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HomeMy WebLinkAboutMiscellaneous - 78 EDGELAWN AVENUE 4/30/2018J Valicumi General Auto, Aute Mme & He#hh Imuram; March 18, 2016 Town of North Andover Building Inspector's Office 1600 Osgood Street Building 20, Suite 2035 North Andover MA 01845 Claim Number: Date of Loss: Insured: Loss Location: Underwriting Company: Policy Number: 2362038 03/10/2016 Sandra Porter 78 Edgelawn Avenue, #8 Integon National Insurance Company 2003519176 PO Box 1623 Winston-Salem, NC 27102 Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1000 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 this writer and include a reference to the above -captioned insured, location, policy number, date of loss and claim number. On this date, I caused copies of this notice to be sent to the persons named above at the address indicated above by first class mail. Mcwk,Chav'pe+it-" Signature: Mark Charpentier, Property Claim Specialist 314-813-2916 National General Insurance PO Box 1623 Winston Salem, NC -27102-1623 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston, Massachusetts 02108-1904 (617) 723.3800 Ma Only (800) 392-6108, FAX (800) 851-8424 NORTH ANDOVER HEALTH DEPT. NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch.139, Sec.36 2x(1.14. TOWN OF NC,;. i H ANDOV c:R HEAL 1v DFPARTMENT Re: Insured: CASSANDRA L LUSSO Property Address: 78 EDGELAWN AVENUE, UNIT 7, NORTH ANDOVER, MA 01845 Policy Number: 1196248 Type Loss: Water Damage: All Other Water Damage Date of Loss: 12/21/2013 Claim Number: 319130 Claim has been made involving loss, damage or destruction of the above captioned propert, which may either exceed $1000.00 or cause Massachusetts General Laws, Chapter 143, section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. MPIUA Claims Division CMA00021 12/26/2013 Date. ...... NORTH TOWN OF �Ofltl(H ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ...!??.....:.2-! has permission for gas installation .. ............... in the buildings)of .... ....... ...................... atNorth Andover, Mass. .......... .............. Fee:Lic. No.?�C� ........... ' SIN T �R Check 6963 %\rM 'q. GIYTI IRGC W W_ MASSACHUSETTS UNIFORMAPPLICATION FOR PERMIT TO DO GAS FITTING ' r CityfTown:�o' Piys4 W)ILKI —,MA. Date: �� 2� 0V1 Permit# ' ( Building Location:/ 4 �- a°�`��Y1 h9e. Owners NameMk\1%t %!S& Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation:] Replacement: ® Plans Submitted: Yes ❑ No %\rM 'q. GIYTI IRGC W W_ N W 0 � OU W y ~ 00 _ � W m= z C7 J Z O 5 N 0 W W w p Q H 0 O W U) W > z m 0 O FW- Q W a N O o W W x LL W ¢ W W> y W w Z N= W~ 0 = Z. w W w z fn ° o o 0 0= a Q m i g w 0 O a z v~i P>>> > z~_ 0 U- 0: SUB BSMT. BASEMENT TsT FLOOR 2 Nu FLOOR 3 Ku FLOOR 4 FLOOR 5 FLOOR 6TH FLOOR 7 FLOOR —t-1-- i I 8 FLOOR (� Check One Only Certificate # Company Name_ 'Ir. `�►� t �� Installing � Corporation � SN City/Town lEcll�* n State:5 : N Address�c� �rATT%171'Ast ❑ Partnership v + Business Tel: �$ \ Colt% Fax: ❑ Firm/Company Y Name of Licensed Plumber/Gas Fitter:17 rRA -'v tt.-zx 'N"% INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes K No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy X 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 Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and .. .. . .. .. 1___ -1 :s :_....,.A S— 6k;� � li—tinn will he in accurate to the best of my Knowleoge ano mat au pwmumw wu: R a::U ...•..-. ...- r-. •••.• .----- .-- ----- compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By ® Plumber ❑ Gas Fitter Signature o icensed Plumber/Gas Fitter Title [A Master Q� CityfTown ❑Journeyman License Number: APPROVED OFFICE USE ONLY ❑ LP Installer j U, LL) LLI LLJ 60f) LL) LLI LLJ Date. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. � � . <!s! -U ..`.. �................ . has permission to perform ... (' SC/.1t t; 6 7 plumbing in the buildings of .. Y&S.. r�r R . ......... at .... ...F. ��� 4.!A .... !l' k4 ....... , North Andover, Mass. Fee.. -Z •.6!/.. Lic. No.. .......... (; PLUMBING INSPECTOR Check # 7434 6 i MASSACHUSETTS UNIFORM APPLICATION FOR.PERMIT TO DO PLUMBING (Print or ypej A/ t l4w, ass. Date 20 Permit # �, dJ Building Locatio Owner's ame e Type of Occupancy New 0 Renovation 0 lacemente `SFWFR # FIXTURES Plans Submitted: Yes 0 No 0 SEPTIC # nstalling Company Name id d 3usiness Telephone &63 9 3 U( f lame of Licensed Plumber or Gas Fitter Check ong: Certificate 0 Corporation ❑ Partnership P--6mICo. