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HomeMy WebLinkAboutMiscellaneous - 88 BELMONT STREET 4/30/2018Phone. 978-632-2660 JAMES A. TRUDEAU Fac: 978-632-2662 Adjustment Service Inc. P. O.Box 7 Gardner, MA 01440 claims a.trudgauadi.com Notice of Casualty Loss of Building Under Massachusetts General Laws, Chapter 139, Section 3B September 3, 2013 Building Inspector 120 Main Street North Andover, MA 01845 YBoard of Health 120 Main Street North Andover, MA 01845 Fire Department KtUEBYZLI Dept. of Records 124 Main Street8 SEP 2��3 North Andover, MA 01845 TOWN OF NORTH ANDOVER Insured: Robert Holland HEALTH DEPARTMENT Loss Location: 88 Belmont Street, North Andover, MA 01845 Insurance Company: Preferred Mutual Insurance Co. Policy No.: PHOO100876073 Date of Loss: August 15, 2013 File Number: 13-11705 Claim Number: 13009555 Type of Loss: Property Damage 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, Chapter 143, Section 6" to be applicable. If any notice under "Mass. Gen. Laws, Chapter 139, Section 313" is appropriate, please direct it to the writer and include a reference to the captioned insured, location, policy number, date of loss, and file or claim number. Claim has been made involving loss, damage or destruction of the above -captioned property, which may exceed $5000. If any notice under Massachusetts General Laws, Chapter 175, Section 97A 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 cause copies of this notice to be sent to the person(s) named above at the address indicated by first class mail. Sincerely, James A. Trudeau General Adjuster Phone. 978-632-2660 JAMES A. TRUDEAU Adjustment Service Inc. P. O. Boz 7 Far: 978-632-2662 Gardner, MA 01440 claims W,t.rudeguacli.cam Notice of Casualty Loss of Building Under Massachusetts General Laws, Chapter 139, Section 3B September 3, 2013 i wilding Inspector 120 Main Street North Andover, MA 01845 Board of Health 120 Main Street North Andover, MA 01845 Fire Department Dept. of Records 124 Main Street North Andover, MA 01845 Insured: Robert Holland Loss Location: 88 Belmont Street, North Andover, MA 01845 Insurance Company: Preferred Mutual Insurance Co. Policy No.: PHOO100876073 Date of Loss: August 15, 2013 File Number. 13-11705 Claim Number: 13009555 Type of Loss: Property Damage RECEWEG SEI .10 2013 TOWN OF NORTH ANDOVER HEALTH 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, Chapter 143, Section 6" to be applicable. If any notice under "Mass. Gen. Laws, Chapter 139, Section 313" is appropriate, please direct it to the writer and include a reference to the captioned insured, location, policy number, date of loss, and file or claim number. Claim has been made involving loss, damage or destruction of the above -captioned property, which may exceed $5000. if any notice under Massachusetts General Laws, Chapter 175, Section 97A 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 cause copies of this notice to be sent to the person(s) named above at the address indicated by first class mail. Sincerely, James A. Trudeau General Adjuster Location`` ;N0. Date '?-J--ajr TOWN OF NORTH ANDOVER Certificate of Occupancy $ �� s • E<� Building/Frame Permit Fee $ •1CMU5 Foundation Permit Fee $ Other Permit Fee TOTAL Check # 418-452�- �Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING x . TWs.Sro> for?fist Use`;pnl' BUILDING PERMIT NUMBER: DATE ISSUED: C - SIGNATURE: Building Commissioner/1for of Buildings Date SECTION 1- SITE INFORMATION. 1.1 Prop Addr lfRTI ljm"P-rsr 1.2 Assessors Map and Parcel Number: 0 :, P A Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Regiured Provided 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private 0 Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record tS1,ti16 u C, It eej�oAlrPf,gAdo ve-r Nate (Pri t) Address for.Service ' 97s-G�8©�39 Si ture Telephone 2.2 Qwner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: 6�oLfi 6 Licensed Construction St}pervisor: rlvPke-- p1 I000T /`{ 6' Q&dOr Address I Q ® 0 4 0 /l O O ignature Telephone Not Applicable ❑ /` Q q 2 G �� 43 License Number 3_' Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ % ./ Company N m " /Vo '1$nue r //lfi �yoo U rlu) /esr- . Registration Number te— �, Address Ll- -7 Expiration Da Si nature Telephone T M Z O 171 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 permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work(check all a Ucable New Construction ❑ Existing Building V Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ?� VJA) , d MIS' �l �joo`fd l �t Co e. r l v e,r�► r� G- 2- r fi f�r� P.sS o rl i'�S, IV S -M ll s� ( Hers n g � �r S, aces �Jv� Y'f-PlIqc'e # roe r��i� Nea) '�� r cioars SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be OFFICIAI, iJSE°ONLY, Com leted by permit a2plicant 1. Building +�S (a) Building Permit Fee J Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) r (b) pd" 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 "INf c) v Cr' as Owner/Authorized Agent of subject property Hereby, authorize OL. to act on My a ; in all n ers relative to work authorized by this building permit application. Si atiue of ONezi r Date S TION 7b OWNER/AUTCHORIZED AGENT DECLARATION Q 04 �'� 1, 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 /� ()L / Pe-i�9 Print Name mt 0 Sip -nature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRVIBERS 1 ST 2 ND 3 IM SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DINE- OF GIRDERS IIEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING x MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE O z x w O p w° Q V)w° Ouw a�G U ie w a w a" o°G is w � W d u ch Ta w CO. a�4 is w a w rA cn o cn CD Z o. O CA D � Ci Om C D — CD .� y C 'r= m Co 4D 0 CD CL CD CD IS 0 cc o a Xca Q o � c CL. CD CD c Z C..i y c C — C CO D ui In Y/ U) W W W c o w� c o � O N C O CJ CJ •dam CL C W O C t :w O N Ea CF z Fa o a GO E c o� t .ts s E h N � m O O N = H Com' m y... N C C _c ti W O Em � :mocm :aSL cm OQ c o m ca `o C=, 0 o CL C5, c Q CD m mac o _ H m N 2 y m a m Z W O �+• �_ .f H " C E CZZ I"v m� Z c U= W L- CL CD y m- O� `� S O a�m� CD Z o. O CA D � Ci Om C D — CD .� y C 'r= m Co 4D 0 CD CL CD CD IS 0 cc o a Xca Q o � c CL. CD CD c Z C..i y c C — C CO D ui In Y/ U) W W W 2 ISO t G)20 k< ? Torn �. / 7 :0 5 §� ! Mz 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 Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: ese"It& 306Fa -reTst 049 bod (Location of Facility) ' /:a • G:::�6 Signature of Perm it -Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: (1 le, �119�F�1 l.Bi^�/►')�C'i�. PAI .��- V, Location: o ! r1i +_I I City MO. 40060-811- PJ19 • Phon( I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 2 P p G p s'I 0 d 7 I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone # Insurance. Co. Policy # Company name - Address City: Phone #: Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.00 and/or one years' imprisonment_as_weU_as_civil.,penaltiesjnshetarm-daBTOP WORK ORDER�nd_a.fine —($1110-D) atlayRgainsim 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. ry I do hereby certify under the pains and penalties off perjury that the informalm provided above is true and correct. Signature �!• r "/\ Date �— 0 o Print name V 1- Official use only do not write in this area to be completed by city or town official 7P G ?J 1 067 City or Town PermMcensirig 0 Building Dept []Check if immediate response is required .0 Licensing Board p Selectman's Office Contact person: Phone #: ❑ Health Department Ei Other PAUL A. PIEROp G 62?5R90R Rent DFC"� of `I'd2S'7t1'r 7�d'yl 1000 TURNPIKE ST. f-kv NORTH ANDOVER MA 01845 978 685-1007 Home Imp. Cont. Reg. No. 103577 SPECIFICATION SHEET Mass Const. ic. No. 039928 SAVINGS QUALITY CRAFTSMANSHIP Home Phone: Owners Name �( o ' S a J Work�'hone: Home Address city iii,', jtd ooe4 State 11Ja. Zip Job Address $- 176 S' city /VC, State XtA Zip C ggcy SIDING 1. Siding Typed �.edcrt'IJ� WidthNRL _ Color 2. Areas to be done. Main House Breezeway /V Garage fV 0 ' Additions eVO Porches bormers �V,0 Bulkhead IV0 Other 3. Prepare exterior walls for siding e ' 4. Remove existing siding ❑ Yes [ No 5. Insulation 9 6. Aluminum trim cover