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HomeMy WebLinkAboutMiscellaneous - 8 LITTLE ROAD 4/30/2018b September 1, 2015 THEfilOPtFOdO(f�D�D0-0ARAGROUP@ U FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 313 Building Commissioner, or Inspector of Buildings c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Board of Health or Board of Selectmen c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Fire Department or Arson Squad c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 RE: Our File No.: P1599959 Insured: CHRISTENA ERLE Address: 8 LITTLE ROAD, NORTH ANDOVER, MA Policy No.: F0219346 Loss Date: 08/31/2015 Loss Type: Building or Other Structure Damage A 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, Ch. 143, Sec. 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to my attention and include a reference to the captioned insured, location, policy number, loss date and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property, and the claim will be paid in our customary manner. Sincerely, Michelle M. Roust Senior Property Claims Examiner 1-800-688-1825 x1171 NORFOLK & DEDHAM MUTUAL FIRE INSURANCE CO.222 Ames Street, P.O. Box 9109, Dedham, MA 02027-9109 DORCHESTER MUTUAL INSURANCE CO. Telephone: (800) 688-1825 FITC HBURG MUTUAL INSURANCE CO. o Fax: (781) 329-1818 March 8, 2013 THER9OQ21f OdOG f'U�DIEDHARAGROUPm FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 313 Building Commissioner, or Inspector of Buildings c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Board of Health or Board of Selectmen c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Fire Department or Arson Squad c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 RE: Our File No.: P1355988 Insured: JACK & CHRISTENA ERLE Address: •8 LITTLE ROAD, NORTH ANDOVER, MA Policy No.: F0219346 Loss Date: 02/09/2013 Loss Type: Building or Other Structure Damage A claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Ch. 143, Sec. 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to my attention and include a reference to the captioned insured, location, policy number, loss date and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property, and the claim will be paid in our customary manner. Sincerely, "a'a' -A - 7?1a-c� Michelle M. Roust Senior Property Claims Examiner 1-800-688-1825 x1171 NORFOLK & DEDHAM MUTUAL FIRE INSURANCE CO. 222 Ames Street, P.O. Box 9109, Dedham, MA 02027-9109 DORCHESTER MUTUAL INSURANCE CO. Telephone: (800) 688-1825 FITCHBURG MUTUAL INSURANCE CO. Fax: (781) 329-1818 7644 Date... Y` TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..":1.4 f0 '/ .... Agxkve .................. . has permission for gas installation• A ................ in the buildings of ...... .!? ( ............................ at ...... ?�}�'4 ........... , North Andover, Mass. FA. -'R) -.Q0.. Lic. No.l?Yj--% AGAS INSPECTOR Check # _ 'K� e 4 617 1$ e'� '\ 1,AASSACHUSE1 S UNIFORM APPL1CA i IO] %' FOR PERIA i T Q D CI (1�-1C ,e✓ir..70�ye 19 P R z riL � 0 own(=r's Nan -)a L. ' Building t Dca1J❑n Tye of Dccupancy / kv G Ner+ ❑ Renovat}on` ❑ 13eplacetnert Mem 5urbmitued.:' Yes❑' bdo ❑ tnstaill�g_comparTy i fame' check one:j. .•Cr=r qft tp - Address 'PO ' � � 7 ❑ ' Cc�rporat�ori I S%v n/ �? �%: `7 C� ❑ .-P�htr rship Business Telephone i % 'r� 01 tnm/Ca: '..Name of Licensed Plumber or CLs'FFtter INSURANCE CQVERAC E.:' - I hate's current I-Fability jrsurance policy, tx- Its substantial e�guiraltnt whlch meets the requirements of MCL Ch.-. 142- Yt-s ❑ '..'.,No ❑ if you have checked'y� please Indicate the type-crrmmge by checidng the appropriate bqx A fiaMrty insura.nca policy./ Other type of lndemnity ❑ Bond ❑ OWNER'S INSURANCE WAP ER_ l am aware that the Ilcensee does not hava the Insurance coverage required by Cha.ptcr 142 of the Mass a! L Generaws, and that my'slgnature on this permit app(Ication.waives this requiremenL Check one: owner❑ Agent ❑ Signature of o�rner or Ownsr's.k,gent I hereby certify that all of the delaIls and informabon I have submitted (or entered) in above application are bue and accurate io the best of my knowledge and that all plumbing work and installations per 6unad under the pennft ' for this appCcabon wt l be in com fiance with all perlinant provisions a( the Massacf)usetts Stale Gas Coda and Chapter 142 of the Ge Laws_ i3y T of UCPlIS� dumb -a Sianzfure of Vr~nsed Plumber or G9 Fitter TrJe -fittsr - !