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Home My WebLink AboutMiscellaneous - 51 WEST WOODBRIDGE ROAD 4/30/2018THEW OPtIFOdO(� rDEDHAHAGROUPo September 10, 2014 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 313 Building Commissioner, or Inspector of Buildings c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Board of Health or Board of Selectmen c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Fire Department or Arson Squad c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 RE: Our File No.: P1479595 Insured: STEPHEN R BEAUCHESNE GAYLE S BEAUCHESNE Address: 51 WEST WOODBRIDGE ROAD, NORTH ANDOVER, MA Policy No.: F0114198 Loss Date: 09/08/2014 Loss Type: Building or Other Structure Damage A 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, Ch. 143, Sec. 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to my attention and include a reference to the captioned insured, location, policy number, loss date and claim or file number. - If no reply is received from your office within ten days, we will assume you have no liens of any type against this property, and the claim will be paid in our customary manner. Sincerely, Marie J. Landers Property Claim Examiner 1-800-688-1825 x1136 NORFOLK & DEDHAM MUTUAL FIRE INSURANCE CO. 222 Ames Street, P.O. Box 9109, Dedham, MA 02027-9109 DORCHESTER MUTUAL INSURANCE CO. Telephone: (800) 688-1825 FITCHBURG MUTUAL INSURANCE CO. o Fax: (781) 329-1818 �F Date...........�................:.... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that................4..........................-�... .`�'"'............................... has permission for gas installation `tom .+ ±........................................ in the buildings of .... } .F'. .t�! Q-- ................................................ at ...... ...... c-- ....:-!., North Andover, Mass. Fee. �..---.... Lic. No..�................................. ............................................ GASINSPECTOR Check # too n 7 2 t►` l A MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _ U� CITYQ' MA DATE , PE,RMIT# �� JOBSITE ADDRESS 1AY,..��c� - /L—_ __ OWNER'S NAME�- --—µ�—iJ t7J�M-S --Aam OWNERADDRESS -/QK_� _ TEI -- --.. �fiAX� TPRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL [ RESIDENTIAL CLEARLY NEW: ] RENOVATION: El REPLACEMENT PLANS SUBMITTED: YES O.f NO® -1 APPLIANCES -1 JLOORS–► BSM 1 2 3 4 11 5 6 7 s 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR-- FURNACE GENERATOR GRILLE INFRARED HEATER F.lf7j. LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATERI- ROOM / SPACE HEATER 1 {� r_ J ) (�� -_ t _ _. I , .,1 I I I J ROOF TOP UNIT nI _ .: TEST UNIT HEATER UNVENTED ROOM HEATER 71-7j= , i I ._ i C, .. I F WATER HEATER,..- a ... G4 �='TS'fl I _ _ - _ J( E . I� ._f -J I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch, 142 YES �. I NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY [ BOND fj 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 [j AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and Information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that ail plumbing work and Installations performed under the permit Issued for this application will be in compl ce 'th all Pertinent roviston of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER GASFITTER NAME LICENSE #17 SIGNATURE .... MP 01 MGF J JP ( JGF LPG[ O CORPORATION PARTNERS�HIP�#� -�� LLC [.�#=.-] COMPANY NAME: �i_._.-�..(.tt2MrJADDRESS CITY l�O f3 J STATE ZIP ®TEL�� 0421 � .. CELL -; EMAIL-AAaa l A m..