HomeMy WebLinkAboutMiscellaneous - 117 PLEASANT STREET 4/30/2018 v
y .
N �
,�
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: Donald &Alice Phair
Property Address: 117 Pleasant Street
Policy Number: H012205626
Date/Cause of Loss: 11/1/2014 Water/Roof Leak
File or Claim Number: 30455-M
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.
Mike Peterson
On this date, I caused copies of this Notice to bg sen ersons named above at the
addresses indicated above by First Class Mail
Signature and Date
ANDERSON ADJUSTMENT CO., INC.
50 Nashua Road, Suite 303
PO Box 1099
Londonderry, NH 03053
I
i
Date.. ..'. . .. . . �. .. ..
Of HO oTN 9h
or TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
�9SSACMUSEt,(
This certifies that . . :. . . .:`. . . . . . . . . . . . . . . . . .
has permission for gas installation . . . . . . . . . . . . . . . . . . . . .
Vin the buildings-of . . . . . k:.):. . ..... . . . . . . . . . . . . . . . . . . . . . . . . .
at . . 0� . `�-:' -. . ...... .:�. . . . . . North Andover, Mass.
f Feed.�. . .�' . . Lic. No.. '� . . .� ; IL :. . . . . . . . . . . .
4 Gkv S PECTOR
Check#
4L 53
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
rn
Ve
4n Mass. Date G2c22- - Permit *
Building LocationOwner's Name!UL/ -
V, Awjo1�-4Type of Occupancy 1 I-)N T1 r
New ❑ Renovation ❑ Replacement Plans Submitted: Yes❑ No ❑
rC
y W
N N V s-
y cc N Q O j. to
W J yW 0 O m ~ .� = y
z o W 4 ¢ a}e a a
_ 1- y O c > W
V W y t CO
W W y W 2 < x S Q W fC W
J W O > U. F- V J
Y < W 0: W Z. < x < i O O W O lil F-
cc x o d x u. 3 0 0 s > o a ►- o
SUB—BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6THFLOOR
7TH FLOOR
i 8TH FLOOR
stalling Company Name 'j Ci AE(Z T A . `Aln Al T A�Q Check one: Certificate
Address 3� CLQ C H ih A ry yIK[. ❑ Corporation
Ili E T H U E 0 01 A - U l F q(4 ❑ Partnership
Business Telephone 1-79-71' 2—irm/Co.
Name of Licensed Plumber or Gas Fitter '�R o jE 2 T A• 5 A M n tg i r<1�o
INSURANCE COVERAGE:
I have a current I" biltty insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142..
Yes &r No ❑
If you have checked ve, please indicate the type coverage by checking the appropriate box
liability insurance policy 0"' 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 performed under the Vn
for thiapplication ' be in compliancewith all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 oaws.fay a T of license:*JI
ber cons u or fitter
Title flet
er License Number 9333
City/Town rneyman
0
1C NL
I
BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCNES PAOGAESS INSPECTION
FEE
NO,
APPLICATION FOR PERMIT TO DO GASFITTING
. i
« I
NAME A TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER OR GASFITTER
LIC. NO.
PERMIT GRANTED
DATE
GASINSPECTOR