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Home My WebLink AboutMiscellaneous - 124 Kingston Street �I i I i j f i ' Ir i i ; 'I i f I' i f i l ' s MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston,Massachusetts 02108-1904 (617)723-3800 Ma Only(800)392-6108,FAX(800)851-8424 3/4/2015 Form of Notice of Casualty Loss to Building Under Mass.Gen.Laws,Ch.139,Sec.36 NORTH ANDOVER HEALTH DEPT. NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 Re: Insured: JOYCE DECRISTOFORO Property Address: 124 KINGSTON STREET,NORTH ANDOVER,MA 01845 Policy Number: 1294353 Type Loss: Ice Dams Date of Loss: 03/03/2015 Claim Number: 333126 Claim has been made involving loss,damage or destruction of the above captioned property,which may either exceed$1000.00 or cause Massachusetts General Laws,Chapter 143,section 6 to be applicable. If any notice under Massachusetts General Laws,Chapter 139,Section 313 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. MPIUA Claims Division CMA00021 Date. N2 f. 2 *L 7 TOWN OF NORTH ANDOVER 3?°•,, '. '��°oma PERMIT FOR PLUMBING ,SSACHUSE� This certifies that . . . . . . . . . . . . . . . . . . has permission to perform . . . .. .. . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . at . 12 . .: .r: /E. . . . .!}. . . , North Andover, Mass. Fee. t .'. . .Lic. No.,�/.f. .F.`.� . . . . . . .�_. . .G . ... . . . . . . PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO UMBING (Type or print) � V t NORTH ANDOVER,MASSACHUSETTS /2 C � _ Date Building Location oZ`i ��1 n S.Q Sta S � Owners Name �l P(/ Permit# OZ n Amount ?J Type of Occupancy qz C S)J e N e(? New ® Renovation ❑ Replacement EL Plans Submitted Yes El No FIXTURES rA 04 z w a W H w a z En 7 x w w a (� A � x a F d w w a 4 �BgVIC M FIOQZ r ZN�flim 1 �d.1 FIOQt 4IH flOCI 2 5M HIM 6IH FIDQt 7IH flaR SII3 HBM (Print or type) Check one: Certificate Installing Company Name \,jT ''I, ❑ Corp. Address �1 6�rC SSS 'CA Cur-��P 1 tC'l r/ M1� CJ) g�D ® Parhier. Business Telephone /—`] / 2 L/ 5'-/ 7 Q Firm/Co. Name of Licensed Plumber: Ve U Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy M Other type of indemnity Bond X\J ❑ 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 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbibi/yJg/��yl�ode and Chapter 142 of the General Laws. By: Sgaturof LIcensea FOUR Type of Plumbing License Title City/Town i7cense MUMMY Master ® Journeyman ❑ APPROVED(OFFICE USE ONLY Date. NORTfj TOWN OF NORTH ANDOVER Of ,41 oA PERMIT FOR GAS INSTALLATION . 4 . "S CH This certifies that . . t . . . .. . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . in the buildings,of at l:?;1 ,!`��-- '. :. . . . . . .f. . . . .. . . . North Andover, Mass. Fee. . . . . . Lic. No, LL . :. . . . . . . . . . ' 'GAS INSPEcR v WHITE:Applicant CANARY:Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING 4.5"'y (Print or Type) NO2x14 A N'I�/el? , Mass. Date 1 a 19 Permit # � 5� Building Location..n�Z Gtr N 6,,S--7'Q/1) -S Owner's Name�M 0A L7� /h ALL-rt4 A/J po-yfL I-A IA 0 t ws Type of Occupancy--B ES1 -DC7 N T i P L New ❑ Renovation ❑ Replacement 2 Pians Submitted: Yes❑ No O N fr! ¢ Y W H W W V Z ¢ m F- W W ¢ O V mF- = 911 tl = u ~ < Co_ o W o < o z ►- < m W y W O rs c s ¢ W < 1� N < W faW S Z O W W Z ¢ W C WW JU tl F Z J_ I' Z F W W CC tl O > U. t- J ¢ Z < W W ` O O W ¢ 00 1#j x ¢ = O tl Y W 3 O tl J V C > O rL H O SUB-8SMT. BASEMENT 1 ST FLOOR 1 2ND FLOOR ' 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR TTHFLOOR STH FLOOR Installing Company Name "l r'!r;=(Z T A • 7--AM MA T 0 r20 Check one: Certificate AddressC�nA C H�v►A ry ` i ❑ Corporation M " T H Ue rJ 01 rl U 1 y ❑ Partnership Business,`Telephone /� 2 -9 9"7 f- 2- Firm/Co. Name of Licensed Plumber or Gas Filter -'Ro(AF-P-T INSURANCE COVERAGE: I have a current fyablltty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes L�e' 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 ❑ 1 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 pe ' � ed for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ne Laws. BY T of License: Plumber %-WhAture of Ucbnsed Plu _. or atter Title tter er License Number X333 City/Town Journeyman (OFFICEONLY) BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE N0. APPLICATION FOR PERMIT TO DO GASFITTING NAME S TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR OASFITTER LIC. NO. PERMIT GRANTED DATE OASINSPECTOR Date. .tom.`. . . . . . N° 4 t, ".�.T:��- TOWN OF NORTH ANDOVER �? 0 ° p PERMIT FOR PLUMBING .,SSACNUS� i f_l 1;-is certifies that : . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perfo m)�=^ ?'"` j . . . . . . . . . . f` plumbing in the uild fgs of . .._. . : .