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HomeMy WebLinkAboutMiscellaneous - 336 CHESTNUT STREET 4/30/2018 (2)N O Illm 2 i � � Cunningham Lindsey U.S., Inc. P.O. Box 703689 Dallas, TX 75370-3689 Telephone (888) 738-8714 CLCATQCL-NA.COM Facsimile (214) 488-6766 ***********************AUTO**3-DIGIT 018 804 T3 P1 95000058994 Building Commissioner or Inspector of Buildings 120 MAIN STREET NORTH ANDOVER, MA 01845 Cunnin fiham va lILindsey Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS Ch. 139, Sec 3B 253873507 253873507 MERRIMACK MUTUAL FIRE INS ICE DAM 2/4/2015 JOSEPH & MARTHA D MILLER CAPORALE 336 CHESTNUT ST Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 36 is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Section 313. No insurer shall pay any claims (1) covering the loss, damage, or destructions to a building or other structure, amounting to the one thousand dollars or more, or (2) covering any loss;.damage or destruction of any amount, which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code, to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to the payment the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending; provided, however, that said proceedings are initiated within thirty days of receipt of such notification. Claim Number: Policy Number: Company Name: i) Cause of Loss: o Date of Loss: Insured: 0 Property Location Cunnin fiham va lILindsey Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS Ch. 139, Sec 3B 253873507 253873507 MERRIMACK MUTUAL FIRE INS ICE DAM 2/4/2015 JOSEPH & MARTHA D MILLER CAPORALE 336 CHESTNUT ST Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 36 is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Section 313. No insurer shall pay any claims (1) covering the loss, damage, or destructions to a building or other structure, amounting to the one thousand dollars or more, or (2) covering any loss;.damage or destruction of any amount, which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code, to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to the payment the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending; provided, however, that said proceedings are initiated within thirty days of receipt of such notification. Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall extend to and may be enforced by the city or town against any casualty insurance policy or policies covering any loss, damage, or destruction pursuant to which the proceedings to perfect the lien were initiated. No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other interested party for amounts disbursed to a city or town under the provisions of this section, or for amounts not disbursed to a city or town under the provisions of this section. 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. Cunningham Lindsey Catastrophe Department cicat@cl-na.com 800-867-3885 y / 2012 Massachusetts Electrical Code Amendments 527 CAM 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the /x\ permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time ofongoing construction activity, and maybe—deemed—by the-Tnspector--of-Wires abandoned_and_invalidifhe— . or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effector existence" during the qualifying period beginning on August 15, 2008 and extending -through August 15, 2012. ule—Permit/Date Closed: "c'— 1 *** Dote: Reapply for new permit ❑ Permit Extension Act — Perynit/Date Closed: Of 'kORT11 HUS Date .......... � t ... 21. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .............. (:.k.....&h /. .. I ....... has permission to perform .... M&T An.., ................... wiring in the building of ........................................eo loe kt7_7L........................................... at ......... 33.4 ... 