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Home My WebLink AboutMiscellaneous - 111 MARBLEHEAD STREET 4/30/2018 111MARBLEHEAD STREET 210/009_O-oD43-0000.0 i Insurance Adjustment Service, Inc. 139 Billerica Rd Chelmsford, MA 01824 (978)256-3334 Fax (978)256-3354 NOTIFICATION UNDER M.G.L c. 139, §311 i Date: June 13, 2016 TO: Building Commissioner or Inspector of Buildings C/O Town Offices North Andover MA 01845 RE: Company: MAPFRE Insurance Insured: Carol Declercq Date of Loss: 06/01/2016 Policy Number: BDJPCY Type of Loss: Water damage File or Claim Number: 3488 Dear Sir or Madam: Insurance Adjustment Service Inc. is the independent adjuster retained by MAPFRE Insurance to investigate and adjust the captioned claim for damage to a building or other structure at the property at 112 Marblehead St North Andover MA 01845 . Pursuant to M.G.L c. 139, § 313, MAPFRE Insurance hereby notifies you that payment of$1,000.00 or more may be made in connection with the captioned claim. If the town of North Andover MA 01845 intends to initiate proceedings under M.G.L c. 139, § 3A; c. 143, § 9, or c. 111, §127B, please forward the notice required under M.G.L. c. 139, § 3B,to my attention within the time provided under that statute. I Thank you for your attention. Very Truly yours, Jennifer Riley Adjuster,Ext 105 jriley@insadjserv.com Cc: MAPFRE Insurance Date.. . . /.'.7/!.Zc. ... .. NORTH TOWN OF NORTH ANDOVER O i 9 • - PERMIT FOR GAS INSTALLATION 9 . 9 SAcHUSE�� F This certifies that . . . !?!?�!�. . . has permission for gas installation in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at .11 . ./ ICI! . . . . North Andove M s. Fee.--� .4V. . . Lic. No..I ZM. . . GAS INSPECTOR Check# AP-625 - 7 8248 MASSACHUSETB UNN ORM AMUCATON FORPERWr TO DO GAS ffn]NG (Type or print) Date NORTH ANDOVER,MASSACHUSETT ZZBuilding Locations Permit# Amount$ Owner's Name AV New❑ Renovation ❑ Replacement Plans Submitted ❑ x w z P; H z W � w G zx z v M a % W 9 a o W U x 0 WF z WWH z F w w � o w H w a H x O x A C7 a U a A a F O SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3 R D . F L O O R 4TH . FLOOR 5 T H . F L O O R 6 T H . F L O O R 7TH . FLOOR STH . FLOOR (Print or type) Check o Certificate Inst Iling Company Name olp. Address C✓ Partner. Business Telephone ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter w��`l�Lj/� � 1061y INSURANCE COVERAGECheck one: I have a current liability Insurance p cy or it's substantial equivalent. Yes 13 No❑ If you have checked y s,please in cate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ 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 Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performe under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachu etts stat s Ctr; ter 142 of the General Laws. By: �gnature of Licensed Plumber Or Gas Fitter Title P er U r �J — City/Town as Fitter tcen e um e ❑ Master APPROVED(OFFICE USE ONLY) Journeyman Date. . . 71.Z-. . 94:81 pORTM .otic TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACNUSE� This certifies that . . �j�5'/� r�'�r'�/ . /�!% a!? . . . has permission to perform . . . . . . .'� plumbing in the buildings of . .jC?Clr eo% . . . . . . . . . . . . . . . . . . . . . . � . . . . . . . . . ., North Andover, Mass. Fee. No./404. . PLUMBING INSPECTOR Check # S /�� 3/ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBIlV (Type or print) NORTH ANDOVER,MASSACHUSETTS / S/• L I/w`'l >� Date Building Location Owners Name A/�PG� o6zAftPermit# Amount Type of Occupancy New Renovation 0 Replacement10/ Plans Submitted Yes 0 No FIXTURES SZ,S)f1SV� Alm 1ST'FIOCg2 M HDOR 3MFLOM 4M ROM 5M FLOC[[ 6MHDM 7II°IMCM 9M RJOOR (Print or type) �j 1 Check on Certificate Company Name orp. Address �{S� e El Partner. Business Telephone O Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the t of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance signature Owner ❑ Agent ri I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed un er Permit Issued for this application will be in compliance with all pertinent provisions of the Massach2 t Kate u in ode and Chapter 142 of the General Laws. By: Signafure ol Licensea/larnDer Ty e of Plumbing License Title (OFFICE [cense um er'�� Master Journeyman ❑ APPROVED iocE USE ONLY BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION • � r. FEE N0. APPLICATION FOR PERMIT TO ADO GASFITTING tt•. NAME & TYPE OF BUILDING :' . LOCATION OF BUILDING PLUMBER OR GASFITTER LIG NO. PERMIT GRANTED DATE GAIS INSPECTOR Date.........72110m: phi TOWN OF NORTH ANDOVER PERMIT FOR WIRING LI This certifies that ...........rj��.... ........................... has permission to perform ......q. Za:......Ilzoax-1111A. r-1-1--111111 q............ wiring in the building of............... 7-ea-1A/z--r— � .... ...................................................... '-'—North Andover,Mass. at......... FeeZ.F*— Lic.No.' a0,3........ 