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Miscellaneous - 59 BRADSTREET ROAD 4/30/2018
59 BRADSTREET ROAD 210/044.0.0004-0000.0 AMERICAN CLAIMS SERVICE ASSOCIATION INDEPENDENT INSURANCE MULTI-LINE ADJUSTERS DIUSTUi DEDI A TO S-1 BUILDING COMMISSIONER OR BOARD OF HEALTH OR INSPECTOR OF BUILDINGS BOARD OF SELECTMAN 1600 Osgood St North Andover, MA 01845 RE: INSURED: Gerald S. Adelaide G.Stewart PROPERTY ADDRESS: 59 Bradstreet Rd, North Andover POLICY NUMBER: PH00100785878 LOSS OF: 07/03/2014; Fallen Tree FILE/CLAIM NUMBER 30897 PD Claim has been made 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 writer and include a reference to the captioned insured, location, policy number, date of loss and claim file number. Craig Gillespie Claims Representative On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Unless we hear from you within the next 10 days, we will not be obligated to pay any portion of this claim to you. i I Date 7/21/2014 7 KIMBALL LANE, BUILDING C, LYNNFIELD, MASSACHUSETTS 01940 TELEPHONE (781) 245-9516 • FAX: (781) 245-1077 AMERICAN CLAIMS SERVICE ASNATI NAL SOCIATION INDEPENDENT ERS S INSURANCE MULTI-LINE ADJUSTERS °'Uy DEDICATED TO ERVIC BUILDING COMMISSIONER OR BOARD OF HEALTH OR INSPECTOR OF BUILDINGS BOARD OF SELECTMAN 1600 Osgood Street North Andover, MA 01845 RE: INSURED: - Gerald Stewart PROPERTY ADDRESS: 59 Bradstreet, North Andover, MA POLICY NUMBER: PHOO100785878 LOSS OF: 10/29/12; Property Damage FILE/CLAIM NUMBER 30122 PD Claim has been made involving loss, damage or destruction of the .above-captioned property, which may either exceed $1, 000. 00 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location,. policy number, date of loss and claim file number. Gerry Gillespie Claims Representative On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Unless we hear from you within the next 10 days, we will not be obligated to pay any portion of this claim to you. October 30, 2012 Date 7 KIMBALL LANE, BUILDING C, LYNNFIELD, MASSACHUSETTS 01940 TELEPHONE (781) 245-9516 - FAX: (781) 245-1077 Date. `. '�. . .3. .. ,,ORTH pf4, TOWN OF NORTH ANDOVER - PERMIT FOR GAS INSTALLATION �,SSACHUSES This certifies that . . F�. . . . r : �1 . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . ./r� . . . . . . . . . . . . . . . . . . . . in the buildings of . . S � .<� . :7. . . . . . . . . . . . . . . . . . . . . . . . at . . � `�. . . .rv` fq.� North Andover, Mass. Fee.-R.... . . Lic. No.,?.��.1 C . . . . . . . . . . . . . . . /GAS INSPECTOR Check# °, 4463 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FTrnNG (Type or print) Date fL� ��Q� NORTH ANDOVER,MASSACHUSETTS Building Locations __ 'J� � �PlI zb Permit# _ V y 015,� Amount$ 36 Owner's Name New Renovation ❑ Replacement Plans Submitted ❑ W o d a a c o H o w °x > v� ' x o a } GO < z d [� Ew y vOi o O k�} 0 Ems- f, 6 �j � O w 3 A C7 Uo a A a H p SUB-BASEM ENT Y BASEMENT IST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH . FLOOR 5TH. FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR N(Prine or type) L/ Check C e: Certificate Installing Company Wa Corp. Address ❑ Partner. Business Telephone ❑ Finn/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes M No❑ Ifyou have checked yes,please indicate the type coverage by checking the appropriate box Liability insurance policy .® Other type of indemnity ❑ Bond D 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: Signature of Owner or Owner's Agent Owner ❑ 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 and it for this application will be in compliance with all pertinent provisions of the M usetts S to Gas Code d apt f the General Laws. By: Signature ofLicensed Plumber Or Gas Fitter Title Plumber .ic City/Town Gas Fitter Icense Number ❑ Master APPROVED(OFFICE USE ONLY) ❑ Journeyman N° 2526 Date...eZ4P— NORTIi TOWN OF NORTH ANDOVER PERMIT FOR WIRING SACNUS� �1 This certifies that '�— - �r?^ .....1�.. .......................................... has permission to perform ... `j""`' )............................................ wiring in the building of................................................................................... j ....... .............�: ................................. :�,;,f-,-''�<-,. ,North Andover,Mass. i i Fee' .."": ..... Lic.No. ............. ....