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HomeMy WebLinkAboutMiscellaneous - 69 OLD VILLAGE LANE 4/30/2018 i 96 OLD VILI}1GE LANE / 210/059.0-0059-0000-0 - - -- - i C114% CUSTARD INSURANCE ADJUSTERS 3135 Avalon Ridge PI Suite 200 Norcross,GA 30071 3/10/2015 CITY/TOWN BUILDING COMMISSIONER Gerald Brown Inspector of Buildings 1600 Osgood Street Building 20, Suite 2035 North Andover,MA 01845 Claim Number: 033557984 Policy Number: 38211400004 Company Name: Arbella Mutual Insurance Company Date of Loss: 3/6/2015 Insured: BenjaminOsgood Property Location: 69 Old Village Lane North Andover,MA 01845 To Whom It May Concern: Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate,please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Very truly yours, Arbella Mutual Insurance Company CC: City/Town Fire Dept, City/Town Health Dept Date...�.. .r. ...... ...... �f �aORTN TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ��ss�cHusE�,h This certifies that .......................... �✓ Xf if t 7 C ` 7— ................................... ^..�........................... has permission to perform ...........:� r'"/ �+� ...... .............. .................. wiring in the building of ' j ........,North Andover,Mass. Fee.:45........... Lic.No...L.! ...3 ............ee'...................... ...........yF..... �> ELECTRICAL INSPECTOR Check # / vQ � v 7142 Commonwealth of Massachusetts Official Use Only r L >V it No. � lug Department of Fire Services Perm � Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/051 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All ,vork to he performed ill accordance Mitb the E-1Q01-ical Clue(MFC).527 CN1R 12_00 (PLL;:9,SI, 1'KIYV7 T 1N]NK OR 1 YPE ALL INFOi NIA770.x`,) 1)ate: ll Z City or Town of: /V' A.?/Z-1- ;�- ,T t o the In.vpector of 4 gyres: By this application the undersigned gives notice of his or er itention to perform the electrical work described below. Location (Street& Number) 6Iq a1 e ll Owner or Tenante- - Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building '.�. ` �,., Utility Authorization No. f Z Existing Service Zoe Amps /2a J z vo olts Overhead ❑ Undgrd R- -No.of Meters l New Service Amps ! Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: • v C pletion of the following table may ivaived by the Inspector rf tVires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fanso.of otal Transformers KV A No.of Luminaire Outlets No.of Hot Tubs Generators KVA i No.of Luminaires SwimmingAbove In- i o. o Emergency Lighting Pool rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.ofRanyes No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Numb Torry iW No.of Self-Contained Totats: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Muuicipat ❑ Other ConnectionNo. of Dryers Heating Appliances KW Security Systems:* No.of bevices or E uivalent No.of aterKms, No. o No. of Data Wiring: Heaters Si Ins Ballasts No.of Devices or E uivalent No. Hydromassahc Bathtubs No.of Motors Total HP Teiecomdriunications Wiring: No.of Devices or E uivalent OTH E:R: .l itac h additiMMY c etait iii desired. or as rer/air e ct!ry the 117.pCetor of 1f'ir�>s. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: %-- f——p? Inspections to be requested in accordance with MEC Rule 10,and upon completion" INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unl9s the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force..and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) /cerlify+,under the pains and penalties of perjury,that the infilrmation on this application is true and complete. FIRM NAME: ,� l f/e LIC. NO.:_?!�±�33 Licensee: i nater LIC. NO.: 2 /'' = l%S�g � tIJ«pa?ic rh ,cvste+ eierrzpt"in the/i-cnse puncher lMe.J f3tfZ?el. No.: g5�e,7 —2Le-ev Address: Alt.Tel. No.: "Security System Contractor License required for this wor it applicable, ter th license�number here: OWNER'S INSURANCE WAIVER: t am aware that the Licensee dos not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature " Telephone No. I� 11 17'FEE. $ Date. .15? . . . Z ",O R7:1ti, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACNUS� .v This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . C.v.r/: °`.�. T. " d L. . ��. . . . . . plumbing in the buildings of . . . .S y L. C-. `' . . . . . . . . . . . . . . . . . . . at . . . . . v {. . . �'.' �'f. ". . -L ., North,Andover, Mass. Fee. Lic. No.. ./. Y. . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # r l 53128 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS _ Date Building Location i� /c� G,O ///li d/-" l��• Permit# Amount T J; Owner At N e57 Good New Renovation Replacement Plans Submitted Yes 0 No 0 FIXTURES �I F t d x a rTk h � &�g1VII�TI' M Hi" M)HIfM 4M KDM 5II3 H-OCR 6M 1HIDOR 7M IMM SIH)FLOOR (Print or type) _ Check one: Certificate Installing Company Name�f�0 l,,E?'T/_' /�L G �T� Corp. Address y/ �lGJ� � Partner. f Business Telephone Gf ) - TlS! G 5 G Firm/Co. t Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policyEl Other type of indemnity Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance 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 Plumbing Code and Chapter 142 of the General Laws. . By: Signature 01 LIcenseaMOM? Type of Plumbing License Title 1`J- f City/TowniceL nse leu en'1• r Master ❑ Journeyman n/ APPROVED(OFFICE USE ONLY LJ I Location No. O 3 6 Date ,S- 6 40Rrh TOWN OF NORTH ANDOVER 0 • OA D Certificate of Occupancy $ �7d'"° t� Building/Frame(Frame Permit Fee $ s�CHusa 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ y Check # I o3` 16533 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �S ihi BUILDING PERMIT NUMBER: ©� DATE ISSUED: _ 3 X ic SIGNATURE: Building Commissioner/I r of Buildings Date Z SECTION 1-SITE INFORMATION dress: 1.1 PO Property . 1.2 Assessors Map and Parcel Number: a ��� �; LIf T9,--- Map Number Parcel Ntinber O 1.3 Zoning Information: 1.4 Property Dimensions: CW X --4 c2 v- Zoning Dtsirid Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.GL.G_40.' 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ _J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No m 2.1 Owner of Record 7:?P7J19W'? C rTy a (, V Name(Print) Address for Service Signature Telephone d 2.2 r of Record: Name Print Address for Service: Z M Si nature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.4icensed Construction Supervisor: Not Applicable ❑ Licensed'C',onnstr,,uction Supervi . -'017 License Number aan 0/� Addres D icit Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number m r Address r Expiration Date ^Z 0 Signature Telephone 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 OMCIALUSE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbin 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 I, 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 A DECLARATION I, L As Owner/Authorized Agent of subject property 4 Hereby de that the statement and information on the foregoing application are true and accurate,to the best of my knowledge and belie 4 �J^�OJ Print Name Si I nature of Owner/Agent Date Now NO.OF STORIES SIZE 13ASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST2 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DH\/T_NSIONS OF GIRDERS I IEIGHfT OF FOUNDATION THICKNESS SIZE OF FOOTING X MA"rERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORT►y Town of : . . Andover No. 03(40 O L AO dover> Mass., 7 ' 116 ob 03 I� COC MIC ME WICK � %ADRA7ED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System dpS r. O BUILDING INSPECTOR ... ... THIS CERTIFIES THAT ........................................................................................................................................... Foundation has permission to erect.... d... ......... buildings on .....`... ..... 0.1.11#461.... µ Rough to be occupied as ��� r s C ���� Ch r�! Od Chimney ................................................ provided that the person accepting this permit shall in every respect conform 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. �O PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STAR ELECTRICAL INSPECTOR 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 Street No. Smoke Det. SEE REVERSE SIDE • O t«.co rb'�'y .11r 4`'+ *•is O . m Town of North Andover Building Department � • �'' 27 Charles Street � CHUSEt�� North Andover MA 01845 Tel: 978-688-9545 HOMEOWNER LICENSE EXEMPTION Please print. DATE_ /� d JOB LOCATION Number Street Address Section of Town "HOMEOWNER Number Home Phone Work Phone PRESENT MAILING ADDRESS S City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be,a one to six family dwelling,attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official, a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner"certifies that he/she understands the Town of No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL I Note:Three family dwelling 35,000 cubic feet, or larger,will be required to comply with State Building Code Section 127.0 Construction Control. i I I