577 North Andover Mass. Fee.. P...Lic.No...0.0.52 .............. LECTRICAL'IN'P'E- y Check # 10698 9 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. o 6 lQ g Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave 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 PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER_ To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps Volts New Service Amps / Volts Telephone No. Yes ❑ No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 01A W k)*1 A1r0bW%, &A DGkkhrcTVA - Completion of the ollowing table in be waived bV the Inspector o 97ires. 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 Above In- Swimming Pool rnd. ❑ rnd. ❑ o. o Emergency Lighting Batter Units No. of Receptacle Outlets 1 No. of Oil Burners FIRE ALARMS 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 g No. of Waste Disposers Heat Pump Totals: Number Tons IKW . ....... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances Kir Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications `dFi'iring: No, of Devices or E uivalent OTHER: I r^, ' Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: � -- (When required by municipal policy.) Work to Start: 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 provides 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 t/t pains and pen hies o perjury, that the information on this application is true and complet FIRM NAME: (� lC► LIC. NO.: 0501 Licensee: a,r Signature LIC. NO.: (Ifapplicabl, ,` ter "exempt" in the licens number 'ne.) Y �'` �� Bus. Tel. No.: l Address: -` Alt. Tel. No.: *Per M.G.L c. 147, s. 57 61, security work requires De rtment 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 Owner/Agent Signature Telephone No. PERMIT FEE. $ r.. 44 ,iloll, lk 9329 Date..? ...... TOWN OF NORTH ANDOVER '• 0 PERMIT FOR PLUMBING This certifies that . !l!�..../f��................... . has permission to perform ..,��. !r1. 7 ..................... plumbing in the buildings of ... .1..o re �/� ............... . at .�.. // �vr. `S.� .. .. . , ort Ando'er, Mass. Fee. .(.?....Lie. No. Zo3�%j'� PLUMBING I SPECTOR Check # ` 62 kw-CITY "NIFFJOB'SITEADDRESS TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK { /� —� MA DATE PERMIT tf � � `OWNER'S NAME1 uP ceeife— OWNERADDRESS TELJ FAY, OCCUPANCYTYPE COMMERCIAL{ { EDUCATIONAL RESIDENTIAL{ / NEW: {fit' RENOVATIQN:1 I REPLACEMENP E { PLANS SUBMITTED: YES 1 { NO( I FIXTURES -1 FLOOR-' 13SM 1 2 3 4 5 B 7 a 9 10 11 12 13 14 BATHTUB _I ...... ....... _ _ CROSS CONNECTION [)EVICE ! DEDICATED SPECIALWASTE SYSTEfvt DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM is 1 , � �..... .j �.. . .. .. _ ... .._ .. DEDICATED GRAY WATER SYSTEM _ DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOORIAREADRAIN j f INTERCEPTOR (INTERIOR)-KITCHEN - - --� -. SINK -- -- '-_— - - LAVATORY ROOF DRAIN SHOWER STALL-- SERMOEIMOP SIN SINK I —i TOILET -i, . . _ I . URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES. _ WATER PIPING ..OTHER j i ...... ... _t i .. f INSURANCE COVERAGE: — 1 have a current habilis hsuralice policy.br its substantial equivalent vihfch meets the requirenients of MG11-Ch.142. YES I I- NO I j IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE.BY CHECKING THE APPROPRIATE BOR BELOW LIABILITY INSURANCE POLICY { OTHER TYPE OF INDEMNITY I BOND (• i OWNER'S INSURANCE:W.AIVER: I ani aware that the Iicensee.does not have the insurance coverage required by Chaplee•142 of the Massachusetts General Laws, and that,nty signature on this pertiiit application waives this regtii(eiiient. - CHECK ONEONLY:. OWNER ( AGENT. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I havatubmilted or eniered regardingYhis applicaliod are true and accurate to the best of my knoedddge and that all plumbing work and Installations performed under the permit issued for this application will Wip complian 'Ih all Pe*eq pegvislon of Massachus2Qs State Plumbing Codean Chapter 142 of Hie G�aeral Laws. PLUMBER'S NAME Dl °Gh� V LICENSE 11 �W� 1p J SIGNATURE MPI I ,1P I CORPORATION I , I #! fPARTNERSHIPj Ifij J LLC I IN 1 COMPANY NAME ive �n< S [ ADDRESS 14Ti%w1,4 " CITYI Pja;6�l� �STATEW'� ]ZIP L13��5� TELL FAX CELL�1 EMAIL z ZO u OLJ m /� \ \ § q 0 w / � � 2 / � � I.