HomeMy WebLinkAboutMiscellaneous - 67 ROCKY BROOK ROAD 4/30/2018 (3) r
67 ROCKY BROOK ROAD {
210/090.A-0049-0000.0 f
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a
CERTIFICATE OF USE & OCCUPANCY
T : . . of North
Andover
U
Building Permit Number / d Date � � T
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 60 7 1p^ e:.C<
C MAY BE OCCUPIED AS �! ( IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
�oRTH CERTIFICATE ISSUED TO V ,(
o c
„ s
p ADDRESS
uddin spector
NA RT►y
To . 0 *10
� 4Andover
,Y ,breT(k
No. /Ay
�o ibrt dower, Mass., (8 1.9 4r
COC HI CMEWIC'K
�� AD RA TED "OL
H BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System 17_-
BUILDING
BUILDING INSPECTOR
THIS CERTIFIES THAT....Q.<.3?.U..M.t#V.tt"......4cam� .. . ......... ........
oun ati
has permission to erect !�.....%:C2i %0_ buildings on ....6.`1....... ! ... ... k..:.... ......((0* SZ, o 4
to be occupied as.��.�UL.....�741 1� �.�. .. . .....`�l......L...Ap..... �46.........:............. Chimney
provided that the arson accepting this permit shall in ever res ect coo rm to the terms of the lication on file in
P P P 9 P y PP Fina
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction.of e � � a/l 7C
Buildings in the Town of North Andover. REGU MIT FOR FOUNDATION ONLY PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. LATED BY PARA. 114.8-S. B.C.
PERMIT EXP 6 IviC�A� low,
FEE PAID Loo— L("'
J-a ,-- ELEC IC INSP T
UNLESS CON U Rou T� ��
PERMIT FOR FRAME/BUILDING - g
............... .. .. ...................... Service
'ce
• t Qs�FEE PAID' a.�� BUILDING INS , TO Ac,
DATE. _`z Fina
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 DEPAR
Until Inspected ..and Approved by the Building Inspector. Burmaq�q�TT�`T
,-j,
`PLANNING 2FINAL CONSERVATION �" ' FINA Street No.G7 Xbckl d4u�k
J
mo
Det.
SEWER/WATR� FINAL DRIVEWAY ENTRY PERMIT—0 M fiq
k. . Location 7 K oG�14 r
N'o• Date l
t`
OR ' 'TOWN OF NORTH ANDOVEFE
6. A Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
- 3AtMU5E
Other.Permit Fee
Yr
Sewer Connection Fee $ --- �
,` ,7Water Connection Fee
7� 17
TOTAL. $
in.g Ins to ,
C391 r� Div. b06 Works
NI
Location .
u a000C
No Date v
of N°oT;.�� , TOWN OF NORTH ANDOVER
Certificate of Occupancy $
.�; Building/Frame Permit Fee $ g
SJAc►+U Foundation Permit Fee $.
Other Permit Fee
Sewer Connection Fee $
t
Water Connection FeeLO
$ '�
TOTAL
ilding inspector
Div. Public.Works
Location Zcic. �a 1
No. Date 1 k 1\
L A3 A
°RTS TOWN OF NORTH ANDOVER
?0 Ytt.a° °.
A e
;, Certificate of Occupancy $
#yr y -Building/Frame/Frame Permit: B
�, `,,• : 9 Fee $ 9
7"
Eta Foundation Permit Fee $
SACHU
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL
Building Inspector
94.66 Div. Public Works
- APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. 1 PAGE 1
AP d-40. LOT NO. r�N ECORD OF OWNERSHIP iDATE BOOK 'PAGE
ZONE I SUB DIV. LOT NO. I I -
I
LQCATI 4.0 O SE OF BUILDING 1\_OWNER'S STORIES SIZE
ti .
lie
OWNER'S ADDRESS [ ASEMENT OR SLAB
�KRCHITECT'S NAME 4 Y SIZE OF FLOOR,TIMBERS ST 2ND J RD
BUILDER'S NAME SPAN
G +'
DISTANCE TO NEAREST BUILD NG r DIMENSIONS OF SILLS A) l lY,.
