HomeMy WebLinkAboutMiscellaneous - 20 LACONIA CIRCLE 4/30/2018 (2)0
CIOL
CUSTARD
INSURANCE ADJUSTERS
4/23/2015
Gerald Brown
Inspector of Buildings
1600 Osgood Street
Building 20, Suite 2035
North Andover, MA 01845
Claim Number:
Policy Number:
Company Name:
Date of Loss:
Insured:
Property Location:
033579665
00898400004
Arbella Mutual Insurance Company
3/24/2015
Anne Harrold
20 Laconia Cir
North Andover, MA 01845
To Whom It May Concern:
Claim has been made involving loss, damage, or destruction of the above captioned property,
which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6,
to be applicable.
If any notice under Massachusetts General Lav, Chapter 139, Section 3B is appropriate, please
direct it to the attention of the writer. Kindly include a reference to the captioned insured,
location, date of loss and claim number.
Very truly yours,
Arbella Mutual Insurance Company
PO Box 699225
Quincy, MA 02269
CC: City/Town Fire Dept, City/Town Health Dept
a
No
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Date.. ...�......... 'l.
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that
.............................................................................................
has permission to perform ...:...:.........
...............................................................
wiring in the building of ......... :......... :...................................................
at..................................:............�.:.:......................... , North Andover, Mass.
Fe/ ........... Lic. No ............. ..............................................................._�..
," ELECTRICAL INSPECTOR
Check
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
T1EC0M110NWEi L7H0FA14.MCIR1S M Office Use
only
�
DEPARTAfflW 0FPUBLIC&4FM Permit No. C7TV
BOARDOFMEPREVEM70NREGU ATIOASS270912:QD
RA
Occupancy &Fees Checked
PPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 !� /� /
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dates 15
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
To the Inspector of Wires:
Location (Street & Number) (2U
Owner or Tenant /' yr 0.,
Owner's Address .�su • ��_,�„�,
Is this permit in conjunction with a building permit: Yes ® No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service -A-Ah Amps1� olts Overhead � Underground a No. of Meters �O�I
New Service Amps` Volts Overhead r--1 Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
Swimming Pool Above
Below
Generators
KVA
ground
1:1ound
No. of Receptacle Outlets
No. of 0il Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS
No. of Zones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
'No. of Disposals
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
LocalMunicipal
Other
No. of Dryers
Heating Devices KW
Connections
No. of Water Heaters KW
No. of No. of
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER'
htst.rartoeCo Pt>tsuattothetaqu6anar$�Tv(GataalLaws
Ihawaauatliabkyh>,stm=Pohcyerhtt*CaVi&CmeraWcritssi ecg.uvalad YES NO
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Signed utxier�ie P�'Ialtres afpejtey:
FIRMNAME Lica�seNa
Lioa see �/ 0, 0/signa�ne Ii isb �36 S / 7
acirmTeLNa
Addte,s._...,��,� �., AIt Td Na
OWNER'SRg1JRANCEWA1VFR;IamawarelhattheI doesnot Laws
ands nTysigcWncnthispar *Wphcmmv"'.ts h mw'ffmut
(Please check one) Owner M Agent
Telephone No. PERMIT FEE $ �
*MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
i
WnVE r , Mass. Date 19-91—
> Building Locatlon ego La Go N t &- % r; c, i 2 _Owner's Name L a /Lt a N0.
Type of OccupancyleadP!J e
G
New ❑ Renovation ❑ Replacement Co/ Plans Submitted: Yes[] No ❑
Installing Company Name JOHN HICKEY
Address 57 Franklia rurept .
STONEHAM, MpASSACHUSET79 02189
Business Telephone +31-1.i b �O
Name of Ucensed Plumber or Gas Fitter r �� i /�+ M 0.4 -(AC
Check one:
IH' Corporation
❑ Partnership
❑ Flrm/Co.
Certificate
MOA c
INSURANCE COVERAGE:
I have a curreptt bll ty Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes LTJ No ❑
If you have checked yS, please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy b3l" 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 Zol 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
knowled a and that all plurbin work and installations performed under the permit Issued for this application will be In compliance with all
pertinent provisions of the Massachusetts Slate Gas Code and Chapter 142 of the Gene 1 Laws. p
BY T of Ucense, ,
Plumber gna ure o cen "or er
Title I Gastitter
aster license Number M q S( �O
( it /Town Journeyman
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Installing Company Name JOHN HICKEY
Address 57 Franklia rurept .
STONEHAM, MpASSACHUSET79 02189
Business Telephone +31-1.i b �O
Name of Ucensed Plumber or Gas Fitter r �� i /�+ M 0.4 -(AC
Check one:
IH' Corporation
❑ Partnership
❑ Flrm/Co.