- LL. 6. leasuggroil Antel BpVan; 'MA.,ut1C(Itir3titcs,4fUighnii'itiaitryitilitidualj` �, i•li../: ��/(� ,. '. � �1 alit (I geilefol ! r vil--frillo.* 1110 suh-COMI-Aclorg . Wo (oil ACIIIAOIlOg 80 11T nftCersGa<<gcKercfsecTlitcir fill 201 ygstrraucc:GotnjFan}��iuhC; .. silo 44djeav mn pip csjk4lvtfl§ tlfojllig ItOlitylprbild O%pFkt Wiles !,I ilia to 1-1110 f -tiat(ted to Ifleoffice-or ol Polu'lliffmi? ilkfills area, jobi" , Ildc0116)t I. l3C;attEotfieii[(ti All Ispeewy C101f-Itt kW4 .q 0, ifim Worth killabilelialice., rdpgr Wprk oil supli ct1ro'llih AllploympIntba-4b. 66 brq ga, . 0111, I Oi in'stl r'um. Comp ip ?scflieT . ern orparfiiers; vro-not reqpirecfto 101 insuranee. Ifft ftGoALP does juivo Accidents forcottfinuationofistsut�uca�overage. sfibnlit(ed to theDepatuient of Inbstelal Im dildeflib"Iffidavit ifioe'rildnWihollid fOrl)'O F01 -11"t Or IWORV is boling tequostcd., not Me-DeparimelAt of 81100 pithath , ir - �##fptA§af[OlIjj0Hq-Y, please call fllej� p�eu . , minihiimmil.^ m—a—..n'f- V -- Q v or ToAll Oinclai.s oEtlit;nftTdavit f0tYOfLtd fi11 bIfUn the-ey6lit the of rice bf jpleftge-b6 SIW (ofiff !a jh6PCnJ)jrjjjC ' Mat inustsubibit intliciple, pemilthicellse, 11 * ppl icaltolk, fit ellylew di yeirpieett-olily pbailt Onotiffidavit indicating current rmai faillB)SUfCCjjSCOj�*j)6rIIj it not related to, i qnSell, ` (Tog iiC.-Cilso oeiannit, to burn h-aves efoj Said PC -ISO syllen orooffillieroial VcOuto It fs NOrT99 u ired to collillle. fc-trds ah idlhif. V-1110 not 110slefe to-glV41p ti call: 1361jadlllent of1qdu61efi.1j&.fdp,,jtS Boston, l 1&02111 TPA.41.617727- ODegt4o DAIIAN-Vi-7749 Vv11vAHSS,g01,1(11ft F Location .�3 C '"S /'v v� S No. %� Date y'S� �,. TOWN OF NORTH ANDOVER 0 F - w a Certificate of Occupancy $ Building/Frame Permit Fee $ 022 s�CH Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a3 t� Check #� t 17168 ✓ Building Inspector M M O �.J M C_ 0 z M 0 r M rM Y) TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ,.R ..r+ ? BUILDING PERMIT NUMBER: -� DATE ISSUED: SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1. i Property Address: 1.2 Assessors Map and Parcel Number. 3 c ,' S ►' q8 -c- I o G Ahv--4�� Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R -red Provided 1.7 Rater Supply M.G.L.C.40. 54) 1.5. Flood Tome Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 SECTION -PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No 2.1 Owner of Record 3 3 ( Name (Print) Address for Service Signature Telephone 2.20wner of Record: Y Name Print Address for Service: Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ 000,&�ns — !U c�t�eL Licensed Construction Supervisor: License Number Address --7/ O Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number 'i !C4. Address �) t �9 — q2-3 1 PS7 Expiration Date T.1( !? - % Si nature ' Telephone M M O �.J M C_ 0 z M 0 r M rM Y) SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 ti 2506) 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 all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of ProposedWork: scI ' V FU —1, SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant MrSE 'O 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) x (b) -�_ 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORI7,ATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 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 Signature of Owner/Aent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ` 2 ND 3 RD SPAN DWENSIONS OF SILLS DRvIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND - IS BUILDING CONNECTED TO NATURAL GAS LLNE Board of Building Regulations g ns and Standards HOME IMPROVEMENTCONTRgCTOR Registration: ;132126 Exp rat1on: :.J1/22/2004 TYPe: DBA EDDIE VIEL'S CARPENTRY SEkv rdWARD VIEL JR: 55A PORTLAND ST. LAWRENCE, MA 01843 4r1m:.i.t"tn GENERAL CONTRACTING SEk *ACES VILLAGE KITCHEN & BATH 56 Main Street North Andover, MA 01845 1-978-423-7105 