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HomeMy WebLinkAboutMiscellaneous - 19 BOXFORD STREET 4/30/2018 / 19 BOXFORD STREET 210ll06.A 0061-0000.0 i I I I 1 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Insured: Eugene Hunt & Carla Ramos Property Address: 19 Boxford Street Policy Number: HP2519737 I Date/Cause of Loss: 9/20/2010, Animal Damage/Woodpeckers File or Claim Number: 23345-J Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL 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 or file number. Jim Taylor I On this date, I caused copies of this Notice to be sent to the persons amed above at the addresses indicated above by First Class Mail. Signa ure and Date ANDERSON A MENT CO. NC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Inspector 1600 Osgood Street North Andover, MA 01845 RE: Insured: Eugene Hunt Property Address: 19 Boxford Street Policy Number: HP2519737 Date/Cause of Loss: 3/2/2015, Water/Ice Dams File or Claim Number: 31299-W Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL 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 or file number. Wade Anderson On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. 7/010 3-/9-/s - gnature and Date ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 Date....9;77. NORTq + 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING CHUS Et This certifies that .........4r4�7 .............C".. has permission to perform ...... .................................... .................. wiring in the building of...........14Ak=................................................... at............ .................... .North Andover,Mass. Fee....: L i c.No. 1Z.2:,I... i4oiL�EC-TRIC! M i&*-***-**-- 7 Check # 8337 N Commonwealth of Massachusetts official Use ottiv Permit No. j Department sof Fire Service � Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev. 9/05 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL, WORK All work to be performed in accordance avith the Massachusetts Electrical Code(MEC)-527 CMR 12.00 (PLEA.SE PRINT IN INK OR TYPE ALL INFORMATION) Dade: Q exs City or Town of: / ). To the b7spector cif wires: By this application the undersiimed gives notice of.his or her intention to perform the clectricnl work described belo\\-. Location(Street&Number) 9 Owner or Tenant — gI � Telephone No. � _ ' Owner's Address —'S4&-C-- Is � bs this permit in conjunction with a building permit? 'des No ❑ (Check Appropriate Box) ]Purpose of Building geW 6244r1C�/ Utilit-,•Authorization No. Existing;Service ZQQ_ Amps /2.0/ Z-Q Volts Overhead � Undgrd❑ No. of Meters T New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters t Number of Feeders and Ampacitr Location and Nature of Proposed Electrical Work: i Coin leiivn of thy,f�lloit'in�took Inca'be u'aiY•cc>~b1'rlre litc xcnn•of fl7res. No.of Recessed Luminaires No.of Ceil.-Susp.(Padtlle)Fans o.o 06 Transformers XVA No�of Luminaire Outlets f No.of Hot Tabs Generators RWA No.of Luminaires � Swimming]Pool Aare - o.o mer�ency ng r -ud. ❑ 07rnil. _ Batter,Units No.of Receptacle Outlets No.of Oil]Burners FIRE ALARMS No.of Zones No.of SnitchesNo.of Gas Burners o.of Detection and 3 Initiating Devices = o tan No.of Ranges No.of Air Cond. Tons No.of Alerting Devices eat mp ___.unn er onsN-0--o-TS-elf-Contained No.of Waste Disposers Totals. Detection/Alertin Devices No.of Dish-washers Space/Area Heating LKW Loral❑ nxnicYpal El Connection _ No.ofDrvers Heating Appliances )EDW Security Svstems:- No.of Devices or Ft anivi&nt o.of iter IOW 0.0 No.of Data Wiring: Heaters Signs Ballasts No.of