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Home My WebLink AboutMiscellaneous - 19 FERNCROFT CIRCLE 4/30/2018 (3) BUILDING FILE • Date.. 29112 °°"0 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING �,SSACMUSES This certifies that ........r ........;1............................................ has permission to perform ......./f.. ............ .................. wiring in the building of...... ........................................................... at.... ............. .North And .... .. ... . .. .... Fee...Z, -K)J. Lic.No.1.1al.ir........ ...A= I ..... .... ...... cq��R ICAL INSPECTOR U 03/14/96 12:03 35.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File Only„ The Commonwealth of Massachusetts0::(ce Use -(_J/`/► � �� Permit go. Department of Public Safety Occupant) S Fee Checked BOARD OF FIR&PREVENTION REGULATIONS S27 CMR 12-00 3/90 (leave plant) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be pctiormed In accordance with the Massachusctu Electrical Code. S27 CMR 12:00 (PLEASE PRINT IN = OR TYPE INFORMATION) Date a 0a) 9 City or Town of To the In;pector of Wires: The undersigned applies for a'permit to perform the electrical work described below. Location (Street & Number) i 4 Circuit moo Owner or Tenant 1 LWrm Owner's Address Is this permit in conjunction with a building permit: Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization NO. Existing Service Amps / Volts Overhead [—] Undgrd❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work LOW VOLTAGE ALARM SYSTEM No. of Lighting Outlets No. of Transformers Total No. of Hot Tubs KVA No. of Lighting Fixtures Swimming Pool gmde❑ In- No. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Batte Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zonas Total No. of Detection and No. of Ranges No. of Air Cond. tons Initiating Devices No. of Disposals No. of Heats Tons tal Total No. of Sounding Devices PumpNo. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices No. of Dryers Heating Devices KW Local nilunicipal icipaln[:]Other No, of No. of I r w Voltage: Burglar 0 Fire No. of Water Heaters KW Sixns Ballasts W Car fl AcceSS = CCTV No. Hydro Massage Tubs No. of Motors Total HP OTHER: - 5 199 INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES S NO ❑ I have submitted valid proof of same to this office. YES❑ NO ❑ If you have checked YES; please indicate the type of coverage by checking the appropriate box. INSURANCE El BOND ❑ OTHER ❑ (Please Specify) ROYAL INSURANCE COMPANY 10/8/96 Expiration ate Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME Security Systems Inc. d/b/a Sentry Protective Systems LIC. NO. 1109C Licensee JAMES W LEES Signature >' LIC. NO } Address 110 EWRENCE STREET MALDEN MA 02 Bus. Tel. No.61 7-3R8—A700 Alt. Tel. No 800-445-4505 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S ay �(3 Signature of Owner or Agent Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings N Andover MA 10845 To: Board of Health or Board of Selectmen N Andover MA 01845 RE: Insured: Flynn Property Address: 19 Ferncroft Circle + , b , A n 11W Policy Number: HP1562747 Date/Cause of Loss: 1/20/11 Ice Dam TOHEAQFNOETH PARTMEPITR File or Claim Number: BOS48458 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. BOS48458 On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. / Signature an Date NEW ENGLAND CLAIMS SERVICE, INC. 131 DODGE STREET, SUITE 6 BEVERLY, MA 01915 Date/* .//.... .... WOR7M of, ,ti o? '` TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION S SS CH This certifies that . D40. . i.frs has permission for gas installation in the buildings of . at . .� c!!?�'!?? C:t . . . . . , No1�*h/Amdover„Mass. Fee. .ZS:oa Lic. No.zS!4f!�i� GASINSPECTOR`~`%r � Check# //5/Z.5` 7852 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING 07, City/Town: •'IaY/�9 /y'l2tp�31�/ MA. Date: 10-13"1/r Permit# Building Location: 19 4--K e �6'C/.*GAA Owners Name: Type of Occupancy: Commercial❑ Educational ❑ Industrial ❑ Institutional ❑ Residential ($� New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes❑ No❑ FIXTURES W Z Cd O M 2 0O W W V N H O = W W z 1- z o W w lx W O 0 w N w m 0 w 0 a H N v Z N t7 ~ w 0 a W = X W I— IlJ W N W Lu l G LL > U W Z O J F— H O Z -� (7 �- I.N. = W W W c°� o o 0 0 _ = g o 0a �a W > > > 0 ' SUB BSMT. BASEMENT VO 1 FLOOR 2 ND FLOOR 3 FLOOR 4 Tm FLOOR 5 FLOOR 6 FLOOR 7 Tm FLOOR 8 FLOOR Installing Company Name: �� Check One Only Certificate# - 'E c�� 9= r ❑Corporation Address:_64:!;-� tw City/Town: & State: [I Partnership Business Tel:��/(�p'� Fax: )Firm/Company Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes❑ No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy P'. 