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Miscellaneous - 34 MAIN STREET 4/30/2018
34- , 3 & 124,* 5,-/— AA�f 4'e—xT �- ,�5C e�, —Z, / A 1! n::: J-.-9 11r: L a 1A W/– .9*/ nA- A.,VD ",P . ow&"av z -EFT Si po - OtFIW vAl5 _ ft- --. e7.aZ$7s kA;lZ-44;:> 7LW-14-1 --7 --fi�— WI -40W, - �,Czr-o ice'' !�k' 'L `i FA' "-AI-7;7-,' A? 11-'P /A -T G 645� 6 6;2:�76V- c S G�c: , 1 %/C�i AE ft AAV ` ice ��wG', .lam RE-eg J /1e --EP /'yj .c.67- LL .5c-ee- I OF- / e— D / -v 1-116- t , `S xI—Vf— � I �--— —A-11 �-- �— �f& � �— I o �6 .10, 0 �-- — eHfgt'l wt&CIAf,— LaMarche Associates 5 North Road, P.O. Box 250 Chelmsford, MA 01824 978-256-8586 Fax: 978-256-8590 September 30, 2013 Building Commissioner/Inspector of Buildings NORTH ANDOVER, MA 01845 Board of Health/Board of Selectmen NORTH ANDOVER, MA 01845 NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B Claim has been made involving loss, damage or destruction of the property captioned below, 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, cause of loss and LA file number. Insured: 855 REALTY TRUST Loss Location: 34-36 MAIN STREET NORTH ANDOVER, MA 01845 Policy Number: BOP0100705319 Date of Loss: 9/26/2013 Cause of Loss: Fire LA File Number: MA -2-23364 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. Kris Kirkpatrick Adjuster LaMarche Associates, Inc.- 800-349-1525 Page 1 of 1 r DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Monday, October 22, 2007 9:36 AM To: Melnikas, Andrew Subject: FW: 34 main st Hi Andy, Have not been able to reach the tenant (line busy) but below are the times staff from here is available. His name is: John Macedonia, 978.682.0181. -----Original Message ----- From: Sawyer, Susan Sent: Friday, October 19, 2007 3:50 PM To: DelleChiaie, Pamela Subject: FW: 34 main st Well, I guess we can give the renter anytime after 11 until 2 For me. Or I will check Monday to see if Michele wants it. I just love housing. S From: Melnikas, Andrew Sent: Friday, October 19, 2007 3:08 PM To: Sawyer, Susan Subject: 34 main st can fit that in on Tuesday. Let me know what time works for either yourself or Michelle Andy rSf A -LielleChiaie, Pamela From: DelleChiaie, Pamela Sent: Friday, October 19, 2007 2:36 PM To: Melnikas, Andrew Subject: North+Andover+Board+of+Assessors+Public+Access Importance: High http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=984780 Hi Andy, I left a message with Diane. Susan took a verbal complaint from a tenant at this address who claims there are no smoke alarms in the apartment. Can you let Susan know when you are free to go over there, and she or Michele will go with you? Diane said that you are out on Mondays, and are busy most of next week, but if you can squeeze it in on Tuesday maybe that might work? Thanks. Pavxela .Dellechiaie Health z)gavtmewt,4ssistawt yy8 6889540 North Andover Board of Assessors Public Access ,poMj of rte•^ „dry O Return to the Home page click on logo New Search Sales Summary Residence Detached Structure Condo Commercial Comparable Sales Parcel ID: 210/029.0-0001-0000.0 SKETCH. Click on Sketch to Enlarge Page 1 of 1 Property Record Card Community: North Andover PHOTO Location: 34-36 MAIN STREET Dwner Name: 855 REALTY TRUST Dwner Address: 91 QUAIL RUN LANE City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 31 - 1 Land Area: 0.21 acres Use Code: 111 - 4 -8 -UNIT -APT Total Finished Area: 3960 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 444,900 408,400 Building Value: 268,000 231,500 Land Value: 176,900 176,900 Market Land Value: 176,900 Chapter Land Value: LATESTSALE Tale Price: 0 Sale Date: 