-I m in "V 0 tz 0 z CA m m > ca --I m m X m un -4 0 a0 The Commonwealth of Massachusetts f - • " Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AD-Plicant Information Please Print LeAly Name (Business/Organizationgndividual): Address: %� ,�/f ' %�/�/,��y ✓ City/State/Zip:/' ��? Phone #: Are you an employer? Check the appropriate box: Type of project (required): 1 I am a employer with /eQ— 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner - have hired the sub -contractors listed on the attached sheet. 7• F1 Remodeling ship and'have no employees These sub -contractors have workers' comp. insurance. 8. ❑ Demolition g. ❑ Building addition working for me in any capacity. 5. ❑ We are a corporation and its [No workers' comp. insurance officers have exercised their 10.❑ Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c.152, §1(4), and we have no 12.❑ Roofrepairs insurance ] uired. t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I -Homeowners who submit this affidavit indicating they aredoing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy andjob site information. W_"/O�y �Insurance Company Name: /1t,",, P 4 Policy # or Self -ins. Lf c. #: � � ExpirationDate: oW4 Job Site Address: ,� ✓�� City/State/Zip: /* Attach a copy of the workers' compensation policy ileclaration 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 form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do Hereby certo under the pains andpenalties ofperjury that the information provided above is frue and correct. Signature: Date: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. EIectrical Inspector 5. Plumbing Inspector 6. Other - - Contact Pers Phone #: "-60MMONWEALTH OF MASSACHUSETTS PL'JMBERS'AND GASFITTERS j LICEI -OED-..JOURNEYMAN GASFITTER ISSUES THE ABOVE LICENSE TO: COL•IN A SHERRY 127 ANDOVER ST.'S' ANDOVER MA 01810-5607 3117 05.'11/14 168116::` ® p p • COMMONWEALTH OF MASSACHUSETTS p ® e •o • :e••ee PLUMBERS AND GASFITTERS __..LICENSED AS A MASTER GASFITTER ISSUES THE ABOVE LICENSE TO: ^a COLIN A SHERRYi�: ----- 127 ANDOVER ST • ji. - ANDOVER MA 01810-5607 1 3549 05/01/14 168115��, • `COMMONWEALTH OF MASSACHUSSTi•S _ pp 'AMBERgg AND G4SFITT R LICA �.ED Jf?URNEY AN a SKITTER ISSUES THE ABOVE LiCBNS6 TO• COLIN A SHERRY 127 ANOOkIER S't ANDOVER MA 01810.-5 07 iI7 D9l11/lp 166116 (COMMONWEALTH of MASSACHUSErM P AA SERS AND ASF1 R LICE S RAS A MASTER ®'ASFITTER fBSUE8 THE ABOVE LICEPJSE Ttl: cp'LIN _A SHERRY 127ANDOVER.$T �+ .-ANDOVER MA 01310-9607 3544 pgllsl�la 3683:k5 Fold. Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS BOARD PLUMBERS AND GASFITTERS GF REGISTERED AS A GAS CORPORATION ISSUES THE ABOVE LICENSE TO: TYPE COL:. f A SHERRY REI'D MECHAi> ICAL CORP -C 127 L.NDOVEk ST `Sp ANDOVER MA 01810-5607 147627 149 05/01/14 147 627 Fold. Then Detach Along All Perforations _ IMPORTANT NOTIC �. PERMITS FOR PLUMBING AAD GAS FITTING INSTALLATIONS ON STATE t-)WNED OR USED FACILITIES MI, -17 BE FILED .r THE OFFICE OF THE STATE BOARth. 9318 Date. �. ..f .. TOWN OF NORTH ANDOVER o PERMIT FOR PLUMBING ,SSACMUSf This certifies that .. .. .... . ....... / .... .... . has permission to perform jeI9#.-e C.Q/ plumbing in the building of... Lx'UCh2 S-Ae ............... at ..137. Q? ........?r . !�`Y .... ,North Andover, Mass. Fee .,�A OF .. Lic. No. //1:....... . PLUMBING INSPECTOR Check # Acol MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO DO PLUI -- --- _ II3ING CITY/TOWN: � � �— --- - D r ( APPLICATION DATE: JOB ADDRESS: _ �liJ��. ._ ii �I PLANS SUBMITTED: YES N0�' P OCCUPAo. NCY TYPE: COMMERCIALL7 RESIDENTIAL[_T NEWC] ALTERATION REPLACEMENT' REMOVAUDEMOLITIONE F PLUMBING: PIPING — FIXTURES - FIXED APPLIANCES — APPURTENANC _TERNATIVF Fr`u�uni nr_v ES Z ENTER TOTAL AMOUNT FOR EACH SELECTION (LIMITED TO FIVE (St Nm irDAI c T NAME: ADDRESS - r_....-__. -....._..' _..