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Home My WebLink AboutMiscellaneous - 48 Bear Hill Road 46 BEAR HILL ROAD 210!064.0-0098-0000.0 i AMML Safety Insurance PO Box 55098 Boston,MA 02205 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: PETER COCO and CLARE COCO Property Address: 46 BEAR HILL ROAD,NORTH ANDOVER,MA Policy Number: HMA 0209321 Claim Number: BOS00067960 Date of Loss: 2/16/2016 Company: Safety Property and Casualty 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. David McDermott Claim Examiner 2/23/2016 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston,MA 02205-5098 Phone: (617) 951-0600 EXT 3537 Fax: (617)603-4866 Email: DavidMcDermott@Safetylnsurance.com D. 7A!A 4 ..... p4 1 A 0 1- TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ,7SACMU This certifies that . . . . . . . . . . . . . . .. . . . . . . has permission for gas installation in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. at $0 "tw,//. - led. . . . . . . . .. North Andover, Mass. . . . . . . . . . . . . . . Fee&,dvO. Lic. No.'s 54 GASINSPECTO Check 4 8235 f 03 /10 -C-\ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO DO GAS F TTI7G CITY/TOWN 61ZY�� lU 01),Ek— STATE:MA APPLICATION DATE JOB ADDRESS:! OCCUPANCY TYPE: COMMERCIAL❑ RESIDENTIAL PLANS SUBMITTED: YES NO NEW[] ALTERATIONE] REPLACEMENT REMOVAiJDEMOLITION[] l NATURAL&LIQUEFIED PETROLEUM GAS:PIPING-EQUIPMENT-APPLIANCES-SYSTEMS Z ENTER TOTAL AMOUNT FOR EACH SELECTION tWED TO FIVE(51 NUMERALS AIR ROTATION UNIT FURNACE: ALL TYPES TEMP HEATING EQUIPMENT BOILER:ALL TYPES I GAS PIPING THERMAL OXIDIZER BOOSTER GENERATOR STATIONARY ENGINE TURBINE BROILER ILLUMINATING APPLIANCE UNIT HEATER BURNER: ALL TYPES INCINERATOR WATER HEATER: ALL TYPES CO-GENERATION UNIT INDUSTRIAL AIR HANDLER EQUIPMENT OVER 12,500MBH COFFEE ROASTER INFRARED HEATER rOTHER NOT LISTEDZ COOK APPLIANCE HOUSEHOLD I KILN f GLORY HOLE I CRUCIBLE COOK APPLIANCE COMMERCIAL I LABORATORY COCKS DECORATIVE APPLIANCE MAKEUP AIR UNIT DIRECT VENT APPLIANCE 11 MECHANICAL EXHAUST EQUIPMENT DRYER: ALL g VEN: ALL TYPES FIREPLACE.VENTED UNVENTEDOOL HEATER FRYOLATOR OOF TOP UNIT FUEL CELL OOM HEATER-VENTEDNENTLESS PLUMBING/GAS FITTING FIRM INFORMATION CHECK ONE ONLY - - - - - ---- - �Co oration Business# NAME: �I' P�Nr- t3f� yNKct -ADDRESS/ 0 S.Ij1 IN 57 I rP -- Partnership Business.# -STATE P CITY:E(117 -- IMA ZI ` E]LLC Business# FAX: 7 7?- E EMAIL:# V__w..__.f' BA l Unincorporated NAME OF LICENSED PLUMBER I GAS-FITTER- .KCL i/1C le. INSURANCE COVERAGE I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES NO If you have checked Yes,please indicate the type of doverago by checking the appropriate box below. 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY OWNER❑ AGENT Signature of Owner or Owner's Agent OWNER'S NAME. TEL! �. FAX I hereby certify that all of the details and information 1 have submitted(or entered)regarding this permit application is true and accurate to the best of my knowledge.I certify that all plumbing work and installations performed under the permit issued,will be in compliance with all pertinent provisions of the Massachusetts Uniform State Plumbing Code,and Chapter 14 a General Laws. (OFFICE USE ONLY) Type of License: Permit ❑Plumber ❑Gasfitter 0J� Inspector ❑Master. ['�Journeyman VeNumber., ignature of Licensed Plumber Gas Fitter ❑Undiluted LP Installer Lic �� ► Fee: ❑Limited LP