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HomeMy WebLinkAboutMiscellaneous - 452 WAVERLY ROAD 4/30/201802 �s SIR Safety Insurance w Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings City Hall NORTH ANDOVER, MA 01845 RE: Insured: Property Address: Policy Number: Claim Number: Date of Loss: Company: Board of Health or Board of Selectman City Hall NORTH ANDOVER, MA 01845 ROSEMARY E TASCA 452 WAVERLY RD, NORTH ANDOVER, MA HMA 0276400 BOS00038055 6/24/2013 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. Gen. 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. Justin Woodworth Claim Examiner 6/26/2013 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3317 Fax: (617) 531-6655 Email: JustinWoodworth@Safetylnsurance.com Date... I./ ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... S/ ..... 1.1-.4 ... ......... .............................................. has permission to .. . .......................................... �2 wiring in the building of ..... at ... 4 ............. J . ... .................. North Andover, Mass. FeeJJ ............... Lic. o . ............. .......................... LECTRICAL INSPECTOR Check # 5319 THE COMMOAMEALTHOFMASSACHUSETTS DEPARTI 1EW OFPU&1CSAFETY BOARD OFFIRF,PREVEMONREGULA770NS527CAM 12.GSI APPLICATTONFOR PERMIT TO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE 1 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Town of North Andover Office Use only Permit No. 6Jf © Occupancy & Fees Checked IRMELE=CAL WORK ELECTRICAL CODE, 527 CMR 12:00 �Cf Date (� To the Spector Aires: The undersigned applies for a permit to perform the electrical workdescribed below. Location (Street & Number) 1� I Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes,t No r7 (Check Appropriate Box) Purpose of Building SeI14 / Utility Authorization No. Existing Service %a d Amps2 6 /1 1''0Volts Overhead (, [Underground No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity �!f/� Ana kvi Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round round No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners No. of Ranges No. of Air Cond. Total FIRE ALARMS No. of Zones Tons No. of Disposals No. of Heat Total Total No. of Detection and Pumps Tons KW Initiating Devices No. of Dishwashers Space Area Heating KW Ng, of Sounding Devices No' U,Self Contained Deii*btion/Sounding Devices No. of Dryers Heating Devices KW LocalMunicipal Other Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER• himn=Cowiage. Ptastmitothemquu> ntnNofNb%achtl,SettsGeroalLaws [have aamu tLiabgtylt auancePaginchxlalgComplefe OpwafionsGoveiaWoritssubsanUegrmla t YES NO [bavestlbmit,dvandproof sametothe0� YES IfyoubawdledcedYES,p)easeindir&detypeofcoverageby :1>eldtgthe LL��..11 INSURANCE BOND F-1 CIIHM (Please Spa*) v EVitationDale EMmatedVArcfEkchicalWolk $ NoiktoStatt lnspeclionDateRegtlesled Rough Ivlal >igned l.�Tr a,&es of p aiwy. LicwseNo. Lio=NO 6-97 iness Tel No. At Tel No. % F 9,f % 3;7/ / )WM R'S INSURANCEWMVIJ2,Iamawatethat theLicm--does nothavedr nAlranwoc)vaWoritsatsMoalegr alTltaswquiledbyMassachuffsOalerallaws x3 that my sigimww on thispemr t appfication waives this wgtlnemerlt ?lease check one) Owner ® Agent Telephone No. PERAMrF FEE $ narure r or gen .: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston; Mass. 02111 Workers' Compensation insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. 0 ' 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. Comaanv name: Address City: Phone #: Insurance. Co. Policv # 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' imprisonment -as _well_as_civil.penaltiesinfheformofa_STOP WORK ORDER..and..a.fine_of_(.$1,00M)_aiday against -me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. /do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. . Signature Date Print name Phone.# 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 if immediate response is required Licensing Board Fj Selectman's Office Contact person: Phone #: ❑ Health Department [-� Other Location 41 S—Q, Lt; A UT R b zy — No Date TOWN OF NORTH ANDOVER 0 41 Certificate of Occupancy Building/Frame Permit Fee C US Foundation Permit Fee Other Permit Fee $ C;? 