HomeMy WebLinkAboutMiscellaneous - 70 SANDRA LANE 4/30/2018 (2)C
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July
1, 2015
Town of North Andover
Attn: Building Inspector
120 Main Street
North Andover, MA 01845
Liberty Mutual Insurance
New England Region Central Property Unit
75 Sylvan Street
Danvers, MA 01923
Tel: (800)566-0323
Re: Property Address: 70 Sandra Lane, North Andover, Ma 01845
Policy Number: H3221226321401
Underwriting Company: Liberty Mutual Fire Insurance Company
Claim Number: 031836279-0001
Date of Loss: 3/28/2015
Attn: Town/City Official
Pursuant to M.G.L. c. 139, � 3B, please be aware that a homeowners insurance claim has been made
involving loss, damage or destruction of the above captioned property, which may either exceed
$1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch.
143, § 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with
Mass. General Laws Ch. 175, 599, if you intend to initiate proceedings designed to perfect alien
pursuant to Mass. General Laws, Ch. 139, S 3A & B, or Mass. General Laws, Ch. 143, 5 9, or Mass.
General Laws, Ch. 111, S 127B.
This letter should not be construed as a waiver or estoppel of any of the terms, conditions or
defenses afforded by the policy or applicable law.
Please direct your notice to the attention of the undersigned and include a reference to the above
captioned property address, policy number, claim number, and date of loss.
Sincerely,
Liberty Mutual Support
Liberty Mutual Insurance
New England Region Central Property Unit
1-800-566-0323
N2 2 136
Date .....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Thiscertifies that ......................... ...................................................................
has permission to perform
. .. ............................... o ............ .1 .................
/
wiring in the building of .: ........................................ ......... 6......................
North Andover, Mass
at ... .......... ......
Fee.... Lic. No.(Id.e�,l � ..............................................................
ELEcrRicAL INspEcrOR
11/17/98 15:39 15.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
The Commonwealth of Massachusetts t
Deporiment of Public Sofety
recall $a.-
occup"CY4 fee tMeaae_��
BOARD OF FIRE: PREVENTION REGUtA'nONS 5V CMR 1200 3/90 (leave blwk)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL. WORK
AN work to be painmed In accordance wttk ttt Mawehweta Eteetrkal Code. S27 CMR
12:00 y
(PLEASE PRXNT X11 n1K oz TYPE ALL 1N80Rn=OM) Date
City or TowB, of yJaut-f- To the Inspector of Wiress
The undersigned applies for a permit to perform the electrical work describedbelow.
Location (Street & Nwaber) 70 SRAi9,e,9 Lpj,
Owner or Tcwmt20 ft) /1lZOWi(L077.C_
Owners Address
Is this permit in conjunction with a building permits Yes ❑ No(Check Appropriate Box)
Purpose of Building �`JSe Utility Authorisation No.
Existing Service _ Amps / Volts Overhead ❑ Undird ❑ No. of Meters
New�cce _Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
,__.Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work pUt'� %fjl�*► ,fYj�'GLy,
No. of Lighting Outlets
No. of Not Tubs
No. of Transformers -Tota
rVA
No. of Lighting Fixtures
Swimming Pool Abovdgrn. ❑ Ind• ❑
Cenerators , XVA
No. of Recepteele Outlets
No. of Oil Burners
No. of Emergency Ligbtlng
Bette Units
No. of SwitcblOuClets
No. of Cas Burnes
FIRE ALAIM Noe of Zones
No. of Detection and ,
]aitiatLag Dovices
No. of Sounding Devices
No. o
.ofDetecSell Contained
mdinining Devices `r
Local ❑ Connecpal. mer
No. of Ranges
No. of Air Gond. tons
No. of Disposals
No. of tat' Total Total•
a Tons 1W
No. of Dls1�4hers
Space/Area Heating KW
No. of Dryers.I
Heating Devices 1W
No. of Wates He+tern KW
S ' Ballasts
Low Voltage
No. Hydro Massage Tubs
No. of Motors Total HP
Y fYRlL•� r
INSURANCE COVERACCs Pursuant to the requirements of Massachusetts Ceneral Lava
I have a current Lt o Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YES No
I have submitted valid proof of same to this office. YES ❑ NO
If you have ehe d YE3, please indicajo the type of coverage by checking the appropriate box,
INSURANCE 1100 ❑ OTHER ❑ (Please Specify)
(ExEstiiaated Yalus of Electrical Work S prat on ate
Work to Start Inspection Date Requesteds
Signed eL.,Ier the penalties of perjury:
