HomeMy WebLinkAboutMiscellaneous - 34 WILLOW RIDGE ROAD 4/30/2018 (2)_�
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March 8, 2015
NORTH ANDOVER BUILDING COMMISSIONER
NORTH ANDOVER TOWN HALL
NORTH ANDOVER, MA 01845
Claim Number:
033543491
Policy Number:
30349400003
Company Name:
Arbella Mutual Insurance Company
Date of Loss:
02/14/2015
Insured:
AVEDIS GARAVANIAN
Property Location:
34 WILLOW RIDGE RD NORTH ANDOVER, MA 01845
To whom it may concern:
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 3B 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.
Very truly yours,
Scott Fleetwood
CC: City/Town Fire Dept., City/Town Health Dept.
• BrightClaim, Inc. PO Box 921759 Norcross, GA 30010 •
Location-�/'���`
No. 11/0 Date "Pei, dz)
MORT1y
TOWN OF NORTH ANDOVER
Certificate Occupancy
$
of
�•�S'cHus
,CHU Eta
sw
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$r
Check # -ZI &
if _u4
Building In &Or
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: DATE ISSUED: �l
SIGNATURE:
Buildi7g Commis ' ner/I or of Buildings Date `
SECTION 1 -SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
RapNumber Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
R red Provide Required Provided
ReqLlired Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
Public ❑ Private Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal 0 On Site Disposal System
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.10 er of Record
2���L� W
Name (Print) Address for Service
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Tel hone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
+Licensed Construction Supervisor:
Address
Signature Telephone
Not Applicable ❑
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
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 applicable)
New Construction ❑
Existing Building ❑
Repair(s) ❑
Alterations(s) ❑
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
fo(q zla I)IX,1617-0
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit a licant
OFFICIALUSE ONLY
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 AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in 1 ma ers r ptive to wor uthorized by uilding permit application.
Si nature of 6caner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
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
Signature of 0e/A ent Date
M -No mom
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 2 ND 3 RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DM/fENSIONS 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 LINE
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Town of North Andover a� Np RTF1
Building Department o
27 Charles Street
North Andover Massachusetts 01845` .^
(978) 688-9545 Fax (978) 688-9542
7e �R�reo �Pay�S�
DEBRIS DISPOSAL FORM
In accordance with the provisions of MGL c 40 s 54, and a condition of
Building permit 9 the debris resulting from the work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a.
The debris will be disposed of in /at:
G -� 7"
Facility location
Signature of A plicant
Date
NOTE: A demolition permit from the Town of North Andover must be obtained for this
project through the Office of the Building Inspector.
e p°RTH
Town of North Andover°•'"
Building Department 4 1
27 Charles Street
North Andover, MA. 01845 �,S •,..o.+"�,g
D. Robert Nicetta Ac
Building
Building Commissioner
(978) 688-9545
(978) 688-9542 Fax
Please print
DATE bl
JOB LOCA
"HOMEOWNER
HOMEOWNER LICENSE EXEMPTION
321 //�/// 1 �/ iP /,�) ►- ��1� %� -�'
Number Street Address Map /lot
PRESENT MAILING ADDRESS 2 `L Z41"' G—ZO I-41� I} IJ6�- A) ,
City Town
State
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 license, 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 procedures and requirements. //
HOMEOWNER'S SIGNA
APPROVAL OF BUILDING OFFICIAL
NORTH TOWN OF NORTH ANDOVER
pf ,,to ,^,tip
P2PERMIT FOR GAS INSTALLATION
9
i •
at
This certifies that ........ C... ................ .
has permission for gas installation i.-_' ..........
in the buildings of .. : c .'J .........:: ..........
at.:1 `,f .. ��. '. r �, < ' .., C :``� , North Andover, Mass.
Lic. No./.('/,.(-. : ..
GAS INSSll CTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFIiTING
New �. Renovation p
Permit
7;3�3 MarneQuP�� aRt:71/Ci/h/A%I
_ Type at 9ccupancY la In d l�� /.i✓h 7�/Q/
0 , Hans Submitted: Yes[ ' No
S Company Name &"S FrMNG'iNC.
49
Udn= Telephone "
ame,di.Ltcensed Humber ar Gas Fitter
Check one:
Ccrporafion
0 Partnership
Q Fum/Ca.
