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Home My WebLink AboutMiscellaneous - 9 PRINCETON STREET 4/30/2018NEW ENGLAND CLAIMS SERVICE, INC. ReplyTo. ❑ - Reply To ❑ Reply To ❑ P.O. BOX 34S 100 CONIFER HILL DRIVE, SUITE 308 P.O. BOX 578 MANSFIELD, MA 02048 DANVERS, MA 01923 SHREWSBURY, MA 01545 TEL. (508) 337-8058. TEL. (978) 777-9900 TEL. (508) 842-3995 FAX (508) 339-5835 FAX (978) 774-9296 FAX (508) 842-7510 ,%I GC iy1C- , Form of Notice of Casualty Loss to Building ; a°'�;c , A,T8 Under Mass. Gen. Laws, Ch. 139, Sec. 31) " w Noy s TO:, Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen addresses RE: INSURED-_ btyok► PROPERTY ADDRESS °i �2r� P��t s-�► �,� POLICY NO.: _ C) i b r 3� L4 LOSS OF: t2 =& Z i ` 40g) FILE OR CLAIM NO.: _ IRC)s - 3'4 Wo 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 3D 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. TITL On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. OATYRE AND DATE// 7/01 cc: Fire Dept. Location 1 P n I ti C *-r U ^--� S t No. 33o- Date 11-1V w Mme,. TOWN OF NORTH ANDOVER Certificate of Occupancy $ �M�SE<Building/Frame Permit Fee $ 3 Foundation Permit Fee $ j Other Permit Fee $ TOTAL $ Check # '2 D ) e r� f=� B ilding Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING n � BUILDING PERMIT NUMBER: CD DATE ISSUED: SIGNATURE: 144 PM ` ` Cu,%, Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1 l��NiG'Pl a►�- �� 1.2 Assessors Map and Parcel Number: pgS 6032 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 ReqWred Provided 1.7 Water Supply M.G.L.C.40. S4) 1.5. Flood Zane Information: Public ❑ Private ❑ Zane Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record z" j, & 2►� 5 Name (Print) G l 1 K- c -e J ',*L 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: Licen,,ed Construction Supervisor: D ' lit c � � _,4S �x 5ffoLyP�C Addrsis Signature Telephone Not Applicable ❑ 06otcZ License Number 0 --� Expiration Date 3.2 Registered Home Improvement Contractor >t A Not Applicable ❑ 2— (2- Company Nam c) 5',-) Registration Number O 2 Address-- W �/� / � S J Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) worKers tompensanon insurance artwavit 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 applicable) New Construction ❑ Existing Building V Repair(s) ❑ Alterations(s) 0 Addition 0 Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: n P SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be, Completed by permit applicant 3 R $FFIC, zs ..,d USE UNI.Y Y -a- 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction �~— 3 Plumbing Building Permit fee (a) x (b) [y 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number i 7 SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ^ I j 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 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 S D, Print !Ztn'� Sr ature of Owner/A ent IV Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TB)MERS 1sT 2 ND 3 SPAN DWENSIONS OF SILLS DIN ENSIONS OF POSTS DIMENSIONS 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 Free Estimates Fully Insured PropoPage1.�..it of - =_ 105 Haverhill Stre-�+. Methuen, MA 01844 55 THOMPSON' S ROOFING (978) 691-135 Shingles — Slate — Rubber Roof Single Ply — Copper Work PROPOSAL SUBMITTED TO / PHONEI DATE —� Linda Burns 6 �SS9�S 11-12-01 _ STREET w /� / JOB NAME 9 Princeton Street CITY, STATE AND ZIP CODE JOB LOCATION over 'MA 018 ARCHITECT DATE OF PLANS We hereby submit specifications and estimates for: PHONE Strip off all roof shingles on house and garagae Renail all loose boards and if any need replacement it will cost $3.0." a ft. (1x8) Install aluminum drip edge around roof line Apply ice and water shield 6 ft.up all along edges Appyl 151b. felt paper on rest of roof -:.area Reshingle with a 25 year Architect shingle Install new flanges around soil pipe Waterproof chimney flashing Remove all work related debris 25 year warranty on material 10 year guarantee on labor construction lic. #060112 improvement #128612 /g// 466 e—Aahc;n_% zz^p t4, /QST%' w,.