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HomeMy WebLinkAboutMiscellaneous - 475 FOSTER STREET 4/30/2018 I ------------ 475 FOSTER STREET 210/104.8 0206-0000.0 i it I I �_ Safety Insurance 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: JAMES R BOUTIN and ALEJANDRA E BOUTIN Property Address: 475 FOSTER ST,NORTH ANDOVER, MA Policy Number: HMA 0081580 Claim Number: BOS00032478 Date of Loss: 10/29/2012 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. 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. Lisa Monette Claim Examiner 10/31/2012 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (857) 233-8618 Fax: (617) 535-5833 Email: LisaMonette@SafetyInsurance.com Location No. �y` Date 2-. ~ORTM TOWN OF NORTH ANDOVER Of • O ,�,y0 3? ' OL Certificate of Occupancy $ CHusEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 6 0, Check # 15 6 3 J wilding Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �1 lt3 V BUILDING PERMIT NUMBER. DATE ISSUED: rn Aly OR ic SIGNATURE: A-A Building Commissioner/InEeEtor of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number 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 Regulired Provided Required Provided v 4- 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Infomration: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Own9t of Record Name(Pri Address for Service: Signa Telephone 2.2 Owner of Record: f)L EJ A Al O 2 A Byy T/A/ LJ7S F7js t e r S e e /V 4t)Cb i�e�-, O Name Print Address for Service: 978 259 M SignaturcV Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensesruction Supervisor: _ y 5� /(P O / a6 � (,(i'C'3(� i �'�/� � �( �� License Number Address r' �/ p 1� 7p S-,3,3 p,T E-pirati n Dae ic Signature �— Telephone r 3.2 Registered Home Improvement Contractor Not Applicable< ❑ 0 S1`bA-, ARE- 7 �Cks �,��✓ i d Company Name m Registration Number rM Addres /l Expiration Irate ^� Si nature Telephone Y' i 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: IC j�7 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICAL;USE ONLY Completed by permit applicant 1. Building (a) 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 ✓" 9.,AC-00 Check Number SECTION 7a OWNER AUTHORIZATIOrr TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, t/ -@_-- as Owner/Authorized Agent of subject property Hereby authorize 0 to act on My be salt; i s relative to work authorized by t is bui ding permit application. nature oTowner Date _+� _J SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 5aAlp���x.��.�-" as Owner/Authorized Agent of subject proferty Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief ( ) CL_ Pri tffe Si atur wn A crit Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3RD SPAN DIMENSIONS OF SILLS DINIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM 7) -e—C (C ' INSTRUCTIONS: This form is used to verify that all necessarya a pprovals/p perrmm its from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANT�� !� I- �4lz(� PHONE_ LOCATION: Assessor's Map Number l13 PARCEL SUBDIVISION LOT(S) STREET_ r^ Jam- ST. NUMBER *****************************************OFFICIAL USE . ONLY*********************************** RECO EN AT S OF TOWN AGENTS: CONSE TION A � ST TOR DATE APPROVED DATE REJECTED COMMENTS �/��C�/1 TOWN ANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED--S DATE REJECTED COMMENTS 11A u4� V 0 , S N) lV e�J PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE_ Revised 9\97 jm North Andover Building Department Tel: 978-6$8-9! DEBRIS DISPOSAL FORM in accordance with the provision of MGL c 40 S 54, a condition of Building Permil 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: (Lo tion ofFacility) Signator �fPermitAn.,1, i licant Date NOTE: Demolition permit from tide Town of North Andover most be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts 4 Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit i - Please Print Name: Location: City Phone r"7 am 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. ComipanY name S �� ti 0 tU/d cI� Address W©l1C—i�SZ, City: Phone - 0 I qt, co v P4 PQI>Fl)')"ciE1V name: Address City Phone#: lngMnge Qo. , Pollcv# r�h,rd to secure coverage as required under Section 25A or MGL 1s2 can lead tothe it 0051.Ion d criminal pen s.of a fine up to$1',500-66 and/or one years'imprisonment as Well as civil penalties in the fo m r a STOP WORK olRDM and a fine of me($10�00)a day against . 