- .•f��RMS G{4`4�w�i:w...:+......rrrr_ - �..._� L .. CITY: I L9,�� rr----.._._.... __ --STATE: ZIP:Iy00/ Part TEL: - FAX: I �J EMAIL: rs t ❑LLC CHECK ONE ONLY ration Business rship Business #E--::—= Business # NAME OF LICENSED PLUMBER: �'�j� DBA / Unincorporated P INSURANCE COVERAGE I have a current liabilityinsurance policy or, its substantial equivalent, which meets the requirements of MGL. Ch. YES 1 N0 If you have checked Yes. please indicate the type of coverage by checking the appropriate box below. A liability insurance policy a Other type of indemnity OWNER'S INSURANCE WAIVER: I am aware that the licensee does not hava the insurance coverage required by Chapter 1442 oBonftheeMMassachusetts G and that my signature on this permit application waives this requirement. General Laws, Signature of Owner or Owner's Agent _ OWNER CHECK ONE ONLY AGENT El OWNER'S NAME:_.......---_._..-_.__._..-- �_. TEL: 1 hereby certify that all of the details and information I 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 142 of the General Laws. (OFFICE USE ONLY) TYPE OF LICENSE: Permit # Plumber Inspector ure of License umber [ Taster _ _ _ _ Fee: []Journeyman LIc Number:.—%�� May 24, 2013 THERlOQTFOLO(f�D�D0-0P�MGROUP� U FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B Building Commissioner, or Inspector of Buildings c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Board of Health or Board of Selectmen c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Fire Department or Arson Squad c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 RE: Our File No.: P1359273 Insured: STEPHEN R BEAUCHESNE GAYLE S BEAUCHESNE Address: 51 WEST WOODBRIDGE ROAD, NORTH ANDOVER, MA Policy No.: F0114198 Loss Date: 05/22/2013 Loss Type: Building or Other Structure Damage A 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, Ch. 143, Sec. 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to my attention and include a reference to the captioned insured, location, policy number, loss - date and claim -or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property, and the claim will be paid in our customary manner. Sincerely, Marie J. Landers Property Claim Examiner 1-800-688-1825 x1136 NORFOLK & DEDHAM MUTUAL FIRE INSURANCE CO. 222 Ames Street, P.O. Box 9109, Dedham, MA 02027-9109 DORCHESTER MUTUAL INSURANCE CO. Telephone: (800) 688-1825 FITCHBURG MUTUAL INSURANCE CO. Fax: (781) 329-1818 6 6 V Date ...� S ,1.. �� .... . � r / l NpRTM pf Sao tip of TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ...� i .. . w.... ..... ..... . has permission for gas inst llation ... ka ... .�� in the buildings of . .) E �'��°_. %h. �!�. �'-!� <:-........ . at North Andover, Mass.. Fee . dO,. C� Lic. No.. �7 1.) � .. .... .:: .. . GAS INSPECTOR Check # 31-) cs)- MYTIIR C W LLj Z MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING Y City/Town: MA. Date: �� /-� / Permit# Building Location: 6j 'd 2e /UU'/,,_ Owners Name: 5�� &4-u c4.eaz2 Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential ❑ W W New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No ❑ MYTIIR C W LLj Z Y Cd F- xw m = O0 W W 0 V CO H O F x w W Z H OLu Z 0 W w O F- LLILLI O ,� Lu x N U W W W > W W Z O J uj Z 1- 1-- O = (A Z J 0 o Il a x W Lu LL W W z 5- 0__ v o 0 a s to W O z O 9 o �, >>> > O LL 0 a. W° F- SUB BSMT. BASEMENT 1 FLOOR 2 Nu FLOOR 3Hu FLOOR 4 THFLOOR 5 FLOOR 6 THFLOOR 7 FLOOR 8 FLOOR Installing Company Name: Check One Only Certificate # Address:--5�Gc-r y &,,,A1hW City/Town: G State:// ❑ Corporation �^ Business Tel: �?O — �,f2'y� %� Business Fax: Partnership .Firm/Company Name of Licensed Plumber/Gas Fitter: c� /� /�, llt tt k INSURANCE COVERAGE: I have a current liability insurance 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 coverage by checking the appropriate box below. A liability insurance policy 1�d 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 Signature of Owner or Owner's Agent Owner El Agent El By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this 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 ---.