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HomeMy WebLinkAboutMiscellaneous - 191 BRENTWOOD CIRCLE 4/30/2018 (2) 191 BRENTW�o�CIRCLE 21 oiosa.aooas-0000.o Claims Processing -Arnica Scan Center Toll Free: 1-888-70-AMICA PO Box 9690 (1-888-702-6422) �L4S Providence, RI 02940-9690 Fax: 1-888-808-1665 AUTO HOME LIFE April 15, 2015 North Andover Town Offices 120 Main St North Andover,MA 01845 File Number: 60002093511 Date of Loss: 03/29/2015 Owner/Insured: Andrea Kohalmi Street: 191 Brentwood Cir Town: North Andover Type of Loss: Water To Whom This May Concern: Please be advised that we insure the above named individual(s). A claim has been made for Damage to Real Property and as the insurer, we are presently in the process of adjusting the loss. We are mandated to comply with Massachusetts General Laws, Chapter 139 and as such, if there are any present liens on the above property, please notify us within 10 days of receipt of this letter. If we do not hear from you, we will be under no obligation to pay you any portion of this claim. Sincerely, 6T.� 111-19 690"�l Tatiana L. Charlot Claims Department 888-702-6422 x21112 TCHARLOT@AMICA.COM AMICA MUTUAL INSURANCE COMPANY AMICA LIFE INSURANCE COMPANY AMICA PROPERTY AND CASUALTY INSURANCE COMPANY AMICA LLOYD'S OF TEXAS AMICA GENERAL AGENCY,LLC. WEB SITE:WWW.AMICA.COM Claims Processing -Arnica Scan Center Toll Free: 1-800-59-AMICA PO Box 9690 (1-800-592-6422) o Providence,RI 02940-9690 Fax: 1-866-759-3140 AUTO HOME LIFE April 2, 2015 North Andover Town Hall 120 Main Street North Andover, MA 01845-2005 File Number: 60002093511 Date of Loss: 03/29/2015 Owner/Insured: Andrea Kohalmi Street: 191 Brentwood Cir Town: North Andover Type of Loss: Water To Whom This May Concern: Please be advised that we insure the above named individual(s). A claim has been made for Damage to Real Property and as the insurer; we are presently in the process of adjusting the loss. We are mandated to comply with Massachusetts General Laws, Chapter 139 and as such, if there are any present liens on the above property, please notify us within 10 days of receipt of this letter. If we do not hear from you, we will be under no obligation to pay you any portion of this claim. Sincerely, 11141'a� 7-44- Ann Marie Falaki AIC, AINS Claims Department 800-592-6422 x47124 AFALAKI@AMICA.COM AMICA MUTUAL INSURANCE COMPANY AMICA LIFE INSURANCE COMPANY AMICA PROPERTY AND CASUALTY INSURANCE COMPANY AMICA LLOYD'S OF TEXAS AMICA GENERAL AGENCY,LLC. WEB SITE:WWW.AMICA.COM , 3078 /a.&o- � Date. ....... ........ A NORTH TOWN OF NORTH ANDOVER g pE ,,io ,e,ti0 IJ7 3j PERMIT FOR GAS INSTALLATION p m f F i • ,SSACMUSE� M ti This certifies that*.. . . . . . .. . . . .. . ... . .. • • • • • •• • • • • •• • •• has permission for gas installation .�. . . . . . . . . . . in the buildings of . . . . . . . . . . . . .. . .. . ... ... ... at . .rte. -• • • • • • •�• • `� '� North Andover, Mass. C Fee k P. .:.. Lic. No. -! . . . V GAS INSPECTOR l/" WHITE:Applicant CANARY:Building Dept. PINK:Treasurer i MASSACHUSETTS UNIFORM APPLICATIO FOR PERMIT TO DO GAS t (Print or Type) NORTH ANDOVER Mass. Date 2� wilding Location9` i-«t7c�lood Permit R Owners Name jx eK t a-an o • Y New Renovation II ReplacementPlans Submitted D .f FIX-rUgFc h W C p .O N = F ¢ E- r x z c f- su G1 Q to N t- yCj = O � 0. 0 W tI- w < — — F- to N W yj Z V M 4 Q O q > tsa a r- r O Fes- 2 j t- z t-, W w O o ? F W 2 4 W < tL .. F' i- N ' O Z � d N 2 a s a u0. 3 cal .4s U s > SUR—asmT. 1 SASEMENIT 1STFLOOR ZHD FLOOR 3817 FLOOR y I 4TH FLOOR I 5TH FLOOR 6TH FLOOR TTH FLOOR STH FLOOR (Print or Type) Check one: Certificate Installing Company Name ANDOVER PLBG. & HTG. CO. , INCA] Corp. 2122 Address 5732 SO. UNION STREET Partner. LAWRENCE, MA. 01843 Firm/Co. Business Telephone: 978 685-8383 Name of Licensed Plumber or Gas Fitter GEORGE LAROSE Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Q Other type of indemnity = Bond Ej Insurance Waiver: I , the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 17 Agent Q 1 hereby certify that Al of the details and information l have submitted (or entered)in above application are true and accurate to the best of my knowledge and that al! plumbing worst and installations petformed under t'trmit issued for this application will be in eompUaneo with all pertinent provisions of tho Massachusetts State Gas Codc and chapter 14:of the General Laws.