es ❑ No Color e Trim to be done: Soffitts Rakes d0Q Ceilings 9)D 8. Gutters add spouts R Yes 0 No Sf'yl 9. Shutters liYYes ❑ No 10. Storm Windows and Doors 11. See notes for replacement ndors, ROOFING Material Type Areas to be done Remove existing shingles Chimney and vents, etc. _ Notes ❑ Yes ❑ No carpentry, etc. 15 lb felt Material and labor cost $�IZ 95 payable as follows: Color Metal Edging Other /a/Z � Y7. "')'al�c� Fascia n-ee- t eZA--j S'L Lr S+vp r17 y " Deposit I st installment 2nd installment Balance on completion Contractor will do all said work in a good workmanship manner. You may cancel this agreement if it has been consummated be a party thereto at a place other than an address of the seller, which may be his main office or branch thereof, provided you notes the seller in writing at his main office or branch be ordinary mail posted, by telegram of be delivery, not later than midnight of the third business day following the signing of this agreement. Bal WITNESS THEREOF, the parties have hereunto signed their names this� � day of / ;' : � 20 Signed,,k Accepted: PAUL=Y�TftOR RE DELING &INSULATION . ner Per: � Signed re resentative Owner Strikes, labor disputes, inclement weather, or material supplier delays resulting in work stoppage are beyond the control of the company. The company guarantees all workmanship for a period of l year from the date on installation. Guarantee of workmanship assumes performance of produce installation under normal tivear and tear conditions and does not guarantee against storm damage, acts ofgod or nature, neglect ofproper maintenance or malicious damage or vandalism. Material guarantees are the sole responsibility of the manufacturers. Location N _ �7r Date .r. TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ PAID B Ot�? P�errnitt Fee $ Sewer Connection Fee $ ' 1 2Iv ter Connection Fee $ �a TOTAL $ = u N®. Andova Cullator t1 x 7 Building Inspector Div. Public Works Location No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ SewerConnection Fee $ �A Water Connection Fee $ _TOTALS $ Building Inspector Div. Public Works PERMIT NO. Ig/ APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MA d40. LOT NO. 2 RECORD OF OWNERSHIP jDATE BOOK 'PAGE ZONE SUB DIV. LOT NO. I — LOCATION PURPOSE OF BUILDINGc OWNER'S NAMEF-94 G NO. OF STORIES "'� SIZE OWNtj ER'S ADD ADDRESS BASEMENT OR SLAB - ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME ✓/✓G�/lam / / L t SPAN - DISTANCE TO NEAREST BUILDING / ✓ DIMENSIONS OF SILLS .. DISTANCE FROM STREET I `l POSTS DISTANCE FROM LOT LINES - SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION ,�� �� THICKNESS t% IS BUILDING NEW - SIZE OF FOOTING - X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND 4 - WILL BUILDING CONFORM TO REQUIREMENTS OF CODE I' WILL IS BUILDING CONNECTED TO TOWN WATER -/ es BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWERS? IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 � �����/G�► �/�� PAGE 2 FILL OUT SECTIONS 1 - 12 EICECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR PERMIT GRANTED OWNER TEL. #— LL7&)y) CONTR. TEL. # b / 7, 19 f Y CONTR. LIC. # o-.07/ 4-'6-7 S &Z 3- PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER f3Q. FT. (J EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING INSPECTOR I OCCUPANCY CONSTRUCTION \TION 8 INTERIOR FINISH a 1 2 PINE HARDW D PLASTER DRY ALL I — - 3 1 BASEMENT AREA FULL '/. 1/2 1/. NO BMT HEAD ROOM I 4 1 WALLS SHIt T SI STUCCO ON FRAME BRICK ON MASONR BRICK -ON FRAME 5 1 ROOF GABLEHIP GAMBREL :MA FLAT I I SHE TAR & GRAVEL 6I' FRAMING WOOD JOIST FIN. ATTIC AREA FIRE PLACES MODERN KITCHEN 9 FLOORS B 1 CONCRETE _ EARTH HARDW'D COMMON _ ASPH. TILE ATTIC STRS. 8 FLOOR WIRING 10 PLUMBING 4TH 13 FIX.1 LAVATORY KITCHEN SINK _ NO PLUMBING _ STALL SHOWER _ MODERN FIXTURES _ TILE FLOOR _ TILE DADO 11 HEATING I I I UNIT HEATERS 71 NO. OF ROOMS GAS OIL B'M`.T 2nd _ ELECTRIC 1st I 13rd I NO HEATING a AIN r �- ik. - Ir ' BUILDING RECORD 12 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. 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