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Home My WebLink AboutMiscellaneous - 7 BLUE RIDGE ROAD 4/30/2018 7 BLUE RIDGE ROAD 210/065.0-0102-0000.0 ;IrMo— Safety Insurance 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 Selectman City Hall City Hall NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845 RE: Insured: LOUIS J PASCARELLA and BEVERLY C PASCARELLA Property Address: 7 BLUE RIDGE ROAD,NORTH ANDOVER, MA Policy Number: HMA 0241385 Claim Number: BOS00046839 Date of Loss: 12/19/2014 Company: Safety Indemnity Insurance Company 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, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. 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 number. Holly Coughlin Claim Examiner 12/30/2014 Safety Insurance Company Homeowners Claims Unit P. 0. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3026 Fax: (617) 531-6684 Email: HollyCoughlin@Safetylnsurance.com Safety Insurance 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 Selectman City Hall City Hall NORTH ANDOVER,MA 01845 NORTH ANDOVER,MA 01845 RE: Insured: LOUIS J PASCARELLA and BEVERLY C PASCARELLA- Property Address: 7 BLUE RIDGE ROAD,NORTH ANDOVER, MA Policy Number: HMA 0241385 Claim Number: BOS00046836 Date of Loss: 12/19/2014 Company: Safety Indemnity Insurance Company 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, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. 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 number. Holly Coughlin Claim Examiner 12/24/2014 Safety Insurance Company Homeowners Claims Unit P. 0. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3026 Fax: (617) 531-6684 Email: HollyCoughlin@Safetylnsurance.com Location J No. -Z� Date NaRT� TOWN OF NORTH ANDOVER Of t` a , ,yC + s + ; , Certificate of Occupancy $ �VS4 MUSEI Building/Frame Permit Fee $ 3a' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �� a Check # f. r + ' ' J Building Inspector Y TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED. SIGNATURE: Building Commissioner/I for of Buildings Date Z SECTION 1-SITE INFORMATION o 1.1 Property Address: 1.2 Assessors Map and Parcel Number: L5- 102 /v _ (�-,vg o\.JC\-(L Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ReqWred Provide RegWred Provided Required Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 9 Private 0 Zone Outside Flood Zone 6 Municipal F— On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHMAUTHORIZED AGENT rn 2.1 Owner of Record 2 t� Name(Print) Address for Service: Signature Telephone ' 2.2 Owner of Record: Name Print Address for Service: O Z rn Signature Telephone go SECTION 3 CONSTRUCTION SERVICES 3.1 Licensed Cdnstruction Supervisor: Not Applicable ❑ I M p-r-hl`{ 0 0 1 Nil LA�j Licensed Construction Supervisor: G S S Zy c". O -1 '�`�1 �� I N C, License Number Address Jaw 44IM fl'�C.Hi 5� O I Expiration Date Signature Telephone r 3.2,,Registered Home ImprovemElent Contractor Not Applicable iv (�CU1Irll..p�1�{ zAAjD �/it_pfLX—S s Company Name �'��'� I 1 y rn Registration Number r Address r v &BOJ . 2auv Z v 2 T?D Expiration Date /1 Signature Telephone V t Z SECTION 4-WORKERS COMPENSATION(RG.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: GD t-IST'RY C:"G 5GCLQ5Z M Fa iukA b t\k Ct,-�L5 T-t.n{ T V q.VC- SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee y v Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing -- Building Permit fee(a)X (b) 4 Mechanical(HVAC) - 5 Fire Protection 6 Total 1+2+3+4+5 4_2 v D 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 6.),u i N LA-M --v—2%�P4ID 3 u1L,V Z(7—S 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 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 r Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I — 2ND 3RD SPAN Z DIIVIENSIONS OF SILLS ---- DIMENSIONS OF POSTS G 6 DIWNSIONS OF GIRDERS Z-Vf t Z HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND v�t� IS BUILDING CONNECTED TO NATURAL GAS LINE r2.S pybuc a� C)z Mlo :"CC�• i I V 00 1 N Or 1 J l I 150,0 1 "�^" r�'-1'..;. „1� ,.��.1•.••1 i;I � 1 � ._—�.� 1 ' , •�. • 1.1• .• .,..1.1....1:,. LU c�;Rxxrxc�T� • �, .• OWNEms) � � I ptRTxFX that the Lot shown harQon DtDD that the �h4wn YLA-N ��- ��..!!•• resent Zoning ` CERT . OF Tx`SL1�i:Ih � � -- of xp TE. 1 of a r-"M The praml s4s o :•""1: notlie within d 1:, ., ••1! •l� a,� designate ,'►;�, .------ I�laod Hazard t� �`: .: ', ' `� q 0tt,l.E1'i 'Lone.� M+P y;:• r,. . 1 a co�awtt� • 1 . �3�ftT •RO G. G04D� , TI.L. ZO�t• cs; 3� �:,�,.;:,•:,��, � � �,�� 1�`u �r;0 82 C N'SR 4'1ZI:PT �,,� ",`•/ "tet• �,.In.F.:,.,•ir ,,+ 'yl� �,��, AIS ApY�'R, it AaS•. . .. ,._.......... ..._ ...._ . J I • I /IV VVIIIIIIVIIrrvvl.Il VI IIIUVVUVI/UVv(tJ Department of Industrial Accidents Office of Investigations Boston, Mass. 02191 ` Workers'Compensation Insurance Afdavit Please Print Namey rt L_P4J -E- Location City �J - Phone (P2- ��(o am a homeowner performing all work myself. �I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: Address City' Phone#: Insurance Co._ Policy.# Company name: Address City Phone Insurance Co Policv# 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 andipr 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 certify under the pa i and ena . i 'ury that the information provided above is hue and correct. Signature Date GST• Z� 29ot, Print name T-14 Y �u t K LpfN Phone# Official use only do not write in this area to be completed by city or town official' 0 Building Dept [3Check if immediate response is required Building Dept 0 Licensing Board 0 Selectman's Office Contact person:_ Phone#: I] Health Department 0 Other FORM WORKMAN'S COMPENSATION III F NORTIy Town of Andover o o dover, Mass., COCMIC ME WICK �d ADRATED S H BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT........ ...e� � rP■.� BUILDING INSPECTOR ...... /T�.v.. ...........................'i..::. ..... . .......... oundation has ermission to erect....i 3-1U11V � p ......... buildings on ........... .......�......... ................. ��.......... ................... Rough to be occupied as........SQ4%'*V A0 A00�'�!1......� 0l1.41*4 ��rC << Chimney ................ ................... ... ...................................................... provided that the person accepting this permit shall in every respect conform to terms of the application on file in Final this office, and to the provisions of the Cbdes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. M loS P PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final LR**JLESS C®NSTRU ® `�.S ELECTRICAL INSPECTOR Rough . .......... ..9.................................... . ...................................................................................... rnce BUILDING INSPECTOR Final Occupancy Permit Required t® Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFina, No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner FIRE DEPARTMENT Street No. SEE REVERSE SIDE SIDE Smoke Det.