HomeMy WebLinkAboutMiscellaneous - 1180 TURNPIKE STREET 4/30/2018 (2)91"INSURANCE
I FOREMOST"
GROUP
January 12, 2015
TOWN OF NORTH ANDOVER BUILDING DEPT
C/O BUILDING INSPECTOR
1600 OSGOOD ST. BUILDING 20 SUITE 2035
NORTH ANDOVER MA 01845
RE: Insured:
Claim Unit Number:
Policy Number:
Loss Date:
Location of Loss:
Subject:
Dear Town Officials:
Toll Free: (800) 527-3907
Email: myclaim@foremost.com
National Document Center
P.O. Box 268994
Oklahoma City, OK 73126-8994
Fax: (877) 217-1389
Xuan Truong
3002445353-1-1
0068620560
01/04/2015
1180 Turnpike St, North Andover, MA
Important Claim Information
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch, 139, Sec. 3b
This letter serves as 10 day notice that a claim has been reported involving loss, damage or destruction of this
property which may exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6 to apply. If
any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please notify us and
reference the insured, location, policy number, loss date and claim number.
On this date, we sent copies of this letter to the persons named above and copied the persons below at the
addresses indicated by first class mail.
If you have any questions, please call me at (401)787-5705.
Thank you.
Sincerely,
Foremost Insurance Company Grand Rapids, Michigan
John Crossley
General Claims Adjuster
john.crossley@farmersinsurance.com
(401)787-5705
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NORTH ANDOVER ,Mass. { .�
Building Location&90 �voP U , Permit
_ Owners Name ai
New '[] Renovation j] ' Replacement [ Flans SMbmitted II ' °;•
FIXTURES
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(Print or Type) Jl Check one. Certlf)ca
Installing Company Name ®d (� / �] Corp. "'.° .•
Address S7N Partner..:
0,)41C-` Z v -M - C) Firm/Co. 7f
Business Telephone
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Name of Licensed Plumber:�/, /O"� r
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box: `, N
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 cayerageS.
• Signature of ownerlagent of property Owner Agent.,_"
I bmbr certify that all of the details and information 1 leave submiUcd lot cntctcd) in alwavc application u 11ut�aid� als l0 Wt beat
k"wkdgc and that all plumbing walk and installations im(atnicd undo t'ermit icsucd for this applicstioa wiN M tam
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Title
City/Town:
.A0DR(1VF:n 70FF1rF USE ONLYI
Signature f•'Licensed Plumber''_'`
Tvpe of Plumbing Licen;/allo_�Urneym,"
License Number ❑ Master
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Date./ /� xrter. 7.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that.°�.� ................... .
has per.missi:on .to perform .. /Y. � ....................
plumbing in the buildings of ....... :..........................
at ........ , North Andover, Mass.
Fee..!; `..Lic. Nod.
PLUMBI G INSPECTOR
12/22/47 17:53 1 192.00 PAID
WHITE:. Applicant CANARY: Building Dept. PINK: Treasurer
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NO 785
APPLICATION FOR WATER SERVICE CONNECTION
North Andover, Mass. �r �� 19 ` -L-
®i n
Application by the undersigned is hereby made to connect with the town water main in i9 e�J/1l'�t _ Street,
subject to the rules and regulations of the Division of Public Works.
The premises are known as No. //70 1 l �� f ` Street
or subdivision lot no.
/" (kIC,
Owner
Address
Contractor pppll
t's Signature
[x5
PERMIT TO CONNECT \\WITH WATER
The Board of Public Works hereby grants permission to /y1"-' -e
to make a connection with the water main at
subject to the rules and regulations of the Division of Public Works.
Inspected by
Date
N
Street
Zogrof Public Works
By
See back for rules and regulations
RULES AND REGULATIONS GOVERNING THE INSTALLATION OF WATER SERVICES
1. No persons shall tap or in any way tamper with water mains which are part of the distribution system of the Town
of North Andover without a valid permit from the Division of Public Works.
2. All water services shall be installed a minimum of five feet below the finish grade.
3. No water services shall be backfilled without inspection by a representative of the D.P.W.—Telephone 687-7964.
4. Service connections shall be 1" type k copper tubing.
5. All fittings shall be brass flange type Mueller or equal
H 15202 Corporations
H 15212 Curb stops
H 15402 Three part unions
H 8185 stop and .waste valves
6. Curb boxes shall be installed at the property line and shall be of the Erie Type with 4'/2 foot rod and brass plug
type cover.
FORM U - VERIFICATION FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: I�' 1��51 a U ( _.off . /V G Phone28 •6Q8?' 31 OZ
LOCATION: Assessor's Map Number 7G Parcel 3
Subdivision Lot(s)
Street 5111eftl +4VNAIL<P il-&.4. 12-L a7' *St. Numberl0
********************** *Official Use Only************************
RECOMMEN ONS S:
Date Approved
Conservation Ad�i �s or Date Rejected
Comments
•
- C a4
own Planner
Comments
Food Inspector -Health
Z=z Z
Septic Inspector -Health
Comments
Date4proved�
Date Rejected
Date Approved
Date Rejected /
Date Approved 1619,q
Date Rejected
-,-
Public Works - sewer/water connections _�� 5)
- driveway permit_
t� Fire Depar ment tLe . �S `4- 69,1 064U101
V� R I -F, It iv" -1b Md-17-91/0-rj, le)/p ;7/-51�7
Received by Buil ing Inspector Date
GEORGE PERNA
DIRECTOR
TOWN OF NORTH ANDOVER, MASSACHUSETTS
DIVISION OF PUBLIC WORKS
384 OSGOOD STREET, 01845
/NORTIy
6. Q
O ft? A
ti
DRIVEWAY PERMIT
Date:
Telephone (508) 685-0950
Fax (508) 688-9573
ILOCATION: / ('7n T
,- 4 ni'� �� lok
BUILDER: phone:
OWNER: phone: 8,37 _ 31bZ
The North Andover Superintendent of Highway Utilities & Operations MUST be notified of the
grade and set -back from street established in any driveway entry onto any street or way maintained by
the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval
of such entry.
FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT.
■ Remarks:
Approval:
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