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HomeMy WebLinkAboutMiscellaneous - 67 ROCKY BROOK ROAD 4/30/2018 (3) r 67 ROCKY BROOK ROAD { 210/090.A-0049-0000.0 f TIP", 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 ta cr _ / t r u n � y • _ � Y ,�i�y I +w.1 � ." � r ,�.. N4?i 9 CdFi Yee i �, q f, 9f ,•� jt�"1 4 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 Cf) •�' �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. q,a uW Y i k s � i r rior PETER BREEN 28 X 44 "ka/ 0LON I AL c 1 40 Shoo 2-CA 4-1218 i 1 i MIMI i —= = = ■a = = ■- ■■■ __ - ■■■ _ _ ■■■son - MEN MEN MM no] = _ _ ■■■ = _ -= IFom __- == ■SRI = - - ■■■ - = mm _ -- a= ■■■ _= = ■■■ _ = ■■■ - _ ■■ _= = ■■■ _ __ aE�Mi =_ • as NEW SON Nunn' son Is - 11 iiiii I all Flamm-_ ■■■ w ----�.■ ■■■■n �— ------ -------- iz- NES ----------------• --- --- ____�� NO • I now 0 0 milli is • • .•• • . • - • • - • .- -. . .• a �■mn n .. u nit Lu l ' l 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 So ' o a co _ O O r") cp r7 c' o C-4310° LLL /1 1 io In a a - c0 O v O � a) st cD - � O u d- N LIVING ROOM FOYER DNING ROOM a - co i 7 N � r7 - O 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 o ; .► i Xi ) t 1 tr----------------------------------- 1 L-------------------------------------------- ------ ' r- --------- � -- -------------' ►' 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 a v v` o m CD v 0 X N IT i I I I I I J i 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