DISTANCE FROM STREET "' POSTS !
DISTANCE FROM LOT LINES—SIDES REAR V GIRDERS
AREA OF LOT 7-74 FRONTAGE�C( J HEIGHT OF FOUNDATION ,{� o THICKNESS
IS BUILDING NEW✓/" c•l SIZE OF FOOTING J jS X 7j l�
IS BUILDING ADDITION If MATERIAL OF CHIMNEY
IS BUILDING ALTERATION IS BUILDING ON SOLID OR F LLED LAND D
WILL BUILDING CONFOR TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY -V6 IS BUILDING CONNECTED TO TOWN SEWER Q
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS 3 PROPERTY INFORMATION
i
SEE BOTH SIDES PERMIT FOR FOUNDATION ONLY LAND COST
REGULATED BY PARA. 114.8-S. B.C. EST. BLDG. COST
PAGE 1 FILL OUT SECTIONS I - 3 EST. BLDG. COST PER 8Q. FT.
PAGE 2 FELL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM
FEE
D V
&T[ 71-5 SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILD G i>coo 4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FIL AND APP VED BY BUILDING INSPECTOR
DATE KILED ov
1 INO IN�P6CTOR
SIGNAtURELIDIF OWNER ZR'AUTi&WiZ A E
c
F E E ��� -� OWNER TEL.#
PERMIT GRANTED PERMIT FOR ERAMUBUILDING ,
CONTR.TEL.//
Lo q/y
19 —DATE: 2FEE PAID' CONTR.LIC.# .3
so
H.I.C.#
At ! 7 1995 L tom► �
A � (,"13 tMM POW IrEl C*l-
- •
f. MK KWff ��
a:-• .}"x
j BUILDING RECORD
OCCUPANCY-7. F ; 12 r
(SINGLE FAMILY -'.r I•• r s oLlfs` THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE PROM
J�.MULTI.'FAMILY d.--_` _OFFICES,';°• BLOT LINES AND EXACT DIMENSIONS OF BUILDINGS: WITH PORCHES. GA- r�
APARTMENTS , .j„ � RAGES. ETC. SUPERIMPOSED:THIS REPLACES PLOT PLAN.
CONSTRUCTION— �_
�
`,2 •.FOUNDATION 8 INTERIOR FINISH 1
CONCRETE' . 1 2 0
CONCRETE BL K. PINEY *-'_ !
BRICK OR STONE HARDW D
PIERS ..FASTER
_ DRY WALL ,', g'.,,'L� •'* 1 =,` .'"`"�
3 BASEMENT
AREA FULL FIN. B'M'TAREA v
'/, 1/2 '/, FIN. ATTIC AREA
NO B M'T FIRE PLACES. _.'•... \w
HEAD ROOM r MODERN KITCHEN
4 WALLS FLOORS
CLAPBOARDS _ 1 2 3 �\� 1 I
DROP SIDING CONCRETE
WOOD SHINGLES ! p EARTH _
ASPHALT SIDING 's `HARDW D _
ASBESTOS SIDING _ COMMCN
VERT. SIDING ASPH.TILE _
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STRS. & FLOOR _ ...�..1.. ir �r 4
BRICK ON FRAME I - �{�•-"fir t.