12/31/1978 ktms Length Sale Code: N -NO -OTHER Grantor: Cert Doc: Book: 01372 Page: 0179 http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=3&Linkld=984780 10/19/2007 0 North Andover Board of Assessors Public Access E ,�oR7y }2 °`'•'' •'•�'0 of •� &sncHu��r Return to the Home page click on logo New Search Sales Summary Residence Detached Structure Condo Commercial Comparable Sales Page 1 of 1 UjProperty Record Card Parcel ID: 210/029.0-0001-0000.0 Community: North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge N� •�ir p 34 36 MAIN STREET Location: 34-36 MAIN STREET Owner Name: 855 REALTY TRUST Owner Address: 91 QUAIL RUN LANE City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 31 - 1 Land Area: 0.21 acres Use Code: 111 - 4 -8 -UNIT -APT Total Finished Area: 3960 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 444,900 408,400 Building Value: 268,000 231,500 Land Value: 176,900 176,900 Market Land Value: 176,900 Chapter Land Value: LATEST SALE Sale Price: 0 Sale Date: 12/31/1978 Arms Length Sale Code: N -NO -OTHER Grantor: Cert Doc: Book: 01372 Page: 0179 http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=3&Linkld=984780 10/19/2007 It I =colo ti IILI LI o II i o 'a I ♦+ ,o I � I U+d 0 I i E p ti v CD 7 ro O 000 CA O00 0A i CI¢'� U I 3 O 0 c j N R H rr bD L C � 00 OI A N � to c r R I � 0 0 ._ 0 U) m CL •U C J 0 (D CDO U) 2 F- 0 au 0 ♦+ L U+d N CD d' O 000 CA O00 CI¢'� U C I cel O N 00 Uig' 00 to r R I � 0 0 ._ 0 U) m CL •U C J 0 (D CDO U) 2 F- 0 au 0 ♦+ L U+d CD O 000 CA CI¢'� C I cel cJa Uig' to ^C •� V r R I � 0 0 ._ 0 U) m CL •U C J 0 (D CDO U) 2 F- 0 au 0 TRAHSMP=;SIOhd VERIFICATION REPORT TIU51E 11/0512807 10:34 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# ; 000B4J120960 PATE,TIME 11185 10:33 FAX HO. /NAME 812878662373 DURATION 00:00:50 delleChiaie, Pamela 02 RE HLT OK MODE STAHDARP ECM Grant, Michele From: DelleChiaie, Pamela Sent: Friday, November 02, 2007 3:47 PM To: Sawyer, Susan; Grant, Michele Subject: FW: 34 Main Street FYI - re: smoke alarm complaint -----Original Message --- From: Metmkas, Andrew Sent: Friday, November 02, 2007 3:35 PM To: delleChiaie, Pamela Subject: RE: 34 Main Street Yes _ I did see that,. I did meet the owner( George Schruender) of the property this morning on site and went over what was needed. His electrician called me and said he would be doing the work as soon as possible ----orlglnal Message ----- From: aeileChiaie, Pamela Sent: Friday, November 02, 2007 1:49 PM To: Melnikas, Andrew Subject: 34 Main Street Iimportance: High Hi Andy, This was the day that called with the complaint last week about the smoke alarms that we could never coordinate with .... .he probably had to cancel because be was too busy making plans to rob tate bank .............. Parry Published; 11/02/2007 Mass. man, arrested in Salem bank robbery Police say he also stole library items By James A. Kimble and Mark Vogler Staff' writers SALEM - A television viewer who recognized a North Andover, Mass., man, in surveillance photos helped police make an arrest yesterday in Wednesday's daytime robbery of C.'iti7e11c RAnt- sylvia lew DelleChiaie, Pamela From: Sawyer, Susan Sent: Tuesday, October 10, 2006 11:29 AM To: Grant, Michele; Leathe, Brian; Brown, Gerald Cc: DelleChiaie, Pamela Subject: FW: Sylvia I am speechless see below from John Carney -----Original Message ----- From: Sawyer, Susan Sent: Tuesday, October 10, 2006 11:28 AM To: 'John P. Carney' Subject: RE: Sylvia Which name is fictitious? -----Original Message ----- From: John P. Carney [mailto:jcarney@napd.us] Sent: Tuesday, October 10, 2006 11:05 