- . By TYPE LICENSE: Plumber Title Gasfitter- Sig ature of Licensed City/Town: Master Plumber or Gasfitter Journeyman 9983 APPROVED (OFFICE USE ONLY) License Number 3132 Date ".a:.�7/........ " ppRTq TOWN OF NORTH ANDOVER 4, 0 ?pb•4�.ao ,e 1 � n PERMIT FOR GAS INSTALLATION . ,SSACNUSEt This certifies that r. ..... ... . ...�.. . . . . has permission for gas . •• •• in the buildings o ._. 4 - ?. . . .. ... . . . . . . . .. . . . . .. . .. . . . at ,��f. . . .. . ..:u � :. .: .• ., North Andover, Mass. Fee./4. . .. . . Lic. N0?$1. 33 . .� - .. nP!. . GAS INSPECTOR ,atvg#ftEs5aicant 1UNAR9AABilding Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) J �ORTfI 1�0a c�t2 —. Mass. Date 3119 Permit Building Location Sl?l t179z©c,0 C,r? Owner's Name 4/1�Vicery/of -10 Type of Occupancy New p Renovation ❑ Replacement Ig Plans Submitted: Yes❑ No N • N WN Y Z ¢ v1 N ¢ N ¢ O N S W j N. W O U m �_ _ 'A c� ¢ ►- a a. Z Z o r � Z O U Q ¢ ¢. O O a m N H +7 w O a C 4 ¢ N C7 W < = Z F N 0 > W W W W y W Z < S ¢ Cr W ¢ W ~ W ~ _ cc I= J W > LL F' W -0j N W Q W > = ~ a a O O W ¢ O �1 F- = O 0 t 4=. 7 3 G C J U ¢ > Q a H o BASEMENT • 'P 1ST FLOOR " 2ND FLOOR ' 3RDFLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name 11411,,0/14,1 P4VWI,1611y Check one: Certificate Address fi Da S 7a ❑ Corporation 11g1111?el--e M,#4- D/lpe/A ❑ Partnership Business Telephone 971 ���gSo�` fl Firm/Co. Name of Licensed Plumber or.Gas Fitter 7 Al 1-1*11017.4W INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes L�r No If you have checkedrtes, please Indicate the type coverage by checking the appropriate box. 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's 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.Gas Code and Chapter 142 of the General Laws. Q� By. T of License: Jew, Plumber Signature of Licensed Plumber or Gas Fitter Title Gasfitter 4 Master Ucense Number City/Town Journeyman APPROVED(OFFICE USE ONL Date. ."!�!. .''p 3969 • 01,"ORT:'� TOWN OF NORTH ANDOVER 0 ' PERMIT FOR PLUMBING tsACMU5��5 This certifies that . . . . . . . . . . . ,�-:: . . . . . . . has permission to perform - . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in thp buildings of . ./,1,� . . . . . . . . . . . . . . . . � �� at. . . . . . . :.`. : . . . . . ., North Andover, Mass. F S. .` . .Lie. No::)IJ .�. . . cs C` PLUMBING IN OR 3/2t 15:56 25,('A DRID WHITE`A:G 'K5e56 CANARY2!Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLU ING ' (Print or Type) m _ AIM?T�� 49-40 L't'/C , Mass. Date 3 l 3 19`— Permit# 9� `—� Building Location9/ ��Pr✓�<,uoo �` Owner's Name Ui�t/<� '7 �U�?�.✓o Type of Occupancy New ❑ Renovation ❑ Replacement 0 Plans Submitted: Yes❑ No Z FIXTURES z m z Z Y < y y y y O Z LU LU us W Y J y u -C y O d C C y Z N 6 C Z O Z y G O - W W y F- u C y y W Z r J y Z C a p 4 a < X () Z !t m y W > f y p Q C7 CL a C O W O p rt < ¢ r <W toW Z W S < _ O Z = 3 X a 1- < X < W LL X W < F > F O N y y F' Z O O o V S < < s - _ < < O < J _j < ¢ ¢ a < O < i- a 0' O ;AL a. �J a WL 3: ' ¢I m 0 � - I SUB-BSMT, BASEMENT x IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name 11'4a2'e1;a/ Check one:. Certificate Address R O' /S o r S 7Z ❑ Corporation ❑ Partnership Business Telephone 97,p Fm1/Co. Name of Licensed Plumber '7a�t �/�9�loQ o��✓ INSURANCE COVERAGE: I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes D;� No ❑ If you Have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy 'lam 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 knowiedge 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 Plumbing Code and Chapter 142 of the General Laws. BY � Signature of Licensed Plumber Title Type of License:Master❑ Journeyman G APPROVE p(OFFICE USE ONLI� License Number N° 2 a 9 8 Dat..�a....`..3°... ��....... NORTIr TOWN OF NORTH ANDOVER t p PERMIT FOR WIRING t•�ss^cNus� This certifies that„ .............................. . has permission to perform,:-::�`:�.i . .Z,% ...... ..........