Certificate
MOA c
INSURANCE COVERAGE:
I have a curreptt bll ty Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes LTJ No ❑
If you have checked yS, please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy b3l" 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 Zol 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
knowled a and that all plurbin work and installations performed under the permit Issued for this application will be In compliance with all
pertinent provisions of the Massachusetts Slate Gas Code and Chapter 142 of the Gene 1 Laws. p
BY T of Ucense, ,
Plumber gna ure o cen "or er
Title I Gastitter
aster license Number M q S( �O
( it /Town Journeyman
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Date .............
<��•° �1�0TOWN OF NORTH ANDOVER
ECEIVED PANVINITAIT FOR PUIN6MG
CHU�A.� OCT 21 1991
SSAS�
This certifies that .
No. Apdover Coliector
has permission to per orm....................................
plumbing in the buildings of ..................................
at ...................................... North Andover, Mass.
Fee......... Lic. No .......... ..............................
PLUMBING INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
Location W0 Arc N/d Irc/t
No. Date���
N�RTM TOWN OF NORTH ANDOVER
F � w
9
• ; , Certificate of Occupancy $ _
�a t
Building/Frame Permit Fee $
sic USE
Foundation Permit Fee $
Other Permit Fee $
TOTAL $`
Check #
r
`Building Inspector
Date . .. .... 7
......
N2 7 JS
This certifies that ............... .......................
has permission to performz ..................................
plumbing in the buildings of ... .........................
at ............... ............... f ....... I North Andover, Mass.
Fee//........ Lic. No .......... ............ , e.l
PLUMBING INSPECTOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
TOWN OF NORTH ANDOVER
0
PERMIT FOR PLUMBING
X
c US
This certifies that ............... .......................
has permission to performz ..................................
plumbing in the buildings of ... .........................
at ............... ............... f ....... I North Andover, Mass.
Fee//........ Lic. No .......... ............ , e.l
PLUMBING INSPECTOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUM13LNG
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Date
Building Location �ca�r� 4 Cr ►�� Owners Name Permit # 4'
I Amount
Type of Occupancy
New Renovation ,� Replacement El Plans Submitted-� No
FIXTURES
(Print or type) ly-� � � � / Check one: Certificate
�Installing
CompanyName �j� t r ," 7't F1 Corp.
',Address nk 1� 14- 5��/.3 .Zy:U
Business Telephone Qy Firm/Co.
Name ofLicensed Plumber. %~yc� c i aik�C i
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity ❑ Bond ❑
Insurance Waiver. I, the undersigned, have been made aware that the licensee ofthis application does not have any one of
the above
Phree in a �?4-u.— _�
ignature 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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Mads hWetts State Plumbing Code and Chapter 142 of the General Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY
Type of Plumbing License
2 5V 6-6
icense um er Master ® Joumeyman
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: %�J� DATE ISSUED:
SIGNATURE: 60� �
Building Commissioner/I for of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
20
1.2 Assessors Map and Parcel
Map Number
Number:
Parcel Number
2.2 Owner of Record:
Name Print Address for Service:
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Area (so
Frontage ft
1.6 BUILDING SETBACKS ft
Not Applicable ❑
Q 7T( 7C
Front Yard
Side Yard
3.2 Registered Home Improvement Contractor
Rear Yard
Required Provide Required
Provided
Regired
Provided
Address
Expiration Date
Signature Telephone
1.7 Water Supply M.G L.C.40. 54) 1.5.
Public ❑ Private ❑ Zone
Flood Zone Information:
Outside Flood Zone ❑
1.8
Municipal
Sewerage Disposal System:
❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIPIAUTHORMD AGENT
2.1 Owner of Re�crord
u�
Name (Print) Address for Service
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
lft,aa,� Pa.j -�,Q
Licensed Construction Supervisor:
P/�3 n� ? i ` �� j
Address i`
Signature Telephone
Not Applicable ❑
Q 7T( 7C
License Number
%
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
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.
'Si ned affidavit Attached Yes .......❑ No ....... 0
SECTION 5 Descri tion of Proposed Work check au applicable)
New Construction ❑
Existing Building ❑
Repair(s) ❑
Alterations(s)
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work: p / /� ( /��
9,4" NFf /!/04/ f[�V/t� ��/1�4� i "�„�7C
/i
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
Xp xC3FFICIA tJS QNLY = f
y
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 er/Authorized Agent of subject property
Hereby authorize to act on
be inalkatters relative work authorized by this building permit application.
Aiature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, As Owner/Authorized Agent 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
Print Name
Signature of Oxvner/A ent Date
NO. OF STORIES SITE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS iST 2 ND3RD
SPAN
DEVIENSIONS OF SILLS
DIMENSIONS OF POSTS
D.RvIENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE "
r
HOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 073476
Birthdate: 03/'27!1968
Expires: 03/2712002 Tr. no: 73476
Restricted To: 00
MICHAEL J PALMISANO _
11 LAWRENCE ST #806.ti �i !
LAWRENCE, MA 01840 Administrator
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Please Print
Z� I Cie
Location: n �`
City &- Phone % 2R
am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
= I am an employer providing, workers' compensation for my employees working on this job.
