HomeMy WebLinkAboutMiscellaneous - 29 SALEM STREET 4/30/2018C) m
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Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
To: Building Commissioner or
Inspector of Buildings
1600 Osgood Street
North Andover, MA 01845
RE: Insured: Gaetano Distefano
Property Address: 29 Salem Street
Company: Vermont Mutual Insurance Company
Policy/Claim Number: H017084437, HC221966
Date/Cause of Loss: 8/14/2016, Pool Damage
Our File Number: 33655-M
Claim has been made involving loss, damage or destruction of the above captioned property,
which may either exceed $1,000.00 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.
Mike Peterson, Ext. 115
On this date, I caused copies of this Notice to be sent to the persons named above at the
addresses indicated above by First Class Mail. 0
Signature and Date
ANDERSON ADJUSTMENT CO., INC.
50 Nashua Road, Suite 303
PO Box 1098
Londonderry, NH 03053
Cc: Health Department North Andover Fire Department
1600 Osgood Street 795 Chickering Road
Building 20, Unit 2035 North Andover, MA 0 1845
North Andover, MA 01845
Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
To: Building Commissioner or
Inspector of Buildings
1600 Osgood Street
North Andover, MA 01845
RE: Insured: Gaetano Distefano
Property Address: 29 Salem Street
Company: Vermont Mutual Insurance Company
Policy/Claim Number: H017084437, HC221966
Date/Cause of Loss: 8/14/2016, Pool Damage
Our File Number: 33655-M
Claim has been made involving loss, damage or destruction of the above captioned property,
which may either exceed $1,000.00 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.
Mike Peterson, Ext. 115
On this date, I caused copies of this Notice to be sent to the persons named above at the
addresses indicated above by First Class Mail.
- 7-56691-
Sionature and Date
ANDERSON ADJUSTMENT CO., INC.
50 Nashua Road, Suite 303
PO Box 1098
Londonderry, NH 03053
Cc: Health Department North Andover Fire Department
1600 Osgood Street 795 Chickering Road
Building 20, Unit 2035 North Andover, MA 01845
North Andover, MA 01845
April 18,2015
ISIS
Building Commissioner/Inspection Services
1600 Osgood Street
Building 20, Suite 2035
North Andover, MA 01845
NOTICE OF CASUALTY LOSS UNDER MASSACHUSETTS
GENERAL LAWS, CHAPTER 139, SECTION 3B
RE: Insured:
Claim No.:
Policy No.:
Date of Loss:
Property Location
Type of Loss:
Ladies and Gentlemen:
Gaetano Distefano
HC210931
H017084437
3/26/2015
29 Salem St
North Andover, MA 01845-3009
Ice Dam
A claim has been made involving loss, damage or destruction of the above -captioned property which may
either exceed $1,000.00 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, locations, policy number,
date of loss and claim or file number.
Thank you for your cooperation.
Sincerely,
Scott Faehnrich
2600 McCormick Dr., Ste. 110 Clearwater, Fl, 33759
Telephone (727) 442-4900 Fax (727) 442-4933
AdEbil
PIWIF"00-1 Safety Insurance
Fonn of Notice of Casuafty 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 0 1845 NORTH ANDOVER, MA 0 1845
RE:* insured: GAETANO DISTEFANO
Property Address: 29 SALEM STREET, NORTH ANDOVER, MA
Policy Number: HMA 0310978
Claim Number: BOS00033707
Date of Loss: 10/29/2012
Company: Safety Property and Casualty 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.
Allan Leavitt Claim Examiner 11/7/2012
Safety Insurance Company
Homeowners Claims Unit
P. 0. Box 55098
Boston, MA 02205-5098
Phone: (617) 951-0600 EXT 3213
Fax: (617) 531-8891
Email: AllanLeavitt@Safetylnsurance.com
I
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.........................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .......... 4
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has permission to perform .........
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wiring in the building of ..................... H ...... 6 ..... /v.. ... .............................