AM To: Sawyer, Susan Subject: RE: Sylvia Page 1 of 2 She is just blowing more smoke, she's trying to con everyone. I advised the housing court (Jay) about the identity issue. He spoke to the judge about it and they say there is nothing criminal about giving the court a fictitious name!!!? I guess they will deal with her administratively. As far as the prosecution is concerned I would go full speed ahead. It's the only way you are going to get compliance. She also made a number of calls to the Senior Center over the weekend. I believe she is complaining about elderly abuse. -----Original Message ----- From: Susan Sawyer Sent: Tuesday, October 10, 2006 10:49 AM To: John P. Carney Subject: RE: Sylvia ok We had an electrician come in this AM, whom she was supposed to meet Friday at her home on Maple Street. She called him Friday evening and told him that the Building Dept had her arrested because the electrician was not licensed??? That is a new one. Anyway, we told him that it was not his fault. He said she told him that she was going to be arraigned on Tuesday at 8AM. Michele called her lawyer and spoke to an associate and they both gathered that the inspection is called off for this morning. We have housing court with her on Thursday at 213M. Any thoughts on how we should handle that?? She obviously has not completed the list of repairs that we first ordered her to correct. Thanks 10/10/2006 sylvia Susan Page 2 of 2 If you hear anything let me know please. We are a little concerned that she may be a bit upset with our office. -----Original Message ----- From: John P. Carney [mailto:jcarney@napd.us] Sent: Tuesday, October 10, 2006 9:25 AM To: Sawyer, Susan Subject: RE: Sylvia Sorry, did not get back to my email on Friday. She was arrested, as you know. She should be in court today and they might hold her on bail pending proper identity. It might be that neither name is correct. -----Original Message ----- From: Susan Sawyer Sent: Friday, October 06, 2006 4:11 PM To: John P. Carney Subject: RE: Sylvia It is 4:10 any news? I don't want to be a pest, but I am leaving at 4:30. If you don't know by then can you call me later on my cell 978 490-6678 thanks Susan -----Original Message ----- From: John P. Carney [mailto:jcarney@napd.us] Sent: Friday, October 06, 2006 3:47 PM To: Sawyer, Susan Subject: RE: Sylvia Jeanie L. Demauro 11 Mill St. Manchester BTS. date of birth 02-27-1944. -----Original Message ----- From: Susan Sawyer Sent: Friday, October 06, 2006 2:16 PM To: John P. Carney Subject: sylvia remember she lives on Maple Street She is heading over there Susan Sawyer, R.S. Public Health Director office 978 688-9540 fax 978 688-8476 10/10/2006 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTIN(; (Print or Type) C . • NORTH ANDOVERMass. Date lS/ �uilding Location .� L� ��{,� S� Permit # Owners NameCC A New '7 Renovation D Replacement Plans Submitted FIXTUPI=S (Print or Type) i Check one: Certificate Installing Company Name �t-CGZyI S ja U Corp. Address /. / �Z(G`; Partner. Firm/Co. Business Telephone: 373 Name of Licensed Plumber or Gas Fitter�-- Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: - _ Liability insurance policyOther type of indemnity Q Bond �( Insurance Waiver: I, the P-ndersigned, have been made aware that the licensee of Chis application does not have any one of the above three insurance coverages. ignature of owner/agent of property Owner U Agent n 1 hereby certify that all of the details and information t 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' Fermit issued for this application will be to compliance with aA pertinent provisions of the Massachusetts Slate Gas Code and Chapter 142 of the Genual LAws. By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE: Plumber Gasfitter Signature of Licensed Master Plumber or Gasfitter Journeyman �/fv5 License Number W w vt x 14 O ZCC Q �; rn w W at N a CC. o V N r Y F - z cn o r rr d 030N 4 W cc o 0' O w tW- a N O w d x. W ^' F^ N a p rx Y q w w w to W z j- Q x W W c W a w I• w r xcc C.