��:.... ............:..� .................. /, � LECMICALINSPECTOR Check # ��C,Q� v WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Office Useoc-�C;-4 The Commonwealth of Massachusetts Permit No. Occupancy tee Checked Department of Public Safety 3/90 (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK . All urork to be performed in accordance urith the Massachusetts Electrical Code. 527 CMR 1 :00 (PLEASE PRINT IN INK OR TYPE ALL A,�LLL�IyN�F,O/RJMAATION) Date ;—,,- City �Q City or Town of V,, fi/N 1/� yy- �� To the Inspector of Wires: The undersigned applies for �alpermit to perform the electrical work described below. Location (Street &��N(('umber),� ��/ Owner or Tenant—6- Owner's Address--s F (Check Appropriate Box) Is .this permit in conjunction with a building permit: Yes IBJ No ❑ Purpose of Building 5� / L y.. AVIF—Utillitty\Authorization NO. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of deters New Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters Number of Feeders and Ampacity // �i f _ Location and Nature of Proposed Electrical Workr' / / [t— [% Total No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA Above In- KVA No. of Lighting Fixtures Swimming Pool grnd. ❑ grnd. ❑ Generators No. of Emergency Lighting Nu. of Receptacle Outlet:; -Two Nu. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges No. of Air Cond. tons Initiating Devices No. of Heat Total Total No. of Sounding Devices No. of Disposals Pum s Tons KW C7m� No. of Self Contained Space Are Heating �, f Detection/Sounding Devices No. of Dishwashers g Municipal n❑Other No. of Dryers Heating Devices KW Local❑ Connectio No, of No. of Low Voltage „'No. of Water Heaters KW Si ns Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCEVCO ERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES NO ❑ I have submitted valid proof of same to this office. YES❑ NO ❑ eu ❑ nate box. q P b checking the appropriate overs g PP P have checked YES lease indicate the type of coverage y If you h . P 9/16/ oa INSURANCE ID BOND ❑ OTHER (Please Specify) _ Expiration ate Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME CONTINO ELECTRIC & CABLE, INC. LIC. N'I.�$3_ -- � -_ Licensee LOUIS CONTINO Signature LIC. NO. Bus. Tel. No. -363-E Address , Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) - Telephone No. PERMIT FEE S Signature of Owner or Agent Location +pr �1 y' No. 511 Date NQRTa TOWN OF NORTH ANDOVER { Certificate of Occupancy $ s�CMUs Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ f-2 Check #14310 'Building Inspedr G TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH�AONE OR TWO FAMILY DWELLING .V x2Ax rn BUILDING PERMIT NUMBER: / ,� i- DATE ISSUED: /j M SIGNATURE: Building CommissionerflEEpector of Buildin2 Date SECTION 1-SITE INFORMATION 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 06 06 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 R red Provided ReqWred Provided —+ I — —1 v 1.5. Flood Zone Information: 1.8 Sewerage Disposal 1.7 Water SupplyM.G.L.C.40. 54) �8 System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record Name(Print) n Address for Service Signature Telephone 2.2 Owner of Record: i O Name Print Address for Service: rn Signature Telephone MM SECTION 3-CONSTRUCTION SERVICES 9" 3.1 Licensed Construction Supervisor: Not Applicable ❑ T r-1 D U ((/r 10 Licensed Construction Supervisor: e Number L�2 0 License Number Address hh Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ v i r, Company Name ! Z rn Registration Number r Address r ��"Signature P �� gel Expiration Date 2^ Telephone Y f 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 rmit. Si ned affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work(check atl applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: I00 ac- SECTION 6-ESTIMATED CONSTRUCTION COSTS ItemEstimated Cost(Dollar)Dollar to be ( OFFICIAL USE{3NLY, �, Com leted bermit applicant , p + ' g (a) Building Permit 1. Building g t Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 PlumbinE Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5' Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, 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 1, 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/A ent r Date mlllillillissio�l mill III! NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2ND 3RD SPAN DIMENSIONS OF SILLS DU,v ENSIGNS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ft4ORTH 01%M ® _ Andover LA O Y Clover, Mass.,—// 'p COCKICHEWICK o ARATED S H ` BOARD OF HEALTH PER IT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ......... 