Devicesor E air:>lent • No.Hydromassage Bathtubs No.of]Motors Total)ETP 7Celecommuniaitions irin�: No.of Devices or E uivAent a OTHER. ©p .drench ncldirionnl derail rf desired• oras required In rlre 11).specror of JVI,res. Estimated Value of Electrical Work: _ (When required b\ municipal police.) Work to Start: Inspections to be requested in accordance with MEC;Rule 10_and upon completion. INSURANCE O ERAGE: Unless waived by the owner,no permit for the performance of electrical Nyork omit\ issue unless the licensee provides proof of liabilite-insurance including"completed operation-coveraS-e or its substantial equivalent. The undersigned certifies that such caveraSe is in force.and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE K BUND ❑ OTHER ❑ (Specif}:) I eertify,under the pains and penalties of perjuq,that the inlfo rmrdion ore this application is true anti complete. � FIRM NAME: en ;-a an ,1 -2;;Q LTC_NO.:zo/J,2 A Licensee: 43e,? r1a Signature<j9 T LTC.NO.: z.G/40- (If applicable, L'Wer •1'_.—fil Jr in the licetlse nuiiiber line.) Bus.Tel.No.: Address: --reryme Rel. Alt. Tel.No,: W--952-OZO/ Securit< S�stern Contractor License required for this w rk:if applicable_enter the license number here: OWNER'S INSURANCE WAIVER. lam aware that the Licensee does Trot frm e the liability insurance coverage normally required by lase. By m) si nahire below,I hereby waive this requirement. I am the(check one)❑otyner ❑owner-s agent. OycnerlAgent PER-MIT FEE: $ Signature Telephone No. Inti 1 0-3 -- 4 II J ' .` The Commonwealth ofMassachaasetts -Department of uilccstrial Accidents Office of Investigations 600 Mashington Street Boston,MA 07111 Workers' Coampensation.Insurance Affidavit: BLHders/Co-nt--actorsf-'lent--icians/1?lu.nbers Applicant Information Please Print Le!aihlV Name (Business/OrganizationAndividual)= �i�1Q41/k Address: L/, rz^p R( j Ciry/State/zip: �sa4 a>�-7l Phone _ Are you an employer?Check the appropriate box: Type of pro ject(required): 1.❑ 1 am a employer with 4. 0 I am a general contractor and I employees(full and/or part-time)-* have hired the sub-contractors 6_ New construction 2-❑,I am a sole proprietor or partner- listed on the attached sheet. 1 y- Remodeling ship and have no employees These sub-contractors have 8. [❑Demolition working for me in any capacity- workers' comp.insurance_ g_ 0 Building addition [No workers' comp_insurance 5- We are a corporation and its required.] officers have exercised their 10-0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per.MGL 11-0 Plumbing repairs or additions myself.[No workers' comp- G. 152, §1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' - ; comp_insurance required_] 1311Other "Any applicant that checks box##1 must also fill out the section below showing their workers'compensation policy information_ r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new'affidavit indicating such_ zContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policyinformation d am an employer tlzat is providing workers'compensation insurance for my employees_ Below is tl:e policy,and job site i�zformation: '�pp' i Insurance Company Name: Policy#or Self-ins.LLic.