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Home My WebLink AboutMiscellaneous - 880 GREAT POND ROAD 4/30/2018 (2)N O O W Q O O O O O O �,_ DOWNEAST ADJUSTERS PO Box: 1.16 * 7 Elm Street • Boxford, MA 01921 TEL: (978) 887-8766 • FAX: (978) 887-0660 01/13/2018 Building Commissioner or Inspector of Buildings City / Town of North Andover c/o City / Town Offices North Andover, MA 01845 NOTIFICATION UNDER M.G.L. c . 139, §313 RE: Merrimack Mutual Fire Ins. Co. Insured: Robert & Kathleen Ercolini Policy No.: FP2626696 Date of Loss : 01/08/2018 Dear Sir or Madam: DownEast Adjusters is the independent adjuster retained by Merrimack Mutual Fire Ins. Co. to investigate and adjust the captioned claim for damage to a building or other structure at the property at 880 Great Pond Rd. Pursuant to M.G .L . c. 139, §313, Merrimack Mutual Fire Ins. Co. hereby notifies you that payment of $1,000.00 or more may be made in connection with the captioned claim. If the City / Town of North Andover intends to initiate proceedings under M.G.L. c. 139, §3A; c. 143, §9, or c. 111, §1276, please forward the notice required under M.G.L. c . 139, §3B, to my attention within the time provided under that statute. Thank you for your attention. Very truly, Mark Malley General Adjuster cc Merrimack Mutual Fire Ins. Co. US Le A Location No. 3 13 Date lb- 31- 03 TOWN OF NORTH ANDOVER Check # &O 16856 gilding Inspector .. 9 Certificate of Occupancy $ b"'•°''<� CHUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # &O 16856 gilding Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Offulh�}� '�., t" °•'Y. ,.. 7{a res t �"ia ,. >:: - bra �,n�;`�. ...fit•.: BUILDING PERMIT NUMBER: l DATE ISSUED: _ 3 SIGNATURE: Building CommissioneE for of Buildings Date SECTION 1- SITE INFORMATION I I I ` 1.110 Property Address: - 1.2 Assessors. Map and Parcel Number: ^� j — ,ct (o c 4 Po1d �1Cc1 t .1� Map tuber Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 9/ <,�7,z- 4, Zoning District Pr os se Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide REE* red Provided R uired Provided 1.7 Water Supply M.G.L.C.40.154) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public Private ❑ Zone Outside Flood Zone Municipal On Site Disposal System ❑ SECT O 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record A—rte 6 6 Name not) Address for Service : ( Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature ��__�. Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed" Construction Supervisor: Not Applicable ❑ Licensed Con�Supervi� 0 9 1 q 77 License Number Address y q- e1 2 0 Expiration Date / 7 Signatuv Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone V ic z O O z M 90 O mn ic r M z 0 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 Gcable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition \v' Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: �iw 3G A) Co �t. v\ C "" -- 7 1) o (b v— SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant - OFFICiA SE ONLY U 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction ® Q 3 Plumbing Building Permit fee lel X (b) -, 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATIO O BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b NER/AUT IZED 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 Print Name c'T� Signature of Owner/A e Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS fiEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE A0 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: C (Location of Facility) 1-01 Signa ure of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector f Tel: 978-688-9545 0 1 Town of North Andover Building Department 27 Charles Street �RSSACHusEt�` North Andover MA 01845 HOMEOWNER LICENSE EXEMPTION Please print. DATE��T % JOB LOCATION �C1 O (��P_ �-7� �/% G. Number Street Address "HOMEOWNER Home Phone PRESENT MAILING ADDRESS_ City Town Section of T( Work Pho Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of 1 or 2 units 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 of two there is, or is intended to be, a one family dwelling, attached or detached structures accessory 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 108.3.5.1) 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 t t he/she will comply with said procedures and requiremen HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICI Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. Revised 4.30.03 Home owner Exemptions Form C Wm Z C -• FAo cT H a® < m .a va n m ® CL m Z =r- y . _4 .. o. o aid y d m �o m m o ..♦ CD co �. o .+ 0 CO) CO) f� o SAO � Al. co O ' a CD CL CZ P- C!) m m Go O O n o m m CA m i gyp , 0 ? m �C)m CD CD m CD � zoe��a7� CA . 6 2 q ON Fu co Cf) =-0'. o 0 Q CD O CD O c m FDF oo w c Co y Cf, O CL C3 y CD ..om:A:� O CD o m CD CD O aCD� O � C b ^ + o CD n f o IJ Cn p CAby ?7 w ",t7 F 71 'fid G {1 w "jd 0 ro 'r9 W ",C G 'r1 C Cn d 'Or9 .CL O 1 0 c