Installer ROUGH GAS INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ R�J�• �Z FJ kl i FEE:$ PERMRA PLAN REVIEW NOTES Psint.Form The Commonwealth of Massachusetts - - Department of Industrial Accidents dice of Investigations I Congress Street,suite 100 Boston,MA 0211"017 www.massgav/dia dersConracors/Elec _ b Workers'Compensation insurance Affidavit:BuilPlease Print Legibly A icant Information rr LAC- + Name(Susimess/organization/Individual): F P C 7�h �FyN� � fig 06- GAIL L Address: �� a ��/� s City/State/Zip: b bD��fV 918 o }9 4�Phone#:CRS 7 " � Are you an employer?Cheek the appropriate bog- Type of project(required): l,�t am a employer with 1_ 4. ❑I am a general contractor and I 6 Q New construction employees(full and/or part-time).* have hired the soh-contractors listed on the attached sheet. 7. ❑Remodeling 2.Q I am a sole proprietor or partner- .these sub-contractors have g, Q Demolition ship and have no employees employees and have workers' working for me in any capacity. comp.insurance# 9. ❑Building addition [No workers'comp.insurance 10.0 Electrical repairs or additions 5.Q We are a corporation and its required_l airs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing rep myself.[No workers'COMP. right of exemption per MGL 12.E]Roof repairs �)t c.152,§1(4),and we have no 13.[.}'Other S o"'O FYI insurance employees.[No workers' 1 tn�Cis comp.insurance required.] t4eP Ti N6- 'Any appiicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating ssuch_ $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number: I am an employer that isproviding workers'Compensation insurance for my emp/oyem Below is thepolicy and job site information. Insurance Company Name: aW G t..RI C R+f Rfs� �—N 193 9 i 03 Expiration Date: X9'2 a Policy#or Self-ins.Loic {,.#: N d p' Job Site Address: t-C I L City/State/Zip: 0 U e-� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the foam of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DLAr insurance coverage verification. Ido hereby certify er pains ena of erjgr that the information provided ab ve is to and correct Si tore: _ �' � —_ .... Date Phone#: ofj'ieutl use only. Do not write in this area,to be completed by City or town offxiat City or Town: Permit/I.icense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person; Phone#• 7502 Date.�� . .. ...... RTM 6 6 6 TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION a SSAC MUSE1 This certifies that . .Z. F7. S.j.�. . .�� hf''�'.` has permission for gas installation . l-�9. in the buildings of . 4!4 G.. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . at . . .4.� /. . . . . . . ., North Andover, Mass. Fee.3.q. . . . . Lic. ., -�:� . . . . .. . . GAS INSPECTOW Check# MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING a (Print or Type) NORTH ANDOVER Mass. Date DEC. 7, 2010 permit# 46 BEAR HILL RD. PETER&CLAIRE COCO Building Location Owner's Name Owner Tel# 978-683-5553 Type of Occupancy RESIDENTIAL New Renovation❑ Replacement Plan Submitted: Yet No[] FIXTURES G Uw x z -!