnent Plans Submitted: Yes ❑ No ❑
tj
Installing Company Name L it/ L G
Address �L/�/U/c,T ,� Check one: Certificate
Al- Qa)F-R N/L a<orporation
Business Telephone -1-3 1 ❑ Partnership
Name of Licensed Plumber or Gasfitter'�L FF1402,c4,1 ❑ Firm/Co.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL
Ch. 142 Yes 0 No ❑
If you have checked Ms, please indicate the type of coverage by checking the appropriate box.
A liabilih- insurance polici Ca----- Other tvpe of indenuutc ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required
by Chapter 142 of the MGL, and that my signature on this permit application waives this requirement.
Signature of (toner or Owner's A ent Chvner ❑ 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 performed under the
permit issued for this application will be in compliance with all pertinent provisions of ass• chusetts State
Gas Code and Chapter 142 of the General Laws.
By Type of License:
Title El—Plumber aster i e of Licensed Plumber/Gasfitter
City/Town ❑ Gasfitter ❑ Journeyman License Number _
APPROVED OFFICE USE ONLY)
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SUB -BASEMENT
BASEMENT
FIRST (1ST) FLOOR
SECOND (2ND) FLOOR
THIRD (3RD) FLOOR
FOURTH (4TH) FLOOR
FIFTH (STH) FLOOR
SIXTH (6TH) FLOOR
SEVENTH (7TH) FLOOR
EIGHTH (8TH) FLOOR
Installing Company Name L it/ L G
Address �L/�/U/c,T ,� Check one: Certificate
Al- Qa)F-R N/L a<orporation
Business Telephone -1-3 1 ❑ Partnership
Name of Licensed Plumber or Gasfitter'�L FF1402,c4,1 ❑ Firm/Co.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL
Ch. 142 Yes 0 No ❑
If you have checked Ms, please indicate the type of coverage by checking the appropriate box.
A liabilih- insurance polici Ca----- Other tvpe of indenuutc ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required
by Chapter 142 of the MGL, and that my signature on this permit application waives this requirement.
Signature of (toner or Owner's A ent Chvner ❑ 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 performed under the
permit issued for this application will be in compliance with all pertinent provisions of ass• chusetts State
Gas Code and Chapter 142 of the General Laws.
By Type of License:
Title El—Plumber aster i e of Licensed Plumber/Gasfitter
City/Town ❑ Gasfitter ❑ Journeyman License Number _
APPROVED OFFICE USE ONLY)
V/ 1-v
- -'�•w � mss-.- �1�--r-�«.-' '-"-'^ --1�� '.� ��.Y V'^`1.. -ter ti.+..�..r � .� F '^.. •-
Location '? / -3 ii14 ,e,,r ed /
No. 42,9 Date '3
NORT1y TOWN OF NORTH ANDOVER
am�mgaft
Certificate of Occupancy
,Building/Frame Permit Fee $ �� � 7'
si P
F6undation Permit Fee
SAGMUSE
Other Permit Fee $
0604 Sewer Connection Fee $ 10-1543
?v46wq*bonnection Fee $ �^
DOTAL $ 20 7 "7• .SV
q q�o „ Building Inspector
6697 Div. Public Works
Location Z
Nv.' �' Date ,
Nom,. TOWN OF NORTH ANDOVER
F - 9 Certificate of Occupancy $
} �o $uilding/Frame Permit Fee $
b��rs •I��,Cj •. 1
cMuSEt . hdation Permit Fee $
Other'P' it (4e $
Sewer bwr4ction Fee $
Water Conneciion Fee $
OTOTAL $
f -hes , h)1 J, es s
Building Inspector
I
6642 Div. Public Works
i
L6r�/,
Location
No. Dated
TOWN OF NORTH ANDOVER
Certificate of Occupancy $ S� J
Building/Frame Permit Fee $
Foundation Permit Fee $ d
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL /�$
Building Inspector
Div. Public Works
Location.
No.df" Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Found tion Permi Fee $
Otemit F6W $
Sewer Connection Fee $
<�C1, Water Connection Fee $
TOTAL $
Building Inspector
6643 Div. Public Works
Location /g� Lar���� /G ¢3
No. Date /0 -/Z -?3
4
7
H°Rr►, TOWN OF NORTH ANDOVER
„ Certificate of Occupancy $
Building/Frame Permit Fee $
CHUs t� Foun atibn Permit Fee $
Other Permit fee., $
Sewer Connection: Fee $ l
�0. 71%/0 ViVer Connection Fee) $
a
Building Inspector
6495
Div,,FTub c Works
i
PER'llI NO. 412
r
l
MAP 4-40.
APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /oZ,1",) ':? 6 ] I/ 1
INSTRUCTIONS
SEE BOTH SIDES V IT FEc / 7 2, `f e�-
PAGE 1 FILL OUT SECTIONS 1 - 3 fDA FEE ._._----_.__moo a' o
PAGE 2 FILL OUT SECTIONS 1 - 12 VA FRAME PERMIT .$ - 0,9 7 .S D
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND/PROVED BY BUILDING INSPECTOR
DATE RI
SIGNATXmt-OF OWNER OR AUTHORIZED AGENT
d
FEE 42 Z Z 7,J 0
PERMIT GRAN
`s�
T OWNER TEL. N
Cy CONTR. TEL. H)94Z r - 33
19 CONTR. LIC. # G buy
ale
j� 6 yi
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST
EST. BLDG. COST PER 8Q. FT. v
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
mum"IAY 1"wrau-Tow
I LOT NO. 7L,
2 RECORD OF OWNERSHIP DATE
BOOK !PAGE
ZONE
SUB DIV. LOT NO. 413
�I
—
LOCATION Jho i�r /
//j
PURPOSE OF
A
OWNER'S NAME l � /1 % e74 �—
NO. OF STORIES) SIZE
SIZE J/
OWNER'S ADDRESS A �, C•�j /1/ t/`-/ / ./I /
BASEMENT OR SLAB P
ARCHITECT'S NAME /� ,rj v�
(� LK^CS_rf�
SIZE OF FLOOR TIMBERS IST , j /G 2ND u 9RD
BUILDER'S NAME
SPAN
DISTANCE TO NEAREST BUILDING /'.� �f
DIMENSIONS OF SILLS LiX C ---
DISTANCE FROM STREET 51- e)
POSTS
DISTANCE FROM LOT LINES - SIDES .� REAR /
" " GIRDERS
AREA OF LOT/ /��� FRONTAGE
v
HEIGHT OF FOUNDATION THICKNESS /U
IS BUILDING NEW {
SIZE OF FOOTING X 9
IS BUILDING ADDITION �V
MATERIAL OF CHIMNEY /e
IS BUILDING ALTERATION yG
IS BUILDING ON SOLID OR FILLED LAND O
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE /
/
IS BUILDING CONNECTED TO TOWN WATER j
BOARD OF APPEALS ACTION. IF ANY 'YY
�� ,
IS BUILDING CONNECTED TO TOWN SEWER �rJ
IS BUILDING CONNECTED TO NATURAL GAS LINE L
INSTRUCTIONS
SEE BOTH SIDES V IT FEc / 7 2, `f e�-
PAGE 1 FILL OUT SECTIONS 1 - 3 fDA FEE ._._----_.__moo a' o
PAGE 2 FILL OUT SECTIONS 1 - 12 VA FRAME PERMIT .$ - 0,9 7 .S D
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND/PROVED BY BUILDING INSPECTOR
DATE RI
SIGNATXmt-OF OWNER OR AUTHORIZED AGENT
d
FEE 42 Z Z 7,J 0
PERMIT GRAN
`s�
T OWNER TEL. N
Cy CONTR. TEL. H)94Z r - 33
19 CONTR. LIC. # G buy
ale
j� 6 yi
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST
EST. BLDG. COST PER 8Q. FT. v
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
mum"IAY 1"wrau-Tow
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY _ �FF
ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY ICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA -
APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
k
Ff
t
CONSTRUCTION
2 FOUNDATION
CONCRETE
CONCRETE BL'K.
BRICK OR STONE
PIERS
_
8 INTERIOR
a
PINE
HARDW'D
PLASTER
DRY WALL
UNFIN.
FINISH
1
2 13
_
3 BASEMENT
AREA FULL
FIN. B'M'TAREA
1/1 1/2
FIN. ATTIC AREA
_
N_O B M
FIRE PLACES
HEAD ROOM
_
MODERN KITCHEN
_
4 WALLS I 9 FLOORS
CLAPBOARDS
B
I
2 3
�_
DROP SIDING
WOOD SHINGLES
CONCRETE
EARTH
C'D
COMMCN
COMfA
ASPH. TILE
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
_
_
_
_
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY
BRICK ON FRAME
ATTIC STIRS. d FLOOR _
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR I� POOR _
ADEQUATE NONE
10 PLUMBING
5 ROOF
GABLEHIP
GAMBREL
MANSARD
BATH Q FIX.)