00 TOTAL Check # 17187 Building Inspector o TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCTREPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING w a v BUILDING PERMIT NUMBER: p DATE ISSUED: SIGNATURE: AN Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Parcelumber c,213 v✓ 1.3 Zoning Information: g5 He ,� Zonis Distrid Proposed seUseU 1.4 Property Dimensions: 6. D 30 Lot ea s Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided Af 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zane Information: Public 0 --_Pm ate 0 Zane __A A— Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1' OWne Record Name (Print)Address for Service: � `� T'� 37gay Signature Telephone 2.2 Gilmer of Record: k Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 ReJgistered Home Improvement Contractor Not Applicable 0 Company Name Registration Number Address Expiration Date Signature Tel hone V M X z O m �v 1z z M 90 0 on ic r v M r r z^ P1 SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidAt in the denial of the issuance of the building permit. Y 13"- / 7-11 �tr— Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Descri tion of Proposed Work check all a licable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Nrk: /� 0 1 Ti � �I i=ce' A -D' , T --l' 1,5x c i T-1 4 / C 13 a✓ 5 i l /G f l� !J I I CFrTFnN A - FCTTMATFD r0NCTR1Tf T10N rnc%TC 1 Item Estimated Cost (Dollar) to be Completed by permit apglicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) oZOD 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) J9P 4600, 00 Check Number SECTION 7a OWNER AUTHORIZATION 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 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 Si ature of Owner/Agent Date NO. OF STORIES Q SIZE / 4 BASEMENT OR SLAB / —4 - SIZE 4 -SIZE OF FLOOR T12VMERS 1 2 ND 3 SPAN DIMENSIONS OF SILLS cL C ;2 ) G DIMENSIONS OF POSTS � " J- /t} 1 "7 (i G DMENSIONS OF GIRDERS , HEIGHT OF FOUNDATION — THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND _ S -- C% L IS BUILDING CONNECTED TO NATURAL GAS LINE FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. eases.a.a...ss...a..�.a.aa... ae.aeare...■..ua..a....s..a....aaa.woman es■ APPLICANT _G PHONE 92Y Y ASSESSORS MAP NUMBER _ LOT NUMBER SUBDIVISION LOT NUMBER STREET �5IYL/ �d� —STREETNUMBER �..ea■r. a. a..aa.a.a.e.a......a■.a..■aa.se..a■m.ea.aam..a...a0aa.a.aasallow OFFICIAL USE ONLY t. Boom ONE a■ma........aa.aa■■aaE's aaae.aa...aaa..a a.a...aaa0aaaaaaaaa..aaaa..■ RECO NDATIONS OF TOWN AGENTS DATE APPROVED CONSERVATION ADMINISTRA R DATE REJECTED COMNIEN'TS J PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE DATE APPROVED TOWN PLANNER DATE REJECTED - COI\rIlyIENTS DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR - HEALTH DATE REJECTED COMMENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE 44 W.0 bin 4JQ W.- vilf"4 U1, Not I? two............ .......... 010 a SIT 002 0 vv"; WIN `hx ME -w4miw, qmqn. -wag wgjg -,"4wnmu "E5V67 1 . 5 41 00 F17 Old %TK rl1+'' V th�- �w toy TOWN U MCI; tv �w ATOP: %my, C 1 ..,XV RQ -7 77 Zi jN NAM"o;w its Pia, w lot MAE Mon PON?rs VOW . . . . . . . . . . . . . . oust , IFMI USA rk C4'xb it l'o", -�Jt, AMU, , 40.1 gk ;# .W'V T v Tim wt 4o 11 m MIMI 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 c11,S150A. The debris will be disposed of in: T , 1 O W /v LZ- ion of Facility) 0C Signature- f Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02919 Workers` Compensation .Insurance Affidavit i "I am a hommeowne/r 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 vamng on this job. Company name. FMWOIo sm"Covagge as na"ner.c and/or one years• irripiisorlrne�ylt; understand that a copy of this statement I dnhereby cae+ W unabr the pain and penal es 2M or t to the ol%ebf Innpestigai Cf #W M forbftI6 ge, bw tb& McmMuarrpromided above is &m aaeBccff&t Signature A . t , �•= �/. -- `�/ i Print name -A % oOWW use only do not write in this area to be completed by city or town offixiar d ✓fze �oanvmm�uuealCfi a�✓z'�aataczuJeCta BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 000859 Birthdate: 09/13/1943 Expires: 09/13/2005 Tr, no: 6064 Restricted: 00 ANTONIO J MARTIN 17 CINDERELLA CIRCLE Ell how DRACLUT, MA 01826 Administrator 92e >°anz�naizcuea`ll a� Z�ac/cuter Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR r Registration: 118072 Expiration: 1/26/2005 Type: DBA MARTIN'S REMODELING ANTONIO MARTIN 17 CINDERELLA CIR DRACUT, MA 01826 ( .Administrator CA 0 49 NO TITLE MEANIMTICN WAS MCMM OR PMMMM 'IN OMOMM WITH THIS CMMANCE. M AMN"HUnM GUMMAIN NO NNW P� CMOMVUALP M, DanMiC J. Tasea and M= L. Tasce. humbmd and pile. BK 41m77 PG 181 of NOtfth A*dCV&. R' MOM Coultv, mmodmSefts. ft"m=W (Pr jWL*jva&m ImW in the smuM of lam and affeetion w1ant 10 Rosanary E. Tama of 452 WAYWICY Road, N=th k4OM, Y44*M&A1MettH 01845 wHh 1 13 9tmjjVj* jposo= 9 bMth kid&=, Lgm CumtY, OMMMA081th Of mamactmoetts, being vhcom as lot bb, 17 cr, a plan of land entitled, "Plan of Lard. inmorkh Andover, mass., May 29, ]954,-x. J, Morris, C.S.,' viAch Plan is reCOVW in t?