� ;n CwJ ¢ wp0 O 0 z azx z pm � OW W � s >wWwzQ x W � AHRxS a s U) W ¢ wa H ° z ozuJ z o c~n x w w > w p a cC d ¢ OO w p w F U G# > A a F O w SUB-BSMT BASEMENT 1ST FLOOR 2N0 FLOOR 3R0 FLOOR i 4T"FLOOR 5T"FLOOR 6T"FLOOR 7T"FLOOR 8T"FLOOR Installing Company Name Eastern Propane & Oil, Inc Check one: Certificate Address 131 Water Street Corporation Danvers, MA 01923 Partnership Business Telephone#800-322-6628 Firm/Co. Name of Licensed Plumber or Gas Fitter. w Cy H 6 Fc +S Y INSURANCE COVERAGE: I have a cur liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. Yes No ❑ If you have c ecked y2s,please indicate the type coverage by checking the appropriate box. A liability insurance policy El 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: 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 installations performed under the permit issued for this application will be in compliance with all ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of theGeneral mss. By jypof License: �- ` --� lumber Signature of Licensed Plumber or Gas Fitter Title Gas fitter • -Master License Number City/Town •-Journeyman APPROVED(OFFICE USE ONLY) 4501 Date..! . ORTH ;! F?op ,o • �ho�p TOWN OF NOR*H DOVER • PERMIT FOR GAS INSTALLATION SACMuSEt 7 This certifies that . . /--w—d*`n/'.L?.. . . .. . . . has permission for gas installation ah,�r/P. in the buildings of ... . .. . . . . . . . . . . . . . . . . . . . . ... .. . at .(. ..��.C. . . . .. North Andover, Mass. Lic. No.?.-. .::. . . . . . . . ,,:)._... .y;.�.. .. . AS INSPECTOR Check# V qg MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) w — NORTH ANDOVER ,Mass. Date NOV. 17, 2010 permit# I` 46 BEAR HILL RD. PETER&CLAIRE COCO Building Location Owner's Name Owner Tel#978-683-5553 Type of Occupancy RESIDENTIAL New W1 Renovation F1 Replacement Plan Submitted: Yet No[] FIXTURES a H Sz a W a a a O h x F f 1 O C4w oa x z o W H Q � z z o F w W w w W z Q x x a w w W H x a a v Q W > W z FC Q w¢ O O W O W E- 0 O = w x 3 A C7 .-1 U 9 > A a r O w s SUB-BSMT BASEMENT 1ST FLOOR 1 2ND FLOOR 3RD FLOOR 4TH FLOOR 5T"FLOOR 6T"FLOOR 7T"FLOOR 8T"FLOOR Installing Company Name Eastern Propane & Oil, Inc Check one: Certificate Address 131 Water Street Corporation Danvers, MA 01923 Partnership Business Telephone#800-322-6628 Firm/Co. Name of Licensed Plumber or Gas Fitter ERIC PELLETIER INSURANCE COVERAGE: I have a cur�°�j liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. Yesl ✓ I No ❑ If you have''c ecked yes,please indicate the type coverage by checking the appropriate box. A liability insurance policy F✓ 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: 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 installations performed under the permit issued for this application will be in compliance with all ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gener By Type f License: - • lumber Signat6re of Licensed Plumber s Fitter Title •-Gas fitter • -Master License Number GI'3 City/Town •-Journeyman APPROVED(OFFICE USE ONLY) Date./. .'. ..... .. ........ .7 .y L NORTH TOWN OF NORTH ANDOVER O PERMIT FOR GAS INSTALLATION F .A A Hus r r J This certifies that . ... . . :. . . . . . . . . . . . . :`. . . . r.. ^ has permission for gas installation . . . . .,. . . . . . . . . . . .. . .. in the buildings of .. . ... . . .. . . . . .. . . .. ... . �. . . . . . . . . . . . . . : . . ... at . ."". ... . . . . . . . . . ... . . . . . . . . . .L. . . . . .. .. North Andover, Mass. Fee.... .. . . . . . Lic. No.. . . . . . . . . . .. . . . . . . . .. . .. . