HomeMy WebLinkAboutMiscellaneous - 339 WAVERLY ROAD 4/30/2018`�
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PO Box 55098
Boston, MA 02205-5098
617-951-0600
TAWW-
Form of Notice of Casualty 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 01845 NORTH ANDOVER, MA 01845
RE: Insured:
NANCY PIERRO
Property Address:
339 WAVERLEY ROAD, NORTH ANDOVER, MA
Policy Number:
HMA 0378972
Claim Number:
BOS00053101
Date of Loss:
2/14/2015
Company:
Safety Indemnity 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.Geri: 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.
Temistocles Devers Claim Examiner 3/4/2015
Safety Insurance Company
Homeowners Claims Unit
P. O. Box 55098
Boston, MA 02205-5098
Phone: (617) 951-0600 EXT 3297
Fax: (617).535-5868
Email: TemistoclesDevers@Safetylnsurance.com
N2 4765
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TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ....................
has permission to perform ..... 4.
plumbing in the buildings of ...................
....... North Andover, Mass.
at '7 (-1-.
Fee. Lic. No../?. . ........ ......
PtUMBING INSPECTOR
Check # q Z L—
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
0
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building
Owners Nam
of Occupancy o
New ® Renovation 10 Replacement rl
L 63
Date CY1Rc/o?T
Permit #
Amount /
Plans Submitted Yes 1:1 No
(Print or type) Check one:
Installing Company Name GyQ,4n blae g/Va3 Ckgg %A4 g z7b, . Er
Corp. .
Address Z-E�6 GAAdAe1'& Z*AP- Partner.
11 Business Telephone X78 —6 9-9�9G Firm/Co.
Name of Licensed Plumber: ' /4.'li9P_ `=
Insurance Coverage: Indicate the type of insurance cover,1ge by checking the appropriate box:
Liability insurance policy R Other type of indemnity 11 Bond ❑
Certificate
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner El 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 performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chap r 142 of the General Laws.
By: Signa uIirre of icense um— ems'
Type of Plumbing License
Title /ell g '9
City/Town License Numoer Master ® Journeyman
APPROVED (OFFICE USE ONLY
W Vin,
-0 I'MONOMMOMMOMMOMMOOMMOMMMMMM
(Print or type) Check one:
Installing Company Name GyQ,4n blae g/Va3 Ckgg %A4 g z7b, . Er
Corp. .
Address Z-E�6 GAAdAe1'& Z*AP- Partner.
11 Business Telephone X78 —6 9-9�9G Firm/Co.
Name of Licensed Plumber: ' /4.'li9P_ `=
Insurance Coverage: Indicate the type of insurance cover,1ge by checking the appropriate box:
Liability insurance policy R Other type of indemnity 11 Bond ❑
Certificate
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner El 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 performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chap r 142 of the General Laws.
By: Signa uIirre of icense um— ems'
Type of Plumbing License
Title /ell g '9
City/Town License Numoer Master ® Journeyman
APPROVED (OFFICE USE ONLY
Location'-�
Date
T TOWN OF NORTH ANDOVER
4L I Certificate of Occupancy $
Building/Frame Permit Fee $
CHU
Foundation Permit Fee $
Other Permit Fee $
TOTAL
Check #
14549
Building Inspec6or
I TOWN OF NORTH ANDOVER
J BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
VON
Sii
BUILDING PERMIT NUMBER: �iwa, DATE ISSUED: 3 z 2
A. A d
•• iQ8
SIGNATURE: �'1 �"'"� �" -1
sof
Building Conunissioner/In ctor of
SECTION I- SITE INFORMATION
Date . "?- `L ••
LI .Property Address:
1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
6
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning District Proposed Use
1
Lot Area (sf) Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard
Rear Yard
Required Provide
Required Provided
Provided
—Required
1.7 Water Supply M.G.L.C.40. 9 54)
1.5. Flood Zone Information:
1.8 Sewerage Disposal System:
Public 0 Private ❑
Zone Outside Flood Zone ❑
Municipal 0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record ;
21
NameBrint AAAd
�( )la %' ress for Service:
gnature / Telephone
2.2 Owner of Record:
.j4ame Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor:
License Number
Address
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature Tele hone
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 all a licable
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition 0
Accessory Bldg. ❑ Demolition 0 Other 0 Specify
Brief Description of Proposed Work:
I SRCTJON 6 - F..,STT MATF.-n cnNCTR1TCTT0N COSTS 1
Item
Estimated Cost Dollar to be
(Dollar)
Completed b permit a licant
A
fiFFIC(IAI.USE
afi fi k 3a.„yaah', �t
r ���, a
07L�1 k€
v ��
1. Building
(a) Building Permit Fee
Multi lier
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
L--- '� '
Check Number
NEC I1UN /a UWf4hKAU IHUKlGAt101V IU JJE UUnFL14:lE D WHN;1N
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf '11 all. ratte r tive to wg aiuthorized by this building permit application.