- O z F. d Z w j GCC z F. .• ►' W y- N O? m = W O t- " `w W _j d I.- rn W w x u> W z 4 a 4 .4 O o rr •... o w i_ - cc cc z o v z u. n a to ,1 O or: y ca a. t- o SUBi—BSti1T. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8THFLOOR (Print or Type) i Check one: Certificate Installing Company Name �t-CGZyI S ja U Corp. Address /. / �Z(G`; Partner. Firm/Co. Business Telephone: 373 Name of Licensed Plumber or Gas Fitter�-- Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: - _ Liability insurance policyOther type of indemnity Q Bond �( Insurance Waiver: I, the P-ndersigned, have been made aware that the licensee of Chis application does not have any one of the above three insurance coverages. ignature of owner/agent of property Owner U Agent n 1 hereby certify that all of the details and information t 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' Fermit issued for this application will be to compliance with aA pertinent provisions of the Massachusetts Slate Gas Code and Chapter 142 of the Genual LAws. By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE: Plumber Gasfitter Signature of Licensed Master Plumber or Gasfitter Journeyman �/fv5 License Number s — Date..... .........:..'. NORTH TOWN OF NORTH ANDOVER 14'O F? y pp PERMIT FOR � —S INSTALLATION 9 ,SSACMU5E� )n �< This certifies that ...l .. �. .!�.� ...>..... 5U l; .�........... . has permission for gas installation ... /!' , ..'...... .......... . in the buildings of ............ at -- .� .. /j.�.. =r.':..?��,' ....... , North Andover, Mass. Fee./i ._Lic. No. d!� 1.... .......................... I /, 4 GAS INSPECTOR WHITE: Applicant ' — CANARY: Building Dept. PINK: Treasurer GOLD: File 356,' Date ........ 0, TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............................................... ...... ..................... • has permission to perform ....... .... ........................ wiring in the building of ...... . at ...... ........................................................................ North Andover, Mass. Fee-..�? ..... ....... Lie. No.............. .......... ............................................. ELECTRICAL INSPECTOR Check # Official Use Only Permit No. 7;(5 eM&WA17M54Z7W 619 7"S5,464WS577S Deux 4 P -P& Satiety Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Ail work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date / -J 6 " D 9 - To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number Owner or Tenant 6nr-� Owner's Address ?,�) C R t C K! I -1 h g /C r Is this permit in conjunction with a building permit Yes ❑ No I& (Check Appropriate Box) Purpose of Building ?eS (eL 11C (' ,?1PAEL�� T rr `�e vkTL f Utility Authorization N, 0 4/ Existing Service 01-- Amps q b Vats Overhead AK Undgmd ❑ No. of Meters it Number of Feeders and Ampacity_ _ZIM Location and Nature of Proposed Electrical Voits Overhead ❑ Undgmd ❑ No. of Meters At W OTHER: INSURANCE COVERAGE. Pursuant to the requirements of Massachusetts uenerai taws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivale YES — NO = 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$ 5&D o GU Work to Start Inspection Date Resquested i( Rough FinalSigned //�� FIRM NAME under ryVQ. hies of pg ury\ q� �I�G� ( �� I ii f -5, LIC. NO Jfi L/ V ttC2 15�D �'1� t CA < µ1 6C?