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HomeMy WebLinkAboutMiscellaneous - 25 EDGELAWN AVENUE 4/30/2018N o m Oi M OD M O2 O z N Y,< O m O z N m 0. N UP REC MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATIONN�/ ) F, :I Two Center Plaza Boston, Massachusetts 02108-1904 TOWN OF 4=14 (617)723-3800 Ma Only (800)392-6108, FAX (800)851-8424 !T#�' 11/16/2011 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec.313 NORTH ANDOVER HEALTH DEPT NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 Re: Insured: MARIA DIANA GARCIA Property Address: 25 EDGELAWN AVE, NORTH ANDOVER, MA 01845 Policy Number: 1023835 Type Loss: All Other Section I Losses Date of Loss: 11/09/2011 Claim Number: 297827 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 CMA00021 NORTH ANDOVER BUILDING DEPARTMENT 1600 Osgood Street NorthAndover Tel: 978-688-9545 . Fax: 978-688-9542 ,BUSiNESS FORtt FOR TOWNCLERK ADDRESS; G,r, v w.e/�i ;Q�-��-e,�� �!✓.2 ,0NINGDISTIiTEOT: r5 TYPE OF BUSINESS.: _. hl -a 1v\ -p— /,A- '7A� "*"A,,/ 0 � n K IL ,DING LAYOUT PROVIDED: YES NO A AlLAE`i.LEE PAR44MG RAMS: ZONING BY L' AW M A.GE: 'YES NO a-LY•m••r�.�v-w .rh .rw •rM•v�t--. rem�•.i-a �v.mny... � ..-.+...�.� 33USMSS FORM FOR TOWN CLERK 2AD Rome Occupation (1.989132) An accessory use conducted vdfl in a dwelling by a resident who resides in the dwelling as his principal address, which is clearly secondaxy io the use. of the binding for luring piuposes. Home occupations shall 'include, -but not *limited to the following uses; personal services such as furnished by an artist or instructor, but not occupation involved with motor vehicle repairs, beauty parlors, animal kennels, or the conduct of retail business, or the manufacturiiig o�goods, which impacts the residential nature of the neighborhood, 4. For use of a dwelling in any residential district or multi-fannily district for a home occupation, the following conditions shall apply: a. Not more than a total of three (3) people may be employed in tho,hozne occupation, one of whom shall be the=ow1ier of the Dome pccupation and residing in said &v'elliug; b. The use is carried on strictly withinthe principal building; c. There shall be no exterior alterations, accessory buildings, or display which are not customary with residential buildings, - d. Not more than twenty- five (25) percent of the existing gross floor area of ;the dwelling unit. so used, not to exceed one thousand (1000) square feet, is devoted to 'such use. 7n comectionwith such use, there is to be kept no stock in trade, commodities or products which occupy space beyond these limits; e. There will be no display of goads or wares visible from the street; f The building or premii es occupied shall not be rendered objectionable or detrimental to the residential character of the neighborhood due to the extador appearance, emission of odor, gas, smoke, dust, noise, disturbance, or in any other waybecome objectionable or detrimental to any residential use within the neighborhood; - g. Any such binding shall include no features of design_ not customaq in buildings for residential use. �ignaiure Data 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.313 NORTH ANDOVER BUILDING COMMOSSIONER NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 Re: Insured: MARIA DIANA GARCIA Property Address: 25 EDGELAWN AVE, NORTH ANDOVER, MA 01845 Policy Number: 1023835 Type Loss: All Other Section I Losses Date of Loss: 11/09/2011 Claim Number: 297827 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 CMA00021 11/16/2011 Date... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... ................................... has permission for gas installation ................. in the buildings of .' 14, -...... .................... at <:,-r ....... North Andover, Mass. Fee -,--R); "� ... Lic. No.