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Home My WebLink AboutMiscellaneous - 30 MILLPOND 4/30/2018N J 0 `0 V1 O D � r g�� Z� g v o � o � �� '_4 AdNhhL pw Safelyinsurance Wo . Form 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: MICHAEL D PISCATELLI Property Address: 39 MILLPOND, NORTH ANDOVER, MA Policy Number: HMA 0351922 Claim Number: BOS00039565 Date of Loss: 8/8/2013 Company: Safety 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, Ch4pter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chqpter 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. Daniel Olsen Claim Examiner 10/3/2013 Safety Insurance Company Homeowners Claims Unit P. 0. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3323 Fax: (617) 531-2762 Email: Danie101sen@Safetylnsurance.com .w +. a �. � A Asa 4209 Date.&��A-;[ . ...... - D ' '6 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ A ....... ............................................ has permission to perform ............................................. �2 wiringin the building of .... ... ................... I ........................................................ at ..................... .. ..... .. ............................... ...... I Nort7hdover, Mass. Feel�-� ... �w ...... Lic. No.4;��!�� ......... Q -2a ....... . ... ........... /EL-EC-TRICAL INSP�B Check # Official Use Only Permit No. Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK AjI work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date - I / — 1 -3 — To tt�e 14spector of Wires: Tom of North Andnvpr The undersigned applies for a permit to perform tht electrical ork d cribed below. Location (Street & Number_ -2-0 'A. owner a owner's Is this permit in conjunction with a building permit Yes No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. E)dsting Service--------------AmPs-- voits Overhead 0 New Service Amps______-yoits Overhead 0 Number of Feeders and Ampacity_ Location and Nature of Proposed Electrical Undgmd 0 No. of Meters - No. of Meters ,I& OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a curr6nt Liability Insurance Policy includ Operations Coverage or its substantial equival n NO I I 'i plett you hg,,7 c%ed YE have submitted valid proof of same to the Offic( YES NO If S please indicate I cove h i appropriate box rge by c INSURANCE = BOND = OTHER = (PleMmlify) PJ, ;� — — (ERpIration Date) Estimated Value of Electrical Work$ Work to Stark Inspection Date Signed under the Pe991019s of perju FIRM NAME TL C LIC. NO. Z-47 Bus Tel No. 29� !:-& t 6 Address Alt'Tel. No I OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not haVelthe insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that mysignature on this permit application waives this requirement. Owner Agent (Please Check one) (Signature of Owner or Agent) �5No. PERMITLIFEE Of Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above 0 In 0 No. of Lighting Fixtures Swimming Pool gmd 0 grnd 0 Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units of Switch Outlets No of Gas Burners FIREALARMS No.ofZone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total 1401. of Diposal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers spa a Heating KIN DetectionlSounding Devices 0 Municipal 0 Other No. of DryeTs Heating Devices KW Local Connection NO. Of No. of Low Voltage No. of Water Heaters KW Signs Bailases I Wiring No. Hydro Massage Tuds No. of Motors Total HP I I ,I& OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a curr6nt Liability Insurance Policy includ Operations Coverage or its substantial equival n NO I I 'i plett you hg,,7 c%ed YE have submitted valid proof of same to the Offic( YES NO If S please indicate I cove h i appropriate box rge by c INSURANCE = BOND = OTHER = (PleMmlify) PJ, ;� — — (ERpIration Date) Estimated Value of Electrical Work$ Work to Stark Inspection Date Signed under the Pe991019s of perju FIRM NAME TL C LIC. NO. Z-47 Bus Tel No. 29� !:-& t 6 Address Alt'Tel. No I OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not haVelthe insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that mysignature on this permit application waives this requirement. Owner Agent (Please Check one) (Signature of Owner or Agent) �5No. PERMITLIFEE Of j � L ��l } � , `' ;A- � t. �. �1 �' i 1 .L Location No. Date TOWN OF NORTH ANDOVER OA Certificate of Occupancy $ Fee $ C,? Building/Frame Permit Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # - 6 Bqa 16012 //M v ( Gs�, Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING Section for Official Use OnI �0018h�r�� BUILDING PERMIT NUMBER: c:;) e (-. DATE ISSUED: A\ I C=5,_ .. SIGNATURE: �� AA -1 I C-(3L-- Buildin.