// .62 We propoOt hereby to furnish material and labor— complete in accordance with above specifications, for the s:;m of: Five thousand six hundred ------ dollars ($ 5, 600.00 Payment to be made as follows: All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tomado and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. Ziereptance of propood — The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: / ( / Y— D Authorized Note: This proposal may be withdrawn by us if not accepted within __ —days. Signature Signature �' 53 s' 1f)-II�-V)M y + 1 INSURANCE CERTIFICATE OF LIABILITY DATE 04-23.01 (MM/DD/YY) 'RO;UCER PELIAM INSURANCE SERVICES INC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. 122'BRIDGE STREET EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PELH,'�M NH 03076- INSURERS AFFORD I NG COVERAGE ;.i{ FIRE INSURER A: Liberty Mutual INSURER B: The Maryland INSURE;? Thomas Loyle DBA INSURER C: •hompsons Construction & Roofi DAMAGE_(Any one fire) 8 West St. Salem INSURER D: NH 03079 INSURER E: C:.'ERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY OD INDICATED. DOCUMENT WITH RESPECPERIPERI NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/'vY, :':IS DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Job: Roofing Job at 6 MIDDLESEX ST. NO. CHELMSFORD, MA CERTIFICATE HOLDER [ ]ADDITIONAL INSURED: INSURED LETTER FRAffi DEAMICIS 6 MIDDLESEX ST. NO. CHELMSFORD, (7/97) MA 01863 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. AUTHORIIIZED REPRESENTATIVE C Page 1 of 2 GENERAL LIABILITY g [x] COMMERCIAL GENERAL LIABILITY SCP 34865353 04-17-01 04.15.02 ;.i{ FIRE $1,000.000 [ ] [ ]CLAIMS MADE [x] OCCUR DAMAGE_(Any one fire) $ 300,000 MED EXP (Any one person) $ 10,000 GEN'L PERSONAL & ADV INJURY $1.000,000 AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 [ ]POLICY [ ]PROJECT [ ]LOC PRODUCTS - COMP/OP AGG 82,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT [ ] ANY AUTO [ ] ALL OWNED AUTOS (Each accident) $ [ ] SCHEDULED AUTOS BODILY INJURY [ ] HIRED AUTOS (Per peIson) $ [ ] NON -OWNED AUTOS BODILY [ (Per accident) ¢ j PROPERTY DAMAGE — (Per GARAGE LIABILITY AUTO OV_� A A--C:i)EN1 $ [ ] ANY AUTO [ ] OTHER -A, EA ACC $ AUTC 0"._ Y : AGG $ EXCESS LIABILITY EACH OCCURRENCE $ [ ] OCCUR [ ] CLAIMS MADE AGGREGATE [ ] DEDUCTIBLE $ [ ] RETENTION $ $ WORKER'S COMPENSATION AND [X] WC STATUTORY [ ] OTHER E.L. EACH A A EMPLOYER'S LIABILITY WC2-31S-314995-019 04.21-01 04.21.02 ACCIDENT $ 100,000 E.L. DISEASE -EA EMPLOYEE $ 100,000 E.L. DISEASE -POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Job: Roofing Job at 6 MIDDLESEX ST. NO. CHELMSFORD, MA CERTIFICATE HOLDER [ ]ADDITIONAL INSURED: INSURED LETTER FRAffi DEAMICIS 6 MIDDLESEX ST. NO. CHELMSFORD, (7/97) MA 01863 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. AUTHORIIIZED REPRESENTATIVE C Page 1 of 2 { Q w w C u �z° N V, w z z r.i C w° to w�' v .0 U ro C wir.cn U a ° �' uz U w � w H w U C w z d Q w c m z n c y- o CD c a C h O C O cv V MC A A O C = O : cm s y E a "�T N co Ec ♦:00 .� v m c E L C, ` L y tm m y :2 C m O r -. c . o E m CD 75 o 0 av m m ; cr.r z o cm os c c 0 cCIO c z c .;� c_ F- o m � coN m C •C i m�3 N ~ $ y CD m w c Z_-00aD .: yC. L C Z LU � `r m y O v •m o o `.� c g C40 a m- O� _ 0 m0 O m CA CDH .CD L CLO L C O CD V 2C H O .v d CO) C O cc O. CO2 �F LLJ 0 C/) U) W W CL LLJcn