`.t; /. . . . . . . . . . . . . . . . . . at .ci : . , North Andover, Mass. Fed. . . . . . . . .Lic. No.. . . . . . . . . e . . . . . . . . . . . . . . f PLU`Bd'G INSPECTOR Check # � WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS S Building Location s � � Name �411 C� Permit# 0- B g Amount Type of Occupancy .New Renovation Replacement Plans Submitted Yes No FIXTURES w w x a Q a E~ w N U d Q w x w a a x ' a a x a a F d w w Q a Q a H a a a a SMBM B�glv�ru' i` M Him ZKl HBM 3M H-OCR 41H FIOQt 5M HO(R sf Hj0CR 7]H HDM 91H FLOOR (Print or type) Check one: Certificate ,installing Company Name ,,,[ -t° Corp. Address S/ ti Partner�Co- Signature 6 Business Telephone i Name of.Licensed Plumber: � Insurance Coverage: Indicate the of insurance coverage by checking the ap nate box: ❑ Liability insurance policyET Other type of indemnityLj 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 Owner Agent I hereby certify that all of the details and information I have submitted •r entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations p ed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa to iu ing Code and Chapter 142 of the General Laws. d By: rgna o rcens Type ofPlumbin i nse Title3 C City/Town rcense um r Master � Journeyman APPROVED(OFFICE USE ONLY Date. . ` N2 4493 TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING �SsAcHUS This certifies that t has permission to perform plumbing in the buildings of - . . .. at . '. . . . . c . . . . . , North An�d'over, Mass. w Fee.-QIP7,�/ Lic. . . . . . . :..:- . . . . . . t' . [� PLUMBING INSPECTOR CheclE WHITE: Applicant CANARY: Building Dept. PINK: Treasurer �?7 06 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Mass. Date' 2D_j Permit # Building Location/��! �� wnet's Name �X %� �/ Type of Occupancy New Renovation ❑ Replacement ❑ Plans Submitted: Ye No ❑ B.P .# SEWER# FIXTURESSEPTIC# z .. rn z x a N to o z �- °J W Y J N > V Q� N j C7 W N N ZW F- W cc = W D N ? O z y a. �t a -j N ; y N Z Q 1.•. o N Y Q LL H = a z V cc W O O Q N W Cr 2 Q W ? O Q N Z dAr 44 �\ S Z = Yd t > O z O o W LL Y < F- N rA N ~ N Z Z W f' O U ? Q (Q a Q z Q J Y J m N O O 3 O SU8—gSMT. BASEMENT 'f Q 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Co mpa y eck one: Certificate # Address - Corporation ❑ Partnership Business Telephone ❑ Firm/Co. Name of Licensed Plum-ger INSURANCE C ERAGE: I have a e liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Y No ❑ rCIf you h check �, please dicate the type coverage by checking the appropriate box. Aaliability 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'sAgent Owner ❑ Agent ❑ I hereby certify that all of the details and information ave submitted(or tered)in above application are t and to to the best of my knowledge and that all plumbing work and install ns performed and a ermitissued this ap a an er op' n e i mpliance with all pertinent provisions of the Massachusetts State e Genera La [By e gnatur f cense lumber 7 /Town Type of License: Master❑ Journeym C� ROyEpOFFIC USE ONLY) License Number � .� `v BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES i PROGRESS INSPECTIONS FEE y NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME do TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE -Z9 PLUMBING INSPECTOR , Date. ......I...`"....... ,&ORT" TOWN OF NORTH ANDOVER of „to ,,�tio F? • �A PERMIT FOR GAS INSTALLATION �,SSACMUSEt This certifies that . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation !�� . .�f . . . . . . . . . . . . . . . . . . in the buildings of . ..... . . . . . . . . . . . . . . . . . . . . . at n e . . . . . . . . , North Andover, Mass. Fee. ./.a.. . . Lic. No../�.' . C. .. .%. . , . . . . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer MAP e W PARCEL a � d MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS G V `(Type or print) Da NORTH ANDOVER,MASSACHUSET TS Q Building Locations / �'r� ` 1/00 Permit' Permit# 3 L Amount$ Owner's Name �� New ElRenovation ❑ Replacement �' Plans Submitted ❑ z F a Z Z O z W �a C O F- w d S W °r oa > d w D L� G7 W ] eZC F t/�� O Z C Z W y w Q W > W O Z Q C ¢ O O W C O W F CCCC S O G7 x w 3 A C7 U C > SUB-BASEM ENT B A S E M ENT 1ST. FLOOR /( 2ND. FLOOR 3RD. FLOOR V 4TH. FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or typ Cone: Certificate Installing Company Name Corp. �.✓ �- r Address ' ❑ Partner. 6 70-7 Business Telephone — 5 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter )qtit do /aL :�J± I A-9 a i INSURANCE COVERAGE Check e: I have a current liability Insurance policy ori ' ubstantial equivalent. Yes No❑ If you have checked yg&please indi a 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 installaf s ed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts d Cha General Laws. By: Si re of Licensed Plumber Or Gas Fitter Title Plumber �2 City/Town ❑ Gas FitteriLicense Number er 1APPROVED(OFFICE USE ONLY) ❑ Journeyman