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at ............ . q ....... 5'1�t
....................... North Andover, Mass.
I - U V.,
Fee............... '.. Lic. ....... ........... ......... ........
Check # -32[3-q_7ZI LE, C" r'RICAL INSPECTO"R
9248
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BOARD OF FIRE PREVENTION REGULATIONS
Of 'ficial Use Only
Permit NO.- L4
Occupancy and Fee Checked
.[Rev. 1/071 (i.... blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All Work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINTIN INK OR TYPE ALL INFORMA TION) Date:
City or Town of: A-rj, J`-
� k) �,-_ �(_ . To the Inspecto*r of Wire ' s:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) ,Q, �j S -f
Owner'or Tenant _ k411s4 ilaAC4,1�Q,n
No. of Ceil.-Susp. (Paddle) Fans
No. of-' ir021f
Transformers' XVA
Telephone No-ot2a99413-a4
Owner's Address
Generators KVA
No. of Luminaires
Swimming Pool Above o In-
garrid. grnd. C1
Is this permit in conjunction with a building permit?
Yes
No.-bf Oil Burners
No (Check Appropriate Box)
Purpose of Building
No. of Switches
Utility
Authorization No.
Existing Service Amps Volts
Overhead
No. of Alerting Devices
Undgrd No. of Meters
New Service Amps Volts
Overhe ad
F1
Undgrd F] No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Space/Area Heating KW
Local 0 municipal
Con nection 0 Other
No. of Dryers
No. of Water
Heaters XW
Heating Appliances KW
No. of No. of
Signs Ballasts
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. of-' ir021f
Transformers' XVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above o In-
garrid. grnd. C1
I Ei.�ergency Lighting
fZotitory Units
No. of Rec eptacle Outlets
No.-bf Oil Burners
FIRE ALARMS
jNo. of Zones
No. of Switches
No. of Gas Burners
No. o Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Totial
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Total!
Number
[Tons
IKW
of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local 0 municipal
Con nection 0 Other
No. of Dryers
No. of Water
Heaters XW
Heating Appliances KW
No. of No. of
Signs Ballasts
rity Systems:*
No. of Devices or� Equivalent
Data Wi ,
-ring:
No. of Devices or Eouivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
ommunications Wiring:
No. of Devices or Equivalent
2 7,:P -73/5-
A flaCh additional detail ifdesired, or as required by the Inspector of Wires.
Estimated Value of Electrica I Work: (S (When required by municipal policy.)
Work to Start: 01`b Inspections to berequested in accordance with MEC Rule 10, and upon completion.
INSURANCE C VERAGE: Unless waived by the owner, no permit for the performance ofelectrical work may issue unless
the licensee provides proof of liability insurance including "completed, operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has "hi ' bited proofofsame to the permit issuing office.
CHECK ONE: INSURANCE (A BONDE] OTHER n (Specify:)
I certijy, under the pains andpenalties ofpeijury, that th Tlh_(Ormation. on this application is true and complete.
FIRM NAME: LIC. NO.:
Licensee: rn OL Ir Y, bQVhLA Signatur
LIC. N.O.:
(7fapplicoble.4,;ter "drem?t In the license number'line.1 Bus. Tel. No.:L
�30 5V V (5-%w
Address: CA --t yn 'Or. 13� lx 0'0 Alt
Alt. Tel. No.:
*Per M.G. L. c. 147, s. 57-6 1, security work requires Department of Public VSafet�y "�S'-' se: Lic. No. 00 17453
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does' thdve the liability insurance coverage normally—
no
required by law. By try signature below, I hereby waive this requirement. I am the (check one)EI owner, El owner's Ment.