�.........:......... wiring in the building of...... .............. ....��............................................. .,North An F� dover,Mass. ....... Lic.No ee� ECrRICAL INSPECCOR 01/04/99 13:34 15.00 PAID WHITE:Applicant CANARY:Building Dept. PINK:Treasurer THE09MM0NWFAL7H0FM4SS4CffVSEM Office Use only DFPARTMENTOFPUBLICS MY Permit No. BOARD 0FFIREPREVENH0NRWUTA710AN5r6912-M Occupancy&Fees Checked APPLICARONFOR PERW TO PEUORM aECI'RICAL WORK ALL WORK TO BE PERFORMED 1N ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 ct�12:00Date ��-�l� 47 _ (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) I f l — 6Db e j Owner or Tenant / Owner's Address Is this permit in conjunction with a building permit: Yes[D No Ea (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead a Underground 71 No.of Meters New Service Amps—Volts Overhead M Underground M No.of Meters �— Number of Feeders and Ampacity k,ocation and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Rot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.o;Dryers Heating Devices KW Locala Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No..lydro Massage Tubs No.of Motors Total HP OTHER L� L;D/l 41� CC/1�E�Z1T 11>SstrarceCo Piasitattbtheteylmaltal��C�realLaws Ihaw aa8a3Liabtil y fiardrxe Policy in±dipg CoaTideOpffabom Cowragecrts abswride4srdiat YES � NO lhatiestb ilbdvaWproafafswciottrOffio,--YES F1 NO If}ouhAedv*WYES,plmeedc*thet}pecfw&aWbydwddngthe WSURANCE ©BOND O11fER M ft=Spa*) ' EgA-atiorrt?a� / E0n*d V"dUeMxM Work$ Wo&%)Stmt l — � " hpeMonD*Re xsWd RD# Final Signadtar]amPl3la)tiesafpczjtey �� &2,6 7cwc FIRMNAME `1�� LixrneNa Lim �D%y/P� /�IfC�6r _ Sim Lio mi b �7 azirtssTCL Na h Z—6262 A J �- 571.4�✓ '�rc� .�I 4 :O/J2/6 AI<TU Na R7 OWNER'SINSURANCEWAIVER;Iamm=tAdxLi se driimrd= oritsaiswU givalartasMimedbyMassadxseMCanalLaws andthatnlyssg made ttlm pxniWpkacimva'%esthis it�nat (Please check one) Owner ® Agent Telephone No. PERMIT FEE$ Location �� Q/s ,u •.- C� No. Date �' MOR7M TOWN OF NORTH ANDOVER 4 ►' 9 Certificate of Occupancy $ •no•�,•� �s E< Building/Frame Permit Fee $ sAC Mus Foundation Permit Fee $ Other Permit Fee $ rd TOTAL $ Check # nil 157 /- 8 (,/ Building Inspectors TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED. �+� M SIGNATURE: Aaw Building Commissioner/InEeector of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel TVuthKr 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.5. Flood Zone Information: 1.8 Sew 1 System; v 1.7 water snpplyM.G.l,.c.ao. sal �Dis>� n D Public 0 Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record Name(Print) Address for Service: i Sign§/cure Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Tele hone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ j Licensed Construction Supervisor: 36 O Z Jam/rsT l�f, �_--//v d h( License RumberMn Ad ss Expiration Date ic Sign;�K 1elephone 3. gistered Home Improvement Contractor Not Applicable ❑ `✓IiJ p nt.) 4• 014 *n /�'Hvv JSF �j.2-rJoKr��i?ooF is p / C mpany Name / 01C IL I 2_ /�t Registration Number r Add ss r Expiration Date z i a Telephone- G) SECTION 4-WORKERS COMPENSATION(M.G.L.C 152 § 25c(6) Workers Compensation Insurance affidavitytGst be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildipf permit. Signed affidavit Attached Yes.......` No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existinly,,Butl ❑ Repair(s) ❑ Alterations(s){,Q❑ Addition ❑ Accessory Bldg. ❑ olition ❑ Other pecify Brief Description of Proposed Work: T,rCd 'goo r'C S`.y �' 1 / G L r 7-"/-/ C- ,S"./ h+GG 4-=� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFCIAI USE-ON)LY Completed by permit applicant 1. Building (a) Building Permit Fee © Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical(HVAC) 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as O-Amer/Authorized Agent of subject property Hereby authorize to act on My behalf,in all maffgq,relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, �.9`lr�o M._7 as OwnerAthonzed Ag f subject Property `"' Hereby declare that the statements and information on the foregoing application are true and accuraic,to the best of my knowledge and belief Y.