Company name:
Address
City Phone #:
Insurance Co Polio #
Company name:
Address
City Phone #:
Insurance Co Policy #
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00
and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do herby certify under the pains and penalties of perjury that the information provided above is true and correct
Signature. _ r
Print name /�-c � � f h.,j Phone #
Y�31 ai
Official use only do not write in this area to be completed by city or town official' ❑ Building Dept
❑Check if immediate response is required Building Dept ❑ Licensing Board
❑ Selectman's Office
Contact person: Phone #: ❑ Health Department
❑ Other
FORM WORKMAN'S COMPENSATION
Town of North Andover
Building Department
27 Charles Street
North Andover, Massachusetts 01845
(978) 688-9545 Fax (978) 688-9542
DEBRIS DISPOSAL FORM
Of NORTH
OL
O 1_
Q_ coe'ucwwicw . �'
SAC
In accordance with the provisions of MGL c 40 s 54, and a condition of
Building permit .# the debris resulting from the work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a.
The debris will be disposed of in /at:
Facility location
Signature of Applicant
2/-zJ 6p
Date
NOTE: A 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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RTIy TOWN OF NORTH ANDOVER
p Certificate of Occupancy $ - --`f
Building/Frame Permit Fee $
'�ss�cH�SEt~' Foundation Pgrmlt Fee $
.•� tW v
_ f O er Permit ee $
• r Sewer Connection Fee $ --
Water Connection Fee $
I �gtIDTAL
Building Inspector
Div. Public Works
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(L.S) 40% Pre -consumer content • Tu"/o Host-uonsumer content Page No. of Pages
ICHARD FLUET CONTRACTING INC.
102 Bridle Path Lane
METHUEN, MASSACHUSETTS 01844
(508) 685-7010
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PROPOSAL SUBMITTED TOP
PHONE
DATE
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CITY, STATE AND ZIP CODE
JOB LOCATION
ARCHITECT
DATE OF PLANS
JOB PHONE
We hereby submit specifications and estimates for:
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Extras or changes to be completed at a rate of' hour, per man
Unpaid balances subject to I'h?o finance charge per month.
Hie propoBe hereby to furnish material and labor — complete in accordance with above specifications, for the sum of:
dollars ($ ).
Payment to be made as follows:
All material is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from above specifica- Authorized
tions involving extra costs will be executed only upon written orders, and will become an Signature
extra charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Note: This proposal may be
Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days.
Araptattre of f rYtppod —The above prices, specifications
and conditions are satisfactory and are hereby accepted. You are authorized Signature
to do the work as specified. Payment will be made as outlined above.
Date of Acceptance:
Signature
PRODUCT 118 3o -s Inc., Groton. Mas 01471. Ta Ortlm PHONE TOLL FREE 1+ 800 225-6380
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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 law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: (� rcY42tJ r_4M 0?T) 4J4 Phone cl _755-3 R.
LOCATION:
Subdivision
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************************Official Use Only************************
RE MMENDATIONS OF TOWN AGENTS:
Conservation Administrator
Comments
Town Planner
Comments
Date Approved �(
Date Rejected
Date Approved
Date Rejected
Date Approved
ZFF d Inspector -Health Date Rejected
IJ _' Date Approved :!� IZ145
Septic Inspecttoor-Health ` Date Rejected
Comments
Public Works - sewer/water connections
- driveway permit
Fire Department
Received by Building Inspector Date
MAY 2 108'�
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TOWN OF NORTH ANDOVER
Certificate of Occupancy $
•-Building/Frame Permit Fee $
CVb`> dation Permit Fee $
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BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
Richard Lamattina
20 Laconia Circle
North Andover, MA 01845
RE: Deck addition
Dear Mr. Lamattina:
June 14, 1993
TEL. 682-t33
Ext. 32
Certified # 273 797 654
Per our discussion concerning the footings of your planned
deck replacement being placed in the septic leaching area:
I recommend that you 1) decrease the size of your deck to
avoid your leaching area; or 2) move your leaching area to avoid
the deck area. You have stated that you do not wish to choose
either of these options. Since the leaching area is not
currently failing and since the State DEP feels that the footings
should be able to be placed in the leaching area as long as the
flow of the water is not impeded, then the Board will allow
construction to continue with the following conditions:
1) If there is any sign that the septic system is failing
it must be repaired immediately.
2) The Health Agent will monitor the septic system
periodically for potential failures.
If you have any questions, please do not hesitate to call
the office.
Sincerely,
Sandra Starr
Health Agent
cc: Bob Nicetta, Building Inspector
Karen Nelson, Director, Planning & Comm. Dev.
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