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142. Yes i No . ❑ 1 If you have checked ves, please indicate the type of coverage by checking the appropriate box. A liability insurance policy pel*�_ Other type of indemnity 0 Bond 0 OWNER'S INSURNACE WAIVER: i am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner 0 Agent 0 hereby certify that all of the details and -information 1 have submitted entered) In above -application are true and accurate to the best of y knowledge and that all plumbing work and installations performed nd r the permit iss for this application will be in compliance with 4 pertinent provisions of the Massachusetts State Plumbing Code a ,F tiA142 of�the Oral Laws. --I v•� w By Sina ure of ed l Licen umber Tide Ciryrrow-n Type of License: bo aster ❑Journeyman APPROVED (OFFICE USE ONLY) q License Number is nstalling Company Name id d 3usiness Telephone &63 9 3 U( f lame of Licensed Plumber or Gas Fitter Check ong: Certificate 0 Corporation ❑ Partnership P--6mICo. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142. Yes i No . ❑ 1 If you have checked ves, please indicate the type of coverage by checking the appropriate box. A liability insurance policy pel*�_ Other type of indemnity 0 Bond 0 OWNER'S INSURNACE WAIVER: i am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner 0 Agent 0 hereby certify that all of the details and -information 1 have submitted entered) In above -application are true and accurate to the best of y knowledge and that all plumbing work and installations performed nd r the permit iss for this application will be in compliance with 4 pertinent provisions of the Massachusetts State Plumbing Code a ,F tiA142 of�the Oral Laws. --I v•� w By Sina ure of ed l Licen umber Tide Ciryrrow-n Type of License: bo aster ❑Journeyman APPROVED (OFFICE USE ONLY) q License Number Location No. 6-6 � Date NORth TOWN OF NORTH ANDOVER O • Os Certificate of Occupancy $ Building/Frame Permit Fee $ sAGNUSE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �6560 // Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT �atREPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER:. DATE ISSUED: SIGNATURE: AMA,c� Building Commissionerfl for of Buildings Date SECTION 1- SITE INFORMATION. A1.1 erty Address: 7� CpGF��9wty .9 v 1.2 Assessors Map and Parcel rapNumber Number: Parcel Number n c � • ^ ® 0 y V /V /V f 1.3 Zoning Information: Zoning DiAiid Proposed Use 2.2 Owner of Record: Name Print 1.4 Property Dimensions: Lot Area s Frontage ft 1.6 BUILDING SETBACKS ft SECTION 3 - CONSTRUCTION SERVICES Front Yard Side Yard 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Rear Yard Required Provide Regaired Provided Regpired Expiration Date Provided Not Applicable ❑ Company Name 1.7 Water Supply M.G.L.C.40. 54) 1.5. Public ❑ Private 0 Zone Flood Zone Information: Outside Flood Zone 0 1.8 Municipal Sewerage Disposal System: 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHMAUTHORIZED AGENT 2.1 Owner of Record ,Zballl�) Name (Print) Address for Service nature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicabl License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 00 M Z O I 0 Z M Ro O mn e r v M r r Z 0 SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 2506) 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 Descri tion of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify, Brief Description of Proposed Work: �9R,)- .14CZ61-11'44- A/ �'�1311y rf -S- 4_9 A / C /2!`�� F� ez SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant QFFYCIAL'IiSEnUNI.Y 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) X (b) �O 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 as Owner/Authorized Agent of subject property Hereby authorize to act on My be f; in al matters relati to work authorized by this building permit application. - 2 S' 3 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 67- 5, ,e Al & S- U Pe? l IV U =tN 7, Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DE�ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Tel: 978-688-9545 a '- Town of North Andover Building Department 27 Charles Street �9SSRCHUSES North Andover MA 01845 HOMEOWNER LICENSE EXEMPTION Please print. DATE Z"� — JOB LOCATION 7 9 E 6 G EL- W IV di l/ Number Street Address �3 Section of Town "HOMEOWNER 761- 2- S' C —1 3 r O Number Home Phone Work Phone PRESENT MAILING ADDRESS i61 rzuMivEo v 1 2r oS� 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. JJ�� HOMEOW NER'S SIGNATURE d 1 ��c 0\ APPROVAL OF BUILDING OFFICIAL Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. m m W 0 m N y 'O C � 10 O CD MZ ca QC r C. y � C n CD O p CD O CL C7 CD Er CD O CD C CD y� �■ CD CL O y CCD C2 CO) O 'o Z CD � o CD C CD O d �• N C C VJ CL 0 O . co 0 w p '�7 _y O d dam, y c= o CCL o O �I0 m 'r1 K o. X � O CD H m Cn .Oi O ZS.