►. NO.,44-164.7-7 Address 60 ��� 5 /�1 �i(r Bus. Tel No. 7�c51 1 A Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the 121censes 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) Telephone No. PERMITIFEE $ (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ gmd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners 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 Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requirements of Massachusetts uenerai taws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivale YES — NO = 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$ 5&D o GU Work to Start Inspection Date Resquested i( Rough FinalSigned //�� FIRM NAME under ryVQ. hies of pg ury\ q� �I�G� ( �� I ii f -5, LIC. NO Jfi L/ V ttC2 15�D �'1� t CA < µ1 6C?►. NO.,44-164.7-7 Address 60 ��� 5 /�1 �i(r Bus. Tel No. 7�c51 1 A Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the 121censes 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) Telephone No. PERMITIFEE $ (Signature of Owner or Agent) \ 1_ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type,)I l 1- f/1) Mass. Date 1g 5 Permit # 30 Building Locatig� X "w 15 / Owner's Name Type of Occupancy New 4 Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ Installing Company Name L �� 11111 �5 911 Business Telephone ' J;73 Name of Licensed Plumber or Gas Fitter Check one: Certificate ❑ Corporation ❑ Partnership ❑ Firm/Co. INSURANCE OVERAGE: I have a curre lability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have hecked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ 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: I, Signature of Owner or Owner's Agent Owner[] Agent F-1 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene I Laws. BY T e of License: Plumber Signature of Licensed Plumber or i ter Title Gaster � Master License Number City/Town Journeyman APPP04ED(OF� N N W tp N N Y U Y Cc S N fn C N C O Q to J N W Z 0 W �. a Q ¢ r it Z i 0 Q} 0 cc H Q C m of W F Q y W O F 0 W a ¢ fa Q yyj W N W = 0 S = S h S Z W Q C C W O Q W ) f' _ N cc t7 .9= J J_ f' = H W H O m V W A Y < W < C Q y N Z O Y E O x Q W 's O C c7 W Y U. Z n 3 S CIO Q Q J O U¢> O W Q O a W H h O SUB—BSMT. BASEMENT 1 1ST FLOOR 2ND FLOOR I 3RD FLOOR 4TH FLOOR STH FLOOR 6THFLOOR 7TH FLOOR STH FLOOR Installing Company Name L �� 11111 �5 911 Business Telephone ' J;73 Name of Licensed Plumber or Gas Fitter Check one: Certificate ❑ Corporation ❑ Partnership ❑ Firm/Co. INSURANCE OVERAGE: I have a curre lability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have hecked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ 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: I, Signature of Owner or Owner's Agent Owner[] Agent F-1 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene I Laws. BY T e of License: Plumber Signature of Licensed Plumber or i ter Title Gaster � Master License Number City/Town Journeyman APPP04ED(OF� m m m r u: N x m -4 A x m N w m r D r 0 x 0 r m A m C N m 0 z r 1 Date....'. ....'..�l..! .:. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ........... Ice has permission for gas installation ... ........ '.t9v, ...... in the buildings of ... ..�'......1. , . , ...................... at �..`+. �l .. 4 -..... ....... , North Andover, Mass. Fee. W. .tic. No..-./ ...'