-
✓'� �..
Signatu f Owner Date
SECTION 7b OWNER/AUTIIORIZED AGENT DECLARATION
i
I, 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
Sienature of 0,Amer/AQent Date
Town of North Andover
Building Department
27 Charles Street
North Andover, MA. 01845
D. Robert Nicetta
Building Commissioner
(978) 688-9545
(978) 688-9542 Fax
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE < (/
JOB LOCATION (/U(d_vp-, i v
Number
"HOMEOWNER 4A
Name
PRESENT MAILING ADDRESS
City Town
Address
Home Phone
State
Map / lot
Work Phone
Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings
of two units or less and to allow such homeowners to engage an individual for hire who does
not possess a licensi, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1)
DEFINITION OF HOMEWOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which
there is, or is intended to be, a one or two family dwelling, attached or detached structures ac-
cessory to such use and/or farm structures. A person who constructs more than one home in a
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 he/she understands the Town of No. Andover
Building Department minimum inspection procedures and requirements and that he/she will
comply with said procedL
HOMEOWNER'S SIGNA
APPROVAL OF BUILDING OFFICIAL
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The Corti o Wit— `' `"''Y
n; f Alussachusetts
Department of Public Sa/eiy -�•�—
rk rup—cy A ree Mrckrd
;r. BOARD OF FIRE PREVENTION FiECULATIONS S27 CMR 1200 3/90
�- (Ieave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 4
All work to be periormtd In accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date '�/ _":p --�
City or Town of To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) 9"
Owner or Tenant O e
Owner's Address
Is this permit in conjunction with a building permit: Yes ❑ No F%71 (Check A grog ate Box
Purpose of Building Re,s�,r%gajJ` Utility Authorizatio 0. Lxp—/�
Existing Service ` 2 .1mps 1,46M Volts Overhead N Undgrd No. of ers�_
flew Service U Amps f/(� / ,_Volts Overhead ® Undgrd o. of Meters__
Humber of Feeders and Ampacity
Location and Nature of Proposed Electrical Work �,� ti p ��� �P 6P v/ r P
No.
of Lighting Outlets
No.
of Lighting Fixtures
No.
of Receptacle Outlets
No.
of Switch Outlets
No.
pf Ranges
No.
of Disposals
No.
of D[shwashers
No.
of Dryers
No.
of Water Heaters
No.
Ilydro Massage Tubs
OTHER:
No. of Ilot Tubs
Swimming Pool Abov
grnd
No. of Oil Burners
No. of Gas Burners
No. of Air Cond.
No. of Ileat Total
Pumps Tons
Space/Area Heating
Heating Devices
KW no, of
Si ns
No. of Motors
no. o
Ballas
No. of Transformers Tbta
KVA
e ❑In-
grnd. ❑ Generators KVA
No. of Emergency Lighting
Battery Units
FIRE ALARMS No, of Zones
tal
ons
No. of Detection and
Initiating Devices
No. of Sounding Devices
Total
KW
KW
No. of Self Contained
Detection/Sounding Devices
KW
Local ❑ Municipal ❑ Other
Connection
Low Voltage
Wirine
Total HP
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liabilit Insurance Policy including Completed Operations Coverage or its substantial
equivalent. .YES ❑ NO Dq I have submitted valid proof of same to this office. YES ❑ NO
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE. ❑ BOND ❑ OIHER ❑ (Please Specify)
Estimated Value of Electrical Work S .0 b
Work to Start
e? -.J/ —fiJ Inspection Date Requested:
Signed under the penalties of per ry:
FIRM NAME V ICA
License
0
Expiration ate
Rough J Final
LIC. NO.zud
_ N0.
Addresse2 /yf6ymej lo*e- TA�Itirshax6 ��. Bus. Tel.AltNo
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the. insurance coverage oris sub-
stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit
application waives this re irement. Owner Agent (Please check one)
Telephone No�&-'3— 7v` %® PERMIT FEE S
gnatu a of er Agent
,ORT"
0
0
lo
Date ........ ... ..........
i
TOWN OF NORTH ANDOVER Q.