� sr Urc3 Number Cii;To'•xn fume„ an (OFI {Cc USE OrfL;"1 " cr mta a 93 ltd ri1 1 _ ' ¢ _ B > i' C7 ••1. f� - q Cr _ S _ Ll C9 U •G '`.r - Q a �` O O C3 ti .:T .1' St1B—B,�IetTc i ' 9 AS Fc TaE*MT -1ST FLOOR ' 214D FLOOR t aRD FF.00R .'• �TEt-FLOOR . ' STH FLOOR - 5TH F.LodR t 7YH FLOOR gTIC FLDOFr tnstaill�g_comparTy i fame' check one:j. .•Cr=r qft tp - Address 'PO ' � � 7 ❑ ' Cc�rporat�ori I S%v n/ �? �%: `7 C� ❑ .-P�htr rship Business Telephone i % 'r� 01 tnm/Ca: '..Name of Licensed Plumber or CLs'FFtter INSURANCE CQVERAC E.:' - I hate's current I-Fability jrsurance policy, tx- Its substantial e�guiraltnt whlch meets the requirements of MCL Ch.-. 142- Yt-s ❑ '..'.,No ❑ if you have checked'y� please Indicate the type-crrmmge by checidng the appropriate bqx A fiaMrty insura.nca policy./ Other type of lndemnity ❑ Bond ❑ OWNER'S INSURANCE WAP ER_ l am aware that the Ilcensee does not hava the Insurance coverage required by Cha.ptcr 142 of the Mass a! L Generaws, and that my'slgnature on this permit app(Ication.waives this requiremenL Check one: owner❑ Agent ❑ Signature of o�rner or Ownsr's.k,gent I hereby certify that all of the delaIls and informabon I have submitted (or entered) in above application are bue and accurate io the best of my knowledge and that all plumbing work and installations per 6unad under the pennft ' for this appCcabon wt l be in com fiance with all perlinant provisions a( the Massacf)usetts Stale Gas Coda and Chapter 142 of the Ge Laws_ i3y T of UCPlIS� dumb -a Sianzfure of Vr~nsed Plumber or G9 Fitter TrJe -fittsr - !� sr Urc3 Number Cii;To'•xn fume„ an (OFI {Cc USE OrfL;"1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly NaMe (Business/Organizatiow/ ndividual): 9,4), /AZ Address: 1¢ City/State/Zip: Phone #:9�—� F2�,,Z­M. e you an employer?Check the appropriate box: Type of project (required): y 4. ❑ I am a general contractor and I 6 ❑New construction ❑ I am a employer with loyees (fulland/or part-time)•* have hired the sub contractorslisted on the attached sheet7. ❑Remodelinga sole proprietor or partner - These sub -contractors have g. ❑ Demolition ship and have no employees employees and have -workers' 9 ❑Building addition working for me in any capacity. comp. inctTrance.t [No workers' compinsrn-ance10.[]Electrical repairs or additions qui5• ❑ We are a corporation and its required.] . ❑ officers have exercised their 11. n Plumbing repairs or additions 3 , I a homeowner doing all work right of exemption per MGL 12.❑ Roof repairs myself [No workers comp. c. 152, § 1(4), and we have no insurance required_] t employees. [No workers' 13•❑ Other comp. insurance required.] *Any applicant that checks box 91 must also fill out the section below showing their workers' compensation policy information J 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 subcontractors and. state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information d Insurance Company Name - Policy # ame:Policy# or Self -ins. Lic. #:. Expiration Date: Job Site Address: City/state/zip- 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 fine 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. I do hereby cert' �dt7� and alti of perjury that the information provided above is true and correct n�+o. Phone # r[6. ial use only. Do not write in this area, to be completed by city or town official or Tov� 1. Permit/License # ng Authority (circle one): ard of Health. 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PluE heract Person: Phone #: I Date.. l �.:./.3.:.,-./... TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION /J� . This certifies that ......,... f? /` .. ............ . has permission for gas installation ...G: �.�... c ......... . in the buildings of .... ......: ........................... . at ..........j .. !. :......� .(......... , North Andover, Mass. Fee. Lic. No... . .(....... GASINSPECTOR Check # 3843 MASSACHUSETTS UNIFORMAPPUCAT'ON FOR (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations Owner's Name New 11" Renovation E Replacement TO DO GAS FITTING Date /2/) 3/0 / Permit # O 3 Amount $ Plans Submitted (Print or type) Name A?, I r .Sly/�/ Address - �U %` �0 L-cY* . �YL 19 �✓� 4 V.-Q✓t <tit �, Name of Licensed Plumber or Gas Fitter D L) b S 4 4, 4"r,, 0-, —e Check one: Certificate Installing Company Corp. Partner. 