-....... Check # 6962 SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: � + NyA Ottyc MA. Date: �A?'O�CIN Permit# l �` '��j �a 4�gWh VC Owners Name �Q•`�'► she. Gr�ty) Building Location: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential Q New: ❑ Alteration: ❑ Renovation: ® Replacement: N Plans Submitted: Yes ❑ No N cY W Lu w 0 n O m = F - Oz • CO N> w rn w J ZV w IX N O U 0 0 LL 0 0 Installing Company Name Address �+�VV%!a`ASS� City/Townczz��+��0n State:lg�� Business Tel: ��� ���� Fax: Name of Licensed Plumber/Gas Fitter: req. tv Vna Hn vnc vn.� ��. '-•----- -- [ Corporation ❑ Partnership ❑ Firm/Company INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ) No El If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy X 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 thisCheck One Only Owner ❑ Agent ❑ Si nature of Owner or Owner's A ent 8y checking this box �; 1 hereby certify that all of the details and information I have submitted (or entered) regarding this 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 en compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of Licenser By ®Plumber ❑ Gas Fitter Signature of Li used Plumber/Gas Fitter Title a Master ❑Journeyman License Number: 2� City/Town F-1LPInstaller APPROVED (OFFICE USE ONLY PJA • • ' NOON IN�� IN��������������������i IN[Now �������������������� Now NOON 0 loommo . wom Now MONO Installing Company Name Address �+�VV%!a`ASS� City/Townczz��+��0n State:lg�� Business Tel: ��� ���� Fax: Name of Licensed Plumber/Gas Fitter: req. tv Vna Hn vnc vn.� ��. '-•----- -- [ Corporation ❑ Partnership ❑ Firm/Company INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ) No El If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy X 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 thisCheck One Only Owner ❑ Agent ❑ Si nature of Owner or Owner's A ent 8y checking this box �; 1 hereby certify that all of the details and information I have submitted (or entered) regarding this 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 en compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of Licenser By ®Plumber ❑ Gas Fitter Signature of Li used Plumber/Gas Fitter Title a Master ❑Journeyman License Number: 2� City/Town F-1LPInstaller APPROVED (OFFICE USE ONLY PJA Fli w CIL O Fli w CIL 12 < � Fli w CIL NORTH pf ,Oo O 9 eK _ �► �OLno �A�'(y 7S TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING r S•�CNUS This certifies that . has permission to perform... . plumbing in the buildings of ................................. . atr7 .?�....i..... North 'Andover, Mass. Fee -`.. Lic. NoJ 7X5-7. f>.... . PLUMBING INSPECTOR Check 9 7597 (Print or Type) Jiss. Data C' - A `7 Rarmit # Buildin Lccaaion o?.- 7l4 L��� !/C �4" 9 %�" Caerer's Nar?e ❑ R,enc';aticn ❑ T; pe of Occupancy RM-PIaceMSnt,-,4' Riars Submitted: Yws ❑ No ❑ 71�7Uria3 SE 710 # In3ta:lir g Ccrrpany Maire 6-161#1 . t–lem ( Lag //9A,' J91f )AY -1, Busirtlss Talephona Marne of Licensed Plumber C1 a,;x cm-): CaFtiiicata. ❑ Cti'i';CLLt0cr1 ❑ P-31 tnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of I7Ch142. Yes No ❑ If you .have checked. yes, please indicate the type coverage by checkir;g the appropriate box. 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 Mass. General Laws,'and that my signature on this permit application waives this requirement. Check one: — ❑ O Signature of Owner dr Owner's Agent Owner Agent I hereby certify that all of the details and information I have submitted (or arterod) in above apocation are true and accurate to the best of my knowledge and that all plumbing work and installation performed undor the p:annit iwwed for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of tha GarAral Laws. By . Title Sigrztura ci' L•c;)nosd P!urr :jr Type of Licort;e: a>au3i�r ! : Journaymar�,.i- City�o.vn L calm.,. �luri ar S—L —_ ZVI zz v, cn Q O ± Z �co z rn ` Q <- ¢ to 2 2I � 01 _z D O �_' z `� ¢ a Q G v J n lL fn c� = .(n _ t- C1 Q Q JJ 01 Q CC (n C. L z _ Q 1 Z F. lu z p¢ Q w Q (n G rr d ¢ (n O 2 G a Q G 0 $ UJ }- d > = �? fn Q (n z =rj) J CL 0 Q a W LL Q u_ . a: "1l 3 g Q m o o Q 3= O Q (n 0 u_ Q c7 D G CUj C Q Q 3 ir U m O sue-aSNIT. BASEMENT' 1 ST FLOOR 2N0 FLOOR 3R0 FLOOR 4TH FLOOR STH FLOOR 6TH r LOCR . . 