CONC. OR CINDER BLK. 4
STONE ON MASONRY — WIRING `
STONE ON FRAME a ]
SUPERIOR POOR �M- Y{sl
ADEQUATE I NONE �I_.... 1'0 - - -
5 ROOF 10 PLUMBING
GABLE HIP BATH 13 FIX.) . -
GAMBREL MANSARD TOILET RM. 12..FIXJI
FLAT SHED WATER CLOSET
ASPHALT SHINGLES LAVATORY
WOOD SHINGES '+ KITCHEN SINK :` � ��• ,'
SLATE NO PLUMBING -
TAR & GRAVEL STALL SHOWER
ROLL ROOFING MODERN FIXTURES
TILE FLOOR - �
-' TILE DADO
6 FRAMING I 11 HEATING
WOOD JOIST PIPELESS FURNACE 3 Lit �. `•.. a •s o i l G �i f.37:,,6 - _
FORCED HOT AIR FURN. t
TIMBER BMS.,&COLS. STEAM '
STEEL BMS. &.-COLS.' _ HOT W'T'R OR VAPOR }
WOOD RAFTERS AIR CONDITIONINGS
rj
RADIANT H'T'G
UNIT HEATERS '
7 NO. OF ROOMS GAS
OIL ,-
B'M'T 2nd 1 ELECTRIC
1st 13rd I NO HEATING ' e
I � T 1 10
NORTH
F
0VM Of �r 4Aindover
0 �_04 � �a
r`
art dower, Mass., u 19 q.r
WICK
A_ COC HIC HE �
'7 A°RATED PPG\
4
H BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT....04'�.U..t.00.k ...... .!n ... ............................................................................
oundatio �,�`
has permission to erect 0.....T-Q" P, buildings on ...6.1......... .94.. . .... 9D Com-I�, Rough
t0 be occupied aS.. UL.....x1�? lt .s�+��..�. .. ......... .....Z...4��,... <+�....................... Chimney
provided that the person accepting this permit shall in every res ect con rm 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. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8-S. B.C.t Rough
Final
PERMIT EXP 6 MCbX _FEE PAID
ELECTRICAL INSPECTOR
UNLESS CON U
Rough
... .. .. ..................
Service
BUILDING INS ECTOR
i Finalf t�
Occupancy Permit Required to Occupy Building G#INIPECTOR
Display in a Conspicuous Place on the Premises — Do Not RemoveQ��
No Lathing or Dry Wall To Be Done \ P
,�•s FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. O6 v Burner
PLANNING FINAL CONSERVATION FINAL Street No.
Smoke Det.
SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT
r
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: Phone
LOCATION: Assessorl Map Number Parcel
Subdivision ' tI Lot(s)
Street St. Number
************************Official Use Only************************
RECO D NS OF TOWN AGENTS: f3
--,, Date Approved �7 �
C nsery ion Administrator Date Rejected
Commen s
T, .6 .l Lr( Q Q Date. Approved
Town Planner Date Rejected
Comments
Date Approved
Food Inspector-Health Date Rejected
Date Approved �17
Septic Inspector-Hea th Date Rejected
Comments
Public Works - sewer/water connections
- driveway permit "Irk) 9-17-95
Fire Depar ment
;Received ;by uilding Inspector vDate
. ,
AUG 171995
1of � s
4 4,
92f
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T,•` 5 � r• � 1 l _iC...�- -��Y� t f �.1 •�4 �t''�f 3r,"�� �'
iii` '•{ i I V , S r t _,,. •. I !� a )z-. �i �y
IO / .. �� ` `All..''�. ��•t�1 jl•' /sem � � � .� Y.ry� .j 4
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•�' �4 5 -,� �. �� - -_ \_ ,_ I -x/91 _�,� t �t" c�� N t• j, 'Ir 6,S .i E
i J Q
a `
7 Plan Of L and
r /n
North Ando ver, Mass.
a sho wing
(�► "As—Built " Foundation Location
OL
p Lot 17 - Rocky Brook Road ,
Prepared For
8 r O O k .
Ogunqult Home,s, Inc.
f'r'ivote — 50• Wide �,
R = 249.49 Scale: 1" = 40' Date: November 14, 1995
L=150.00,
Zoning Dis tric t: R- 1
(Residence 1 District
Under R--2 Z ning)ed Subdivision
Top Of Found.