-r---..__ -..... -...-•••••-••, r•�••�•�•• ••• •••� •••.,��...,....acaaa .�aa ac rl uulLulau VVuc 2111u 1111dPtUr -14L OT Ale loeneral Laws. Type of License: By ❑ Plumber Title Gas Fitter Signature of Licensed Plumber/Gas Fitter Master City/Town ❑Journeyman License Number: APPROVED OFFICE USE ONLY 0 LP Installer CONTRO1 # C-n If this license is lost IMPORTANT of p or destroyed Sth Floor, aosrotessionalnotify Your 13 -'censure, 239 C oa ton, AM 02114. aus at thy: eway St., If Your name or address sh Wn is chap of correct name. or addressoto Renewal Apph * This lic pation A/w insure ged' notifyYour ora � ense is S vect to Always I PrpPer rn board,; 0 Your license of mended it ub- refer t ail' P,rs the next I se numb s Is Provisions Of the General er . signed to onal Privilege and Laws"' Person or any other Person- I� Must not be Posted as required b , eep this i- loaned;;,'; t. WARNING , Y law. license on Y-, FNkIANcED ECUNtENT HAS �ttr EAT(jR(j'S 8993 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that...... I . 1. ..... �/./. .................... v i has permission to perform ... plumbing in the buildings of ... P vle ...... 9f. 6t. at. AIV.3.� m-1.00( .. North Andover Mass. H66.- (-.0.. Lic. No..�-. �..... . PLUMBING INSPECTOR Check # Installing Company Name: Check One Only Certificate # Address:/ 1*'_4k"/44 sc.. G• El corporation � State: a`( ��f 1�-2 ��e g� ❑Partnership BusinessTeL•� a� / Fax: &Firm/Company Name of Licensed Plumber: 4a INSURANCE COVERAGE: I have a current liability insurance 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 coverage by checking the appropriate box below. A liability insurance policy. Jam, 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 Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best o_1 -m y Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title ❑ Plumber Signature of Licensed Plumber City/Town [!Master APPROVED (OFFICE USE ONLY ❑Journeyman License Number: 1,92> �' S.�%,9 UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING FMASSACHUSETTS City/Town: MA. Date: S�� Y �- I i Permit# Building Location: -5 f Lcf 5%^ 13A,c�� _ .Owners Name:. Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No ❑ FIXTURES �. DEDICATED H SYSTEMS Z > a w 0 LnZ Y U D Z H Z iQ- Q ' u z mat Z a w C7 LU E Z Q_j� W U E = yin a Z W o: z u a s _� a s a = Z Q 0: LUOLL 0. N J a E W W = 6 W LU z N a a 4 to m m o v� O > > O O O Z Q a a = I H o x �e g g y ; ia- 3 3 3 0 Q -SUB BSMT. a 0 c9 0 3 BASEMENT 1sT FLOOR 2"D FLOOR 3RD FLOOR 4T" FLOOR ST" FLOOR 6T" FLOOR 7' FLOOR BT" FLOOR Installing Company Name: Check One Only Certificate # Address:/ 1*'_4k"/44 sc.. G• El corporation � State: a`( ��f 1�-2 ��e g� ❑Partnership BusinessTeL•� a� / Fax: &Firm/Company Name of Licensed Plumber: 4a INSURANCE COVERAGE: I have a current liability insurance 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 coverage by checking the appropriate box below. A liability insurance policy. Jam, 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 Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best o_1 -m y Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title ❑ Plumber Signature of Licensed Plumber City/Town [!Master APPROVED (OFFICE USE ONLY ❑Journeyman License Number: 1,92> �' S.�%,9