HomeMy WebLinkAboutMiscellaneous - 327 SALEM STREET 4/30/2018 (3)0
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MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1.904
(617)723.3800 Ma Only (800)392.6108, FAX (800)851-8424
101612016
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: JOHN MCLOUGHLIN AND LYNNE MCLOUGHLIN
Property Address: 327 SALEM ST, NORTH ANDOVER, MA 01845
Policy Number: 1295158
Type Loss: Smoke
Date of Loss: 10/03/2016
Claim Number: 409475
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
CMA
00021
MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only (8001392.6108, FAX (800) 851-8424
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:
JOHN MCLOUGHLIN AND LYNNE MCLOUGHLIN
Property Address:
327 SALEM ST, NORTH ANDOVER, MA 01845
Policy Number:
1295158
Type Loss:
Ice Dams
Date of Loss:
01105/2015
Claim Number:
401655
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
1111212015
.,_ a _-•�.1.. _-+►,.. .«w -w.- ow.,...._,.+......w.�-+���......... , . �,..._ _ .r... _..-...-.. �.-_ ..-....,.....,..- wr... �-.c...- �. -
6397
Date.. L Z J `......
Of NORTH
,•,• oL
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
.c .••.1 th
SACMUSEtLOX'*'
This certifies that ..
/x. .4.f?:.... ... . .....
has permission for gas
. ... . ... .
installation ... «.. ... .
in the buildings of
at .. .� .. ?�.."
...... ..... .... , North Andover, Mass.
Fee. Lic. No...U. 3 `... ... .- ...... .
GAS INSPECTOR
Check # i (`i 61
6397
3a
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
Mass. Date 2009 Permit #
Building Location .��7 �7%%7/�r/ �Cj� Owner's Name
Owner's Tel # q'9 Ctv 3 � Type of Occupency
New El Renovation M Replacement ® Plan Submitted: Yes M No
Installing Company Name Addario's Plumbing & Heating LLC.
Address 20 Cooper Street
Lynn, MA. 01905
Business Telephone 339-440-8100
Name of Licensed Plumber or Gas Fitter Steven J. Addario Jr.
Check one: Certificate
X Corporation 2720
Partnership
Firm/Co.
Insurance Coverage :
I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ❑X No
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Miability insurance policy ❑x Other type of indemnity ® Bond ED
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:
Owner Agent
Signature of Owner or Owner's Agent
I hearby 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 performed under the permit issued for this applica ' ill be i lance wit pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
By Type of License:
Title X Plumber
City/Town Gasfitter Signature of Licensed Plumber or Gas Fitter
Approved (OFFICE USE ONLY) X Master
Journeyman License Number 13106
■
•
in
•
Installing Company Name Addario's Plumbing & Heating LLC.
Address 20 Cooper Street
Lynn, MA. 01905
Business Telephone 339-440-8100
Name of Licensed Plumber or Gas Fitter Steven J. Addario Jr.
Check one: Certificate
X Corporation 2720
Partnership
Firm/Co.
Insurance Coverage :
I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ❑X No
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Miability insurance policy ❑x Other type of indemnity ® Bond ED
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:
Owner Agent
Signature of Owner or Owner's Agent
I hearby 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 performed under the permit issued for this applica ' ill be i lance wit pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
By Type of License:
Title X Plumber
City/Town Gasfitter Signature of Licensed Plumber or Gas Fitter
Approved (OFFICE USE ONLY) X Master
Journeyman License Number 13106
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Location
No. .��` Date
TOWN OF NORTH ANDOVER
41
qL Certificate of Occupancy $
Building/Frame Permit Fee $
sic Musi
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
15818�f1��
r: ---Building Insped6r
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
3z as f
211,22 _ �..,,..a',,", .i
BUILDING PERMIT NUMBER: DATE ISSUED:
-a
SIGNATURE: A4U /I&/10
Building Commissioner Idings Date
SECTION I- SITE INFORMATION I .
1.1 Property Address:
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
1.2 Assessors Map and Parcel
'Number
Number:
Parcel Number
./1/� ✓� c � Vim►/ did'I /� D t� S
art �- 3�7 s41
Address for Service:
1.3 Zoning Information:
Zoning District Proposed Use
Signature
1.4 Property Dimensions:
Lot Areas
Frontage, ft
1.6 BUILDING SETBACKS ft
2.2 Owner of Record:
Name Print
Address for Service:
Front Yard
Side Yard
Telephone
Rear Yard
Required Provide
Required Provided
ReqWred
Provided
Telephone
Not Applicable 0
License Number
Expiration Date
1.7 Water Supply M.G.I—C.40. 54)
Public 0 Private ❑
1.5. Flood Zone Information:
Zona Outside Flood Zone ❑
1.8
Municipal
Sewerage Disposal System:
❑ On Site Disposal System 0
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SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
Lrt- I �
Name (Print) �1
art �- 3�7 s41
Address for Service:
Signature
elephone
2.2 Owner of Record:
Name Print
Address for Service:
Signature
Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature
Telephone
Not Applicable 0
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Si nature Telephone
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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 .......❑ No ....... ❑
SECTION 5 Description of Proposed Work check a!1 applicable)
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify _
Brief Description of Proposed Work:
I
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SFCTTON 6 - F.STTMATF.n VnNCTQ1TrT1nN rnCTC
Item
Estimated Cost (Dollar) to be-'OFFICIALLUSE
Completed by permit applicant
:R r +' ... W
ONIY�a gar
1. Building
O O
(a) Building Permit Fee
Multiplier
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
11VII is VWINhKAUIrIVXUGAIWIN -I lfh C:UMYLE'J'Ell WHEr4
OWNERS AGENT OR CONTRACTOR __APPLIES FOR BUILDING PERMIT
I, C YV A 11•2 � t !�"t%� H � Vl as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf; all nlAtters rel e to work authed by this building permit application.