Certificate ar
ALU
tSUkMCE COVERAGE:
we a CWMri�ttatj#Ity Insurance policy or Its substantial equivalent which mee!s the req*emertts of MGL CIL 142
Yes:• No E3 ,
YOU,hW ecicedY—eS. please indicate the type coverage by checking the appropriate box _
W&MY Insurance peifcy jk Other type of Indemnity Q Bond D
WHER'S INSURANCE WAVER: I am aware that the licensee does not have the InsurancecoYirtage recalled by
laPtw 142 of the Mass. General Laws. and that my signature on this permit 2PPucatlon waives this requirement.
Check one:
Fsawte at Owner or Ou+rttar s Agent .
nerCi Agent 0
udhof the dsies and infmination t have submitted (or enieted) in above iopGcatton are We and acsste to Hee best of test
plt&tg work
and lnstaliatlons performed under the petmlt Issued for this ap a lR tt3tpQdtiCs qty an
or iha lrtasssdtusatts State Gas Cada and Ciaptar 142 of the Genetai
TgJaurneyman
of ucense.
e�Flum� `e Lure of or tter
t►1%wn ucerese Number --
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1 ST /FL a o R
-,Ht FLOOR
WED FLOOR
4TH IkOOA
STH FLOOR
6TH FLOOR
T'aK FLOOR
8—+H FLOOR
3
S Company Name &"S FrMNG'iNC.
49
Udn= Telephone "
ame,di.Ltcensed Humber ar Gas Fitter
Check one:
Ccrporafion
0 Partnership
Q Fum/Ca.
Certificate ar
ALU
tSUkMCE COVERAGE:
we a CWMri�ttatj#Ity Insurance policy or Its substantial equivalent which mee!s the req*emertts of MGL CIL 142
Yes:• No E3 ,
YOU,hW ecicedY—eS. please indicate the type coverage by checking the appropriate box _
W&MY Insurance peifcy jk Other type of Indemnity Q Bond D
WHER'S INSURANCE WAVER: I am aware that the licensee does not have the InsurancecoYirtage recalled by
laPtw 142 of the Mass. General Laws. and that my signature on this permit 2PPucatlon waives this requirement.
Check one:
Fsawte at Owner or Ou+rttar s Agent .
nerCi Agent 0
udhof the dsies and infmination t have submitted (or enieted) in above iopGcatton are We and acsste to Hee best of test
plt&tg work
and lnstaliatlons performed under the petmlt Issued for this ap a lR tt3tpQdtiCs qty an
or iha lrtasssdtusatts State Gas Cada and Ciaptar 142 of the Genetai
TgJaurneyman
of ucense.
e�Flum� `e Lure of or tter
t►1%wn ucerese Number --
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Department of Public Safety
•_ One Ashburton Place, Rm 1301
Boston, Ma 02108-1618
License: SPRINKLER CONTRACTOR LICENSE Birthdate: 08/31/1957
Number: SC 1002265 Expires: 08/31/2001 Restricted To: 00
THOMAS R GAGNON
PO BOX 8860
SALEM, MA 01970
Tr. no: 333
Keep top for receipt and change of address notification.
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Department of Public Safety
•_ One Ashburton Place, Rm 1301
Boston, Ma 02108-1618
License: SPRINKLER CONTRACTOR LICENSE Birthdate: 08/31/1957
Number: SC 1002265 Expires: 08/31/2001 Restricted To: 00
THOMAS R GAGNON
PO BOX 8860
SALEM, MA 01970
Tr. no: 333
Keep top for receipt and change of address notification.
