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HomeMy WebLinkAboutMiscellaneous - 21 SUTTON PLACE 4/30/2018PO Box 55098 Boston, MA 022055098 617-9.5170600_ Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845 RE: In-sured: HAROLD MCELROY and ELENA MCELROY Property Address: 21 SUTTON PL, NORTH ANDOVER, MA Policy Number: HMA 0300788 Claim Number: BOS00058099 Date of Loss: 2/15/2015 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. 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 number. Pam McPherson Claim Examiner 4/3/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3521 Fax: (617) 531-2741 Email: PamMcPherson@Safetylnsurance.com N2 2607 Date... .0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that D,E;� .... .......... . ................................. has permission to perform...... �-� , TC t, .................................................................... 0 wiring in the building of ........ M.( ........ . ... .. ......................................... at .... .�A ........ ........ ....... . NOPKAndover Mass ,`/, Fel�S .... q�... Lic. No.,42V2 ............... i4—, ...... . .. ..... -1 LE iZAILINSPEc-rolk Check # z WHITE: Applicant CANARY: Building Dept. PINK: Treasurer THE CWAIOAV"4 771OFAMSS4a %SMS OfficeU��6g7 y I DER4RTA1UN 'OFPIUBUCS9FE7Y Permit No. BOARD OFMEPREVEMONREGUTA770NN5270MRlz-IXI Occupancy & Fees Checked M � APPLICATTONFORPERMIT TOPERFORM==CAL 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) Date Town of North Andover. To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. VAP PARCEL Location (Street & Owner or Tenant Owner's Address S/r'F•`"t ' Is this permit in conjunction with a building permit: Yes rNo r (Check Appropriate Box) Purpose of Building Si '), 7 A /� sti , A/ Utility Authorization No. No. of Meters l No. of Meters Existing Service 2-4- U / Amps / l �y Overhead a Underground Amps / Volts Overhead � Underground New Service 7�' Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work G✓ yGla e- �- N%of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No: of Lighting Fixtures Swimming Pool Above ound Below and Generators KVA _ N of Receptacle Outlets No. of Oil 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 Davices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other KW of Dryers Heating Devices 0 Cocmcctions a No. of No. of Water Heater; KW L Si s Bailasis ydro Massage Tubs No. of Motors Total HP hr�==Cowrr. R,3jarttotheregmmiatsdN GmemIL ms Ibawacun=l bkhwr&= �Cyrrdr�Caripl&Cowwcrits alegrivabt YES E3 --NO Ibaw�mttodvabdptodefszmtolheO� YES Yf xubawdl�dYES pkageir>diatthet peafcowW ydradm*the NaRANM MIR Valuecf0ac�l Work $ Wolk to Sw // — v C/ � Rou r i �� �✓'� �� Final Licarsee a/`�yl w OW,IR'SINS[1RANCEWAIVER;Iamawarethatthelioamdomnnitumdrita a= Lire WNo. % � y 3 Rancss-TeLNa� ��7 vs 1/0!/�-� A1C Td. Na • i� .. .. oil. :a. A: :P_.. t:a. iq:_a �. \/ ,�. y, N. -I. i1:C .�.w. andth�rrnstgnahaemlhspentlrtapphc�arwatw;thsrac�manari. (Please check one) Owner Agent � Telephone No. PERMIT FEE $ V ]gra e o weer or gent Location �1 No. U Date -.►aRTN TOWN OF NORTH ANDOVER _ o _ t Certificate Occupancy $ of s,cHus Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # r 4 2 IC 9 ifs - ---Building I&ctor Ma M z 10 M z M 90 O Mn M z 0 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ET BUILDING PERMIT NUMBER: b n DATE ISSUED: SIGNATURE: Building Commissioner/Inspector of Buildings Date 773-T — 0-0 SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 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 R red Provide Required Provided Provided -Required 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public Cii/ Private ❑ Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record %a_ Na a (Print) Address for ` SService C) Signature Telephone 