1.1141%%*$'Iliwl***"***"""*****,*"""***"****"""**,,*-... ............................. Foundation has permission to erect........................................ buildings on g ...... ....... ................................ ............ ... Rough - to be occupied . Chimney . .. ........ ... .... ..... .............................................................................................................. provided that t e person accepting this ermit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of th Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC'T'ION ST T ��jj��� ` /r� 4'4 Rough ................................................................................................................. Service 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 Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner 1 0 Street No. SEE REVERSE SIDE Smoke Det. 4i . j!I i Town of North Andover � t'°oT b aY�+ \ Building Department o �► 27 Charles Street North Andover, Massachusetts 01845 978 688-9545 - ° ( ) Fax (978) 688 9542 'p COLKKWwKM , ��SsgArm cus���� I i DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 50a. The debris will be disposed of in/at: Le we C S a S 5 Ile cu u � . /. � G Facility location Signature of Applicant i -2- Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. I I i • � - __ �!: l'-'49TL!}t{1'tt{,[MdZt�ft• D�..-'j.ti;Srjrf tf{3E'�.�+1 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number.*CS 0601120 + Birthdate: 08/04/1956 t Expires. 08/04/2002 Tr.no: 748 Restricted To: 00 THOMAS T DOYLE 8 WEST ST (•�+ SALEM, NH 03079 Administrator � (� J1.q{j�rxn�anu�-ijD�`0���naarar�rtse/�a =` HOME IMPROVEMENT CONTRACTOR ° Registration 126612 _ a1 Type - •DOA Expiration 04/29!01 THOMPSON'S ROOFING THOMAS T. OOYLE G� UTIVEST ST ADMINISTRATOR SALEM NN 03079 II s •fipropogal Page of \ 105 Haverhill Street Free Estimates ,.r Fully Insured Methuen, MA 01844 THOMPSON'S ROOFING (978) 691-1355 Shingles — Slate —Rubber Roof Single Ply — Copper Work DROPOSAL SUBMITTED TO PHONE DATE Mr. & Mrs . Stewart 8-28-00 STREET JOB NAME 59 Bradstreet C"' STATE AND ZIP CODE JOB LOCATION North Andover MA 01845 ARCHITECT DATE OF PLANS JOB PHONE rt1ery submit specifications and estimates for: ereb ip offall roof shingles on !souse and garage :Renail all loose boards Install 8 =_nch a..um:inum dt-ip ed-Je arout}d ro.:)` line Apply ice and water- shi..=.ld 3 feet up all alcng edges and on entire back entrance roof Apply 151b. felt paper on rest of roof area Reshingle with a 25 year shingle, Architect, your choice of color Install new fainges around soil pipe Cut in ridge vent on house Remove all work related debris 25 year warranty on material ,✓ 10 year guarantee on labor ,I� U Construction lic . #060112 �! Improvement #128612 I we PrO1l0OC hereby to furnish material and labor—complete in accordance with above specifications,for the sum of: Six thousand eight hundred ------------ dollars($ 6 ,800 . 00 �. Payment to be made as follows: All material is guaranteed to be as specified.All work to be completed in a workmanlike manner I/ �,1 IZ/ 1":5�jxc" according to standard practices.Any alteration or deviation from above specifications involving Autho extra costs will be executed only upon written orders,and will become an extra charge over and Signature above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tornado and other necessary insurance. Our workers are fully Note:This proposal may be covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within _j days./ Of propont—The above prices,specifications and conditions are satisfactory a are hereby accepted.You are authorized to do the work as specified.Paym ill bee made s outlined above. I Date of Acceptance: r" Signature- �1 .`;-'// %lam 7 /f' / �!