HomeMy WebLinkAboutMiscellaneous - 188 VEST WAY 4/30/2018r_r
�fLib�qy Mutual.
INSURANCE
March 10, 2015
Town of North Andover
Attn: Building Inspector
120 Main Street
North Andover, MA 01845
Re: Property Address: 188 Vest Way, North Andover, Ma 01845
Policy Number: H3521818933170
Underwriting Company: LM Insurance Corporation
Claim Number: 031499608-0001
Date of Loss: 2/14/2015
Attn: Town/City Official
Liberty Mutual Insurance
New England Region Central Property Unit
75 Sylvan Street
Danvers, MA 01923
Tel: (800)566-0323
Pursuant to M.G.L. c. 139, 5 3B, please be aware that a homeowners insurance claim has been made
involving loss, damage or destruction of the above captioned property, which may either exceed
$1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch.
143, 5 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with
Mass. General Laws Ch. 175, X99, if you intend to initiate proceedings designed to perfect alien
pursuant to Mass. General Laws, Ch. 139, 5 3A & B, or Mass. General Laws, Ch. 143, 5 9, or Mass.
General Laws, Ch. 111, § 127B.
This letter should not be construed as a waiver or estoppel of any of the terms, conditions or
defenses afforded by the policy or applicable law.
Please direct your notice to the attention of the undersigned and include a reference to the above
captioned property address, policy number, claim number, and date of loss.
Sincerely,
Liberty Mutual Support
Liberty Mutual Insurance
New England Region Central Property Unit
1-800-566-0323
Location
No. 3 �� Date 'y�
140*y#q
TOWN OF NORTH ANDOVER
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Certificate Occupancy $
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Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ 4/0 i
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Check # ,�;
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Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
r,
BUILDING PERMIT NUMBER: — DATE ISSUED:
SIGNATURE: /►� C
Building 6m- missioner/I ctor of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
Map N tuber Parcel umber
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Required Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
Public ❑ Private ❑ Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
2—®v 0%,e & 1-9,9 V66 7'
Name (Print) Address for Service
Signature Telephone
2.2 Owner of Record:
Wame Print Address for Service:
SiSpature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
4 /,
Licensed Construction Supervisor:
1 � �� � -.7ra��
Address (/c-
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Si nature Telephone
Not Applicable ❑
License Number
Vc 2
Expiration Date
1�/' ;L0 104e
3.2 Registered Home Improvement Contractor
Ur- C -VS A91j-� s� �
Not Applicable ❑
Company Name
_2 C•, (� VY
Registration Number
Address
5-
Expiration Date
Si natu-r6 Tele hone
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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 applicable)
New Construction ❑ 1 Existing Building V I Repair(s) Alterations(s) ❑ I Addition ❑
Accessory Bldg. ❑ I Demolition ❑ I Other ❑ Specify
Brief Description of Proposed Work:
M
I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
OFFICIAL USE ONLY
1. Building
2(a)
F7 �"'�
Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
7
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5)
Check Number m—
SECTION 7a OWNER AUTHORIZAYION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BURDING PERMIT
I, as Own r/Authorized A en f subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
V �
I, C g-, Z - � as Owner/t±HEq 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
Priri
Si � ature o ent Date
,.. 5
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIlVIBERS 1 2 ND 3 RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HE- 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
NORTH ANDOVER BUILDING DEPARTMENT
Tel: 978-688-954
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 properly
licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A.
The debris will be disposed of in:
(Location ofFacility)��"�
IV/- - /
Signa e of Pe Applicant
l9`O3
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for this project
through the Office of the Building Inspector
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