2.2 Owner of Record: �,-\ZA3 Name Print Address for Service: O Si nature Telephone SECTION 3 - CONSTRUC SERVICES 3.1 Licensed Construction sor: Not Applicable ❑ Licensed Const tion Supervis r: 14 r7 �i %� License Number 14djess) Expira on DA Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Com ny me "'17 <� S � � ' Registration Number Address 9 ` ` Expiration Date Si nature Telephone Ma M z 10 M z M 90 O Mn M z 0 SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 2506) 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 buil ing 22rmit. Signed affidavit Attached Yes ....... No ....... 0 SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: �/� o�a < \ Vy SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE�ONLY, , 1. Building V �L+ (a) Building Permit Fee Multiplier 2 Electrical > C C 4, (b) Estimated Total Cost of Construction 3 Plumbing C\ Building Permit fee tel X (b) C ' 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 BU"ING PERMIT 7 as Owner/Authorized Agent of subject property Hereby thorize :C)" to act on My beh in all r rs ve Mork thorized b'y this building permit application. Signature of Owner Date SECTION 7b OWNIER/AUTHORI GENT DECLARATION ��Iu �' `I, C A as Owner/Authorized Agent of subject property Hereby declare that the statements and informatio the foregoing application are true and accurate, to the best of my knowledge and belief Pr Name Si ahu e' of Owner/A ent Date I NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS 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 0 rs OL w aha u O w U) v cn w O w O w U w w O w C w a O nG w o O a G iw ZW a w cn ° cn r H CO) W LL. H W COD H o Cc C h O_ c O _v V •p,'O dC A R m c •+ O cc �Ea4 o a N E� ow a0+ CD CD c 06= H �C VC01 m N y; C 3 ED m .� C c � 4:. a 'Z C N O ESA CLS L�o N O m c Q y . dC� as: v N O c0 O Q O N m C N OL. ~ W Z m y .E QmvCD CL �O z $ cO m g 0 a R! � T O � r L O Z � 0. O h � C C C N� p 'O h O O m m Z O� 3.0 CD cm CD L cc O d M:0 CO �a cc v c Z CD V co c C C ■ C CL CO2 D fi 0 W ir cc ��W/� V/ AC�R�,M CERTIFICATE OF LIABILITY INSURANCE o9i28i2o 0 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION NORTH ANDOVER INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 9 WAVERLY ROAD HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NORTH ANDOVER, MA 01845-241 LIMITS P:978-686-2266 F:978-686-6410 INSURERS AFFORDING COVERAGE INSURED INSURER A: TRAVELERS PROPERTY CASUALTY Michael V. .Bodden INSURER B: 47 Prescott Street INSURER C: INSURER D: North Andover MA 01845 - INSURER E: FIRE DAMAGE (Any one fire) $ COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRTYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ ❑ COMMERCIAL GENERAL LIABILITY ❑ CLAIMS MADE ROTI OCCUR FIRE DAMAGE (Any one fire) $ MED EXP (Any one person) $ ❑ PERSONAL & ADV INJURY $ ❑ GENERAL AGGREGATE $ GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ ❑ POLICY ❑ PRO- jEcT FE -1 LOC AUTOMOBILE ❑ LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) ❑ ❑ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) ❑ El HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ❑ ANY AUTO ❑ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY ❑ OCCUR 1 CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DEDUCTIBLE $ ❑ RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 820UB849K419500 01/01/2000 01/01/2001 WC LIMIT ❑ OTH- NARY S E.L. EACH ACCIDENT $ 100, 000 E.L. DISEASE - EA EMPLOYEq$ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS %.crc r irs%,m r rr nvLUcrc I " I ADDITIONAL INSURED: INSURER LETTER: I:ANL;tLLA I IUN TOWN OF NORTH ANDOVER NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 ACORD 25-S (7/97) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 010 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ATIVE ©ACORD CORPORATION 1988