HomeMy WebLinkAboutMiscellaneous - 84 WOODSTOCK STREET 4/30/2018r
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INSURANCELibertV Mutual,
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: 84 Woodstock St, North Andover, Ma 01845
Policy Number: H3221232993012
Underwriting Company: Liberty Mutual Fire Insurance Company
Claim Number: 032008541-0001
Date of Loss: 5/12/2015
Attn: Town/City Official
Pursuant to M.G.L. c. 139, 5 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, 5 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
Date ..:...'?.... ..........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...........
S 'r `.Y
has permission to perform .......+r�..� ...�r.,. r.- ........... �. s :..................................
wiring in
.the buildin of ................
............ S
..................................
at..��//....W...........5�x,North
Andover ass.
Fee.37: .n........ Lic. Nok 49:. ................
.. ...............
E�crxtcni.Itvsre ox
Check # %Z Y 6
Commonwealth of Massachusetts' Official Use /only
Department of Fire Services Permit No. I
BOARD OF FIRE PREVENTION REGULATIONS
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL
WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT ININK OR TYPE ALI•,INFORMg,TION) Date: ?- — 7/ - /l
City or Town of: Ah�` + el- - To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) jyy A', -v a
Owner or Tenantdf
/% i f , y ,� Telephone No.
Owner's Address ei -
Is this permit in conjunction with a building permit? Yes ❑ No wilding Permit #
Purpose of Building i7t, % . cr // C Utility Authorization No. /
Existing Service /Ur/ Amps fi / Z //Volts had ❑ Undgrd ❑ No. of Meters l
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity G /lcc G.1-o'
Location and Nature of Proposed Electrical Work:
Completion of the following table may be waived by the Inspector of Wires.
No. of Recessed Fixtures
No. of Ceil: Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Above ❑In- ❑
Swimming Pool rnd.
o. of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
g
No. of Air Cond. Total
Tons
No. of Alerting Devices
Heat Pump
I Number
I Tons
KW
No. of Self -Contained
No. of Waste Disposers
Totals:
I ' * '
f ...............
I ........................
Detection/Alerting Devices
No. of Dishwashers
S ace/Area Heating KW
p g
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances KW
Security of Systems:
or Equivalent
No. of Watero.
KW
of No. of
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE [OND ❑ OTHER ❑ (Specify:)
(Expiration Date)
Estimated Value of Electrical Work:
(When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the pains and penalties of perjury, that the information on this application is true and complete. Current
Insurance certificate must be on file in our office and affidavit must also be filled out with each application.
FIRM NAME: /4 IC. NO.: %� 3
Licensee:" ,Z 1f �r�! Signature Xz;eLIC. NO.:
(1f applicable, en r "exempt in the license number line.) Bus. Tel. No.:`,
Address: Alt. Tel. No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent..
Owner/Agent
Signature Telephone No. PERMIT FEE: $
ELECTRICAL PERMIT NO. INSPECTION REPORT:
ELECTRICAL INSPECTOR - DOUG SMALL
1. ROUGH INSPECTION:
Passed — [ j Failed — [ ] Re -inspection required ($50.00) - [ ]
Inspectors' comments:
(Inspectors' Signature - no initial
2. FINAL INSPECTION:
Passed — Failed — [ j
Inspectors' c mments.
kiubpectu s aignazure - no
3. UNDER GROUND INSPECTION:
Passed — [ ) Failed — [ )
Inspectors' comments:
(Inspectors' Signature - no
4. INSPECTION — SERVICE:
DATE CALLED NATIONAL GRID:
Passed — [ ) Failed — [ ]
Inspectors' comments:
-no
5. INSPECTION - OTHER:
Passed — [ ] Failed —
Inspectors' comments:
' Signature - no
-le-inspection required ($50.00)-f
Date
j
Date
;e -inspection required ($50.00) - [
j
Date
NAME:
tiinspection required ($50.00) - [
j
Date
inspection required ($50.00) - [
)
Date
--1
DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT
ACCESSIBLE AND A RE -INSPECTION OF $50.00 IS TO BE CHARGED.