• "•I F 1 CATE OF L I AB I L I TY I N S U R A N C E DATE 051---001(MM/CD/vv) PRODUCER 6THE ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS HE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTEn PELHAM :NSURANCE SVCS INC VERAGE AFFORDED BY THE POLICIES BELOW. In) ARIDGE STREETINSURERS AFFORDING COVERAGEPELHAM NH 03076• UEA: The Maryland 'NSURED INSURER B: Liberty Mutual Thomas Doyle INSURER C: DBA Thompsons Construction & Roofing 8 West St. INSURER D: Salem NH 03079 INSURER E: OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. N'7 'THSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS -RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AL: THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POLICY EXPIRATION 'TR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000.000 A �X� COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 300,000 � [ ) CLAIMS MADE [X) OCCUR SCP 34865353 04.15.00 04-15.01 MED EXP (Any one person) s 10,000 j PERSONAL & ADV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2.00^,C10 C ]POLICY [ ]PROJECT [ ]LOC PRODUCTS COMP/OP AGG $2.000.000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ] ANY AUTO (Each accident) E ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY(Per �erson) $ HIRED AUTOS VON-OWNED AUTOS ODIL INJURY(Per accident) $ I PROPERTY DAMAGE ' (Per accident) s GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY; AGG S EXCESS LIABILITY EACH OCCURRENCE $ C ] OCCUR [ ] CLAIMS MADE AGGREGATE s [ ] DEDUCTIBLE $ ] RETENTION $ $ $ WORKER'S COMPENSATION AND ( ] WC STATUTORY ( ] OTHER B . EMPLOYER'S LIABILITY WC2.31S-314995.019 04-21.00 04.21.01 E.L. EACH ACCIDENT $ 100.000 E.L. DISEASE-EA EMPLOYEE $ 100.000 E.L. DISEASE-POLICY LIMIT s 50C.nn0 OTHER - DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Roofing. CERTIFICATE HOLDER [ ]ADDITIONAL INSURED: INSURED LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Don Foss THE EXPJRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR, 9 Gumpusus Pond Rd. TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION ?,�lham OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR NH 03076 REPRESENTATIVES. AUTHORIZ D REPRESENTATIVE p Page 1 - 2 Date. N° 4551 4 NORTH TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING SA 04US This c e r t i fi e s that i,q-�. . . . . . . . . . . . . . . . . ,.Pas permission to perform . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . — North n over, Mass. He�S. Lic. . . . . . . . PLUMBING IN Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FO ERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date 71C �MrBuilding Location J- �C 3`u /1 Owners Name V � �J/'�1i�44<17 Permit# Amount Type of Occupancy New Renovatio ? Replacement Plans Submitted Yes ❑ No ❑ FIXTURES z F > w o z a a a a H Cn a s o w W x x 3 3 0 x x a o H d w F o v x 3 x a ca in A a a 3 x HZ w A 3 x All o >aAwaNr 1n Elfm ZnHDR V' V' 3M HDM 4M FL" 51H Hl= sliFl" 7MHfM • gm film Print ore) Check oneCertificate InstallingCompay Name ;tl ElCorp.Address Partner. Business Telephone J^ � /— �� Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the twe of insurance coverage by checking the appropriate box: Liability insurance policy LU Other type of indemnity ❑ Bond 0 Insurance Waiver: I,the undersigned,have been made aware that the licensee ofthis application does not have any one of the above '"%threeinsurance Signature Owner ❑ 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbinge nd Chap r 142 o t Gen al Laws. ot- BY tgna e o teens um er Type of Plumbing License tX Title a q � City/Town ricense Number Master ❑ Journeyman APPROVED(OFFICE USE ONLY �J �I� Location No. Date 8-10 aoRT� TOWN OF NORTH ANDOVER 3? i •. O F � i r Certificate of Occupancy $ CMUs<�' Building/Frame Permit Fee $ o Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # 14G73 /` Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: rn SIGNATURE: C Building Commissioneffl for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map N Parcef Number Q 1.3 Zoning Information: 1.4 Property Dimensions: (� Zoning District Proposed Use Lot Areas Frontage ft _ \I 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided v 1.7 Water Supply M.G.L.C.40.1 54) 1.5. Flood Zone Information: 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 Owner of Record Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: d Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES . 90 3.1 'censed Constructiorvisor: Not Applicable ❑ 4Jl� Y";z,Li-Ansed Construc on Supervisor: ! O .'O 1 � License Number mn Ad ss (� 7� /O 00 Expira on ate ic gnature Telephone '.. 