FIRM XW o/<
lA� 61_�
Y
Rough Final
LIC. NO.
LIC. NO. 0'76 G ZS
But T Tele No. —7,S/ 4 / // _
— All. Tale Noe C3 a
OQUIS INSURANCt WAIVERS 2 an aware* that* the Licensee does not haw the Lasutaeee coverage or s, au
staatial equivalent as required by Massachusetts Cenesal Laws an_"tat my sip►atuss on this pe' it
application waives this requirement. Owner, Agent (Please cheek one)
Telephone No. PM11% FE'S $ r
Signature o er or gen)
Location
.. Date
No, _
Ir TOWN OF NORTH ANDOVER
/oL
9
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ e
Check #
18674
Building Inspe6tor
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPA15 RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
b
...
BUILDING PERMIT NUMBER:DATE ISSUED:
T1 AG -i%- c, .
SIGNATURE: 1 "✓ll „".+-
Building Commissioner/Inspector of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Prop Address:
1.2 Assessors Map and Parcel Number:
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
Required Provide Required Provided
Recpjired
Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
1.8 Sewerage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone ❑
Municipal ❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
Historic IS CIC : Yes 0
2.1 Owner of Record
Name (Print) Address for Service:
d/I�FI '..p � • �/` OniGii% Ga%G i`3'e�j'�
Sign ephone
971r(-'L9'Z-
2.;?Gner of Record: Duval Roofing, LLC
PO—Box 627
Na nt No. Reading, 1A bsfgOrvtce:
S a'ture Telephone `
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable ❑
%4
Licensed Construction Supervisor:
License N.117k
Address
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor
Not Applicable ❑
DIng LLC C
Company Name Y
PO BOX 637
/ 1
'9 V
ff
Registration
Add ss No- Reading, MAO! 864
umber
7b
V �`����
Expiration Date
S' nature Tel hone
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 buildiUd25rmit.
Signed affidavit Attached Yes ....... No ....... ❑
SECTION 5 Description of Proposed Work check all a livable
New Construction ❑
Existing Building ❑
Repair(s) ❑
Alterations(s) ❑
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other pecify
Brief Description of Proposed Work:
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
- OF"CIAIE,}+E (jl1TL
1. Building
(a) Building 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 7
-
I, Z7X/,r% as Oxvner/Authorized Agent of subject property
orize to act on
HerVbeha
My m all/m/atters r iv o ork autho ' by this building permit application.
Si a e of Owner Date �
SEC ION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, as Owner/Authorized Agent of subject
property
Hereby declare that the statements and inf rmation on the for oing application are true and accurate, to the best of my knowledge
and belief Duval Roofing, LL
PO Box 637
Prm' Reading, MAO! 864
Al L. X�r_
Si tore of Own; ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TUABERS 1ST2 No 3RD
SPAN
DIN ENSIONS OF SILLS
DIN ENSIONS OF POSTS
DM ENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHM4NEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
i
Page No. of Pages
4
Builders License # 58443
J_ Home Construction Reg. # 109288
o
�0�00
(781) 944-1994 (998) 664-2559
"The Areas Oldest Roofing Company"
i P.O. Box 637, North Reading, MA 01864
PROPOSA
STREET
JOBNAME
CITY, STATE AND ZIP CODE
JOB LOCATION
We hereby submit specifications, and estimates for: Recommended
(Included in price)
Optional
(Not included in price)
Rip & Remove all shingle debris from roof & job site: 0'"1 layer ❑ 2 layers ❑ 3 layers or more
—
• Repair/or Replace any roof decking; not to exceed 50sq. ft.