#: �5(0 0(�tt3 - 2/� C'7 a--&-p�' Expiration Date:_ . Job Site Address: ! esu—d City/State/Zip: a­" 47��„�r s 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 e. I52 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 WORT{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 fq insurance coverage verification- 1 do hereby certify under the pains and penalties of perjury that the inforrnation provided above is trite and correct_ Sienatur �� Date: Phone#: 9 �- UfJ Official use only. Bo not write in this area,to be completed by city or town official `I � I City or Town: Permit/License 9 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other �� ,� it r Date NOR, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING . i . ,SSACMUS� - This certifies that . . . . . . . . .! . f. . . . . . !t.l�. . . . . . . . . . . . . . . . has permission to perform . . . . .(?lky k4 -i• .: r . plumbing in the buildings of JL7 . . . . . . . . . . . . . . . . . . . . . . at. . r.p-y.f=C.AA. . . . . . . . . . . . . . , North Andover, Mass. Fee. .'/. . !. . . .LIC. No.. .f.?. . . . . . .if``,.: .���-^'` ,r--171. . . . . . . . PLUMBING INSPECTOR Check # 3 L 3 f 7822 - D � = - rn ic OR e� Z � e� A a s a �. u a .• N N , �F $ Mgt R � .� x s s r. r r G r0 N n oi' T' m oo o o O o 0 o 0 -4. -j 0 IL 0z rn. N a N z z 2 a 9 N ❑ WATER CLOSETS .3. r KITCHEN SINKS (/ o. � N LAVATORIES 0 ? to BATHTUBS - 39 -� �+ 3 SHOWER STALLS $ DISHWASHERS 3i 3 DISPOSERS $ O " 0) _ LAUNDRY TRAYS 'W — C WASH.- MACH. CONN. �'' o i g NOT WATER TANKS D TANKLESS C• �. Z SL ❑ SLOP SINKS 21 s� FLOOR DRAINS ❑ � 73 OAS TRAPS 'W m �, O ❑ � URINALS $, a �0 m ❑ ❑ g 7f ¢ DRINKING FOU14TAIN 1i r ii AREA DRAIN �i ❑ 0 7C WATER PIPING C -0 O. .. Z ROOF0 g� DRAINS �., �. O• a,, 3* ❑ BACKFLOW PREY. g 1 Q, OTHER FIXTURES: .� C 1� f r {� -+ Date.o. ✓. ./..1..� 1260 i NORTH ° TOWN OF NORTH ANDOVER °G p PERMIT FOR WIRING CHusf F t; This certifies that .... &.......��.�R h �...5................................................ ,I has permission to perform ' ...... ii Q...... ............�...... wiring in the building of...Q_G.`z. �....ak ill.t)S....... I .. ....'? .....1.!.Ht?.... at......q...... ............................ .North Andover,Mass. Fee.....?ti,1..l1..... Lic.No..G��y. .' 1.............................................................. / ELECTRICAL INSPECTOR t�nn������//qq�� 50,00 PAID WHITE:Applicant CANAfi�f*.4?iitiing9dept. PINK:Treasurer ... � r .. .. .... .. _., .. .. J r � ... .. .... i Of1bs Use 0*VC UMMIUmalth of + ii � ✓� G . i Permit Eptutint ti of 'Public 96ttfciq Occupancy A Fera ctucMd BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 Peaty blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacnusetts Electrical Code, 527 CMR ] .00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Oats O OW or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) g Do k/pi e Owner or Tenant �i�+ P/C)S ,I- Owner's Address Is this permit in conjunction with a building permit: Yes _ No / (Check Appropriat Purpose of Building _ ,l�f�C/ Utility Authorization Existing Service Amps —J Volts Overhead ! Undgrnd a No. of Meters New Service L? Amps J/ r -_3�/otts Overnead 77_ Unagrna C No. of Motors I . Number of Feeders ana Ampacity ,4 77 Location and Nature of Proposed Electrical (Nock Sary 44F_ (:t_ i n.. No. o1 Lighting Outlets I No. of yot ':-s Total KVA No. of Transformers ransformers KVA No. of Lighting Fixtures i Swimming P^oi Aocve.— In. f— grro. _ grnc. ( Generators KVA No. of Emergency Lighting No. of Receotacts Outlets I No. of Oil Eurners I Battery Units No of Switch Outlets I No. or Gas :--urgers FIRE ALARMS No. of Zones No. of Ranges I No. ct Air C.:r.c. iO1ai No. of Oetection and i :cns Initiating Devices No: o) Oisoosals I No.of Heat To:ai ,otai Purr cs :ons Kt'✓ No. of Sounding Devices No. of Dishwashers No. of Sell Contained SoacerArea �+eatir.a ic`'✓ Oetection/Sounoing Devices Y No. of Dryers I Heating Cevices KWLocal - Municipal Other Connection ' i No. of N 31 Low Voltage ; N0. of Water Heaters KW I Signs ea lass Wiring ' No. Hyoro Massage Tubs I No. of Moicrs Total HP [. OTHER: INSURANCE COVERAGE. Pursuant to the reou,rements at '.tassac-.users ;eneral Laws l'I: a.