1 understand that a copy of this statement may be forwarded to the Office of investigations of the DIA for coverage verification I do herby certify u pal the pns penalties of penury that the warmawn provider!above is true and-cofnect Signature Print name UC e6-. �������C� Phone Official use only do not write in this area to be completed by city or town official* Building Dept . Or-heck if immediate response is requtred Building Dept p Licensing Board Contact person: Phone# p Selectman's office Q Health Department ❑ Ofher ?JU WORKMAN'S COMPENSATION MORTGAIG � INSPECTION PLAN NORTHERN ASSOCIATES, INC. 401 SOUTH BROADWAY, LAWRENCE MA. 01843-3522 TEL:(978) 837-3335 FAX:(978) 837-3336 MORTGAGOR:JAMES * ALEJANDKA BOUTIN DEED REF: .2603/60 LOCATION: 475 FOSTER STREET PLAN REF: 10294 CITY,5TATE: N. ANDOVER, MA SCALE: 1 "=30' DATE: 08/07/01 JOB #: 201 "OG9G5 F0 - -- sST�� sT � / \ \ • 38.44 Q 86, 2 112 STORY WOOD LOT I -A - , #475 3.0009 ACRES31. \ ��• � DECK � - � 84.49' N, LO i O I J F_ ' 64.02' 41 .0 ��E DN ION5 TH155 AREA \ CA � c9 2 15.90' 120-23' X30.37' CERTIFIED TO: . FIP.5T 1-ASTERN MORTGAGE CORP Flood hazard zone has been determined by scale and is not necessarily accurate.Until definitive plans a-re -issued by HUD anal/or a vertical control survey is performed,precise elevations cannot be determined. NOTE: This mortgage Inspection lrws prepared This mortgage inspection was repared in accordance specifically fbr mortgage yttrpose only and pp is not to be ballad upon as a land or and with the Technical Standards jlir Mortgage Loan line t to used Inspections as adopted by the Massachusetts Boast of y, Jbr recording, preparing daed Registration of Profbssional Engineers and Land descriptions, or construction. No corners were f Surveyors 260 CMR 605. set. Buildoxim tel location and offu d are �Z �,(',� I further state that in my profbssional opinion that are show si- located on ground and F V the structures shown confirm with the local zoning horizontal are shoran re not b fir zoning determination. i�° dniensiotual setback requirements at the time of construdionor only and are not to be used to establish property \J re exempt under previsions of M.C.L CH. {0—A Sec. 7. lines. The matters shoran hereon are based an � � / i client—furnished infbrmation and may be subject ®I. Property/House is not in Flood Hazard to further out—sales, takings, aasaments and rights o �1 (2 1 V O 3. Iln Perty flan se is i a Flood Hazard Area. of way, arui other matters of wand and prvserlrtive L� � �. � (� � .Ib picettl to determine Flood Hazard or other rights. Northern Associates, Inc. assumes responsibility herain to land owner oroccupant, P Q accepts no responsibility )br damagas restdt{ng from said 9 S�� Q Flood hazard determined from latest Federal Flood ruliartce by anyone other than tho said rnorigagoa and its asspay 0 7�s in connection with its proposed rrwrtgage financing to said I? O SUR`tInsurance Rate Map Panel .2 Soo I O Date n• 2 Zona /n.7161% NORTH E Town of Andover 0Y O LA dover, Mass., _ � � 1:0c HIc WC ACRATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT...:J! � ...I..T. .!�^N Qj(NA'......... BUILDING INSPECTOR .. . a ��.�......t............................................ Foundation has permission to erect...�. A�. .......... buildings on ....�"'�. ..� ..I� ...... .. i.,4*r 5................ ...4. .......... Rough ..... . ................... to be occupied as...I 9.�X& S' DEC � a `� �*G� } IQ V (4 pe r C Chimney .... ... ................................... ............................ .. . provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. ' 9)4 D /dQ 0 to 1300 dw PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST TS ELECTRICAL INSPECTOR Rough Servie.............A . .... .. BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry (Nall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner • Street No. r Smoke Det. SEE REVERSE SIDE L 1 115 0L,W- I it x(a --J.............. ........... I I i -4- JJ �,,:-__..,c�/./.",1 .,.,....p...,..< .�.-.--L.,...,...f. .,,.,�.,�...,. 4 € t i 4 '.�'4.„ � _.,., € € �`*`i�.' £.,...,,,-�--�.-..,a-.„,._........_. .. ,_._..._ ....... ,a�---- --�^ ... 4 w...�...... a-,..<.<......�,��. � ���..... 77 IL 4--4– 7 _j -4— ...... -T- JOB SIGNATURE DECKS AND SHEET NO. 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