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner Signature of Owner or Owner's Agent Agent ❑ By checking this box❑;I hereby certify that all of the details and information I have submitted(ore d)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed u r the rmit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chap r 142 of t General Laws. Type of License: ey El Plumber Title ❑Gas Fitter J;:�ature�Unsed PI ber/Gas Fitter ❑Master Cityrrown Journeyman License Number: APPROVED OFFICE USE ONLY) ❑LP Installer 9 1 4 3 Date TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 40 , o ,SS^CMUS� This certifies that has permission to performF�f. . . . . . . .�? . . . . . .. ..rGs plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at. 4.. . . . . ., North Andover, Mass. Fee�� U.Lic. No. !/ PLUMBING INSPECTOR Check # i 1 I all MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMjNo City/Town: 1&r7 tl ,�tW4AOW- MA. d Date`:�p Permit# Building Location:_ �� C`�7` �1�'Cl owners Name: Type of Occupancy: Commercial[❑ Educational❑ Industrial❑ Institutional New:❑ Alteration:❑ Renovation:❑ Replacement: Plans Submitted: FIXTURES DEDICATED LU Z SYSTEMS 2 z � 0 j Z O N a a Z FQ- Q U I.N.. w ❑ ❑ cn Z Q Q w (7 cr Z a O m it in } w Q y O i a h N vdi w IW ❑ ❑ Q Q m mF Oa Q]w V S O U Z a 00OS O O _Q c2nQ Q LL = .dda 0 Q [C Q Q Q I= ❑ N w Q Q -SUB BSMT. BASEMENT ,IT FLOOR 2"D FLOOR .� 3RD FLOOR 4'FLOOR Sr"FLOOR e FLOOR 7r"FLOOR 8r"FLOOR If7Si C31 =? Cr O:! • C:- ;f�` - r }�• ❑Corporation Address ��y 4ty/Town: te Star 7 Business Tel:'�D) �Z El Partnership Fa irm/Company Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes❑ No❑ If you have checked Yes,please indicate the-type of coverage by checking theappropriate box below. A liability insurance policy. 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 Massachusetts General Laws,and that my signature on thisermit application ppllcatlon waives this requirement. Check One Only Si nature of Owner or Owner's A ent Owner El Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)regarding f ' lication are true and accurate to the bast Of my Knowledge and that all p!!mLing t:erk and Instalfat;o,�s performed under the permit i�ss� or this plication will be in compliance with all Pertinent provision of the Massachusetts Slate Plumbing Code and Cha o42"f4he en ai Law . iy Type of License: 'itle ❑Plumber Signature icens Plumber ity/Town ❑Baster � _`/L PPROVED(OFFICE USE ONLY) ourneyman License Number: 7 COMMONWEALTH OF MASSACHUSETTS LICENSED AS A JOURNEYMAN PLUMBE, : ISSUES THE ABOVE LICENSE TO: i DANIEL DRIGGERS 655 MAIN ST HAMPSTEAD NH 03841-204 24644 05/01/12 78330 The Commonwealth ofMassachusetts Department oflndustrid(Accidents Office of Invesfigationg 600 Washington Street Boston,MA 02111 yY ` www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/EIectricians/Plumbers A licant Information Please Print Legibly Name(Business/Organizatioivhdividual): Address: < < City/State/Zip: z [am an employer?Check the appropriate box: a employer with 4. ❑ I am a general contractor and I Type of project(required): loyees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction a sole proprietor orpartner- listed on the attached sheget. t 7• ❑Remodeling and have no employees These sub-contractors haveing for me in any capacity. workers'comp.insurance. 8' ❑Demolition workers' comp.insurance 5. ❑ We are a corporation and its9 ❑Building addition ired.] .officers have exercised their lo.❑EIectrical repairs or additions a homeowner doing all work right of exemption per MGL 11.N Plumbingrepairs or additions lf. [No workers' comp. c.152,§1(4),and we have no ance required.]r employees. 12•❑Roof repairs [No workers' comp,insurance required.] 13.[:]Other *Any applicant that checks box#1 must also fill out the section below showing their workers'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. tContractors 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showingthe 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do Izereby certify r7l s and a Ittes o , P r fperjury that the information provided above is true and correct. Signature- O _71 el Date: ?none#: Fonly. Do not write in this area,to be completed by city or town offrciaZ n: Permit/Licenseority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electric 6.Other al inspector 5.Plumbing Inspector Contact Person: ' 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 apartinents 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 ofpublic 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 Depaitment 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 for 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 Colnomoriwealti1 of l assacijsetts Depaztmew of ladustriai Accidents Office of Investigations 600 Washington Street BostQn;MA,02111 TO.