3.2 Registered Home Improvemen ntractor Not Applicable ❑ v 6 Company Name Q ,j m Registration Number r A dress V r Expiration ate ^ Si nature Telephone V 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: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAI<,USEQ1�1Ly Completed by permit applic t an �n� _ �a 1. Building (a) Building Permit Fee L otv Multiplier 2 Electrical (b) Estimated Total Cost of a 0 O Construction 3 Plumbing Building Permit fee(a)X (b) �^ 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 0 per,) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 7 1, 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/AUTHOR17,ED AGENT DECLARATION 1, Ke(L, r as Own uthorized Agent of sub t property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief S ✓; Print me Si ture of a ent Date = =Mwts low NO. OF S ORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3 SPAN DIIv1ENSIONS OF SILLS DlIvIENSIONS OF POSTS DRAENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE W, I I 1 r w ._ ........ ...... ...... 1: i ,2 Iz i ^> _ _ S d 1 f ' - -._ _ J W _ T n i y . . ! i Y Its M rll � ! d _ _ _ f . n :: _ _ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: ��I� Location: City Phone am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees workingon is job. Company name: t<� — e ;7'. Address Al City: A)2. Aid V-e--l" I A Phone#: 97 g 6 9 7-7b(o Insurance Co. uQ2, 9. Policv# Company name: Address City: Phone#: Insurance Co. Policy# 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 penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby cert7up Y the p i and pe alti of perjury that the information provided above is true and correct. Signature Date 19 /a 1 Print name �. Phone# & e -7otpy/_ Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept p Licensing Board F-1 Selectman's Office Contact person: Phone#: F-1 Health Department Other FORM WORKMAN'S COMPENSATION �r e I — �� "(aamvnraszuretr.��� a�✓�Y�ralrr�.[ 4 BOARD OF BUILDING REGULATIONS � } License: CONSTRUCTION SUPERVISOR k - a Number: GS 001724 I Birthdate: 03/05/1956 ; f Ekpiris:03/05/2002 Tr.no: 26194 F Restricted To: 00 i KEVIN J SMITH i 110 HIGH STREET r! •• : N ANDOVER, MA 01845 Administrator I I IPF'ROVCMENT-CO TRAi.TOR y - Registrattop fOOSII z Ck Type IFIDIVIOt1Ai t Ptratloq 08129,fO0 T izT d H CONSTRUCTION Cc ev`f J. Saab 'ADm ISTR p j g; $t 1 Andover MAI018,�s i i I i V NORTH BUILDING PERMIT of'JtLeo qti TOWN OF NORTH ANDOVER �2 y ` "' '° O ti APPLICATION FOR PLAN EXAMINATION 7° I Vb T Permit NO: �I Date Received 1 Date Issued: I �RSSACHUS���y IMPORTANT: Applicant must complete all items on this page �. s - _ . _ h r PROP€RT A, �-- nn 77"'11, UR li IMAP NO: PARCEL �ZONINGj®ISTIR CTS Historic District{ter ayes �n _ _ _ MachmeSho Villa ew 4yesL TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building *60ne family ❑Addition ❑ Two or more family ❑ Industrial 'dAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other rs tlI Dstnc_t �_ Water/Sewers Jx - -- _� } DESCRIPTION OF WORK TO BE PREFORMED: —Identification Please Type or Print Clearly) OWNER: Name: Phone: 05-3 t) Address: �CONTRACT®R Name .h = om-� ,� rPh©net_ Y rvrso�sConstructioriLicense �H elmprovernent License - a -- �} ARCHITECT/ENGINEER ���.�, Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost:, L0 FEE: $ ► V 1) _ Check No.: 1/L16 2 Receipt No.: NOTE: Persons contractin with unregistered contractors do not have ace s to the guaranty fund Sign a_ture of Agent/O:vv ria ure %,,"I frac Location No. Dat . • TOWN OF NORTH ANDOVER • ���;ti v�� ` Vic Fd. s• W, Certificate of Occupancy $ " Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# l/Yy-;! 25980 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS ! Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street +..res .+R .e.- ,:. �+- iFIRE DEPARTMENT Temp;Dumpster,on siteyes � � r .ino s = r ,y'3� Glx �Located�pt124'�Main�Street�- t -_ _Frearmnsi T`G� �3 fr y:.S'v 4 a`•9 > �B'�'' ✓+��d�Y �,.�� S, :Fd +b�s�' � yt ��:i? ` ds;�' �`s's"Si l { �:1:'q'4� �',&��: Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine j NOTES and DATA— For department use ® Notified for pickup - Date I Doc.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑. Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building pp Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (if Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 NORTH own of E ., Andover o zti C, 'AN1 h ver, Mass, COC KK ftf WICK y1. RATE1) P4P,i'(5 S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR 45 has permission to erect ......... ............... buildings on ..�....... .. .. .. .................................. �� _- Rough to be occupied as ............. ......... ...4.r.:............r1.��l�......D !!!�. ....Ml� ...................... Chimney provided that the person accepting his permit shall in every respect conform to the rme application Final on file in 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. PLUMBING INSPECTOR Rough l I: VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 M THS - ELECTRICAL INSPECTOR UNLESS CONSTRUCTI Rough Service .................. .......... ................................................. Final BUILDING INSPECTOR { GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT rr° Until Inspected and Approved by the Building Inspector. Burner Street No. f Smoke Det. SEE REVERSE SIDE Kevin • 98 Forest Street • North Andover,MA 01845 • PH:978-688-5335 Building Contractor FAX:978.688-7207 Prupow To: Jay &Glenda Stewart 59 Bradstreet Road All Home improvement Contractors and Subcontractors engaged in home improvement contracting,ting,unless North Andover, Ma 01845 specifically exempt from registration by Provisions of Chapter 142A of the general laws,must be registered with the Commonwealth of Massachusetts.Inquiries about registration and Status should be made to the Director,Home Improvement From: Kevin Murphy Room 1301, oston MA�02108 6ct 177} - %.72785Ashburton Place, CC: Date: 11/16/2012 .lob: Storm Damage Repairs Date of plans: None Architect: None Location: Same Section I-Work Schedule Contractor will begin the work or order the materials before the third day following the signing of this agreement, unless specified here in writing contractor will begin work on or about 11116/12. Barring Delay caused by circumstances beyond Contactors control,the work will be completed by 5/15/13.The owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall no be considered as violations of this agreement. Section 11-Warranty The Contractor warrants that the work famished hereunder shall be free from defects in materials and workmanship for a period of 1 year following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup,the Contractor shall, at his own expense, forthwith remedy,repair correct,replace,or cause to be remedied,repaired,or replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. Section 111-Scope of Work Page 1 of 4 Kevin Murphy Building contractor Page 2 of 4 98 Forest Street North Andover,MA 01845 PH:9786885335 FAX:978688.7207 General Proposal is to repair all damage to existing house, caused by large tree during recent storm. Building permit will be obtained by contractor. Building Two new Harvey window units will be supplied and installed to replace existing damaged units. Two new basement windows will be supplied and installed in front of house. Three other Harvey screens will be replaced as required. Any damaged cedar clapboards on front/side of house will be replaced. Front of existing house will be completely stripped and reroofed. Architectural shingles will be supplied and installed to match existing. Crown molding/roof trim on side porch will be replaced. Flat roof on porch will be stripped and replaced. Electrical Existing post lamp will be replaced.An allowance of$450 has been included for light fixture. Plaster Wall in second floor bedroom will have hole patched/plastered to match existing finish. Interior Trim/Doors Any interior trim around damaged windows will be replaced to match exisitng. Painting Front and side of existing house will be completely repainted. Color to match existing. Second floor bedroom will have all walls repainted. Color to be determined. Any new interior trim will be stained / painted to match existing.Two additional ceiling will be repainted due to water staining. Waste Removal All construction debris will be disposed of by contractor. Items Not Included There have been no allowances made to repair/replace awnings over first floor windows. They appear to be undamaged, but upon removal,further inspection may be required. i I The CommonweaUh of Massachusetts Deparhnad of b dry hid Accidents Office ofIrrpa*atdons 600 Washmgton Street Boston,MA 02111 www.massgov/dda Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business ommizationftol idud): - Address: IR i City/State/Zip: IJv 3 Are you an employer?Check the appropriate box: Type of project(required): L ISI am a employer with . 