Si Mature of Owner aDate
SECTION 7b OWNER/ ITTRORYZED AGENT DECLARATION
I, as Owner/Authorized Agent of subject
property
Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Name
Signature of Owner/Arent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 ST 2ND 3ko
SPAN
Da4ENSIONS OF SILLS
DIMENSIONS OF POSTS
DINMNSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS T ��
SIZE OF FOOTING x
MATERLAL OF CHIlvINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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D. Robert Nicetta
.Building Commissioner
(978) 688-9545
- (978) 688-9542 Fax
Town of North Andover
Building Department
27 Charles Street ..
North Andover, ,MA, 01845
HOMEOWNER LICENSE EXEMpT1pN
Please print
DATE
J06 LOCATION 3a -7 Sa le S �
Number Street Address
"HOMEOWNER a4'o01iv k i litT1/�j N1 u h l
Name Home Phone
'RESENT MAILING ADDRESS_
City Town
Map ol/ t
The current exemption for "homeowners" was extended to include owner -occupied dwellings
of two units or less and :to alk w such homeowners to engage an individual toe hire who does
not possess a license,. provided that the owner acts as supervisor (Stade Sut7 ng Code Section 108.3.5-1)
.DEFINITION OF HOMEWOWNER:
Pf.-rson(s) who owns a parcel of land on which he/she resides or Mends to reside on which
there is, or is intended to be, a one or two family dwelling, attached or detached structu'ac-
cessory to such use and/or farm structures A. person wtw e q one hoirri resac-
two-year period shall not be'considered a homeowner
The undersigned "homeowner' assumes responsibility for compliance with the State Building Code and other
Applicable codes, by-laws, rules and regulations,
The undersigned "homeowner" certifies that hL-Jshe understands the Town of No. Andover
Building Department minimum inspection procedures• and requirements and that he/she will
compty with said procedures and requirements_
HOMEOWNER'S SIGNATURE t/"Ot-'� ' /A ` 1 // I I
APPROVAL OF BUILDING OFFICIAL
Code
If
I
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:
6 V-hA e&v✓ J P -e c
of Facility)
Signature of Vrmit Applicant
Date
NOTE:, Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
IN
D'0AU"Ubt:1 IN UNIFORM APPLICATION FOR PERMIT IU UU I LUMtlINU
(Print or Type) 'cv
NORTH ANDOVER
.Mass. Date �� , , _10�
Bulldlnp Permit # , c!. %
Location . ��. � ���� ��
Owner's/
Name C Po K -
New D Renovation ❑ Replacement Pla a Submitted: Yes ❑ No. ❑
FIXTURE$
Ch It one: Certificate
Installing Company Name V-.ti`/��
Address %3 % So / u ;, S 7`_ Partnership
re -et r e /V.. , ❑ Firm/Co.
Business Telephone
Name of Licensed Plumber
INSURANCE COVERAGE: CHick one
I have a current Ilabli ty Insurance policy or No substantial equivalent. Yes ❑ No ❑
If you have checked y", please Icate the type coverage by checking the appropriate box.
A Ilabllty Insurance n policy Oiler type of Indemnity O 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:
slonOwner ❑ AgerA ❑
a urs o ata OMmsr s en
I hereby certify that all of the details and Information I have submitted tot enl•r•d) In above application are Irus and accurate to the best of my
krx wIWi;* and that aN plumbing work and Installations performed under the permit Issued Ior this ap tion will b• InNance with all
pertinentprovisions of the Massachusetts State Plumbing Code and Chapter 11 as taws,
BySigC�^"^-
THIe
na • sa r
License Number
Cityfrown
Type of Plumbing license: Master
AMICIVED (OFFICE USE ONLY) Journeyman ❑
Date..
TOWN OF NORTH ANDOVER
.` '• °°c
PERMIT FOR PLUMBING
This certifies that : �� �. ' ...... • •.. ............ • • •
has permission to perform ........................ .
plumbing in the buildings of ..�.. `..,.:. f. /s ............ .
at .. :! ........... , North Andover, Mass.
Fee. Lic. No.. (t > .. ..............................
PLUMBING INSPECTOR
02/09/94 09:56 27 50
1H1JJ
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File