Elev. = 127.94 Note. Property line data taken from o Definitive
Subdivision Plan Of "Rocky Brook Estates" By
Thomas E. Neve Associates, Inc., Dated November
- - 24, 1986.
Existing Concrete 16
Foundation
N /n my opinion, the proposed Dwelling is not in a
ZI Flood Hazard Zone as shown on the U.SD.H.UD.
N o Flood Hozord Boundary Maps, Community Panel
No. 250098 007 C, Revised to June 2, 1993.
17
�E�����•v 48,538 S.F. / hereby certify that the foundation on this property
is located as shown on plans and complies with the
1. 11 A cres
�, �-f• zoning requirements of the Town of North Andover,
Masscchuset
•EpG� \ P
FT �' Na1rx M Professional Land Surveyor
p MAN T P L/ 00 uwe
NSE q 7701VC
Thomas E. Neve Associates, Inc.
Engineers — Surveyors — Land Use Planners
447 Old Boston Road — Route 1
14A oy Q U.S./ Topsfield, Mcssochuse t is 01983 887-8586.
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rior
PETER BREEN
28 X 44 "ka/ 0LON I AL c
1 40
Shoo
2-CA
4-1218
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NES
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NO
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0 0 milli is • • .•• • . • - • • - • .- -. . .•
a �■mn n ..
u nit Lu
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19'8" DECK 42'4" SCREENED—N—PORCH
12'2" 716" 4'8' 14'2" 9'0" 3'0' 5'0' 616" `
410n 396*
v a0 N
- T 1/2 BATH
--- O
! �s
6'0" SLUNG --- n -r L------.i
2'6' O G
STUDY BREAKFAST KITCHEN FAMLY ROOM
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N LIVING ROOM FOYER DNING ROOM
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co i 7 N �
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3,0" C-4''
4'0" 7'6" 4'2" 6'4" 6'4" 4'2" 7'6" 410"
15'8" 12'8" 15'8" 50" 81
0" 5b"
44'0' 18'0'
62'0'
FIRST BOOR PLAN_
3/16" - 1'0" 10184 3-13
,i 44'0"
7'0' 11'6" mile 9'0' 16'6'
710" 4'0' 5'0" 8'9' 79"
WALK-IN BATH o BEDROOM #4
CLOSET BATH 10
0 10 CL. 4,4" 6,0. 6,0»
24 16
2 - 2' '
N CV -
CLOSET CLOSET N
2 - 2' " o
IGD CN
aCV jv]
{� 2'6»
0
0
p: co
0
M BEDROOM #1 BEDROOM 12 BEDROOM 13
CL. ,
_00 N Z
CV
410" 716" 4T 3'10' - 8'611 2,0" 7'6" 4+0"
158" 2'6" :124' 13'6"
SFCQND FLOOR-PLAN
s
3/16" = 1'0'
10184 4-13
709" 7,9„ 2'3"
10 ia. Concrete er
19'8" 42,4„ (5 Req'd)
16'4' 26'0"
TO
-------- 5'0"
r-------------------------- o,
O
. �. , t .► ,
I I I i i L------- 1 ' -
_I --L_ 1_�_ - ------------ _----------- -----------------------------� r----1 1 O
L ----------------------------------- --------- - ,
--- s'o" I 6'0" s'0" FOUNDATION ----------------------------------------- ,I CN
„ , „ GARAGE FINISH
-- ►. ; 10 Concrete Wall 8 0 Pour o;
/ All Wood constructed Walls and Ceiling
••. ; 10" Dp x 1'8" W Cont Footing to have 5 8' type 'X' Fire Rated
3 1/2" Dia. Lally Columns / yp ,
With 2'6" Sq. x 1'0" Deep Wallboard installed L; QD
'�' '• ' Footing (3 req'd) 1 o
' 4 Concrete Slab a,
oil i3
2'8" 6 6
6 6 6 6 g 6 6,6„ 616„ 63
6" „ ^ 1
66 66" x
2'8' 3'10" o
�►-
r � / o
1 - ----r ------ ------------------------------- ------- ------ --- ------------ _ c
o
w N
O
-- -
r---C14 '► / -----------------------------------------
x 12 Center Beam (typ.) 0 40(min) Step down into Garage 0: 1 ; o
1
r7
-MI 1
►n - - —� 9 — 3 1/2" Dia.Lally Columns „ �, t ••-
With 2'6" W. x 1'0" Dp. 4 Concrete Slab W$ I 110
o _ Strip Footing Slope 1/8" per foot �; 1 o 0
t
>11 1 a'
/ 1 uP 01 ) 1 0
•/ t = 1 t m
1 0l 1
1
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1
tr-----------------------------------
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-- -------------' ►' t _o
L ------------------------------------------------------------------------------------------- . N
2'0'
44'0" 18'0" al .