.1 . .......................... r' 1 GAS INSPECTOR WHITE: Applicant— CANARY: Building Dept. PINK: Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION FOR (Print or Type) Cel LAWRENCE Mass. Date Building Locationj__ New ❑ Renovation ❑ Replacement ❑ PERMIT TO DO GA Z ING -- 19 Permit_ # J/c Owner's Name Type of Occupancy Plans Submitted: Yes ❑ No dA .y Installing Company Name ��Ya �P 5 zy&- e Z Address A aac�? s �� �&d Business Telephone Name of Licensed Plumber or Gas Fitter J Check one: Certificate # ❑ Corporation ❑ Partnership ElFirm/Co. iZC INSURANCE COVERAGE: I have a curr liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you haver/checked rte, please indicate the type coverage by checking the appropriate box. A liability insurance policy. ❑ Other type of. indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that tha, 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 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 installation performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Type of License: 7plumber Title ❑ Gasfitter City/Town ❑ Master APPROVED (OFFICE USE ONLY) El Journeyman Signature of Licensed Plumber or Gas Fitter License Number Z � v) (YjV M z lA ~ m Z O S t- W Er W a O O W QQ a= O Z O Z f - cn cn C7 W w W = rn W z O (n ( O W > Q W W w W W z Q= Z o: cc W Q w > w _ J ac W \(1 z Q Q W> W J Q W D H z H Q >- Q � Q O Q z0 Qu 8 ~ W¢ W O W ►- a: = O 0= u- 3 o c7 ¢> o a O SUB-BSMT. BASEMENT 1 ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR / 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name ��Ya �P 5 zy&- e Z Address A aac�? s �� �&d Business Telephone Name of Licensed Plumber or Gas Fitter J Check one: Certificate # ❑ Corporation ❑ Partnership ElFirm/Co. iZC INSURANCE COVERAGE: I have a curr liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you haver/checked rte, please indicate the type coverage by checking the appropriate box. A liability insurance policy. ❑ Other type of. indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that tha, 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 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 installation performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Type of License: 7plumber Title ❑ Gasfitter City/Town ❑ Master APPROVED (OFFICE USE ONLY) El Journeyman Signature of Licensed Plumber or Gas Fitter License Number 0 a m N z m T m 3 -i 0 X D z m a r z 0 T r C 3 ao m M 0 0 a N m m r 0 0 z 0 m W cF O z 0 z D 3 m AD m 0 m C F 0 z a T -o r D 0 z m 0 M T m 3 0 0 0 a N z m z D r z N .9 m 0 J 0 z m m 3 m 0 c -i m N m z a r z N '0 m 0 1 0 z N X m -1 0 x m N z 0 '0 0 6) M m N N Z N '0 m 0 -i 0 z N 4p Date ..................... ,NORTH TOWN OF NORTH A U DOVER , pF ,,o ,e,ti0 0'PERMIT FOR GAS LLATlOIN SACHUSEtAy s i (yJ This certifies that . I ...I e I r .. ?.....�.. .. . �.. ... K)4 ....... . has permission for gas installation .,::. ; ..... ... ! ............ . r in the buildings of at Fee. ,a.�.. Lic. NO.. . i.'>... . `r' GAS INSPECTOR WHITE: Applicant' CANARY: Building Dept. PINK: Treasurer GOLD: File a Location `{ No./a- Date MORTIy TOWN OF NORTH ANDOVER Of �'•' '•,�O � OL 9 Certificate of Occupancy $ MUsE<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee f $ TOTAL $ r r' Check # i 633 �t Building Inspector TOWN OF NORTH ANDOVER 4 BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Buildin Co one.ragsilpitor of Bu'1¢in Date SECTION 1- SIT pkt ,51 LI Property Address: 1.2 Assessors Map and Parcel Number: 3 Map Numb r— 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 Required 4- Provided 1 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record &e,(?Z ev • MaWe( t) Mdress for Service V � Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: a. Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 istered Home Improvement Contractor Not Applicable ❑ AeoAkAl RooF -2 om any Nam e C2.:)l eZon of 411>00e egistration Number&r — Ad cess P A 4j FWIO&T iration ate lrtgjrure 1ele one 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 Ucable New Construction ❑ Existing Building ❑ Repair(s) ❑ TAlterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify , Brief Description of Proposed Work: ' """` ►�' ` SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be OFFICIAL USE ONLY Completed by permit applicant g (a) Building Pe 1. Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical(HVAC)V- 5 Fire Protection d 6 Total (1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WIZEN 1, , as Owner/Authorized Agent of subject p;operty Hereby authorize to act on My behalf, in all matters relative to work authorized by this building pen -nit application. Signature of Owner Date SECTION 7b OWNER/AUTH©'RIZED AGENT DECLARATION 1, As Owner/Authorized Agent of subject property Hereby declare that the statemenis` information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Si2nature of Owner/A ent NO. OF STORIES BASEMENT OR SLAB SIZE OF FLOOR TIMBERS SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DWENSIONS 01%GflFWE3&.� HEIGHT OF FOILTA�iQI _ SIZE OF FOOTING MATERIAL F CHR%4NEY+( IS B Dj C, ON S R F.ILLEI IS B ='IN6 CO _ TO NA' ,* V Date V, a A 'k f A 13 ft M A 4 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 c 11, S.150 A.. The debris will be disposed of in: rT- N C) o )0 (Location of Facility) oignarure of t-errn t Applicant 5 - o Date _ NOTE: Demolition permit from the Town of North Andover must be obtained for this project through. the Office of the Building Inspector C O 53 N C 0. @ 0) CL J10? I nM 0? CD CL f0 j s ' CL � M Z y N C a + Q rr Z 3 m O n, co The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print I o 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. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' irrprisonment_as_weelLas_civil_penattiesin.ihe%un-faSTOPY!/ORK ORDER md_aFme_of._($111DM)-aAN againstn-e. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check d immediate response is required .0 Licensing► Board E] Selectman's Office Contact person: Phone A- R Health Department o Other /� p /�^�c VIC1TIFICA'11'G' •O;I�'):I�SVf r 1 Q ti ".�, .1 ISSUE DAIS (MMA)II/YY12� 1_1.05/t PHUOUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND::* CONFERS NO pIGHTS UPON THE CEITIFICATE HOLDER. THIS CERT)FICAT FTM T.F. WARD INSURANCE AGENCY INC 'DOES EXTEND OR ALTER THE COVERAGE AFFORDED'BY HE3 POLICIES BELOW: 403 FRANKLIN' LT COMPANIES AFFORDING COVERAGE gl MELROSE MA 02176/ COMPANY LETTER A HERMITAGE INS.. CO.: COMPANY INSURED LETTER MICHAEL KE011AN COMPANY LETTER COMPANYID 54 ELM ST P N LETTER NORTH ANDOVER MA 0184$CpMPANY ` { ,4w`- LETTER +r ri e. . 1 .,�wr...�' i "r." ; yi,v;.. .r . •r•. i:+=-� =a'JuJ aartrrs;,_w.: ;ro.•' , wa,, . •CO.VEFiAQE$:: :r� �3>:..1• ';�;.i: ..�� �F' �' h6. �_�ea�x.rmr ."'3;:t �� �. z�e�s '�•�::;":, THIS IS TO CERTIFY THAT THE POLICIES OF INSVRANCE LISTED B�.LOW HAVE'BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD FP:M `AEMENT, TERM OR CCVDITIONOf OTHER DOCUMENT WITH.AESPECT INDICATED, NOTWITHSTANDING ANY ANY CONTRACTOR TO WHICH THIS :;ERTIFICATE MA'.' 192 Is$vHD Lia MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT, O ALL THP TERMS., t'XCLUS•ONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER VE POLICY EFFECTIVE IC POLY EXPIRATION f r LIMIT LTA Ml DATE (MDDIYVI DATE (MMlDO/YY) GENERAL LIABILITY GENERAL AGGREGATE S] Q Q Q 000 X X COAIMCRCIAL GENERAL LiAMtL11•Y HGL4 3 816 9 05/20/02 0 5/ 2 0/ 0 3PNODUGTS COMPIOP ACG. III:�'0 0 0, 0.0 O MAXX OCCUR. PERSONAL & ADV.[j ,CLAIM$ 000 OWNER'S d CONTSACTOWS PROT. EACH OCCURRENCE $500, 000 --% FBTE DAMAGE IAny one Ilro) £5 0 000 MED. EXPENSE (Any one Dcr,oni, 31 , 000 AUTOMOBILE LIABILITY COMBINED SINGLC S . ANY AUTO LIMIT .. BOOILV INJURY i t ALL OWNED AUTOS- SCHEDULED AUTOS (Por pnrponl I BODILY INJURE' ! �Sti. HIRED AUTOS' • NON•OWNED AUTOS (Par ocoldonq A GAAn4;E LIABILIIY ( I PROPERTY DAMAGE I L —j EXCESS LIABILITY EACH OCCUfIREdCE� $ S IUMORCLLAFORM AGGREGATE ! i "• F_lOIHIiRTHAN UMBRELLA FORM A''�.'r�.yw.,:"+++"NI',�� rtyy! F, r� :;�'>d �j•,L4y:1'a!iMl.9'�; ��1_. ::• .M1: ' 'I" -r �I r!-�'•:' '� :jJ':T:i _.y.• WORKER'S COMPENSATION STATUTORY LIMITS ;v. CACH ACCIDENT S •'>°" -'" AND I DISEASE—POLICY LIMITS F►tPLOYERS' LIABILITY DISEASE—EACH GMpLJVGG 2 OTHER ; 6� f.l *x•r 'l'-':• its } •: DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS ROOFING — COMMERCIAL lCIRTIFICATE'HOLDH:3 1,+ww".dl'i�':i"f,'i:,ll.°T'.-..�,��,,, slC•�i..t .,�i:• ••';t: -.;f ... A(VClrL•Lp.T:IQNl"-.r.�.'tcadY+Gkl. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO. MAIL -!P- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALT_ IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ' 1. .,..,�.�+�r,�_. .r�ll�;'"':jj: 'i�Ju .I:i�!1�:Fi: �'��,�1'•1:1'.Iti: ^P: ?::� •N �' ti•. ;..;1 .. 1� :.'1. •. .R. I,1 .I. fi'1 .. ....::'v.,_... .•!P'.LY...... ,..,;'li;,t:r'1 ..i..a•h.da:.+:rr1.•eii:o:.:J.•...Itl-..... .. ... ...L w .n-_-� TOTAL P.01 NOTICE OF ASSIGNMENT EMPLOYER: MICHAEL KEDHAN DBA KEDHAN ROOFING COMBO I.D. STATUS OF EMPLOYER 54 ELM ST 000004064 Individual NORTH ANDOVER, MA 01845 COVERAGE GROUP. 0004064 The Waiver of Our Right to Coverage under this assignment Recover from Others Endorsement applies to Massachusetts is available on Pool policies. operations only. For coverage Contact your agent.for details. outside of Massachusetts, contact the appropriate Pool or Plan for that state. AGENT T F WARD INS AGCY INC OR 403 FRANKLIN ST PRODUCER: MELROSE, MA 02176 AGENCY FEIN: 042895924 INSURANCE COMPANY: TRAVELERS INDEMNITY CO MS JACKIE DENNIS P 0 BOX 3556 ORLANDO, FL 32802 (800) 443-4404 CLASSIFICATION OF OPERATION CLASS ESTIMATED RATE ESTIMATED CODE TOTAL ANNUAL PREMIUM -------------------------------------- ----- REMUNERATION ------------------------ ---------- ROOFING-NOC-& DR 5545 $0 33.29 $0 EMPLOYERS LIABILITY 100/100/500 9845 LOSS CONSTANT 0032 $50 STANDARD PREMIUM $50 EXPENSE CONSTANT 0900 $122 RISK MINIMUM PREMIUM 0990 $500 ESTIMATED ANNUAL:'PREMIUM $500 DIA ASSESS. 4.5% OF STANDARD PREM. $17 EST. ANNUAL PREM. PLUS ASSESSMENT $517 INSTALLMENT BASIS: Annual REQUIRED DEPOSIT PREMIUM $517 H COMMENTS Coverage effective 12:01 AM on 02/26/03 DATE OF NOTICE: 02/27/03 PREPARED BY: Joanne Shea EXT 530 * * SERVICING CARRIER ASSIGNMENT LETTERID: 378353 COPY: EMPLOYER The Workers' Compensation Rating and Inspection Bureau of Massachusetts 101 Arch Street • Roston_ MA 02110 Board of Building Regulations and Standards One Ashburton Place -Room 1301 Boston, Massarthusetts 02108 Home Improve,nent Contractor Registration '. Registration: 133221 Type: DBA w Expiration: 05/23/2003 i - x KEOHAN ROOFING MI,HAEL KEOHAN--- 54 ELM ST. __- N.ANDOVER, MA 01845 Update Address and return card. Mark reason for change f� f Arldress �I Renewp! r- i� innlovmPnt F--1 Lost Card 4 v h Ir W it r�O x O w C a�O v) O c7 c w O w v U C w U W PLAO p w G ii o W A ¢ w p oG v ct U z p m G W w w C cQ 2° cn D o cn E d H t ,r N O a N C O v CD C: m C cc 0 m C_ �C N CD t O 2 O 0 F. 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