�; n ='O O �.* n ,, .. O ? E � O y c Co. r . c� V J \ / O O O � � z �Z C17 �i G 0 O Z 0 W O cc 0 C co CD CO c C. CL 0 co) y m 1 c s� O d �• N C C VJ CL 0 O . co 0 w O .+ C '�7 _y O d dam, y c= o CCL o O �I0 m 'r1 K o. X � O CD H m O,n = • .Oi O ZS.�; O a m ? ='O aCA C:, o n ,, .. O ? E � O y cl-o Co. o-: y =� �1 y _�. co,.�W CA 1 O "O � ■rt O 0 0 3 : CA .► : mei .-« m .T caCD 0 : �C. „d: a O : N m O T m CA 1`J •: 1m (n ow d rtl oCL v7 z 71 ;;i?1 c� b ` w '�7 n O 0 M ,'t7 A � r �' Q orf n ? CD ;z 'r1 K o. w �' � O cn n "a � 'z7 o rL xto a O 071 x M fJ� 0=3 0 9 0 c Date ..:.. .: G .? ....... pf iaaao ,°,ti0 Y, °` TOWN OF NORTH ANDOVER a s PERMIT FOR GAS INSTALLATION This certifies that .Z� � ./.". < tl4..... Pd . /.............. . has permission for gas installation .../f4N f .............. in the buildings of ..fir ...... at . ..;?. lu. �--.�� ..l �. t.... , North Andover, Mass. Fee ... ?:.... Lic. No. !f- I. ...... GAS INSPECTOR' Check # 4431 MASSACHUSETTS UNIFORM APPLICATON FOR PERNIlT TO DO GAS FITTIl-TG (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations 7.9 k -a e E.)-il• wty A-V Permit # I �� Amount $ 2 r Owner's Name DAVID O u A-61 MO New Renovation Replacement © Plans Submitted E (Print or type)C® one: Certificate Installing Company Name �I/ /9 / F L Ld Pn " lil %i 61 G��j //Vey Corp. Address %a^ O 1�S / ;� �r r1��01 E:] Partner. SS ®/73 L Business Telephone r79 J- 7 f01V3 Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes D No D If you have checked yes, please indicate the type coverage by checking the appropriate box- Liability oxLiability insurance policy. M Other type of indemnity 11 Bond D Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. i rhP lr rw - Signature of Owner or Owner's Agent Owner D Agent 0 I hereby certify that all of the details and intormation 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 GasFode and Chapter 142p't�e General Laws. VED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber Gas Fitter License Number ® Master EiJourneyman O' NOR71y ,� ,SSACMUS� Date ............. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . ......i . f r has permission to perform .. R e ..... ............. plumbing in the buildings of... ................. . at ... ...... North Andover, Mass. Fee .i p,4—' ... Lic. . ..... . .... I .... . PLUMBING INSPE TOR Check # �j u 5704 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS " �,,� Date 9' 3 '��3 Building Location %? FQ� ����y-W/V �Wwners Name �j�VI D r UA8 )�i/Q Permit #• 5'1 OL( Amount Type of Occupancy New [:] Renovation 0 Replacement Is Plans Submitted Yes [] No CIO It 0 • a . . G • M ........................ (Print, or type) Check one: Installing Company Name cap &11 El 1,0 60214 M 0/ /VG //tomR Corp. ElPartner Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 11 Other type of indemnity 1 Bond ❑ Certificate 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 El 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 PI bing Code and C V142 of the General Laws. Type of Plumbing License icense MumDer Master ® Journeyman ',D (OFFICE USE ONLY <-\ o." r°i MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston, Massachusetts 02108-1904 (617)723-3800 Ma Only (800)392-6108, FAX (800)851-8424 NORTH ANDOVER HEALTH DEPT NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec.36 JUN N NiO i TOWN 00f NORTH ANDOVER j l HEALTH DEPARTMENT 1 Re: Insured: SANDRA PORTER Property Address: 78 EDGELAWN AVENUE UNIT 8, NORTH ANDOVER, MA 01815 Policy Number: 1095723 Type Loss: Water Damage: Plumbing Systems Date of Loss: 06/19/2010 Claim Number: 278053 Claim has been made involving loss, damage or destruction of the above captioned propert, which may either exceed $1000.00 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 number, date of loss and claim or file number. MPIUA Claims Division CMA00021 6/23/2010