� I have a current Liaoility Insurance Policy incluoing Com_-:etec Ccerations Coverage or its substantial equivalent. YES — NO — 1 have au0mltted valid proof Of same to the Office. YES = NO _ If you nave checked YES. please indicate the type coverage by 4 ' 1 hg the ipprbpfiate OOic. INSURANCE - w _ INSURANCE � 80"0 = OTHEFj( _ (Please Scec:t-w) Estimated Value of E!ectncal Work S / (Excitation Dalai Work to Stan Insoecaon Dale iacues:ec: Rough Final Sighea unser the Penalties f 'W FIRM NAME Sry. v' e S.t����-- UC.NO. ��-� 4censeI, y; Sig^azureCZ / Addreia a� �jG<�Q w /� Bus. Tel. No t Alt. Til. NO. i• OWNER'S l SURANCE WAIVER: I am aware that the u:censee toes roi nave the insurance coverage or its sucistahtial equivalent as re-, quireq by Massacnusetts General Laws. ano that my signature on :his z-ermit aoptication waives this requirement. Owner Agent (Plea"check oner 'eieonone No. PERMIT FEES i - (Signature of Owner or Agenn Date. No 4. 6 t 9 TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING ,SSACHUS This certifies that-...�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . plumbing in the buildings of -X411--fk 7- .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . ./. . . 1<1 . . . . . .. . . . . . .. North Andover, Mass. - ��j5 '; Fee-?f. . . . . . .Lic. No:. . . . . . . . . . ..... .. . . . . . . . . PLUM914G JNSPECTOR Check # / /) /-/ WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING Mx {Print or Type) _, mass. Ewe� _l,9� permit # Building Location-2--?_ Q,� �% Owners Name A47Type of t 5 17 E ti It r'I L_ New El Renovation ❑ Replacement 27"" Plans Submitted: Yes❑ No ❑ FIXTUR z 29 P _ 29 Z F M O 2 �' > I W W M W C x a: Z 0 W Z ~ < W H Z C 4 V = O W S Z < W a o < a z . G. O N r' IL= Q Q M = Z W �' 39 O t9 W 3 m a c 3 x o o < s m o Sue—&$MT. BASEMENT IST FLOOR 2ND FLOOR SRO FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company NaCheck one: Certificate Address CO AC 14 mtu) A A.j ❑ Corporation -- _ al E i 4 !6 1_ M A 01T ❑ Partnership Business Telephone �� L-i97 1 CirmJCo. Name of Licensed Plumber •Zf`r3Fe7' SA�ytrY1,4 tr4�" INSURANCE COVERAGE: I have a currentjWIty insurance policy or its stlbstardial equivalent which meets the requirements of MGL Ch. 142. , Yes a No ❑ If yod have checked yo. plem indicate the type coverage by decking the appropriate box A liability Insurance policy lel Other type of Indemnity ❑ 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: Owner ❑ Agent❑ 'gnature o Owner or 's rat 1 hereby OMW that ad of the details and information I have sulmOnd for entered)in above application aro true and accurate to the best of my taNations knowledge and that all plumbing work and inswm r UM permit• for this application vaN be in compliance with all pertinent provisions of the Massachusetts State rhmnp6gtow and of the Laws. 3@50m—of Ljmnm By u Title Cityrrown Type of License: Master gam/ Joumeyrnib❑ License Number q3 3 5 BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES- PROGRESS INSPECTIONS FEE i NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME i TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED ` DATE 18 PLUMBING INSPECTOR r MASSACHUSETTS UNIF40RNI APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NORTH ANDOVER Mass. Date t3uilding Location ,/ a-+� �� �T Permit � -?