& Commissi�r�/l �or of Buildings Date A �cr 1. 1 Property Address: zc> 1.2 Assessors Map and Parcel Number: !i SS cc) 30 M*Numb& Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (s FrontaE (11) 1.6 BURDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. § 54) Public 0 Private 0 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Zone — Outside Flood Zone 0 Municipal On Site Disposal System 0 2.1 Owner of Record F— I le �-t Address for Service: Signature Telephone 2.2 Authorized Agent 114L Ai nt Address for Service: C?79-)- (09-)( Signature Telephone 3.1 Licensed Construction Supervisor Not Applicable 0 Address License Number Licensed Construction Supervisor: E)Tiration Date Signature Telephone 3.2 Registered Home enl Contract _.!�Sc Not Applicable 0 Company Name'. s(,-;. A Registration Number t 112 2 Address ( 2) ExP' ration Date Signature 1elephone -0 M X M 0 M 3: Z 0 Z M 90 0 M Z G) as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are. true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of pedury Print Name Signature of Owner/Agent Date MM NO 01-10"N'R Item Estimated Cost (Dollars) to be Completed by permit applicant 1. Building (0 o (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing Building Permit fee (a) x (b) a30 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number W "M �k' sn;�nm;'11111 sl-� M, NO. OF STORIES SIZE BASENIENT OR SLAB SIZE OF FLOOR TUMBERS iST 2 No 3 RD SPAN DEN11ENSIONS OF SELLS DENENSIONS OF POSTS DMENSIONS OF GIRDERS HEIGHT OF FOLMDATION TFUCKNESS SIZE OF FOOTING x MATERIAL OF CHB4NEY IS BLTILDING ON SOLID OR FELLED LAND IS BLTILDING CONNECTED TO NATURAL GAS LINE Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial ofthe issuance of the buildinp oermit. I I Si2ned affidavit Attached Yea ....... L1 No ....... 0 1 5.1 Registered Architect: Name: Address Signature Telephone Company Name: Responsible in Charge of Construction Not Applicable D Area of Responsibility Registration Number Expiration Date Name: Address: Signature Total Not applicable 0 Registration Number Expiration Date Name: Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signa Telephone Company Name: Responsible in Charge of Construction Not Applicable D New Construction ri Existing Building Repair(s) [I Alterations(s) 0— Addition 0 Accessory Bldg. D Demolition Other D Specify Brief Description of Proposed Work: Independent Structural Engineeogg Structural Peer Review Required Yes 0 No 0 SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date tSE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly 0 A-1 0 A-2 0 A-3 ]A 0 A4 0 A-5 11 1 B 0 B Business 0 2A A 0 C Educational 0 2B 0 F Factory 0 F -I [I F-2 0 2C C 0 H High Hazard 0 3A D 1 Institutional 0. 1-1 0 1-2 0 1-3 0 3B 0 M Mercantile 0 4 R residential 0 R -I 0 R-2 0 R-3 —DI 5A D S Storage 0 S-1 0 S-2 5B U utility 0 Specify: M Nfixed Use 0 Specify: S Special Use 0 Specify: COMPLETE THIS SECTION ]IF EXISTING BUHDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 ClvM 34: Independent Structural Engineeogg Structural Peer Review Required Yes 0 No 0 SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date Board GfBuild:n t g Reculn lons and Standards HOMEMPROVEMEMT CONTRACTOR , �lh Registration: 1321,26 4Ex-piration., -,1/22/2-00-2 Type: EDDIE VIEUS CARPENTRY SERVI EDWARD VIEL JR. 55A PORTLAND ST. LAWRENCE, MA 01843 Administrator GENERAL CONTRACTING SERVICES VILLAGE KITCHEN & BATH 56 Main Street North Andover, MA 0 1845 1-978-423-7105 