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Home My WebLink AboutMiscellaneous - 70 EDGELAWN AVENUE 4/30/2018 IU EDGELAWN AVENUE Ujr 210!451.1_0070_0001.D AMERICAN CLAIMS SERVICE MULTI-LINE ADJUSTERS Letter 143 August 16, 2016 Town of North Andover Building Department 1600 Osgood Street North Andover, MA 01845 Attention: Building Inspector Board of Health and/or Board of Selectman Insured: Cocuzzo Location: 70 Edgelawn Avenue Apt 2 North Andover, MA 01845 Policy: 1188053 Loss Date: 8/1/16 Loss Type: Water damage ACS File: 160249 Dear Sir/Madam, 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, loss date and file. On this date, August 16, 2016, 1 caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Unless a response is received within the next ten days we will not be obligated to pay any portion of this claim to you. Respectfully submitted, Tim McLaughlin Claims Representative 7 KIMBALL LANE BUILDING C LYNNFIELD, MA 01940 PHONE 781-245-9516 FAX 781-245-1077 claims.acsCaD-verizon.net Date./ MORTM TOWN OF NORTH NDOVER PERMIT FOR PLUMBING • SSACNUSE� J / This certifies that . . . C�.`'. '. .'. . . . . . . . . . . . . . . . has permission to perform . . . . .D. . .�. . . ../. . . . . . . . . . . . . . . . . . plumbing in the buildings of . . .Ce'.�'. �! t'.6. . . . . . . . . . . . . . . . . at. 7 U. . .f.T. . .�!^-.. . . . . . ., North Andover, Mass. �Fee. �-��. �.Lic. No.. �.?.1 .`� j' . { U. . . . jPLUM. BING INSPECTOR Check # - U MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING city/Town: /VC(fk A14 Ad't)a r . MA. Date: 16-- OV-10 Permit# Building Location: )(1) &LeLwn dE Owners Name: _N'I , 6o m d e k IQ Type of Occupancy: Commercial❑ Educational❑ Industrial ❑ institutional❑ Residential( ' New: Alteration: Renovation:❑ Replacement: Plans Submitted: Yes[] No FIXTURES DEDICATED oe Z SYSTEMS z m u► oe o2 Z z W � � � d ' � H �oc ��( Q W Q 0 W z 0: 0: 411 C� W d m c c gz S g 3 3 3 a 3 SUB BSMT. BASEMENT 1 FLOOR FLOOR .FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate# Installing Company Name: J O n !f cha-r / ,^, Corporation Address: G (G►'h c�cca C k 6)CWrown: a State: N`if, \\ v�d31 Partnership Business TeI:C60'? ) -?00 '-go 3/ Fax: -- ❑Firm/Company Name of licensed Plumber: J-C) k INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 Yes❑ No❑ If you have checked Ye , pI ease indicate the type coverage by checking the appropriate box tabu. A liability insurance policy- Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only _Signature of Owner or Ovmer's Agent Owner ❑ Agent E] I hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title ❑Plumber ure o 1 sed Plumber crtyrr°ionMourneaster APPROVED OFFICE USE ONL ]Jyman Llcen umber. COMMONWEALTH OF MASSACHUSETT PLUMBERS AND GASFITTERS LICENSED AS A MASTER PLUMB R ISSUES.THE ABOVE UCENSE TO: JOHN A LEONARD f I 6 TAMARACK LN AMHERST NH 03031-2261 r' 1324805/01/12 795817 z AGM CERTIFICATE OF LIABILITY INSURANCE = mm "1001E°` DMICO wAM808MMAMUMMas oa xs io hutt"*ft Teewmaod Gwv AIS cors M Mo MMM uP=TMO 501 Nxmw*th 7Rssd HOUML TM CBtTWPCAM OM MOT AMS, I m OR WadoaOdazrY MR 03053 ALTM in OOVOW&K AFFOYM M 71!I+OLow m QW,. 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Flood Zone lnfotmstion: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside blood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No M 2.1 Owner of Record Name(Print) Address for Service: Signature Telephone i 2.2 Owner of Record: Name Print Address for Service: z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 L' nsed Constructs n Superviso : Not Applicable ❑ � (�')Lll L11 Licen struction Supervisor: v • � � L��C� �� License Number Expiration Date �. Sign a V Telephone r 3.2 Registered " ImproveContractor Not Applicable ❑ R Ty67,4. 4 �_� 9 M Company 5-3 L tion Number r" Address Expiration Date !Si re Telephone SECTION 4-WORKERS COMPENSATION(XG.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.......0 No.......❑ SECTION 5 Description of Proposed Work check appMcablel New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief l)escn' tion of posed Wo c r u0 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL.USE ONLY Completed b permit applicant 1. Building (a) Budding Permit Fee 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 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. r Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION t 1, as Owner/Authorized Agent of subject property Hereby decl at the stateme in ation on the foregoing application are true and accurate,to the best of my knowledge and e M r� t Name XSignature f Owner/Agent ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRVMERS I 27D 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DMIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations - 600 Washington Street \\ Il Itfl ! Boston MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information pPlease Print Legibly Name (Business/Organization/Individual): 0, " Address: �3 City/State/Zip: �l/C �� ss Phone #: Are ou an employer?Check the appropriate box: Type of project(required): I. I am a employer with 4. ❑ I am a general contractor and 1 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. + 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. workers' comp. insurance. Y P h'• 9. E] Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its • required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is tite policy and job site information. j Insurance Company Name: / �/e y Policy#or Self-ins. Lic.#:_&/6 �—' 3Ls'.