0-Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 13/No If you have checked }_es, please indicate the type coverage by checking the appropriate box. Liability insurance policy 13— Other type of indemnity M Bond 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. Check one: Signature of Owner or Owner's Agent Owner 13 Agent uereuy cenny mat an or me aetans ano mrormatton i nave 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 Massac,�s State Gas Code apd Chapter J42 of the General Laws. APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ©'Plumber X 3 L MGas Fitter License Moer 13—Master rj Journeyman CA Ij w a w w x x z w c un at z, rz p H, w GH ,o ao. °a w�w U x z z7 c w a ° w V� a U x >aa. o� H o SLyB-BASEM ENT B A S E M ENT 1ST. FLOOR 2N, FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7 T H. F L O O R 8TH. FLOOR (Print or type) Name A?, I r .Sly/�/ Address - �U %` �0 L-cY* . �YL 19 �✓� 4 V.-Q✓t <tit �, Name of Licensed Plumber or Gas Fitter D L) b S 4 4, 4"r,, 0-, —e Check one: Certificate Installing Company Corp. Partner. 0-Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 13/No If you have checked }_es, please indicate the type coverage by checking the appropriate box. Liability insurance policy 13— Other type of indemnity M Bond 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. Check one: Signature of Owner or Owner's Agent Owner 13 Agent uereuy cenny mat an or me aetans ano mrormatton i nave 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 Massac,�s State Gas Code apd Chapter J42 of the General Laws. APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ©'Plumber X 3 L MGas Fitter License Moer 13—Master rj Journeyman PERMIT NO. m APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP h4.• LOT NO. I 2 RECORD OF OWNERSHIP IDATE BOOK PAGE '.— ZONE ti SUB DIV. LOT NO. 7—I LOCATION 1, % Ad PURPOSE OF BUILDING G� ,� K q,tv 0 / �,' OWNER'S NAME ..sA y, ,./ �y,�,-,. 1� le NO. OF STORIES SIZE OWNER'S ADDRESS tom L� rC /1 v �•�Cp{ / BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME � G�� �•� % �• r SPAN --- DIMENSIONS OF SILLS POSTS DISTANCE TO NEAREST BUILDING DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR '" GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X ,IS BUILDING ADDITION MATER:AL OF CHIMNEY 1� UILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS DA ANS MUST BE FILED AND APPROVED/BY BUILDING INSPECTOR E FILED V SIGNATURE OF OWNER OR AUTHORIZED AGENT pp ) ✓ FEE e�S • �/ PERMIT GRANTED q ! 19o �+� V 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST 90460 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY SUILDING INSPECTOR OWNER TEL. rr 3 -7`1 — 3 1 CONTR. TEL. # S r2 141 G CONTR. LIC. # C c� H.I.C.# i1 0 �� I OCCUPANCY 1 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION I 8 INTERIOR FINISH B 1 2 13 PINE CONCRETE_Ill CONCRETE BL'K. BRICK OR STONE HARDW'D PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ '/. 1/2 1/1 IN. ATTIC AREA N_O B-M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS DROP SIDING WOOD SHINGLES CONCRETE EARTH B _ 1 _ 2 �_ ------ 3 _ _ _ ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ HARDY✓'D COMMON ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR I_ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I --i POOR ADEQUATE NONE 10 PLUMBING 5 ROOF GABLE GAMBRELMANSARD A HIP BATH 13 FIX.) TOILET RM. 12 FIX.) _ FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK - _ SLATE NO PLUMBING TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR _ TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ to 13rd ELECTRIC NO HEATING BUILDING RECORD THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. - _ -_ ._-��--�..w^-- _ I��M C.R•.0 _s—��-�`_..-� �. i�-�....--.-.-..:>..,=-. � ^ -...- 3- rila6io�. __TOwn of` OFFICES OF: __- �`' __ .,r,:,....Str . . _ . _ r,--= ! _ ,120 Main Street �S _ worth Andover. APPE. .y. - NORTH ANDOVER massachusenlsoi8-is BUILDING t, CONSERVATION DMISON OF HEALTH - — PI1i.NNING PLANNING & COMMUNITY DEVELOPMENT In acc--rte ;Rcr with the rC%iSIC .S=f:iGi. =:,. $ 3 conditicn of Buildir.s Pe-r.:it Number ��2. is thzt :ne dc" --'s resuttinc ircm this work Shall be disnom-, of ... a prone: :i.. rs -ctid ;este :-_.. s ....:....1 by ti1Gi_ G iii. S ine de�-,ris will be dispose:! of in: ti.:cacr. ct Sicnatw of FC. -MIL Acoticant Date , NOT=: Demolition permit fro= the Tomm of ;forth Andover must be obtained for - this project through the Office of the Building Inspector.