CONTRACT This Agreement is made between Jay Cgporale , hereinafter called Customer of 336 Chestnut Street in the town of North Andover, in the state of Mass. and General Contracting Services this _th day of December in the year 2003. Description: See Estimate as attached document Job Total: $ 23338.80 Deposit: $ �,2 88 . f -2,k40 12 -J -3>'/C)3 Payment: As needed Balance Based on allowances I. It is understood by the Customer and by General Contracting Services, that the above Job Total includes material and labor as per attached proposal only. Any additional, costs to the above Job Total, whether by necessity or by the request of Customer will be considered an extra charge and therefore governed by paragraph (VI). It is also understood by Customer 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 by necessity or by the request of the Customer. II. All jobs accepted by General Contracting Services are subject, however, to strikes, accidents, or details occasioned beyond the control of General Contracting Services. III. All 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. IV. 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. V. The customer also promises to pay any and all attorneys fees and/or cost(s) associated with the collection of the amount stated herein this contract. VI. All materials are guaranteed to be as specified. All work to be completed in a workman like manner according to standard practices. Any alteration or deviation from specifications involving extra cost will be executed only upon written orders signed by the Customer known as a Change Order and will become an extra charge over and above the original contract price. VII. General Contracting Services works from a positive cash flow wherein work will not be carried out and materials will not be furnished if it would cause the Customer balance to I _ become negative. If any amuurit of money is withheld by the Customo. )that exceeds the balance of work or material to be furnished to the job, the highest amount of interest allowed by the state of Massachusetts will be charged. VIII. All fixtures and hardware, excluding cabinet order, purchased for this job must be paid for by the Customer, in full when picked up/delivered. IX. The terms of the contract are not to be varied, except in writing, signed by a duly authorized officer or agent of General Contracting Services. X. This contract covers all of the agreements between the two parties hereto, and is governed by the uniform Commercial Code and other applicable state laws. XI. Any request for a delay of said delivery of goods, merchandise, and site labor by the customer which exceeds a ten (10) day period shall cause customer to be liable to General Contracting Services for any damages caused by such delay, including but not limited to, storage charges on goods or merchandise, and General Contracting Services shall have the option to invoice customer and receive payment within ten (10) days. XII. General Contracting Services guarantees its products for a period of one (1) year from the date of delivery against defects in workmanship or materials. XIII. General Contracting Services cannot be held responsible for damage to work after delivery to the delivery site. XIV. In any event, General Contracting Services' liability is limited to the repair or replacement at the option of General Contracting Services of such work that is defective in either workmanship or material. General Contracting Services Custol L913 -�e � Edward E. Viel, Jr. Date: 135 2O-3 Date: I A &l 103 2 Jay Caporale Kitchen 336 Chestnut N, Andover 978-689-2881 h 978-475-6890 work Description Totals Details Allowances Tear out $ 750.00 Dumpster fees $ 475.00 x Electrical fixtures $ 700.00 Recessed lights / switches / etc. x Electrical labor $ 1,925.00 x Plumbing fixtures $ 800.00 sink & faucet x Plumbing labor $ 675.00 x New Cabinets $ 6,288.80 Cabinet install promo / sale ends 12/31/03 materials $ 575.00 If needed x carpentry