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer GOLD:File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTINGL/ (Print or Type) = NORTH ANDOVER Mass. ii Date Ijrll �uild �ing Location �l In L �f 1 1Permit /7 Owners Name CCx� .Y • New 77 Renovation D Replacement p Plans Submitted D • FIXTLIp=C in � W N Y Z !Z of N Q N tC O =7 W = 1�• W a m a O U m t: x t» to h CM UJ of w w F �' o y w N U Itt y Uj < Q a W w a E Q Z a a: Q 0: W 1— us V t7 Q 0 F- Z J F� 2 �W.. N a ? O ~ W O N S 2 d W < cc Cd ' or Q t.1C W Z < C d d O O W O W i x O O z u6 n t7 .t u cr > a a F- O SUZY—$S..1T, t SASEMEHT I ISTFLOOR I a 2MD FLOOR 3RO FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR (Print or Type) Check one: Certificate Installing Company Name C� ab 1�} Q Corp. Address 2SF Partner. Firm/Co. Business Telephone: Name of Licensed Plumber or Gas Fitter j 220 Insurance Coverage: Indicate the type of insura,-ice coverage by checking the appropriate box: Liability insurance policy 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 ❑ Agent I hcrcby ccrtiry that all of the details and information 1 have submitted (or entered)in above application are true and accurate to the best of my knowledge and that all plumbing woric and Llsatllations perforated under Permit issued fo: this application will be in compliance with all pertlncnt provisions of tho Massachusetts Slate Car Code and Clupter 142 of the Genetaf L►ws. By TYPE LICENSE: Plumber Title Gasfitter ,Lau re of Licensed Master Plumber or Gasfitter City/Town: Journeyman Z(W a APPROVED (OFFiCF USE ONLY) License Number 32549 '�-' ;,"q Date.. ...... ..... ........ P p NORTH TOWN OF NORTH ANDOVER .0PERMITPERMIT FOR GAS INSTALLATIOI0 9 r • ,SSACMUSEt .K� This certifies that has permission for gas installation stallation z in the buildin`gs,of . . . . . . . . . . ... .. . . . . . . . ... -• •� at . . ` . .h ...... . . . . .--.—.. . .. ., North Andover, Mass. GAS INSP�,TPR� Fee; ��' . Lic. WHITE:Applicant CANARY:Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) ,MA Date1 1(o t9CL$ Receipt# Permit# ?a-Lo Building Location µb l`J�fig' �� a . Owners Name C\cx T'E, On r-tn Map: d(o Lot: 06 Zone: Type of Occupancy 1f E-5 c d E YN C& Nev Renovation ❑ Replacement❑ Pians Submitted: Yes❑ No ❑ Fee: y O: N Y W tC 0 N W W Q 2 H R W - X N Q O ¢ rn = H V, W ¢ O V � S N Z J 2 W ~ } 01 = 2 Q ¢ O W ~ Q ¢ z D O Z w lAJ ¢ m N r W w O o n. O W F- W Q Q N ¢ �' o W = Z Q ¢ O p > w Z J ��X 2 W W O O > LL F U= LU .. J H W - Z Q W J ¢ H Q ¢ Q Q O O W ¢ O W F- Q W > R O 2 ¢ x 0 w 3 3 o O ¢ > o a E- O • SUB-BSMT. t� BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR. 7TH FLOOR 8TH FLOOR Installing Company Name ):—A S 6 a•]n ?-r'en Q- E- C-04.5 , Mn C- Check one: Certificate Address 1,3 1. Lia 1-E r Yrt r�k a i 4 3 a IS Corporation EstimateVolueofWork: ❑ Partnership BusinessTelephone I- Y Oc^ -- b :1 1 -C.y ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Ig No ❑ If you have checkedems, please indicate the type coverage by checking the appropriate box. A liability insurance policy Ir 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. Checkone: 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 installations performed under the permitissuedforthisapplic+wilinnce with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Ge ralLBy Type of License: Plumber Si re of LicensedTitle Gasfitter Master License Number City/Town Journeyman APPROVED (OFFICE USE ONLY) 0 r0/day, o V BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME&TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC.NO. PERMIT GRANTED DATE 19 GASINSPECTOR i