FOUNDATION PLAN
3/16' — 1'0"
w 10184 5-1 �
2 X 12 Ridge Hoard Asphdt/Fberglass Roofing
Building Paper
1/2" Plywood
-- - __ 2x10016" OD.
•� 1 x 8 Collor Ties ® 48" O.C. a
12 I
I
Z
W -
i
1
i
1
I�
FLOOR 10" Overhanging SofFA
3/4" Plywood
2X8@VOD. i
o �
cc 00- R30 Fberglass Insulation
CO
`a '3 WALL
o FLOOR �—
Seng
0 3/4" Plywood Air Barrier i
_ 2 X 10 ® 16" OD. Sheathe
(I 2X40160OD. '
Insulation j
Vapor Barrier
1/2 Wallboard
i
o I
m
FLOOR
3/4" Plywood
2X10@16" 0D. SLL
_. R20 Insulation over garage 1 — 2x6 P T,1 — 2x6 KD.
_ Continuous SII Sealer
1/2" Dia x 12" L Anchor Bolts
GARAGE FINISH 3 — 2x 12 Center Beam 0 8'0" O.C.(maxi
- All Wood constructed Wails and Cefing 3 1/2" Dia.Lally Columns i
to have 5/8" type 'k Fre Rated M fDN PLAN FOR LOCATIONS) FOUNDATION
o Wallboard installed 10 Concrete Wall / 8'0" Pour
co 10" Dp x n" W Cont Footing
SECTION THRU HOUSE
- 1/4" = 1'0"
10184 :6-13
1
2 x 12 Ridge BoardXP `
Vv
12 _ w
ROOFING
Asphalt/Fberglass Roofing
Buiding Paper
1/2" Plywood
2X 10016" X.
CEILING R30 insulation
_ 2x8016" OL.
h: R30 Insulation
Vapor Barrier
- r 1/2" Wallboard.
' - 10" Overhanging Soffa
Q, with Venting
0
o •
00
FLOOR WALL
3/4" Plywood Siding
2 X 10 0 16" O.C. Siding
R20 Fberglass Insulation A? plywood
2X4 ® 16" O.C.
hsulation
GARAGE FINISH 3 — 2 x 12 Center Beam Vapor Barrier
All Wood constructed Wags and Ceiing 3 1/2" Dia.Lally Columns 1/2" Wallboard
to have 5/8" type 'X' Fre Rated F°"PUN FOR�oca»o
_ Wallboard installed
_ SILL
1 — 2 x 6 P.T, 1 — 2 x 6 KD.
_ Continuous Sill Gasket
1/2" Dia x 12" L .Anchor Bolts
4" Concrete Slab ® 8'0" 0L.(max
- � o
1
} w SECTION THRU FAMILY ROOM
1/4 1#011
- = 10184 7-13
s
Continuous Baffled Ridge Vent
I
2 x 10 Ridge Board j
1x8CoRarTies ® 4'0' O.C.
i
12
9 ROOFING
Asphalt/1 bergiass Roofing
Building Paper
1/2" Plywood
2x80, 16" O.C.