labor $ 900.00 Take wall down install beam if needed x New sheetrock $ 1,125.00 new ceiling / wall repair x Counter tops $ 1,800.00 x ____ ;_ 8 Total _._ W $ 16,013.0 G.0 Fees $� 4,625.00 Management Fees $ 2,375.00 Permit Fees $ 325.00 Grand Total $ 23,338.80 Payment received Balance NATIONAL GRANGE MUTUAL INSURANCE COMPANY 55 West Street, Keene, NH 03431 Telephone: 1-888-646-7736 INS] CONTRACTORS POLICY DECLARA Named Insured and Mailing Address EDWARD E VIEL DBA GENERAL CONTRACTING SERVICES 55 A PORTLAND ST LAWRENCE, MA 01843 Agent: CHAS F HARTSHORNE & SON INC AGENT PHONE : 781 245 4300 POLICYHOLDER INFORMATION Policy Number. MPI66885 Account Number: CAC I66885 Producer Code: 20 0167 Named Insureds Business: CARPENTRY INTERIOR Entity: INDIVIDUAL Policy Term: 12 Effective: 09/20/03 (12:01 A.M. Standard Time at the address Expiration: 09/20/04 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 schedules for Description of Premises, Property Coverage, Optional Coverages, Forms and Endorsements applying to this policy and Mortgagee Schedule if applicable. BUSINESSOWNERS LIABILITY COVERAGE LIMITS OF INSURANCE Liability & Medical Expenses - each occurrence S 300,000 Personal and Advertising Injury Limit $ 300,000 Products -Completed Operations Aggregate Limit S 600,000 General Aggregate Limit S 600,000 Fire Legal Liability - any one fire or explosion S 500,000 Medical Expense Limit - per person S 10,000 Business Liability and Medical Expense: Except for Fire Legal Liability, each paid claim for the above cover- ages reduces the amount of insurance we provide during the applicable section DA. of the Businessowners Liability Coverage Form. annual period. Please refer to for policies subject to premium audit: Annual Audit Applies, Countersigned: 64-5470 (9100) Estimated Annual Premium: S 592 TOTAL PREMIUM AND CHARGES S 592 07/30/03 RENEWAL KB_ By: 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 Z 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) Signature of Permit Applicant Dtf- ps_ o CF Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector a TL m m m y m y m O = o■ _ QF) Cl) Z y CD �•. r � � O CL y '0o v CD CDCL O Q� =r l< d CD CD CD C_ O Hmm • �O y CD C=D p c-y?'oto o d i EL" .m y Zy m .. --- c a. m S'fl N -4 .. m dad r19 CD -4Q m y p y -4 O co O � a O �� � ® to 0 n o o y. cl : :L a CD "�� S.m lA/ m m y m w 0CD: c o. mca '+• O N y �� VV y C=, d � CD tN Qp c V'J a y CA e m® O\ 9 ® . ® ®o�W N 2.CDo ab CD w d t ate. C o Ct,� N o CD CI O� 77,rbo �"p ~ d w G w i/1 7�7 C C17 O �. O C 7 y P O G O C (n to 'b ^r1 p O ,W,w) V, v 0 c a yORTry e AL O A �,SSACMUSES Date..Z"/'�` .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that has permission to perform' wiring in the building of .........,...................................... at . ....... `.. �.........�................ , North Andover, Mass. o Fec.�?.,e ............ Lic. ....................... {'� ELECfR1CAlINSPECTOR Check # 8�J 0� �'�l 5i37 i\ Official Use Only Permit No. 6 3 7 7s Fi%�%%��i1%CJ Det 4 Pat& Sam Occupancy & Fee Checked o-/ BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date yam! < To the Inspector of Whires: Town of North Andover The undersigned applies for a permit to perform tt Location (Street & Number 33(- r i1 Owner or Tenant 1 © r Ck ` C Owner's �work described below. by S p vf, Is this permit in conjunction with a building permit Yes fV No 0 Purpose of Existing 12%IG ` 0 Voits Overhead New Service Amps Voits Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Overhead 0 (Check Appropriate Box) Utility Authorization No. Undgmd 0 No. of Meters Undgmd I No. of Meters OTHER: INSURANCE COVERAGE. Pursuant to the requiremenfits of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivaler i�'rYE NO have submitted valid proof of same to the Offi ES NO - h c ecked please indi to the of coverage by n appropriate box. IN�URAbICE - BOND - OTHER - (Please Specify) / Y t' =%2 N47 Q 0 �x/!J (Expiration Date Estimated Value of.Electrical