Location?
No. Date
"�,_ TOWN OF NORTH ANDOVER
07
K
• � ; . Certificate of Occupancy $
t1�' Building/Frame Permit Fee $
s�cHus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 2
17486
Building Inspector~
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATIO TO 4NSTRUCr REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
�! SAI' ' UR 91114
BUILDING PEPOVff NUMBER: O � DATE ISSUED:
SIGNATURE: A a4&104 I
. Building Commissioner/1for of Buildings Date 3 — d
SECTION 1- SITE INFORMATION
1.1 Property Address:
vi,'ILlP-•t. rum IVU
1.2 Assessors Map and Parcel Number:
Map Number Y Gl ��GS C
14
f 6
Parcel Number
' kV G�vv ods% �S
Address for Service
Signa
1.3 Zoning Information:
Zoning District Proposed Use
/ 7k ` l
D
1.4 Properly Dimensions:
Lot Area Fronto
ft
1.6 BUILDING SETBACKS ft
fig Are
Telephone
Front Yard
Side Yard
Rear Yard
Required Provide
R 'red Provided
Regaired
Provided
3.2 Registered Home Improvement
Contractor
Not Applicable ❑
1.7 Water Supply M.G.L.C.40. 54)
Pubfic ❑ Private ❑
1.3. Flood Zone Information:
Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal ❑On Site Disposal System ❑
R4 4
Or,%,aivi'A-ravrrr[II vw11ILMOrltr/AUIriUKILEUAGENT
vi,'ILlP-•t. rum IVU
2.1 Owner of Record
&JA4-7- r/-'- -
Name (Print)
o b ti (Z- 7- /5 ,
as N,�,
, A) N /,'- t
' kV G�vv ods% �S
Address for Service
Signa
Telephone
I
/ 7k ` l
D
2.2 07wner of Recor-a:
�mc Print
j� _ s
Address for Service:
fig Are
Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Lic lensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature Telephone
Not Applicable
License Number
Expiration Date
3.2 Registered Home Improvement
Contractor
Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
0
Z
M
90
0
Oni
e
rl
v
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Z
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Q
4
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 building it.
Signed affidavit Attached Yes .......❑ No ....... 0
SECTION 5 Description of Proposed Work(check all a me
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I
Item
Estimated Cost (Dollar) to be
Completed bpermit applicant
OFFICIAL USE ONLY
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
eo
4 Mechanical HVAC
S Fire Protection
6 Total 1+2+3+4+5
d
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�authornize to act on
My be rs el ive to work authorized by this building permit application.
tur of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, as Owner/Authorized Agent of subject
property
Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge)
and belief
Print Name
of Owner/.
Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS Isr 2 ND 3 RD
SPAN
DINIENSIONS OF SILLS
DIN ENSIONS OF POSTS
DRAENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIlvINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
D. Obert Nicetta
Building Commissioner
(978) 688-9545
(978) 688-9542. Fax
Town of North Andover
Building Department
27 Charles Street �o
North Andover, MA. 01845
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE 7,73V -
JOB LOCATION cf 7 A)0.0 01,5'
Number
"HOMEOWNER/1 C
Name
PRESENT MAILING
City Town
41V% ;?-/
a/0•-[aZX.5 - /�--Od3'v
Address Map / lot
Home
State
Work Phone
The current exemption for "homedwners" was extended to include owner -occupied dwellings
of two 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 108.3.5.1)
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 or two family dwelling, attached or detached structures ac-
cessory to such use and/or farm structures. A person who constructs more than one home in a
two-year period shall not be considered a homeowner.
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.
HOMEOWNER'S SIGNAT014!
f 11/1 1
APPROVAL OF BUILDING OFFIC
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