6. ..... .... -��i�s �T /E C�L Check # . 2 3 7942 Commonwealth of Massachusetts Official use O ly = Department of Fire Services Permit No. Occupancy and Fee Checked '.w ,•` BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank) 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 IN INK OR TYPE ALL INFORMATION) Date: City or Town of: �' �`ni�A�/'`C� To the Inspector of Wires: By this application the undersigned gives notice of his or her intention perform the electrical work described below. Location (Street& Number) G— � � Tnn Owner or Tenant „� V lj��c�,,l Telephone No. q-)C� Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. c' Existing Service Amps / Volts Overhead 211" Undgrd ❑ No. of Meters �1 New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector gl'Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle) Fans No. of Total Transformers KVA iNo.of Luminaire Outlets No.of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ o. of Emergency Lighting rnd. grnd. 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 Initiatin Devices No.of Ranges No.of Air Cond. Total No. of Alerting Devices Tons g No. of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of No.of Heaters KW Ballasts Data Wiring: Si ns No.of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalentj A OTHER: Attach additional detail if desired, or as required by the Inspector i 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. 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. Tile undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) certify,under the pains acrd natties of perjury, that the hifornuation on this application is true and complete FIRM NAME: �pr... �` LIC. NO.: � d 3 Licensee: Me Signature LIC. NO.: (/J applicable, enter xerrspt in the Jlicense nnrn ber/ire. M �� Bus. Tel. No.: Address: �'�^ ;,��/t„_ /n, I Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. 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: $ Date./� � .. ... . ,ORTM f o ° p TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION t • > s SSACNUSE This certifies that . . . iY.j.� �"`. . . . . . . . . has permission for gas installation . ./pi/. A.�; .�.`.`. . . . . . . . in the buildings of . . . ' . �i .0 j� . . . . . . . . . . . . . . . . . . . . . . . . . at North Andover, Mass. Fee. ./U¢. ..Lic. No.. .. . . . . . . . . 1� ,�`. . . . . . . GAS INSPECTOR Check# 1 7 1 6275 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING ��'YW7 (Print or Type) . V C,p7f1 Ali D ,j6L , Mass. Date /a 11,31,W16-7 Permit # 2 J Building Location 1P/— //3 nA£61C-11 1-0 Sc7 Owner's Name k'A�t?SND S Iv1a�T AJOR-TR A1j06*P. Type of Occupancyk'LS/�'ENil�4l.- New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes[] No ❑ 0 � ti1 N W N 2 W W CL o a m F� y .p q UJ tl O W a d z o r W z Iz J - ' a p W N tl W a = a > Nz o c WW O 0 Cr W W cc tl zJaW r ° UaW a zH m z o z o x a W > W 0.cC O L. n J V y O 2 43 SERB-DSMT. BASEMENT 1 ST FLOOR 2ND FLOOR f 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR. STH FLOOR Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET X1 Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership Business Telephone Q 7 IB-6 8,7-110 5 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K NO ❑ If you have checked Yes. please Indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity❑ 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❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in abo plication are true and accuWe to the best of my knowledge and that all plumbing work and Installations performed under the permit iss f r this application will n mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. (/ BY Te of Ucense: Plumber Signature of Licensed Plumber or Gas CIM Title Gastiitter Master License Number 374"5 City/Town Journeyman APPP0VEffT0TFJ--CCETIsFo9[YF- BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION 1. FEE N0. APPLICATION FOR PERMIT TO,DO GASFITTING • ~�- NAME i4 TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIG NO. PERMIT GRANTED DATE GASINSPECTOR