-9
PERMIT FOR WIRING
8
A
This certifies that ............. . ..... ........... 4 oz
......................... ......... .......................
has permission to perform ......... I ........ ...... ....... ; .......................
wiring in the building of .... / .............. .............. I .................. I ..... ......
at ............
................................................... ................ . North Andover, Mass.
.......... —... Lic. NoJ ..............................................................
ELECTRICAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
Office Use Only
the C�ammnnur>ztti of tsttr�usl'�rs
Permit No.
letrattralewof lthl'tt Occupancy & Fee -Checked
_. 3T (leave blank
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
T& or Town of NORTH MOVER To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant /&�
� g
Owner's Address Com'
Is this permit in conjunction with a building permit: Yes El No (Check Appropriate Box)
i4 Purpose of Building Utility Authorization No.
9"
_ Existing Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters
New Service Amps __! Volts Overhead ❑ Undgrnd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
OTHER:
INSURANCE COVERAGE: Pursuant to the reauirements of Massachusetts general Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES = Me = 1
have submitted valid proof of same to the Office. YES = NO = If you have checked YES, please indicate the type of coverage by
checking the appropriate box.
INSURANCE = BOND = OTHER = (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work $
Work to Start Zed Inspection Date Requested: Rough Final
Signed under the Penalties of perjury:
FIRM NAME LIC. NO.
Licensee C �G' e Signature LIC. NO. l
Bus. Tei. No.
Address 1J �� L' �D P r S`Q X16 >�a KH Alt. Tel. No. �U y �✓ O
OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re-
quired by Massachusetts General La�and that my signature on this permit application waives this requirement. Owner Agent
(Please c" k one) /J a�'✓ S V
_ Telephone No. i'�.� .4 PERMIT FEE S 5
/ f Signature of Owner or Agent x-6565
Total
No. of Lighting Outlets I
ubs
No. of Hot T
No. of Transformers KVA
No. of Lighting Fixtures i
Above.—
Swimming Pool grnd. i
in -
grnd. I
Generators KVA
No. of Emergency Lighting
No. of Receptacle Outlets
No. of Oil Burners
I
Battery Units
No. of Switch Outlets '
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Total
No. of Ranges
9
No. of Air Cana. tons
Initiating Devices
No. of Sounding Devices
No. of Self Contained
Heat Total Total
No. of Disposals No.of Pumas Tons KW
No. of Dishwashers !
Scace/Area Heating
KW
DetectioniSounding Devices
Municipal
Local ii Connection ❑Other
No. of Dryers I Heating Devices KW
i No. of No. of
Low Voltage
No. of Water Heaters KW
I Signs Ballasts
Wiring
No. Hydro Massage Tubs
I No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the reauirements of Massachusetts general Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES = Me = 1
have submitted valid proof of same to the Office. YES = NO = If you have checked YES, please indicate the type of coverage by
checking the appropriate box.
INSURANCE = BOND = OTHER = (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work $
Work to Start Zed Inspection Date Requested: Rough Final
Signed under the Penalties of perjury:
FIRM NAME LIC. NO.
Licensee C �G' e Signature LIC. NO. l
Bus. Tei. No.
Address 1J �� L' �D P r S`Q X16 >�a KH Alt. Tel. No. �U y �✓ O
OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re-
quired by Massachusetts General La�and that my signature on this permit application waives this requirement. Owner Agent
(Please c" k one) /J a�'✓ S V
_ Telephone No. i'�.� .4 PERMIT FEE S 5
/ f Signature of Owner or Agent x-6565
2759
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ..... kk'. 1.?. 1/ ....... ..................... A
CU
- . -V -
has permission to perform ....... ................
wiring in the building of ......
.................................................
CU
at .... ...... C/ ...... ........... . North Andover, Mass.
. ..... ..... .......
Fee ... 1..rdo .... Lic. No./. .7 V-0 ........... i�i� R . ICAL . INSP . Ec-rOR .................
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
Date....
OF
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ..... kk'. 1.?. 1/ ....... ..................... A
CU
- . -V -
has permission to perform ....... ................
wiring in the building of ......
.................................................
CU
at .... ...... C/ ...... ........... . North Andover, Mass.
. ..... ..... .......
Fee ... 1..rdo .... Lic. No./. .7 V-0 ........... i�i� R . ICAL . INSP . Ec-rOR .................
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File