Owner/Agent
Si2nature
T.-lenhnnp Nn- PERMIT FEE: S
Department of 4elp- c�af�
blic Safety
One -As6burton' Place, RM 1301
Licen-er: S -Lir -&.)'n . se B0Sto-n,.Ma,,,- 2108-1618
Num6er: SSCO 000953 Expires: 02107/20t1-.-rfj-7--=T7
ostricle-4 - nn
MA ILI( A bROP)'-1 Y S R
I I I MORSE S*r
)46RWOOD. MA 02062
::.CA; 0 ^0M-6"-00iUf4ML(CA1*00�-jzuua
O�WAe
IDWARTMENT OF PUBLIC SAFCTY
� �TPR
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uA
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COMMOkWEALTH-.0F MASS*ACHUSETTS
DOARD
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C' G.' 8 -C - QONTRACTOR
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Date...................... .
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that—
...............................................
has permission to perform ........ . .......................................................
wiring in the building of ..... . * ........................................
at s7� .............................................. . North Andover, Mass.
�Fe�P..'::� ...... Lic. N,��-�7 ....
.... .. ........ I ............................
ELECTRICAL INSPECTOR
04/13/99 13.40 "�-_ 50- 00 PAID
WHITE: Applicant CANARY:Ci�j O� PINK: T asurer
Bu I i
Office Use only
TBF09W0NWE4LTH F
DLPARTAfE7YT0FPUB1JC&1F= Permit No.
BOARD OF ME PREVEM'0NRWM (W12.00 Occupancy & Fees Checked
A PPUCATION FOR PIRAff TO PIRFORM ELECMCAL WORK
PRN ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELEcTRICAL CODE, 527 cmR 12:00 112
(PLEASE T IN INK OR TYPE ALL INFORMATION) Date �0/ - / � �
J If
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perfbrm the electrical work described below.
Location (Street & Number) SAI-4nvv, A;Z-
Owner or Tenant F <
d "— rr 0
Owner's Address SXVVI& E
Is this permit in conjunction with a building permit: YesEfLNo M (Check Appropriate Box)
Purpose of Building k-- \ k 1-4 E7 Utility Authorization No.
Existing Service Amps Volts Overhead Underground No. of Meters
1:3
New Service Amps Volts Overhead M Underground No. of Meters
Number of Feeders and Ampacity -3 b-T?q-,Uk 5 V—Ln AA
Location and Nature of Proposed Electrical Work (Z 9� ct.
No. ofLighting Outlets
No. ofHot Tubs
No. ofTransformers
Total
KVA
No. of Lighting Fixtures
Swirruning Pool Above
Below
Generators
KVA
wround
E3
ground M
No. ofReceptacle Outlets
No. ofOil Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. ofGas Burners
FIRE ALARMS
No. ofZones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. ofDisposals
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No. ofSounding Devices
No. of Dishwashers
Space Area Heating KW
No. ofSelfContained
Detection/Sounding Devices
Local Municipal
Other
No. of Dryers
Heating Devices KW
M Connections
M
No. of Water Heaters KW
No, of No. of
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
* OTHER -
k&M=CUXM8r- RVSMttDtCMqMMMIiSdNbsmdusetisG=rA Laws
I ha,,eaomt!rtL!abkyhmm=poLynidTcm#&IeOpwafi*cmCamaWcritsst MOVAft YES 6M__.a, NO
Iha,.eabnodvandproofofsmrlDfeOffim YES [2_NO If�xuhmedvJod YES, plemmdc*the�pecfwmaWbyd=ki[gthe
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Telephone No. PERMIT FEE $
Location A ,/",I S-/
4114 14,�
No. Oq 69 Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
CHU
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
'13037 78. 00 PAID Builcli�g— inspector
04/1319B, 13:35 Div. Public Works
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FORM U - LOT RELEASE FORM .3'
INSTRUCTIONS: This form is used to verify that all necessary approvals/perrr�ts
from
Boards and n�n, artments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or reqUirOffonts.