#617-727-4900 ext 4406 ox 1-877,M SSAFE Revised 5-26-05 Fax#617-727-7749 Www.mass.l;ovfdia 15 d Date .a.".. ..�...�.. HORTI{ TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SSUS This certifies that ....... +.s .............. .......... '� ,�-�l•,,, �2 has permission to perform ....... ...................................................................... wiring in the building of.. f..Gf/1 h.......l i?e4...�...(,!". 7-1 t u. .- j at ......,t-�' Lc.�O f.................. North Andover,Mas Fee..... . Lic.No. ....��j..�...�........... .. . . .. . . .. Ec n[ IN croR Check # I �"3S Common-wealth of Massachusetts Official Use Ouly /� Department of Fire Services Permit No, 1 �j �p Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR12.0 (PLEASE PRINT INWK OR TYPE ALL INFORMATION) 'Date: City or Town of: V - (/A� To the Inspector o fres: By this application the undersigned gives notice ofbis or her intention to perform the electrical work described below. Location(Street&Number) JU , r Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a b 'ding pe 't? Yes No ❑ (Check Appropriate Boz) Purpose of Building 1 Utility Authorization No. Aper Existing Service Amps / )7-L Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters r .. Number of Feeders and Ampacity Location and Nature of Proposed ElectriWork: ou c 14 Completion of the following table may be waived by the I ector of Wires. No. of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- E] o. o mergency g g d. d Batte Units No. of Receptacle Outlets / No. of Oil Burners FIRE AT,ARMS No.of Zones No. of SwitchesNo. of Gas Burners No. of Detection and ' Initiating Devices No. of Ranges , No.of Air Cond. Total No. of Alerting Devices Tons g No. of Waste Disposers Heat PSP lNumber Tons KW No. of Self Contained Totals: Detection/Alerting Devices No, of Dishwashers Space/Area Heating KW Local [3 Municipal ❑ Other Connection t No. of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or E uivalent No.Hydromassage Bathtubs No. of Motors Total HP . Telecommunications Wiring: No.of Devices or Equivalent OTHER Anach additional detail if desired,or as required by the Inspector of Wires. 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 coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of El •cal Wor 20, 4�Jhen required by municipal policy.) Work to Start: Inspect ons to be requested in accordance with MEC Rule 10, and upon completion. I certify, under epains.ndpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: Q, (r- 1--P-,J l,� r t c Cc, ,l I^C- LIC.NO.: `7 9 Licensee: U OSD o it Signature LIC.NO.: (Ifapplicable, enter "em t"in the license number line.) Bus. Tel.No.: �� ' i'�7 Address: �2 CJ G h /'�.e ,O Z �`'j�� d �c��4—j' Alt. Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ 1 V ADDRESS �ze2in.i.t nttm$E�r. . +7O i xz� N m � is • r The Commonwealth of Massachusetts t Department of Industrial Accidents Office of Investigations uq� 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Le ibl Name(Business/Organization/Individual): Address: P. a , � 2 laaa FFF City/State/Zip: C145!6 hone#: Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors _ 2.❑ I am a sole proprietor of partner- listed on the attached sheet. * ?•>�Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp.insurance 5. We are a corporation and its IMNrequired.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doingall work right of exemption per MGL 11. Plumbing repairs or additions P P ❑ g P myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp. insurance required.] t *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation 0olicy information. t 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 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 tine 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. 1 do hereby certify under the pain mndpeg sof perjury that the information provided above is true and correct. Signature: >� Date: '/ G Phone#: s1 -7 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: t TOWN OF NORTH ANDOVER Office of the Building Department o` �►ORT►y Community Development and Services 0 1600 Osgood Street, Bldg. 20,Suite 2035 0 ti A North Andover, MA 01845 �.9 p�gATED SPP`,(5 SSACHUS Gerald Brown, Inspector of Buildings October 29, 2015 To: Gerald and Camille Flynn From: Gerald Brown Re: 19 Ferncroft Circle Dear Mr. and Mrs. Flynn, Per our conversation today regarding the second stove in your home,you verified that the stove has been in its current location since 1969. Due to that fact the second stove satisfies a grandfathered condition. The residence is a single family home which reflects the assessor us code of 101—Single Family Residence. Sincerely, Gerald Brown Inspector of Buildings • s � iZilii � iiZii ��7 � c�li � ►Z � �o��l�s s� TOWN OF NORTH ANDOVER 557�u��3 Office of the Building Department NORT{j q Q �tLED ,6 .y Community Development and Services t6 OO - p 1600 Osgood Street, Bldg. 20,Suite 2035 North Andover, MA 01845 7� DAA7ED�.PP,`.