HomeMy WebLinkAboutMiscellaneous - 115 MILLPOND 4/30/2018 (2) 115 MILLPOND
210/095.A-01 15-0000.0
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Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
To: Building Commissioner or
Inspector of Buildings
1600 Osgood Street
North Andover, MA 01845
RE: Insured: William Anderson
Property Address: 115 Mill Pond
Company: Union Mutual Fire Insurance Company
Policy/Claim Number: HOP0048060, CLM24078
Date/Cause of Loss: 2/15/2016, Water/Pipe Burst
Our File Number: 33259-R
Claim has been made involving loss, damage or destruction of the above captioned property,
which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER
143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS,
CHAPTER 139, SECTION 3B 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.
Ryan Werner, Ext. 116
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.
Signat hand Date
ANDERSON ADJUS ENT CO., INC.
50 Nashua Road, Suite 303
PO Box 1098
Londonderry, NH 03053
Cc: Health Department North Andover Fire Department
1600 Osgood Street 795 Chickering Road
Building 20, Unit 2035 North Andover, MA 01845
North Andover, MA 01845
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTING ` t
(Print or Type)
t NORTH ANDOVER Mass. Date
_ �uilding Location /s /)1,16-6 Arv17 Permit tl -)
Owners Name •L L
• - New Renovation Q Replacement Plans Submitted 0
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2ND FLOOR
3RD FLOOR
4TH FLOOR
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6TH FLOOR
7TH FLOOR
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(Print or Type) J Check one: Certifi to
Installing Company Name l�vd�}� /7i�r//'i,(� i�i� �,� Q Corp. o'
Address �i,��l6J "f - Q Partner.
��LsZL rj � Q Firm/Co.
Business Telephone:
Name of Licensed Plumber or Gas Fitter �� L CG�f��'—YX
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy P�T Other type of indemnity Q Bond Q
Insurance Waiver: 1 , the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
Signature of owner/agent of property Owner Q Agent Q
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 perforated under Permit issLed for this application will_be in compliance with ad pertinent
Provisions of the Massachusetts State Gas Code and Chapter 142 of tho General Laws.
By TYPE LICENSE:
Plumber
Title Gasfitter Signature of Licensed
City/Town:
Master Plumber or Gasfitter
9 y
Journeyman X39
APPROVED (OFFICE USE ONLY) Lie ease Number
S .e
Date. .. ...............
TOWN OF NORTH ANDOVER
Of NO. . ,
j 0 `p PERMIT FOR GAS.INSTALLATION
�9SSHCMUSEt� -
This certifies that . ..S . . . . :f. . .. . . . . . .k . . . . . . . . . . . . . . . . . .
has permission for gas installation . .%f . . . . . . . . . . . . . . . . . . . . . . .
in the buildings of 'r� {. . .'. . . . 4`. . . . . . . . . . . . ... . . . . . . . . . . . . .
at '. . . . . . . . . . % ... . .. . . . . . . . . . . . , North Andover, Mass.
Fee. ! . . . Lic. No.. }�y��
# 01/23/95 09:34 1 iNSP O'R
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File
J.
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type) 1
l NORTH ANDOVER Mass. Date -y
_ building Location /�j j�/ `j Permit # lG 7 '�-
.� - Owners Name
• New 77 Renovation E] Replacement Plans Submitted D
FIXTUP=I
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f I I I I I I
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BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
(Print or Type) / Checone: Certificate
Installing Company Name lO Corp. dj76
Address 'e6�� - Partner.
/ /, Firm/Co.
Business Telephone: 5 •-"Oy---/
Name of Licensed Plumber or Gas Fitter
Insurance Coverage: Indicate the type of insurance cove age by checking the
appropriate box:
Liability insurance policy ET"'Other type of indemnity Q 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 coverages.
Signature of owner/agent of property Owner U Agent El
1 hereby certify that ail of the deuils and information I have submitted (or entered)in above application are true and accurate to the best of my
knowledge and that aU plumbing work and Installations petfomud under Permit issued for this application will-be in compliance with all pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. ..
By TYPE LICENSE:
Plumber
Title Gasfitter SignaE re Licensed
City/Town: Master Plumber Gasfitter
Journeyman
APPROVED (OFFICE usE.ONLY) Lic6nslyNumber
r
e
j
Date,f. ..... .. .............
• , +fr
'
,ORT ry TOWN OF NORTH ANDOVER
ti
?per61 6
1ti OA
PERMIT FOR GAS INSTALLATION
I' ,SSACMUSEt
This certifies that . . . . . .'. . . . . . . . . . . . .f . . . . . . . . . . . . . . . . . . . . .
has permission for gas installation .•!..°. . . . . . . . . . . . . . . . . . . . . . . .
in the buildings of .:t. . . . . . . . .: ... . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . . . . . . . . . . . . . . . . . . . . . . . , North Andover, Mass.
Fee. .! .?-. . . . Lic. No. . . . . . . . . . . . . . . �. . t.
12/08/94 08;44* 15.00 AS INSPECTOR
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File