�o�i•� - 7 ter► ;kik 0 LJr Printe Si atOwn ent Date —�� NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TUABERS 1 2ND 3RD SPAN DIMENSIONS OF SELLS DIMENSIONS OF POSTS DIIv1ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHA1NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH % Town of over o dower, Mass. -D?� COCMICK V > A0OATED PP��.(y S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT Foundation ..................... ........ . fl� has permission to erect........................................ buildings on .1.................. Rough to be occupied as.04A!.. .. Chimney *des ................................................................................................................ provided that the person accepting thll in every respect conform to the terms of the application on file in Final this office, and to the provisions of thBy-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Fina` UNLESS CONSTRUCTION ELECTRICAL INSPECTORT TS Rough .................................................................. s......................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner FIRE DEPARTMENT Street No. SEE REVERSE SIDE smoke Det. i ✓fu:�onzmvnr���z11/t a�.�ladtrzr/uraelta BOARD OF BUILDING REGULATIONS f License: CONSTRUCTION SUPERVISOR, z Number: CS 046636 I Birthdate: 06/02/1948 i Expires:06/02/2003 Tr.no: 10578 Restricted To: 1 G RAYMOND E DAMPHOUSSE JR 75 BUTTERNUT LANES- ! METHUEN, MA 01844 Administrator t �a From: V ✓ / A{/<. /i / jr fS, \/- F ! / / '" s L.rJ ! .�, ! w r �/ J tNiJme) --- Address) To:-DATUM L UMIUM J. AIM SONS 11MG CID,91C., SOX 431 LAWRENCE P.O., LAWRENCE, MASSACHUSETTS 01842 I (we) hereby authorize the Contractor to furnish all materials and I or necessary to instals, construct and place the improvements described below In-on building located at No. City / ,�( dG -t State �j,�� r .1 In accordance with the fol#owing speciflcatlana: ":�: 'r ;� =✓fir _ F�1 .� •/ r ��� c_. �� - r /�;-� 3� ' <.��., %/,+ , ,— ,1� _ i ./ ' ` ( �//�- N :`] < rr .J�:-=i'c�.G ^�. ) � y� �L a� Z : 1 % , /-! ✓= ,C,bOd� 1..-! . �G.."- "Al i 'i ,� GC% r G 1'1,.f'/-I _S1i� L (( i r1�.I1�✓ / J l/•(' ,�:'J © 0 J. S .,/,r_ �..l l r �i �'3 y r' ✓� /'/I.cf' :.�� /.I ✓ .�''✓ /7/GS" o'S�" ry '�' � < -10 All of the above work to be done In a good and workman-like manner. _ All men and souipment Insured. Promises to be left clean upon completion of work. For the total Sum of _ dOltara. Entire Sum to be paid immediately upon completion In accordance with p4n as shown below. TOTAL CASH SELLING PRICE .. ... ..... f DOWN PAYMENT IN CASH . ..... .. . _. DEFERRED BALANCE i J`? ;, 1 +� is) ���2" UPON COMPLETION The ndersigned agrees to keep property mentioned in this agreement properly Insured against loss by fire irtcludtng the Contract 's interest therein. �. Thio,agreement shall become bindinQ only upon the written acceptance hereof by said Contractor, and upon such acceptance ihis shall constitute the entire contract and be binding upon the parties hereto, there being no covenants, promises or agreements. written or oral except as herein set forth. it is the intention of the parties hereto that this contract shall be binding upon;their respective heirs,quecutors,adrnlnistrators, successors and assigns. Customer agrees to pay a reasonable sum as attorney's fees and Court Costs if placed in hands of attorney for collection. The owner further agrees that in event of cancellation of this contract after acceptance by the contractor and before the work is commenced the OWNER agrees to pay 201A of the total conslderatlon herein named as liquidated damages for breach of contract. I � Sold contractor shatl not be responsible for damage or delay due to strikes, tires, accidents, or Other causes beyond his reasonable control. We, the undersigned, certify that we are the sole owners of the property herein described on which said work or repairs are to be performed. IN WITNESS WHEREOF, the undersigned has(have) hereunto set his(their) hand(s)and seal(s) the day and year written above. Accepted ey sband k ND E. DAM OUSSE,JR. AND SONS Wife _ ROOFIN CO.,INC. _--- Mail Address ' � +1r df!'ennr tram�Dovtl gn�4u �nCR THIv I 1