i
'
Fold. Then Detach Along All Perforations
COMMONWEALTH OF MASSACHUSETTS
BOARD
IN PLUMBERS AND GASFITTER
PL
LICENSED AS A JOURNEYMAN PLUM
-
ISSUES THIS LICENSE TO
TYPE
THOMAS R GAGNON
—J
P
PO BOX 8860
SALEM MA 01971-8860
572487
18597 05/01/00 572487
f
~ Fold, Than Detach Along All Pedorations
Fold, Then Detach Along All Pedorations
a
COMMONWEALTH OF MASSACHUSETTS
,
BOARD
IN PLUMBERS AND GASFITTERS
PL
LICENSED AS A MASTER PLUMBE ,
ISSUES THIS LICFN^.f i0
TYPE
THOMAS R GAGNON
F —M
\\��
PO BOX 8860
SALEM MA 01971-8860
572485
10136 05/01/00 572485
YEms=S
Fold, Than Detach Along All Pndoratio-
Fold, Than Detach Along All Pc,lctotiona
COMMONWEALTH OF MASSACHUSETTS
BOARD
IN PLUMBERS AND GASFITTERS
PL
REGISTERED AS A PLUMBING CORPI
ISSUES THIS LICENSE TO �I
TYPE
THOMAS R GAGNON fF�
W
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i..
PO BOX 8860
SALEM MA 01971-8860 I,
572486
1524 05/01/p000 572486
Fo;d, Then Detach Along A11 Pnrinrn,ien
IMPORTANT NOTICE
PERMITS FOR PLUMBING AND GAS FITTING
INSTALLATIONS ON STATE OWNED OR USED
FACILITIES MUST BE FILED AT THE
OFFICE OF THE STATE BOARD.
IMI-OI3TANT NOTICE
PERMITS FOR PLUMBING ANO GAS FITTING
INSTALLATIONS ON STATE OWNED OR USED
FACILITIES MUST BE FILED AT THE '+
OFFICE OF THE STATE BOARD.
IMPORTANT NOTICE
PERMITS FOR PLUMBING AND GAS FITTING
INSTALLATIONS ON STATE OWNED OR USED
FACILITIES MUST BE FILED AT THE
OFFICE OF THE STATE BOARD.
Date.. �Z.../y... ... .
NpRTh TOWN OF NORTH ANDOVER
pf ao ,s�hp
PERMIT FOR GAS INSTALLATION
This certifies that ................. ..............
has permission for gas installation . ...................
in the buildings of . ' '.'" t ! :''...: t....... ............. .
at--�'xe . fir. ,o A - %j ���.. , North Andover, Mass,
��rr X
Feed?..'... Lic. No.! ......... .......�, :�.! ✓........
/ GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type) I
NORTH ANDOVER Mass. Date 172
-x -
1huilding Location
Owners
Y
• New Renovation Replacement Plat
FIX7U1?r1z
Permit # -3.311-d
Name l.-, ara✓fin ia`i C;�5, C
s Submitted 0
(Print nr Twnal
Check one: Certificate
Corp.
Partner.
!� Firm/Co.
Business Telephone:
Name of Licensed Plumber or Gas Fitter.
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy E:r Other type of indemnity = Bond �(
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 coverages.
Signature of owner/agent of property Owner 17 Agent El
1 hcreby certify that all of the dctails and information I have submitted (or entered) in above application are true and accurate to the best of my
knowtedge and that all plumbing work and installations performed under' Permit issued for this application wW-be "mpiianca with all paliaent
provisions of tho Massachusetts slate cas Cade and Clupter 14: of tho General Ltws //
By
Title
City/Town:
APPROVED (OFFICE USE ONLY)
TYPE LICENSE:
Plumber
¢asf i.tter-
Master
Journeyman
Sigr{ature of Licensed
Plumber or Gasfitter
2
License Number
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BASEMENT
IST FLOOR
2ND FLOOR
3130 FLOOR
I
4TH FLOOR
STH FLOOR
6TH FLOOR
TTH FLOOR
STH FLOOR
-
(Print nr Twnal
Check one: Certificate
Corp.
Partner.
!� Firm/Co.
Business Telephone:
Name of Licensed Plumber or Gas Fitter.
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy E:r Other type of indemnity = Bond �(
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 coverages.
Signature of owner/agent of property Owner 17 Agent El
1 hcreby certify that all of the dctails and information I have submitted (or entered) in above application are true and accurate to the best of my
knowtedge and that all plumbing work and installations performed under' Permit issued for this application wW-be "mpiianca with all paliaent
provisions of tho Massachusetts slate cas Cade and Clupter 14: of tho General Ltws //
By
Title
City/Town:
APPROVED (OFFICE USE ONLY)
TYPE LICENSE:
Plumber
¢asf i.tter-
Master
Journeyman
Sigr{ature of Licensed
Plumber or Gasfitter
2
License Number