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Home My WebLink AboutMiscellaneous - 24 MAGNOLIA DRIVE 4/30/2018MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston, Massachusetts 02108-1904 (617) 723-3800 Ma Only (800) 392.6108, FAX 18001851-8424 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: THOMAS REGAN AND CATHERINE REGAN Property Address: 24 MAGNOLIA DR, NORTH ANDOVER, MA 01845 Policy Number: 1297683 Type Loss: Ice Dams Date of Loss: 02/13/2015 Claim Number: 330366 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 2/18/2015 Date ........ ...... TOWN OF NORTH ANDOVER , PERMIT FOR WIRING I -.- This certifies that ...... t—A L 0 ....................................... ............................ has permission to perform .............. 70� ... gu7ou ......................... wiring in the building of .......r ............................. at..,.2-..q.RWj ......................... . North Andover, Mass.. Fee Lic. No.P ........ iL... 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Location (Street & Number) 24 Magnolia Drive Owner or Tenant Tom Regan Telephone No. 978-683-8887 Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Boz) Purpose of Building Single family dwelling Utility Authorization No. Existing Service 100 Amps 120/240 New Service 200 Amps 120/240 12580013 Volts Overhead ® Undgrd ❑ No. of Meters Volts Overhead ® Undgrd ❑ No. of Meters lumber of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install new 200amp service and associated equipment. Completion of the followine table may be waived by the Insnector of Wires. No. of Recessed Luminaires No. of CeiL-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above In- ❑ E:]Batte o. o Emergency Lighting rnd. rnd. Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pum Num Tons KW .......... No. of Self -Contained Totals Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Omer Connection 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 Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: $1500.00 (When required by municipal policy.) Work to Start: 3/13/12 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee pro- vides 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:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Facilico, Inc LIC. NO.: A17545 Licensee: Bryan Regan Signature __Vle LIC. NO.: E36113 (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 866-929-2100 Address: 10 Walnut Hill Park Woburn,MA 01801 Alt. Tel. No.: 617-201-4373 *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. 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!t7 Owner/Agent Signature Telephone No. PERMIT FEE: $ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass 02111 www.mass Pov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Facillco, Inc. Address: 10 Walnut Hill Park City/State/Zip:. Woburn, MA 01801-6823 Phone #: 866-929-2100 Are you an employer? Check the appropriate boa: 1. ® I am an employer with 12 employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all the work myself. [No workers' comp. insurance required.]* 4.❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance. $ 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, 3 1 (4), and we have no employees. [No workers' comp. insurance required.] Type of Project (required): 6. ❑ New Construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building Addition 10.® Electrical Repairs or Additions 11. F] Plumbing Repairs or Additions 12. ❑ Roof Repairs 13. ❑ Other m Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they are doing work and then hire outside contractors must submit a new affidavit indicating such. t Contractors that check this box must attach an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: St. Paul Travelers Policy # or Self -ins. Lic. #: IEUB 87K 735 5311 Job Site Address: 24 Magnolia Drive Expiration Date: City/State/Zip: 5/6112 N. Andover, MA It 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 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification: I do hereby certify under the pains and pena&ies of perjury that the information provided above is true and correct Date: 3-15-2012 Phone #: 866929-2100 11 Official use only. Do not write in this area, to be completed by city or town offMial, 11 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 #: MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston, Massachusetts 02108-1904 (617) 723-3800 Ma Only (800) 392.6108, FAX (800) 851.8424 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec.36 NORTH ANDOVER HEALTH DEPT. NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 Re: Insured: THOMAS AND CATHERINE REGAN Property Address: 24 MAGNOLIA DR, NORTH ANDOVER, MA 01845 Policy Number: 0961326 Type Loss: Windstorm due to: Other Causes Date of Loss: 1211212008 Claim Number: 258277 CMA00021 1211612008 RECEIVED DEC 2 9 2008 TOWN OF NORTH ANDOVER' HEALTH DEP'll.R I MENT Claim has been made involving loss, damage or destruction of the above captioned propert, 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 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston, Massachusetts 02108.1904 (617) 723-3800 Ma Only (800) 392-6108, FAX (8001851-8424 NORTH ANDOVER HEALTH DEPT. NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 Re: Insured: Property Address Policy Number: Type Loss: CMA00021 Date of Loss: Claim Number: Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch.139, Sec.36 THOMAS REGAN AND CATHERINE REGAN 24 MAGNOLIA DR, NORTH ANDOVER, MA 01845 1297683 All Other Section I Losses 09/06/2014 325905 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 a] SES' 15 ZO14 NuRxH iO ATH DEPART R 9/9/2014 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston, Massachusetts 02108-1904 (617)723-3800 Ma Only (800)392-6108, FAX (8001851-8424 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec.36 NORTH ANDOVER BUILDING COMMOSSIONER NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 Re: Insured: Property Address: Policy Number: Type Loss: Date of Loss: Claim Number: CM/\00021 THOMAS REGAN AND CATHERINE REGAN 24 MAGNOLIA DR, NORTH ANDOVER, MA 01845 1297683 All Other Section I Losses 09/0612014 325905 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 36 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 0 Q 9/912014 ff Z. Location No. 711 r Datea�--- TOWN OF NORTH ANDOVER �• Certificate of Occupancy $ A,-. Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # 15931 - Building Inspector v � - Ll�l'Vl\1111111V1\ 1.1 Property .Address: 1.2 Assessors Map and Parcel Number: c Map Number Parcel Numb 1.3 Zoning Information: 1.4 Property Dimensions: Gonm Dtsinct Proposed Use Lot Area (so Frontage (fl) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided Re red Provided 1.7 Water Supply .r.G.L.C.40. 54) 1'5' Flood Zone Information 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name Print) O oa Signature Telephone Address for Se e : 2.2 Owner of Record: Name Print Address for ServiEe: 9� Signature Telephone SECTION 3 - CONSTRUCTION SERVICES I 3.1 Licensed Construction Supervisor: Lice 1tsed Construction Supervisor: kddress tgnature .2 Registered Home Improvement Contractor ompany Name ddress i enature Telephone Telephone Not Applicable ❑ License Number Expiration Date Not Applicable ❑ Registration Number Expiration Date TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING M INS'-Sec#o> '#or difiddUse'OaI BUILDING PERMIT NUMBER: D DATE ISSUED: �a _ D a L SIGNATURE: /� � _ Building Commissioner/I for of Buildings Date CST /TTtAAT v � - Ll�l'Vl\1111111V1\ 1.1 Property .Address: 1.2 Assessors Map and Parcel Number: c Map Number Parcel Numb 1.3 Zoning Information: 1.4 Property Dimensions: Gonm Dtsinct Proposed Use Lot Area (so Frontage (fl) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided Re red Provided 1.7 Water Supply .r.G.L.C.40. 54) 1'5' Flood Zone Information 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name Print) O oa Signature Telephone Address for Se e : 2.2 Owner of Record: Name Print Address for ServiEe: 9� Signature Telephone SECTION 3 - CONSTRUCTION SERVICES I 3.1 Licensed Construction Supervisor: Lice 1tsed Construction Supervisor: kddress tgnature .2 Registered Home Improvement Contractor ompany Name ddress i enature Telephone Telephone Not Applicable ❑ License Number Expiration Date Not Applicable ❑ Registration Number Expiration Date 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. Signed affidavit Attached Yes ....:..0 No ....... 0 SECTION 5 Descrintion of Prnnosed Work (rhMi Al anntirAhin 1 New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition ❑ Accessory Bldg. ❑ Demolition 0 Other 0 Specify Brief Description of Proposed Work: /f- X 30 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant 1. Building qt ® �. U (a) Building Permit Fee Multi lien 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 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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 Si ature of Owner/Agent NO. OF STORIES BASEMENT OR SLAB SIZE OF FLOOR TIlvIBERS 1ST SPAN DM ENSIONS'OF SILLS DWIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION SIZE OF FOOTING MATERIAL OF CHINvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Date SIZE —T THICKNESS X f FORM - U - LOT RELEASE FORM V vwof pod / INSTRUCTIONS:. This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT TSS k -e PHONE VF 683 — M7 ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER STREET 4�I,�`� (� /� 0 L 1 A l STREET NUMBER INSMEMONME OFFICIAL USE ONLY I.............................................■.............................■ RECOMMENDATIONS OF TOWN AGENTS .......................................................................... DATE APPROVED ho 0o2 CONS RVATIONADMINISTRATO DATE REJECTED COMMENTS DATE APPROVED TOWN PLANNER CONIIv1ENTS DATE REJECTED DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR - HEALTH DATE REJECTED CONQvIENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE 08/05/2000 07:39, FAX l�jp2 MORTGAGE INSPECTION PLAN i I. /r i.� ► � ._t.or 18 t.ar ' 9 i 1� ioo.00 -U-4-rf 2 i A=a2S SF- I L.OT 13 ( Lor 2I 29l{ N ti i Ioo.Oo i Nk1 NoLAA 4LIV£ TNSPIAN19fiASW0NAMW64X0)6V(40TAN"TRUMEWSUAVEYIANDOMMUS&oKMMO QA"Purfo s6dLLr. TM8VFM.THE OMWMAS SH0!M 04 M MOTSE UBE070CS7ABWSH tMi Ob"uNM es sw*x , i COUNTY PLAN OF LAND DEED REFERENCE= PIAN REFERENCE: I y�, PL No. 19 8K 50SI PG. 1'}19 PBK PL.._ IN CERT. NO. I Bim — PG. N O.XrC .A At W b a V ER. ' I hereby Ce" that to 0W^A ainiaures aro iomw applw*" as 00" wt0 PREPARED FOR: were not in vkAaation of the zoning by tarts at the tine of wttstnrcdort, or are exempt rs from violation wftmpnm w ibn tmdDr. lea W 40A SAC4en 7 of Ifs Mew6_ Gwww Laws. T1s 6lnrchNes �o tocared in Zws G.. 9 w tls lm"" -MCIMA& j, &A-NeLl Mie aftAttJ . ._ F.EMA map. Note: Zona C mpra wrtt anm of mw4rdF4Wmg. FLOOD HAZARD COMMUNITY NO 250019 . BOUNDARY MAP NO. 0003G EFFECTIVE 9 JAN AS i SCALE I IN -30 FEET O THOMAS SAILLIE & COMPANY C. LAND SURVEYING A RESEARCH e 33 HOWARD STREET RECa1STERED D SURVEYOR Mo"'f` READING. MA. 01867 8- f -goo I �' 1l� ' PHONE: (781) 944-2767 FAX (781) 944$112 DATE C/) C m C/) Cl) m C3 y ca CM) d 'O O cZCZ CO) CD O 'C C. 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