This Agreement is made between Ellen Brant of 30 Mill Pond in the town of North Andover, in the state of Massachusetts and General Contracting Services this 7 day of October in the year 2002. Description: See Estimate as attached document Job Total: $ 22116� Deposit: q 15 �18�0. P77 (39 Payment: ed Balance Based on allowances It is understood by Ellen Brant and by General Contracting Services, that the above Job Total includes material and labor as per attached proposal 2&11. Any additional, costs to the above Job Total, whether by necessity or by the request of Ellen Brant will be considered an extra charge and therefore governed by paragraph (V). It is also understood by Ellen Brant and by General Contracting Services that the management and general contracting fee included in this contract is subject to change in accordance to extra time and management involved in extra work carried out. 1. All jobs accepted by General Contracting Services are subject, however, to strikes, accidents, or details occasioned beyond the control of General Contracting Services. 11. AD sketches furnished by General Contracting Services shall remain the property of General Contracting Services and no use of same shall be made, nor any idea obtained therefrom be used, except upon compensation to be determined by General Contracting Services. 111. By signing the acceptance, the customer (or his/her representative) agrees to all terms and conditions as outlined, and binds him/herself to accept the contract in its entirety. INSURED NATIONAL GR-NNGE MUTUAL INSURANCE COMPANY 55 West Street, Keene, NH 03431 Telephone: 1-888-646-7736 CONTRACTORS POLICY DECLARATIONS Named Insured and Mailing Address policyNumber: MP166885 EDWARD E VIEL DRA Account Number: CAC 16 6 8 8 5 GENERAL CONTRACTING SERVICES 55 A PORTLAND ST LAWRENCE, MA 01843 Producer Code: 2 0 0 16 7 Agent CHAS F HARTSHORNE & SON INC AGENT PHONE 6 781 245 4300 POLICYHOLDER INFORMATION Named Insureds Business: Entity: Policy Term: Effective: CARPENTRY INTERIOR INDIVIDUAL 12 09/20/02 (12:01 A.M. Standard Time at the address Expiration: 09/20/03 of the Named insured stated above) In return for the payment of the premium and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. See the attached schedulles for Description of Premises, Property Coverage, optional Coverages, Forms and Endorsements applying to this policy and Mortgagee Schedule if applicable. LIMITS OF INSURANCE BUSINESSOWNERS LIABILITY COVERAGE $ 300,000 Liability & Medical Expenses - each occurrence 300,000 Personal and Advertising Injury Limit 600,000 Prod ucts-Completed Operations Aggregate Limit 600,000 General Aggregate Limit 500,000 Fire Legal Liability - any one fire or explosion 10,000 Medical Expense Limit - per person Business Liability and Medical Expense: Except for Fire Legal Liability, each paid claim forthe above cover- ages reduces the amount of insurance we provide during the applicable annual period. Please refer to section DA. of the Businessowners Liability Coverage Form. For policies subject to premium audit: Annual Audit Applies. Estimated Annual Premium: 539 TOTAL PREMIUM AND CHARGES 539 Counlersigned: 64-5470 (9100) 08/05/02 RENEWAL KT By: NATIONAL GRANGE MUTUAL INS. CO. EDWARD E VIEL DBA GENERAL CONTRACTING SERVICES Agent: CHAS F HARTSHORNE & SON INC Policy Number: MP166885 Account Number: CAC166885 Effective Date: 09/20/02 Producer Code: 2 0 0 16 7 CONTRACTORS DECLARATIONS - COVERAGES APPLYING TO THIS LOCATION DESCRIPTION OF PREMISES - ADDRESSES Prems. Bldg. No. No. Address DESCRIPTION OF PREMISES - OCCUPANCY AND CONSTRUCTION Prems. Bldg. No. No. Occupancy Construction COVERAGES PROVIDED Prems. Bldg. Limit of No. No. Coverage Insurance OPTIONAL COVERAGES Orems. Bldg. No. No. Coverage 4LL ALL GL AGGREGATE LIMITS APPLY PER JOB 4-NISS-1 9/00 08/05/02 RENEWAL KT Limits SEE BP0702 Protection Ded C/) m m :30 m m m cn m cn 0 m F M CO2 CD CO) CD 06 C') Co CL = CO) 70 1 0 a) CD MC Q 0 CD CL cr %< cm CD CD CD CD w C" a. CD rX CD C2. C2 CO2 CD 0 CD a, . 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