7TH i•LCCR aT; i FL:GCR In3ta:lir g Ccrrpany Maire 6-161#1 . t–lem ( Lag //9A,' J91f )AY -1, Busirtlss Talephona Marne of Licensed Plumber C1 a,;x cm-): CaFtiiicata. ❑ Cti'i';CLLt0cr1 ❑ P-31 tnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of I7Ch142. Yes No ❑ If you .have checked. yes, please indicate the type coverage by checkir;g the appropriate box. 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 Mass. General Laws,'and that my signature on this permit application waives this requirement. Check one: — ❑ O Signature of Owner dr Owner's Agent Owner Agent I hereby certify that all of the details and information I have submitted (or arterod) in above apocation are true and accurate to the best of my knowledge and that all plumbing work and installation performed undor the p:annit iwwed for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of tha GarAral Laws. By . Title Sigrztura ci' L•c;)nosd P!urr :jr Type of Licort;e: a>au3i�r ! : Journaymar�,.i- City�o.vn L calm.,. �luri ar S—L —_ • cn rn D '^ rn � m r > m m O r O Z T � � O � z 4n O ® �f o ,O � Z r as " City of Lawrence &N - Inspectional Inspectional Services Department na ii x! cr lep i y7H,4031 y �� -3'W' Pf?tom 200 Common Street Office Hours Lawrence, MA 01840 8:30-10:00 a.m. Tel: 978-794-5950 1:00-2:00 p.m. Fax: 978-794-1251 Date 4.: S..aro/ NN 4--44 TOWN OF NORTH ANDOVER '• 0 wpm w p PERMIT FOR PLUMBING ,SSACMUSE� f This certifies that .............. has permission to perform .`'�'"—y^�✓ ............. . plumbing in, .fib buildings of : %*� �... - ............ f at: ...... . . r_:............. , North �/ndover, Mass. Fee .. ... Lic. No....—........Vit........... . PLUMBI'NG•INSPECTOR Check # Z y y G WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLU14 84M Re) or Ty# p Mass. Date,? ys��4 // -Perms 'Building Location — .Owner's Name, Llva—,A)I�GISiUl1/ c Ayole��-' ., Type of Occupancy, t S 17 E ti it A � New C] Renovation ❑ Replacement (i� Plans Submitted: Yes ❑ No ❑ LN SUa-BSMT. BASEMENT ISTS T.�..�_ 2ND 3R3RDFLOOR �_ 4TH FLOOR STHFLOOR �� 6TH FLOOR --�_ 7T7THFLOOR ��_ 8TH FLOOR N N11-� N z Y J N X X JO tff S Q ~ rt W O O � d W y O O _ H z a O z tW- > > r o W n � Y � m Nlalal� Wcc N FIXTURES X N11-� z Z O X X j V7 U 2 < F N Z O O C7 =_ H W C a. W O O 0 N Y < W z Wcc N Ct J O a¢ p O -1 U. _ N~ Y 2 d D O O F' N Q Z Y X Q W W. f UL O Y V W _ 3 z ai uJ,l v a al's a .mlc Installing. Company Name P101'iEel L - -SAmyl,}TAe- Check one: Certificate Address3 0 C0,4 4 /nr1n J /-, !� E3 Corporation IY1 E% N I' n 1 YO A 01 ❑ Partnership Business Telephone �7� -�97 d 2<r /O, Name of Licensed Plumber F?- 7- Irl ,SAe3QA114 I -eq e "? INSURANCE COVERAGE: I have aY usrrent Ii bility insoura ce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. If you have checkedes, please indicate the �, type coverage by checking the appropriate box A liability insurance policy 1d" 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: Cinnn4nrn of n.......... n..---'- •__-• 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 Wormed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plump6geode and qapter of the eral Laws. BY tiL, L Title re of Ucensed Ium r City/Townown Type of license: Master % Journeyman C]p APPROVED 5IC UONL License Number ! 3 .3 5 Location O93 A,, No. a—? i Date q TOWN OF NORTH ANDOVER + ; ; Certificate of Occupancy $ ITS •""°'�t�' Building/Frame /Frame Permit Fee $ CH9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $� Check # / 80 15 5 6 J ,f Building Inspector Y TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: —,=— Building CommissioneTARELwor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Ni ber Parcel Number L 1.3 Zoning Information: Zoning District Pfoposed Use 1.4 Property Dimensions: Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide 4egWred Provided Provides 1.7 water Supply M.QLC.