`� U •r Owners Name • New 77 Renovation Replacement iK Plans Submitted L] c U3 us us GIQ p! cm o ut 2 to y i W ur C o. CC W d N C VI � = to < G C A ,u m j < _ c _ u1 c ut r" to r _ csur c a � a t- '� ..tIwW c ' a ccs W < o o L6 } o .1 v o. t- o t u+ o ut t= BASEm. ExT I I I I I I I1 I I I I1 I{ I I I ! I I I I I I I 'IST FLOOR —NO FLOOR 13811 FLOOR 4TH FLOOR STH FLOOR I I I I I I } ( ( I I I I ! I I I I I I I I I 6TH FLOOR 7T)i FLOOR STH FLOOR I I I I I I I I (Print or Type) Check one: Certificate Installing Company Name Corp. Address Partner. Firm/Co. Business Telephone: Name of Licensed Plumber or Cas Fitter Insurance Coverage: Indica--e :tee type of insurance coverage by checking the appropriate box: Liability insurance policvOther tvpe of indemnity = Bond Insurance Waiver: 1 , the undersicned, have been made aware that the licensee of this application does not have anv one oc the above three insurance coverages. Signature of ownerlagent or property Owner = Agent Q !hctcby certify -hat all of the details and information 1 have submitted (or entered)in&Love appfieation are true and accurate to the best of my E.iowtedse and Mat stl plumbinit wort and tnutslS&tionsps d under ft-rmit iuu d Co: this appse3tioo will be to eompiiancs with an peztiaest provisions of rho Massar-husetts State Gar GCsde and uptc taZ ei tSe Gcncai Laws. By TYPE LICTNSE- 1 Plumber Title 1 Gas�itter ignature of iricensed City/Tcwn- 1 Master plumb or Gasfitter Journeyman APPROVED (OFFICE USE ONLY) License Number Date.. . .. . . . . .. .. ... . . v� OE NORTs4 3� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 9 SACMUSEtS This certifies that . . . . . . . . . . . . . . . . . . . has permission for gas installations in the buildings of -• 7. .,.J. . . . . .. . . . . . . . . . . . . . . . . . . . . at . .' . :. - .' --- . - . . . . . . . .. North Andover, Mass. `"Fee:fr . . . . . Lic. No. . . . . . . . . . . . . GAS INSwii' OFi Check# 44117 2 - 3 To 2134 Date. . . . ... .. ..... �6,.... TOWN OF NORTH ANDOVER oE,,�to Sao PERMIT FOR GAS INSTALLATION �9SSACeHUSEt A This certifies that . . . . . . !. . �. . . .. has permission for gas instal i�o�n/ . . . ��11LL . .. in the buildings of .I . . . . .J.7. ... . . . . . . . . . . . . . . at . ... . . . . . . . . ., North Andover, Mass. co Fee.—? Lic. Noa.,D. . . . . . . . . . . . . .... GAS INSPECTOR WHITE:ApplicantCANARY:Building Dept. PINK:Treasurer GOLD: FII Mass. Approval # MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or T , Mass. Date 3 Permit# Building Location rT?C Owner's Name Type of Occupancyos New Renovation ❑ Replacement ❑ /Plans Submitted: Yes ❑ No ❑ lug Y— FIXTURES c0 W 03 GQ oocccc Go cc0 CC C6 z = N �-1 v� °C P cc O wz = = ¢ OC mW W 'C = z {� �a cc 0 0 0 W Cr CIco O CCCC W 0 M ~ � F � 00CC c Z � Pz � � wOt� Q � W -jGO � = ILLI CC CC ddOOW0 Lr = OC� _ � � c� (� � OOCoa � O SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Check one: Certificate Installing Company Name YANKEE GAS Q Corporation 1 0 3 C Address 140 SOUTH MAIN ST ❑ Partnership MIDDLETON, MA 01949 ❑ FimVCo. Business Telephone 978-774-2760 Name of Licensed Plumber WILLIAM R. HARRIS INSURANCE COVERAGE: I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes§I No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy R Other type of indemnity ❑ 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 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 the Massachusetts State 77W27/-- 3 of the General Laws. By Type of License:❑ PlumberTitle Gasfitter City/Town 0 Master Signature of Licensed Plumber APPROVED (OFFICE USE ONLY) 0 Journeyman License Number_ 3785 Y