-- CELNG
2 x 10 0 W Of- i
3/4" Plywood
o
cc j
FLOOR
3/4" Sheathing
2X ;0 (P.T) 016- OC.
0
I
1'0" Dia.Concrete Pier
i t 1 I I I (5 Req d) i
-
i
SECTION THRU P-ORUFI
1/4" = 1'0'
10184 8-13
F-11FF- T T11
II I I I IIII I � I
IIU III
II I i ( 2'x'16 (P.r.) ® 1s"'o�c. I I I I
IIII I I IIII � �,
LY
IIIII � � =j=
� � Iill
III I -Lu[-JH I 1 -1
All members are 2 x 10 ® 16" O.C.
FIRST ROOR FRAMING PLA
3/16* = 1'0"
10184 '9-13
i
Flush Framed Beam
i
i
Fff7
i
Flush Framed Beam
All members cre 2 x 10 0 16' C.C.
SECOND FLOOR FRAMING PLAN,
3/16" = 1'0"
a.
10184 10-13
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CD
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0
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N
IT
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Flush Framed am I I 1 1 2 x 12 Ridge Board
Lower Roof Framing
2 x 10 ® 16" O.C.
Attic access to be located by builder
All members are 2x8 ® 16" O.C.
ATTIC FLOOR FRAMING- PL
3/16"
' i
10184 11-13
.. o
i
-- i
I7-1
. 1
2 x 12 Ridge Board
AP members are 2 x 10 ® 16` O.C. a
ROOF FRAMING PLAN
3/16" = 1'0'
10184 12-13
Roof Sheathing �rnin.� Space
1 - 2x6K.D.
Fascia do Trim 1 – 2 x 6 P.T.
Conthiots Sill Seder
10" Overhang w/vents Foundation r Strcps
(max)
r
Roof Rafters
A CATHEDRAL SOFFIT 1/2„ = ,*o" B RIDGE VENT 1/2" = ,.o"
0
1/2" Plywood
Sill Gasket aintaii 2" (min.) Air space
or Caulk
0
1 – 2 x 4 Bottom PlateV-314" plywood 12 0
19 —Alum. Dip Edge
2 x 10 Rim Joist
1 x 8 Fascia o
with trim
2 - 2x4Top Plate o
2x10@16" O.C. 2x3Nailer
Floor Joists o e
I \—Soffit w/vents
10"' � f
C INTERM. FLOOR 1/211 - D SOFFIT 4• Concrete Slab e -
1/2" _ 1'0"
r
Gasket or Caulk 1 – 2 x 4 Bottom Flat � FOUNDATION
3/4" Plywood 3 4' plywood 10" Concrete Wail / 8'0" Pour
2 x 10 16' O.C. / p y 10' Dp x 1'8" W Cont.Footing
1 - 2x6P.T, 1 - 2x6 K.D. 2x10016" O.C.
o ConUr=us SM Seder, Z – 2 x 10 Rim Joist
Foundation Anchor Straps
8'0" O.C. (max) 2 – 2 x 4 Top Plate
10" Conc.Fdn
E SILL _
1/2" = 1'0" F INTERM. FLOOR 1/2" _ 1.0" G 10" CONC. FDN. 1/2" = 1'O" 10184 13
13
Oh12v0s0b3T
Advantage Claim ' Services
2100 Lakeview Ave .
Dracut, MA 01826
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 Selectmen
Town Hall address Town Hall
01845 North Andover, MA 01845 North Andover, MA
Re : Insured: Jay Huapaya
Property address : 67 Rock Brook Rd
North Andover, MA 01845
Policy # : HP2104387
l
Loss of : 07/02/04
File or Claim No. AD 7038
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 _Cha ter_143 _Section_6 to be applicable. If any
notice under Mass_Gen_Laws,—Ch._139_Sec. 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 or
file- number.
Glenn Guarente
Title : Adjuster
On this date, I caused copies of this notice to be sent to the persons
named at the addresses indicated above by first class mail .
Signature and date