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal system: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PAOPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record L Gcee r, CoTrus+ ( N. 4j&er Name (PriAddress for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.I Licensed Construction Supervisor. Licensed Cons ction Supervisor. /^ ` I� LP C® ,r e 6�A- Glg`15 Address 2/ 3 / a �07 [ �7 Signature Telephone Not Applicable 0 License Number _ Iq—O� '`� Expiration Dated 3.2 Registered Home Improvement Contractor Not Applicable Company Name Registration Number Address Expiration Date Signature Telephone ou M Z O Q a rn z M 90 O r M r r 101110 z G) SECTION 4 - WORKERS COMPENSATION (XG.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 Description of Proposed Work check all applicable) New Construction �"Ebstmg Building ❑ Repair(s) ❑ Alterations(s) ,❑* TAddition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify ` °t YET 4 Brief Description of Proposed Work: S -<< re- rioo� SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by t applicant (a) Building Permit Fee Multiplier n 1. Building '— 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) �• 5 ® �S ° 4 Mechanical (HVAC)r- 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 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. Si hue of Owner Date SECTION 7b OW.NER/AUTFIORIZED AGENT DECLARRATION Res 1, &O' S e.,t �z `� Jet U t I►nC.. f ,as Owner/Authorized Amt 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 Priv am f Siature of A en NO. OF STORIES, . 5-12162, 20 Datj— d' �� t INS 11111 SIZE BASEMENT OR SLAB SIZE OF FLOOR 'nNMERS 1 2ND 3RD SPAN DIIv1ENSIONS OF SILLS DIMENSIONS OF POSTS DPVIFNSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CH]NINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO .NATURAL GAS LINE —o, y C � .p p CD Com! ,Z CO) CL pin• � IM C Cn Cn�- iCN n m co0 m o m '� Z mCD C/)p o CD m CL CO Q Cl) �� CD V J ^F CD O CD O m CD CO) Z CL o y C/) -• O COCD I �' o CA p CDC4 p� �: 0CD A 0 C y` Q y = a 0 o y 5 CD0 m 'c0c.� m ? d r+ a, 0 CD m a m y O y --I o =rm mCD S cc 0 1 c y C00'! n C cmrr ;Q � mCD O y 0 �• - C m . CL �o GO ,A . s m _. ? y nd �C CL CL 0 P 0 m CO) co Go EM q 0 1 �0 •y.►CT y :O c m . p C :f 4DO-cal, al yCD e p ED 31� CD 0 �1 a� 0 0 07 W: CLIO h r. C 0 CF = Q •' - l J rU) ° W �• y Oql 0 a o x CGOD cn CA V. • 6 O z 0 1c )Mq 0 9 0 CDc rl BOARD OF BUILDING REGULATIONS- License: EGULATIONSLicense: CONSTRUCTION SUPERVISOR � Number CS 475259 Birthdate 1 211411 96 5 8xpiris: 12/1412002 Tr. no: 75259 Restricted To: 00 } BiRADLEY J SONTZ 7 PINE HILL ROAD SWAMPSCOTT, MA 01907' 4 Adrtsinislrator The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 Workers` Compensation Insurance Affidavit Please Name: Location: CRY hope am a homeowner performing all work myself. �I am a.sole proprietor and have no one working in any capacity Ix i am an employer providing workers' compensation for my employees working on this job. .A % _ . . Cibt' �i Vi(� �"1� Oloir�Z Phone# "/75 � ��%� � /�0� • M��i�E� nar11B: Aff6i��� Insurar7� ca CNA- - Poli► �c �'l9� 56�/ j Paitare tri sMU06 coverage as required under Seeffon 25A or MGL 152 cart lead tetlie WVM*n of C_ rkr*ai . and/or one years' imprisonment aS •welt as Chd per. QUes. of a fine up to $1;500.00 penalties in the form of a STOP MAX o understanei that a c of this st ernent 00Y may be fw*wded to the Offiee 0(kwestigationg and afire of 13100:00) a day against -me t of the f)14 for cmwa" verftmtlon. I do herby certify under the p ns aloes of perfury drat the k*matfari . a�d�en pn�vria�d above iss true ar►itoamect 1 Sn-Loz Signature Proms Date 5 2 o Print name-_ 1��f. �� L Phone # M1S�j -� Official use only do not write in this -area to be completed by city or town d xial' Or-heckif immediate response is reoAired Buildinng Dept O Building Dept ' P O L icerrsing Board Contact person Phone # O �electr»an`s Office? O Health Department O ©flier WORKMAN'S COMPENSATION e North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility X9 Ga� L9 110St.C-vfce5� Inc, Srqbature of- rmit Applicant s 2 o? Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector