HomeMy WebLinkAboutMiscellaneous - 38 PHILLIPS COURT 4/30/2018N
VERMONT MUTUAL INSURANCE GROUP®
89 STATE STREET - PO BOX 369
MONTPELIER, VERMONT 05601-0369
® Claims 800-435-0397
Since 1828 Property/Liability Claims Fax 802-229-7647
Auto Claims Fax 802-229-8941
E -Mail claims@vermontmutual.com
March 18, 2015
Building Commissioner/Inspection Services
1600 Osgood Street
Building 20, Suite 2035
North Andover, MA 01845
NOTICE OF CASUALTY LOSS UNDER MASSACHUSETTS
GENERAL LAWS, CHAPTER 139, SECTION 313
RE: Insured:
Claim No.:
Policy No.:
Date of Loss:
Property Location
Type of Loss:
Ladies and Gentlemen:
Broderick, Margaret
HC208654
H012231339
2/17/2015
38 Phillips Ct
North Andover, MA 01845-2911
Ice Dam
The above insured has filed a claim involving loss, damage or destruction of the above -captioned
property 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 undersigned and include a
reference to the captioned insured, locations, policy number, date of loss and claim or file number.
Thank you for your cooperation.
Sincerely,
Scott Faehnrich
VERMONT MUTUAL INSURANCE COMPANY -NORTHERN SECURITY INSURANCE COMPANY, INC.
GRANITE MUTUAL INSURANCE COMPANY
-0
4
0
Date ... ......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ............. z . .................
.... .. ......
has *permission to perform .................. ............................
%wiring in the building of ........... ................................... 4
at ............... .................... . North Andover, Mass.
Fee4 Lic. No.'°i2 ,,............
1.
....
........
Cr?RICAL NSPECrOR
Check #
7868
Commonwealth of Massachusetts Official Use only
Department of Fire Services Permit No.
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[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: Z7-6 "
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notif of his or her intention to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant
Owner's Address
1's this permit in conjunction with a building permit? Yes
Purpose of Building 12 e-�C1/ e.,
Overhead ❑
Existing Service Amps / Volts
New Service Amps / Volts
Number of Feeders and Ampacity
Telephone No.
No ❑ (Check Appropriate Box)
Utility Authorization No.
Overhead ❑
Undgrd ❑ No. of Meters
Undgrd ❑ No. of Meters
Location and Nature of Proposed Electrical Work:
Completion of the follnwinv tnhle m— be waived by the 1--t- of wi-,
No. of Recessed LuminairesNo.
of Ceil: Susp. (Paddle) Fans
No. of Total
Transformers KVA
No :of Luminaire Outlets.
No..of Hot Tubs
Generators . KVA - -
No' of Luminaires _
Swimming Poor Above ❑ In- ❑
rnd. rnd.
o. o mergency, Lighting
Batter Units
No.-of.Receptacle Outlets
No. of Oil Burners
FIRE ALARMS,
No. of Zones
No. of Switches' -
No. of Gas Burners
No. of Detection and
- Devices
No. of Ranges
No. of Air Cond. Total
Tons
—Initiating
No. of Alerting Devices
g
No. of Waste Disposers
Heat Pump
Totals:
Number
"'
Tons
" ""."""'""
KW
..'"...•"
No. of elf -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal El Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water K`�
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
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:) `
Iycertify, under the pains_artd penalties of perjury, that the information on this application istrue and"cmnplete.
FIRM NAME:
Licensee: t/1 Signature J LIC.NO.:�
(If applicable, enter ,,"exempt " in the license mmiber. line.) p // Bus. Tel. No . _ 1-09 .5— 9' 5'f3�
Address: / 5 . �/�i� � If, �2. � L/ 1%fit Q�4 J�
—�--- Alt. Tel: No.. 617 7416 %d9->
*Per M.G.L c. 147, s..57-61, security work requires Department 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 agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $
P�. . Bk / �-'- /-I c a I /�
1
a
Location_'-
No. Date
NORTF� TOWN OF NORTH ANDOVER
4e
Check # O
17610
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
TOTAL
$ 64� 0-e
1.1 P/r'Werty Address:
1.2 Assessors Map and Parcel dumber:
am (Print)
Address for Service:
Signature
Telephone
2.2 Owner of Record:
447V�!����
L�
���y'
�—,--ran ,�L��
Map Number
Parcel Number
1.3 Zoning Information:
Signature
1.4 Property Dimensions:
Zoning District Proposed Use
Lot Area
Fronts ft
1.6 BUILDING SETBACKS ft
Not Applicable ❑
�
Front Yard
Side Yard
Rear Yard
Required Provide
ReqWred Provided
Regaired
Provided
License Number
Address
_
1.7 Water Supply M.G.L.C.40. 34)
1.5. Flood Zone Information:
1.8
Sewerage Disposal System:
Public 0 Private 0
Zone Outside Flood Zone 0
Municipal
0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSEEMAUTHORIZED AGENT
2.1 Owner of Record
am (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:
Not Applicable ❑
�
c
Licen6ed Construction S rvnsor.
J
o,,3 le
License Number
Address
_
r
Expiration Dife
Signature
Telephone
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Co pang Name
Regi Number
Ad re
4
1
i
Z 7)6
Expiration DIV
Si at 1 Tel
lepbone
w
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 it.
Signed affidavit Attached Yes .......C1 No ....... 0
SECTION 5 Descri tion of Proposed Work(checka11 ■ ble
New Construction ❑ Existing Building 0 Repair(s) ❑ Alterations(s) 0 Addition 0
Accessory Bldg. ❑ Demolition ❑. Other 0 Specify
A S
Brief Description of Proposed Work: �) ` 5 J+NN 1\ `.
1 SECTION 6 - RSTIMATRn CONSTRUCTION COSTSt I
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
OFFICIAL USE ONLY
1. Building(a)
0
Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
4 Mechanical HVAC
5 Fire Protection
6 Total (1+2+3+4+5)
Check Number
bL,Liiui4 is uwP1Y,t( Au inuKuAt1VN M tfr; I:VMPLE11,I) WnEN
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
SECTION 7h OWNER/AUTHOR17F.D AGENT nF.Ci.ARATtn N
Date
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 T
Si atur o er/A ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TII-iBERS I FF 2 NU 3 RD
SPAN
DIMENSIONS OF SILLS
DUVIENSIONS OF POSTS
DRAENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHDANEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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Castricone Roofing & Siding
REPAIRS FREE ESTIMATES
Telephone (978) 682-4266
MARIO CASTRICONE
31 Court Street, North Andover, Mass. 01845
I/we, the owner (s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish all necessary
materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and
conditions, on premises below described:
Bt2
Owner's Name ..................... c...................................................................................................................................................................................................
3� �h
Job Address ..... .................... ..... ... ........... uCity...Vo ..:'4........�....�.....V.........i............... State.../A
.......
......................................
SPECIFICATIONS
....... _..... _.............. ................................... ,� ....... ........................ ,...,... .. .....�.T..,............ ..y.�.......,...�..... �........x:.......yC,�c. �t
.. t .. ....... .. .... .......................
.......?'
, ......P`. .., .. ..........�` � . ;,,,nl ...., .l... ...........
"p --...y......, c .��.:...... ..............Cr?,!1�
.............�°....�.,�. P....................................................................................................................................................................................
.....................................................................1...............1.............................................�....................................................................................................................
$ �r�..L�. lr
Materials and labor to cost ......... .... ...................... Payable �,� .�'r!I.-'.l. on ................................and balance in............
monthly installments of $............ .............................each, payable on ........................................day of each and every month thereafter until paid
in full (..............% charge per year is to be added to above cost of labor and materials and is included in monthly payments.)
Contractor will do all of said work in a good workmanlike manner.
Upon completion of above work, all undersigned agree to execute and deliver to contractor, their joint note in accordance with his (their) above obligation and a
completion as requested by the contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpaid
immediately due and payable. It is agreed that if permitted by law contractor shall be paid by the owner(s), all reasonable costs, attorney fees and expenses, in
addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of this contract and/or any lien in connection therewith.
It is further agreed that this contract may be assigned by contractor; and also that the obligations hereof shall bind and apply to their heirs, successors or estates
of the parties.
The undersigned warrant(s) that he is (they are) the owners) of the above mentioned premises and that legal title thereto stands of record in his (their) name(s).
PROVISO: This contract shall be void and of no effort if credit approved of owner(s) is refused.
There are no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is this
contract dependent upon or subject to any conditions not herein stated. Any subsequent agreement in reference hereto shall be binding only if in writing and signed
by all parties.
Cover attic storage cleaning not included.
Receipt of a copy of this contract is hereby acknowledged, and it is further acknowledged by the undersigned that the foregoing provisions have been read and
the contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and
understandings of said parties are contained herein.
Owner or Owners are not responsible for Property Damage or Liability while job is in operation.
IN WITNESS WHEREOF, the parties have hereunto signed their names this ..............X.i.?
C ....... day of........ �.......... 1Tn.�d�!
Accepted:
(OWNER HAS 3 DAYS IN WHICH TO CANCEL CONTRACT)
Per.. . ... ..
...................................
Repre ntative
Signed...'\.".J.�! �:. �3......�.................................`.",
caner
Signed......................................................................................
Owner
Signed......................................................................................
Y •7 y,✓%e 'L�o9lr/I�LIY9r�/feCU�it, 1Y�4�!/GQd:�CIt[�.Oe.G[4
BOARD OF BUILDING REGULATIONS
r--
i' License: CONSTRUCTION SUPERVISOR
y' Number: CS 034049
Birthdate: 12/08/1923
Expires: 12/08/2005 Tr. no: 12443
Restricted: 00
MARIO T CASTRICONE
31 COURT ST,
N ANDOVER, MA 01845 Administrator
CASTRICONE ROOFING & SIDIN
Plano Castricone
31 Court St.�
"tor
N. Andover, W.01845
At4iiin`istr
✓fe �a�r�iraiaurea� of✓liC.rarilacfurJe%�6
�ti,.
Board of Building Regulations and Standards
Lf3 =
HOME IMPROVEMENT CONTRACTOR
Registration:, 1"03317
Expiration: fie#- 71716
Type: DSA
CASTRICONE ROOFING & SIDIN
Plano Castricone
31 Court St.�
"tor
N. Andover, W.01845
At4iiin`istr
4Trc CorUMMe+akii of %anwAuxtu
opmmnt of .Fndwtria[* dmU
of600 a .s
ftjt^ XA 02111
Workers' Comp=ea$oa baran: a AffWwrit
hale
Location:
City:
CD I ata a homeowner performing all work myself.
Telephone 0:
i aa: sole proprietor and have no one workm in my =spry
0 I oma an
Company Nam
Address: y,1
City. AA
Insurance C01111pany.
workers' compgnsanon for my employees working on this job
TelephoneMl� ', A Q
Policy #: Lf Z 8 ` - I`f 9, „L_._-
14 .�
1 am (circle one) sole proprietor, general contracts: or homeowner and have hirea'be cuntractcrs l;pA, below woo tfave`tite following
workers' compensation policies: r ,
Company Name:
Address:
City:
Telephone #
lnatu'aace Company:
�Icm»pany Mame:
Address:
Ciry:
Policy #:
Telephone #:
Insurance Compsay: Policy #:
Attach additional sheet if neseasary
Fahurt to secure coverage as required under Section 35A of MGL 15B can lead to the zmpositim of criminal penalties of a fine up to 51,5DO.1U
an&or ont years' imprisonment as well as civil penalties in tae form of a STOP WORK ORDER and a fine of S100.00 a pie; against me. 1
undetataad that a copy of this statement may be forwarded to the Office of Imea:;gations of the DIA for coverage ver_fication.
I do hereby certify under alis pains and pen ties o, jpsrlury that the information above is true and correct
Signature,'! -�L A� Date:
Print Name: ,(�g*r ijo T-L-sa-�s r r �_iti�u-� Phone #.V=
i
Official Use ONLY - Do not write in this area
c Building 3epertment
:tty err T ;Win: Pa mall icenae #: c Licensing 9oaro
o swec"en a Ofte
j{ G 'ieatih Dewmnent
(
0 Check if trnmediate responee is requirod o Ott,ar