* North District Basm Wlztxy of Deeds as Plan No. 2251. Said pmva ;L -i WwA4 and described as follam; Mortbarly 100 feet by Lot NP. 16 as shown an maid plan; u9terly 75 test by a proposed stzeet as shorn on said Pmt southerly 100 feet by TAt No. JB as shown on said p1m., and Westerly 75 feet -by Wwn!rly F100d. f6marlY FaUrne Avenue. Subject to acrditime and zmatrLotion of moord j=of= as the stare a now in force ad applicable. WW.the Sam P=i$*$ **mMod to Us by deed of Joseph S. MaXiOri, cit V2, by deed dated July 1, 1958, xmorded in N=t:kL Digi=jat ftgiztxY of Deeds, Book 875, rap 381. 6 md tbil ........ Uth ........ —Ay �_219mcrh �.4 a . . ............................................. ........... ............. .......... ...... -1 .......... ...... .......... . ft amwMMMA at AMMUORM Thea Perx=RY appeared the stow cawed DMORk Z. TMMM and Mary L. Tam *a41&mWk*d the foxgWaS lamment to be their fm ad MW 404 WO.,, - Linda J. Ca a1 ,7 i4mmmWaod"Am Out. 'go (%Avldmd —Mat Tmzm — Temmu in commm — Tmft hy g* U*.gT.) Ouptu m fisc 6 As AMMM 3yr QWm jai or ast dw xftmw JK "M4 Mho ., ao 1 0 bees mftm upas k do 64 amk ndiftm =I Pm A* mum of do pow himm - -m* V* 66 own d" =* Mod dwvamby of or 40L vb pubm of ftb Ad kftr R 4"d br Awe&# MW k b Im -opla" vim do to me: of th nwm tJA 44 C Q Q O O J J I `'aREEpE V c Q o II y J W 2 h d 1 I `'aREEpE `' II r— itARj k'S 0 evno e Jinq 17 CINDERELLA CIRCLE • DRACUT, MASS. 01826 • (617) 957.1382 Miss Rosemary Tasta 452 Waverly Rd No. Andover, Ma 01845 Estimate for the following work: RE: Terrace Addition BUILDING REMODELING 0 CABINETS 0PORCHH ENCLOSURES ..tree l�tim.aied ANTONIO J. MARTIN CONTRACTOR DATE 3-3 5-04 19 Build to existing house, a 12' x 14' addition. Foundation to be (5) peers 48" deep bell bottom peers. Lattice work on bottom of addition. Underneath of floor to be insulated with R 30 and covered with plywood and caulked for tight seal. Siding to match that of house (shakes) Gable roof to tie into existing roof. shingles to match as closely as possible to existing. Install Andersen # CW 155-4 white casement window .unit at gable end. Insulate wall R19 sheetrock walls and ceiling (flat) and prime the same. Electrical (5) outlet devices. Extend existing heat register. Install ceramic floor, to be supplied by owner. Paint outside of addition, (no inside paint) Cut arch into existing wall for new entrance. Remove old bulkhead and close off with new shed roof and asphalt shingles or D.C. Bid Price........ Thank you, Martin's Remodeling Antonio J. Martin $19,600 �00 a r - 'S em ® die lit nq 17 CINDERELLA CIRCLE • DRACUT, MASS. 01826 • (617) 957-1382 Miss Rosemary Tasta 452 Waverly Rd No. Andover, Ma 01845 TERMS & AGREEMENT O BUILDING • REMODELING • CABINETS • PORCH ENCLOSURES ,}ree citima 0i ANTONIO J. MARTIN CONTRACTOR DATE 3_1 5-n4 19 - Total ..... 9 Payment schedule for 12' x 14' Addition 1st. payment upon signing of this agreement,,, $4,000.PO 2nd. payment upon starting of Frame work.''' $7,000.00 3rd. payment upon wiring and insulation & drywall" ' $5,000.00 4th. payment upon Job Completion''' $3,600.00 Total..... 119,600.100 All payments due as designated on payment schedule... OWNER CONTRACTOR I P O E U x Y'd W x � YZ � ,.� u o x � `NG x w ®0 i � : � a co A CJ E-0 v J a w" w w w lb w x w 0 z . o cn y+; N�� 7'I,' Y'd W YZ � ,.� u o Q r 0 � `NG W CM i O M O O CD L cc A C O C.2 'L3 C a co CD C..a y c C ma ®0 � : C L O N co CJ E-0 J CLc Cc m c O lb :a� E a c m O V :tea E5 c Ots O C m mca — L N t N ? CD 3 � A •' a o L •: t C c c E CD 6 1 O p, L = O C co c `; C H Q _ -O p,cZ � O m : V O O .ate C! Q o =3 mL. b' 0 y off' m z W � t .N C F- oc -E E M 0 � -N Z o CMC.3 m��� 5 CL �*§L-3 o s0.4 -CC W CM i O M O O CD L cc A C O C.2 'L3 C a co CD C..a y c C