4- ❑I am a general contractor and I 6. []New construction employees,(full and/or arttime . have hiredhe sub-contractors 7. Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet.I _ ship and have no employees These snub-contractors have S. ❑Demohtwn working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑Weare a corporation and its ectrical or additions required.] officers have exercised their 10.0 El repairs 3.❑ I am a homeowner doing all work right of exemption per MGL 11.[]Plumbingrepairs or additions c.152,§I(4),and we have no 12. Roofmyself[No workers comp. ❑ repairs insurance required.]t employees.[No workers 13.❑Other comp.insurancerequ r A] *Any applicant that chcc s box#1 must also fill out the section below showing theirwockae compensation policy inIbmution. t Homeowners who submit this affidavit indicting they are doing all work ana thenhhe outside contractor must submit anew affidavit indicating such. #Contractors that check this boxmust attached an additional sheet showing the mime ofthe sub-contractors and their wodmis'comp.policy information. I am an employer that is providing workers'compensation baurancefor my employees: Below h thepolicy mrd fob site information. Insurance Company Name: :ems P-. Policy#or self-ins.Lic.m V-!o k-�C— 3 t-xb O b Expiration Date: i 3 Job Site Address: TI-ICK-A- City/StataMp: to 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 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herebI cerh)yunder the pains and penddes o4perfiff that the information provided above is bw and correct, 5i tore: ate. Phone M Oficial use only. Do not write In this area,to be completed by city or town official City or Town: PermitUcense# Issuing Authority(circle one): L Board of Health 2.Building Department WCity/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other ContactPerson: Phone#: DATE(MWDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8/7/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. Astatement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER WN IAL;I NAME: M P Roberts Insurance Agency Inc a°No,Ext: 978-683-8073 (A/CC,No):978-683-3147 1060 Osgood Street North Andover Ma 01845 ADDRESS: sandi@mprobertsinsurance.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: PROVIDENCE MUTUAL INSURED KEVIN MURPHY BUILDING & REMODELING INSURER B: MERCHANTS INSURANCE 169 BOXFORD STREET INSURER c: GUARD INSURANCE INSURER D: NORTH ANDOVER, MA 01845 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRR TYPE OF INSURANCE ADDL INSSR 4WD GENERAL LIABILITY POLICY NUMBER (MM/DDM'YY) (MM/DD/YYYY) LIMITS EACH OCCURRENCE $ 1 000 000 X COMMERCIAL GENERAL LIABILITY UAMA13tTOREN PREMISES(Ea occurrence) $ 100,000 CLAIMS-MADE CIOCCUR MED EXP(Anyone per,on) $ 5,000 A CPP0060868 11/22/1111/22/12 PERSONAL BADVINJURY $ 1 000 000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 21000,000 POLICY JE4T F1 -LOC AUTOMOBILE LIABILITY Ea accident $ 1,000,000 ANYAUTO BODILY INJURY(Per person) $ ALLOWNED U MCA7013608 01/23/12 01/23/13 B AUTOS BODILY INJURY(Per acadent) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS (Per accident) UMBRELLA LIAB EACH OCCURRENCE $ EXCESS UABAGGREGATE $ DED RETE $WORKERS COMPENSATWC STATU- OTH- AND EMPLOYERS'LIABILITY YIN X TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE C OFFICER/MEMBER EXCLUDED? ❑ NIA E.L.EACH ACCIDENT $ 500,000 (Mandatory in NH) KEWC317800 07/01/12 7/01/13 E.L.DISEASE-EA EMPLOYEE $ 500 000 If yes,describe under r DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (AttachACORD 101,Additonal Remarks Schedule,'rl morespaceis required) CERTIFICATE HOLDER CANCELLATION TOWN OF ANDOVER BUILDING DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ANDOVER MA 01810 ACCORDANCE WITH THE POLICY PROVISIONS. 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