��oZSG� v�/ Expiration Date: / Job Site Address: City/State/Zip: A4a—wee , 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 tine 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. 1 do hereby certify er the pai r / tallies of perjury that the information provided above is true and correct. Si nature: Date: Phone#: t � ✓ �� Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. if an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be tilled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 61,7-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia ey oo` y Al Ne of Pagf4 LEBLAMC ND SON . P.O BOX 5889 BRADEC?E�b; fA��35 n i 97 } 856=9440 {978 41;9.6575 CELL " {.i : �#CS€l9042�4 Y. u Rso .#co1�3t5 829 "*WA biaan n LIA PROPOS An : f1 iK3Bfi7AFAE s CITY,STATE (/ 100A71CNd ¢ Y .ARCHITECT DI�rEOE PIANS. We hereby submit specifications and estimates for. ` 4F t Pro S reby to furni -teria4 and tabor. : co ' fete in accordance with above specifications,for the sum of- _ - dollars($ Payment to be made as follows: All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications Authorized involving extra costs will be executed.only upon written orders, and will become an extra Signatu charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire,tornado and other necessary insurance. Our Note:Thi proposal maybe workers are fully covered by Workman's Compensation Insurance, uvtt by us if t accepted within days. Acceptance of Proposal -The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the Signatu work as specified.Payment will be mati as ouV ed above. //it �. .-- e GULATIONS OARD OF BUILDING SUPERVISOR B • CONSTRUDTION License: ` '';• 090414 Number: CS Y 0112811959 90414 Birthdate: Tr,no: Expires:0112812008 Restricted: 00 / 4 Lp RRY J LEBLANC GJ,,4�•- 21 ORGATE ST#704 issioner HA\jERHILL, MA 01832 Comm t.,,<srI t. ;� sa��gtan : fees o Bupding�eg�N�GONTEtPc'TOa M IMPROVEM 5 9 E b? NO e9�strat�on'.1511412p06 zJ � RRV\0 LARRY LEGE ST # 041 21\N`NGPLL,MP 0183 V A� NORTH ® o ver No. �f ' L A O dover, Mass., COCKICMEWICK �ADRATED PY 5 '9S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...........6-ii �. ...del�.� ...... .................................................................. Foundation has permission to erect.....................4. .j* ...... buildings on ...7.0. ..:.. ..10.�,�GMI....A�./..... Rough to be occupied as ,�� „�j`j-� ,� .............Ir,... .. Chimney provided that the person accepting this per7hit 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. - PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STARTS Rough ............ .......... .. .. ....... .. Service UIL ING 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. SEE REVERSE SIDE Smoke Det. 70 ED GELA ON A VENUE U-3 451.1-0070 Complaint Detail Report Printed On:Mon Dec 05,2005 Complaint#: CT-2006-000007 Status: jClosed _ GIS#: 8225 Violator: ppRTh Address: 70 EDGELAWN AVENUE U-3 Map: 451.1 Address: Date Recvd.: Oct-11-2005 ITime Recvd.: 08:31 AM Block: 0070 _ o Category: Housing Lot: Type: z r f ' • GeoTMS Module: Board of Health District: Trade: ,''�•_..•'''s Recorded By: Pamela DelleChiaie Zoning: Structure: 3SACMust --- - -- -- — Description Complaint: Received a message on the machine this a.m.From a Diane Markee-978.975.3189. Her landlords are:Steven&Jeannie Crabtree-978.683.8201. Ms.Markee has been in the apartment since June 2005. There have been ongoing issues with the water from the tub not draining. She had standing water in the tub on Friday. Landlords finally came and had it fixed over the weekend when she threatened to sue them and that she called the Health Dept. The drain where the plate is is still dripping,though the blockage was fixed. She anticipates that this will be a problem again. The sliding glass doors are in disrepair. She is worried that the doors will fall in,as they are not installed properly. Inspection appt.Scheduled for today(10/11/05)at 11:00 a.m. Ms.Markee will not be at home,but her boyfriend,Anthony Xenaxis will be present for the inspection.--pfd. Comments: Callers Date Time Name Phone Best Time To Reach Recorded By Response Oct-11-2005 8:31 AM Diane Markee (978)975-3189 Q Any Pamela DelleChiaie Follow-Up by Health Inspector Actions Taken GeoTMS Module Status Date Time Response Type Action Taken Comments Board of Health REFERRAL Oct-12-2005 1:09 PM Follow-Up by Health Ms.Grant went to the location,and no health Inspector violations were found. Case closed. GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. Page I of 1 3COMPLAINT NUMBER DDDDDDDDDDDDDDDDDDDDDDDDATE:DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD? 3£45 NOVEMBER 30, 1995 3 CDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD4 3COMPLAINTANT:MAUREEN KAELIN CLOSE DATE: 3 3 3 3ADDRESS:70 EDGELAWN AVE. £2 PHONE: 975-0049 -- ,a.�acl.�ese 3 CDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD4 3OWNER:JACK MILLER PHONE £: 851-9992 3 3ADDRESS: 36 APACHE WAY, TEWKSBURY, MA 3 CDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD4 3INSPECTION DATE: ORDER L DATE: 3 3COMPLAINT: SHE STATES NO HEAT WHEN COLD OUT-HEAT WHEN IT IS WARM OUT. 3 3 LANDLORD TOLD HER TO CALL THE ASSOCIATION. SHE'S BEEN CALLING 3 3 SINCE END OF OCTOBER. STATED FURNACE NEEDS A PART. AND TOLD 3 CDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD4 3ACTION:HER THE PART WOULD BE IN ON MONDAY. 3 3 3 3 3 3 CDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD4 G A- :5-t :5-t a 4-e-A �. a-!- ke- loZ�l/�5 .-` � ec.essa A'y /3tz/'-7