"APPLICANT FILLS OUT THIS SECTIOW
APPLJJCANT
PHONE
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LOCATION: Assesibes Map Numbe
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SUBDIVISION -
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STREET
ST. NUM13ER Z-1
- — -----------
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/RECOMMENbATIONS OF TOWN AGENTS:
CON66AWION ADMINISTRATOR
DATE APPROVED
DATE R�JECTED
COMMENTS A-- I D(D Crj ri,4 "N "T,
TOWN PLANNER
DATBAPPROVED
DATE REJECTED
COMMENT
t
FOOD INSPECTOR -HEALTH
DATE APPROVED
1,
DATE REJECTED
.1 4
SEPTIC INSPECTOR -HEALTH
DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR
DATE
02/11/99 18:18 FAX
4
WNW-
NSPEC
TION PLAN
Al*
9',SALEM STREET
`-WORTH ANDOVER, MA.
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PLAN NO. 6832
GICRTIFI&D. W.'HOMES TEAD MORMAGE CORPORA TION
DATE.7 FEBRUARY /it 1,998
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(617)846-SODO FAX (617)846-S106 I RIO L;rK1Iiri%,P%iZ ujo vo-wrU ^0 0% RM I I ER v
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
.11iot, Whittier, Hardy & Roy
Insurance Agency, Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
$7 Putnam Street C mPANIES AFFORDING COVERA E
..................................
Winthrop. MA 02152 COMPANY Transcontinental Ins. Co.
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Ann: Ext:
.............. ...... ..... ..... .......... . . . ... ... . ...... - .............. .............................
COMPANY Transportation Ins. Co.
Family Pool & Patio Co— Inc.
92 sooth Broadway C ' OM - PANY CNA IN SURANCE .. C . 0 M - PA N 1 1. E S - ........ ..............
Lawrence, MA 01743 C
............ . ...... ........... ...........
COMPANY
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INDICATED G Y REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT 000THER DOCUMENT WITH RESPECT TO WHICH THIS
RISED HEREIN IS SUBJECT TO ALL THE TERMS.
CERTIFIWE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES OESC
EXCLUSIONS AMD CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
.................. ........................... .......................... ... - ....... ........... .............. ............... -- ......... ........... . . .......... . .. ....... .............. -
POLICY r=FrECTIVE POLICY EXPIRATION::
Co TYPE OF INSURANCE POLICY NUMBER LIMITS
DATE (mutourryl *ATE (MMIDDfYY)
LTR
0ENERAL AGGREGATE 1000000
911KIRALLIAMUTY ...... - .. ................. -
PAODUCTS � COMPMP AGO S 1000000
X COMMERCIAL GENERAL LIABILITY ......... ........ -.- ..................... ........
........ PERSONAL& ADV INJURY S SDDOOO
CLAIMS MADE X OCCUR
C164095968 1.2/31/1999 a EACH OCCURRENCE
A 12/31/1998
OWNER'S & CONTRACTOR'S PROT .... .. .......... ........ 5.00000
:FIRE DAMAGE (AAy One Inj 6 $0000
... ....... . ... ....... .........
. ....... MEV EXP (Any 006 PO(OW)
5000
AUTOMOBILE UAGILITY
COMBINED SINGLE LIMIT
11000,000
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ALL OWNED AUTOS
BODILY INJURY
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3038607
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12/31/1998 IZ/31/1999
............
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:X NON-OMED AUTOS
.. ......... - .........
..............
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PROPERTY DAMAGE
AUTO ONLY - EA ACCIDENT
GAnAge uAWLITY
...........
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....
............
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..... . . . ....... .. .
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OTHER THAN UMBRELLA FORM
waFtKeRs cOMPBWJATION AND
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EMPLOYEW LIANLITY
EL EAC14 ACCIDENT
100000
C WCCIS6942897
........... . .... - ........ ..
1Z131/1998 12/31/1999 EL DISEASE - POLICY LIMIT
1
... ... ..
500000
THE PROPRIETORJ XINCL
......................
......
.... .. ..........
PARTNERS/EXECUTIVE
......................
EL DISEASE - EA EMPLOYEE
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OFFICERS ARE: EXCL
To whom it May Concern
SHOULDANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING COMPANY YtILLFNDFAVOR To MAIL
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