✓x Install 8" aluminum drip-edge/and rake -edge along entire perimeter. Choice of mill, white or brown
-- -- ---
Install ICE & WATER underlayment along horizontal eaves, valleys, sidewalls and sky -lights & chimneys
— --- ---
�' Install premium base sheet underlayment between roof deck and roofing shingles
• Install 25yr CertainTeed/GAF/Tamko or Owens & Corning traditional 3 -tab roof shingles ❑ 30 year
•✓ Install 30yr CertainTeed/GAF/Tamko or Owens & Corning architectural roof shingles
- - ----- --- —
❑ 40 yeao ❑ 50 year
❑ Lifetime
See manufacturer warranty policy for more details
T
✓ Install new aluminum vent -pipe flange (s)
• Chimney (s) -counter-flash and re -step existing flashing
❑ Cut & Install new lead flashing
• Ridge-vent/exhaust vent with low profile design, hidden by shingle caps
❑ Soffit -ventilation YRoof louver -vents r (�
• Seamless style aluminum gutters - custom fabricated at job site
❑ downspouts
—
I
•' Other -
t
*Please Note: All items in roof attic should be removed or covered due to falling roof particles, at time of roof tear -off
Price includes all items above that are checked only / others may be priced separately upon request.
We Propose hereby to furnish material and labor - complete in accordance with above specifications, for the sum of:
�- Total price not including options. dollars ($ ! .•
Payment to be made as follows: — -
30% deposit required before ordering materials. Balance due in full upon day of completion.
Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864
Late charges of $50 per week for all outstanding bills due upon day of Authorized
completion. Signature
- Accepting proposal means agreeing to the terms of the enclosed binder Note: This proposal may be
contract. Please sign contract & return top copy (white) with deposit. withdrawn by us if not accenteri within t3 rinvQ
BOO
v
NORTH ANDOVER BUILDING DEPARTMENT
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
at: is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
III 150 A.
Also, note Permits are required under Fire Prevention laws Chapter 148 Section
I 0A.
The debris will be disposed of in:
Fire Department Sign off:
Dumpster Permit
ation of Faci, rty) cU
Signature of Permit Applic
Date
Department of Industrial Accidents
Ogee of Investigations
600 Washington Street
Boston, MA 02111
www.massgov%dle
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridans/Piumbers
Aaalicant Information Please Print Legibly
Name (Business/orpnization/Individual): Duval Roofing, LLC
n/1 D'HiE-tl07
Address: No. Reading, MA 01864
City/State/Zip: Phone #•
J
plover? Check the appropriate box:
Are=wna
1.ployer with
4. ❑ I am a general contractor and I
employees (full and/or part -tune)."
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet. t
ship and have no employees
These sub -contractors have
working for me in any capacity.
[No workers' comp, insurance
workers' comp. insurance.
S. ❑ We are a corporation and its
required.]
officers have exercised their
3. ❑ I am a homeowner doing an work
right of exemption per MGL
myself. [No workers' coag,.
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
S. ❑ Demolition
9. ❑ Building addition
10.0 Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.❑ Roof repairs
13.❑ Other
-^UY uwzr: wa UM& uua v, zz u WOU 011 VYl me aecuoa oclow tDowtg MW woltm' compeamUm policy mipnnstnn
t Homeowners who submit this affidavit mdk* ft they are dolma an work and then hire outside oonhactors must submit a new a8'idsvit "catilra suck
tContrectols that check this box resist attached an additional sheet showing the name of the sub-eonit eters snd thea woltas' comW. policy iufornu tion,
I am an employer that !s providing workers' compensation insurance for my employees. Bdow is the polhy and job slit
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #: :2J _ �`l3 ° y Expiration Date:_ v,
Job Site Address: :7 t�x 1_1 City/Statetzip:—"
Attach a copy of the workers' compensation policy declaration page (Showing the policy number and expiration date).
Failure to secure coverage as requirof 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-yearprisonmen% 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 Orrice of
Investigations of the DIA for insurance coverage verification.
I do hereby ceetify under the pains and penalties of perjury that the information provided abVM is &M and correct
Offleia/ use only. Do not write in thb arta, to be completed by city or town o.&iaL
City or Town:
Permk/I.icense #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. Cky/Town Clerk
6. Other
4. Electrical Inspector S. Plumbing Inspector
Contact Person: Phone #:
iniormatiun anu junti uq tlivaiia
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 atm 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 tate
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 licease or permit to operate a business or to construct buildings is 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 -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLQ 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 Departmnent 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 permittlicense number which will be used as a reference number. In addition, an applicant
that must submit multiple permiAcense 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 fl� been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid a is on fie for future permits or licenses. A new affidavit must be filled 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. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 5-26-05 wwwmm.gov/dia