TOILET RM. 12 FIX.)
L
FLAT
SHED
WATER CLOSET
ASPHALT SHINGLES
LAVATORY
_
WOOD SHINGES
KITCHEN SINK
_
SLATE
NO PLUMBING
7_^
TAR & GRAVEL
STALL SHOWER
L
ROLL ROOFING
MODERN FIXTURES
_
TILE FLOOR
TILE DADO
6 FRAMING
11 HEATING
WOOD JOIST
I
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. & COLS.
STEAM
STEEL BMS. & COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
AIR CONDITIONING
_
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS
GAS
OIL
B'M'T 12nd
3rd I
ELECTRIC
I NO HEATING
k
Ff
t
FORM U - LOT RELEASE FORD
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 local or state lav, r
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: 'A, c/av,-A (70-S-1, -4 10yc ,1 06/f'phone -9711-7-3y,5--z
LOCATION: Assessor's Map Number ,% 1/ D Parcel / 7 U
Subdivision Yc-S Lot (s)
Street /3��� ctc k %i l St. Number 66D
************************Official Use only**********************
RECO2ENDATIONS OF TOWN AGENTS:
Data Approved M/zl
Conservation Administrator Data Rejected
Comments
Data Approved
Town Planne Date Rejected
Comments
r' Q
Date Anaroved
Health Agent Date Rejected
Comments
Public Works - sewer/water connections 13-i3
- drivewav pe --=it
Fire Department
Received by Building Inspector Date
0 14 1993
BL 111.1)ING
c:t )Ntil :l tVA'1'It )N
I Ilii\1:1'11
1'Ir\I�'NIN(;
ATE Yl ,
C::=�•:-':' Nta��'1'A� �1►.NUU`rL'lt
PLA.NN1NG. & t;t)!11l�IlINI'1'1' l)l:�'l:i.t)1'l111 N'1'
KAHEN N I I.P. NJ: I.ti( )N. I )Il tl (A ()I t
CHIMNEY APPLICAHON ANO PL -13111'
r�1:1l;�:tt Iltl•;t'll'� II I;i4.1!i
Ilii iitif 5.1 r!;
PLKM11'. #ix
)CATION
VNER' S NAME:
lILDER'S NAME:...,�.�oU-��
SONS NAME: �"� ; ; i- �;, ��.,�J-r 1
kSON'S ADDRESS:'�--
ISON' S TELEPHONE:
JERIAL OF CHIMNEY:
IFERIOR CHIMNEY: LXl LRI OR C1IIMNLY:
IMBER AND SIZE OF FLUES:
II CKNESS OF HEARTH:
: u Clvullnw an (.vicenCace con(joui to Vie u( the curie curl! flava -tuce.3 curl(
,gutat Ojo been neeebe(i:
.TE:
.NATURE OF MASON:
:RMIT GRANTED:
'BERT NICETTA
'ILDING INSPECTOR
SPECTEU:
'A ARKS:
CLL ass ; oy
SOLID BLOCK REQUIREA) r. T 14 igm
THIS PERMIT MUST GE OISPLAVLO 014 111E PRL1,11 ES'
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CERT/F/ED FOUNDA TION PLAN
LOCATED IN r�o• Aad,, MA•
SCALE: /"_ DATE to l% `33
Scott L. Gi/es R. L. S.
50 Deer Meadow Rood
North Andover, Moss.
LO 43
LOT 33
LOT' 4-G
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ANCA 5TE � �P'- t'
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/ CERT/FY THAT OFFSETS SHOWN ARE FOR THE USE or
THE OFFSETS OF THE SU/L DING /NSPEC TOR ONL Y
SHOWN COMPLY AND SUCH USE /S FOR THEv ;s
WITH THE ZONING DETERMINATION OFZONING
SY LAWS OF CONFORM/TY OR NON -CONFORMITY c4.•tk°'
No. AtJDNEfz-,MA, WHEN CONSTRUCTED.
WHEN BUIL T
1 3'�53
CERTIFICATE OF USE &OCCUPANCY
Town of North Andover
10
Building Permit Number 478 (1993) Date MARCH 22, 1984
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 180 LANCASTER ROAD (lot #43)
MAY BE OCCUPIED AS SINGLE FAMILY DWLLING W/3 CAR GARAGE_ IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
CERTIFICATE ISSUED TO Andover Const. & Dev. Corp.
66 Spring Hill Rd.
0
ADDRESS North Andover, MA
,�,Budde g Inspector
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