�5 S . CHUb Gerald Brown, Inspector of Buildings September 14,2015 To: Gerald and Camille Flynn From: Gerald Brown ` Re: 19 Ferncroft Circle -j; Dear Mr. and Mr nn, 1'5obse�rvedj*lkanaccessor, � I visited the above property on September 14, 2015U I kitchen located in the basement of the propertyw4ifh has been a part of the building for many years The residence is currently being use as a single family home which reflects the ass or use code of 101—Single Family Residence. Sincerely, � rs Gerald Brown Inspector of Buildings i MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston,Massachusetts 02108.1904 (617)723-3800 Ma Only(8001392-6108,FAX(800)851-8424 2/12/2015 Form of Notice of Casualty Loss to Building Under Mass.Gen.Laws,Ch.139,Sec.313 NORTH ANDOVER BUILDING COMMOSSIONER NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 Re: Insured: GERALD FLYNN AND CAMILLE FLYNN Property Address: 19 FERNCROFT CIRCLE,NORTH ANDOVER, MA 01845 Policy Number: 1311910 Type Loss: Ice Dams Date of Loss: 02/0712015 Claim Number: 329848 Claim has been made involving loss,damage or destruction of the above captioned property,which may either exceed$1000.00 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. MPIUA Claims Division CMA00021 } NEW ENGLAND CLAIMS SERVICE, INC. Incorporated 1985 F-1 Reply To Reply To Mansfield, MA 02048 131 Dodge Street,Suite 6 P.O. Box 345 ASSOCIht Beverly, MA 01915 TEL. {508}337-8058 u`Sf ` TEL. {978}927-3000 FAX{508}339-5835 FAX{978}927-3002 wrandall@newenglandclaims.com Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec 3B To: Building Commissioner or Inspector of Buildings City Hall North Andover, MA 01845 RE: Insured: Flynn, Camille&Gerald B. Property Address: 19 Ferncroft Circle Cause of Loss/Date: Water 2/11/2014 File or Claim No: BOS052074 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. Section 3B. No insurer shall pay any claims (1) covering the loss, damage, or destruction to a building or other structure, amounting to one thousand dollars or more, or(2) covering any loss, damage or destruction of any amount,which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code,to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to payment the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to y section nine of chapter one hundred and forty-three,or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending;provided,however, that said proceedings are initiated within thirty days of receipt of such notification. Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall extend to and may be enforced by the city or town against any casualty insurance policy or policies covering any loss, damage, or destruction pursuant to which the proceedings to perfect the lien were initiated. No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other interested.party for amounts disbursed to a city or town under the.provisions of this section, or for amounts not disbursed to a city or town under the provisions of this section. Paul A.Dionne General Adjuster 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. ASat,ure Date Columbia Gas- of Massachusetts A NiSource Company 995 Belmont Street January 2,2014 Brockton,MA 02301 Mr. Gerald Flynn 91Z19 Ferncroft Circle North Andover,MA 01845 Dear Customer: During a recent visit, our service technician detected a safety problem with your gas heating system located at 19 Ferncroft Circle North Andover,MA 01845- sooted boiler. Accordingly,we have issued a Warning Tag because of this situation. Under the circumstances,we strongly urge you to correct the code violation. In addition, the Massachusetts code pertaining to the installation of gas appliances and gas piping, established under Chapter 737 Acts of 1960 requires that the condition be remedied. P > q If you have any question,please call our Service Department at 1-800-677-5052 and ask to speak with the Service Supervisor. Please disregard this notice if the condition has been corrected. Sincerely, Customer Service Department Columbia Gas of Massachusetts