Work$ Work to Start Signed FIRM NAME under the Pep _alpesf�jltryf Inspection Date Resquested Rough / Final /} �j C / en f� _ I i l LIc_ No.27 C ! � C �O S—OX l ✓ f G / ®��� /Bus. Tel No.A Address r r ( Aft Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) O -L% Telephone No. PERMIT FEE $ (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above 0 In 0 Njt. of Lighting Fixtures Swimming Pool gmd o gmd 0 Generators KVA No. of Emergency Lighting NJ. of Receptacles Outlets No. of Oil Burner; Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Diposal No. Pumps Ton KW No. of Sounding Devices Nol of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices 0 Municipal 9 Other No. of Dryers Heating Devices, KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases I Wiring No. Hydra, Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremenfits of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivaler i�'rYE NO have submitted valid proof of same to the Offi ES NO - h c ecked please indi to the of coverage by n appropriate box. IN�URAbICE - BOND - OTHER - (Please Specify) / Y t' =%2 N47 Q 0 �x/!J (Expiration Date Estimated Value of.Electrical Work$ Work to Start Signed FIRM NAME under the Pep _alpesf�jltryf Inspection Date Resquested Rough / Final /} �j C / en f� _ I i l LIc_ No.27 C ! � C �O S—OX l ✓ f G / ®��� /Bus. Tel No.A Address r r ( Aft Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) O -L% Telephone No. PERMIT FEE $ (Signature of Owner or Agent) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: Location: City Phone am a homeowner performing all work myself. �I am a sole proprietor and have no one working in any capacity I am an employer providing. workers' compensation for my employees working on this job. Company name: Address City Phone #: Insurance Co Polipy # , n i Company dame' Address City Phone t Insurance Co Policy # Failure to secure cmerage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 andlor one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct y Signature Date 1 Print name Phone # i Official use only do not write in this area to be completed by city or town official' Building Dept El Check rT immediate response is required Building Dept p Licensing Board C] Selectman's Office Contact person: Phone #.-_ E] Health Department Other FORM WORKMAN'S COMPENSATION VIEW ENGLAND CLAIMS SERVICE, INC. ReplyTo ❑ Reply To ❑ Reply To ❑ P.O. BOX 345 100 CONIFER HILL DRIVE, SUITE 308 P.O. BOX 578 MANSFIELD, MA 02048 DANVERS, MA 01923 SHREWSBURY, MA 01545 TEL. (508) 337-8058 TEL. (978) 777-9900 TEL. (508) 842-3995 FAX (508) 339-5835 FAX (978) 774-9296 FAX (508) 842-7510 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec. 3D A 2 TO: Building Commissioner or Board of Health or 3 Inspector of Buildings Board of Selectmen addresses RE: INSURED se!1 F},c OAO- rHA- C PROPERTY ADDRESS 33k0 �1Lal: (+1oav� � OAgj b i sm POLICY NO.: LOSS OF: �1 a�l 03 19 FILE OR CLAIM NO.:S_ 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 3D 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. TITLE 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. 1 1 74 S JGANATURE AND DATE cc: Fire Dept. NEW ENGLAND CLAIMS SERVICE, INC. ReplyTo 0 Reply To 0 Reply To O P.O. BOX 345 100 CONIFER HILL DRIVE, SUITE 308 P.O. BOX 578 MANSFIELD, MA 02048 DANVERS, MA 01923 SHREWSBURY, MA 01545 TEL. (508) 337-8058 TEL. (978) 777-9900 TEL. (508) 842-3995 FAX (508) 339-5835 FAX (978) 774-9296 FAX (508) 842-7510 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139 Sec. 3D TO: Building Commissioner or Inspector of Buildings addresses Board of Health or Board of Selectmen 91 RE: INSURED® �. PROPERTY ADDRESS - = POLICY NO.: 3 LOSS OF: `j - lit FILE OR CLAIM NO.: _ � a �! 7__ 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 3D 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. T ff 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. 22,01 T&, -vii of NORTH m!SIGNATURE AND DA BOARD OF Ht. ,tea i JUN 2 2 2001 __ . -1