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Home My WebLink AboutMiscellaneous - 125 BOSTON STREET 4/30/2018 125 BOSTON STREET / 210tIO7.B-0043-0000.0 I I i Arnica Toll Free: 1-888-70-AMICA PO Box 9690 (1-888-702-6422) Providence, Rhode Island 02940-9690 Fax: 1-888-808-3057 AUTO HOME LIFE fi May 5, 2011 Town of North Andover Attn: Building Inspector North Andover MA 01845 s File Number: 60000899256 Date of Loss: 04/29/2011 Owner/Insured: Robert A. Deadder Street: 125 Boston St. Town: N. Andover MA 01845 Type of Loss: Water To Whom This May Concern: Please be advised that we insure the above named individual(s). A claim has been made for Damage to Real Property and as the insurer; we are presently in the process of adjusting the loss. We are mandated to comply with Massachusetts General Laws, Chapter 139 and as such, if there are any present liens on the above property, please notify us within 10 days of receipt of this letter. If we do not hear from you, we will be under no obligation to pay you any portion of this claim. Very truly yours, Megan Eckstrom AIC Claims Department 888-702-6422 x21131 MECKSTROM@AMICA.COM AMICA MUTUAL INSURANCE COMPANY AMICA LIFE INSURANCE COMPANY AMICA PROPERTY AND CASUALTY INSURANCE COMPANY AMICA LLOYDS OF TEXAS AMICA GENERAL AGENCY,INC. WEB SITE:WWW.AMICA.COM MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING ' (Print or Type) n OLoZe�C , Mass. oats 91-'Y—L20 Oa Permit# r Building Location �S to Owner's Name ,-� Type of Occupancy i NewA Renovation ❑ Replacement O," Plans Submitted Yes C No G, fx YW (A Z cc Ui W W a: O m Z OJ W H Q � _O ? 8 Z W CO 0 t-- w w O a W ~ W ¢ Lu C7 Lu U W = N w Q W p = c� Cr U' H Z -� P: Z W W U` O t1 U J H W Z W w X Q ¢ 2 a tr ¢ C0 O 8 w CC O W t- Q i O = LL 3 o 0 U X > o CL f- O SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 5TH FLOOR 7TH FLOOR 8TH FLOOR , Installing Company Name Check one: Certificate Address 29 1 qate ill n q/Corporation Sterlina 64A 015124 OR2 O Partnership Business Telephone 9 O Firm/Co. Name of Licensed Plumber or Gas Fitter G, y L INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes O No ❑ If you have checked y" es, please indicate the type of coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ t OWNERS 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: Owner ❑ Agent O Signature of Owner or Owner's 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 permit issued for this application will be in compliance with all pertinent provisions of the MassacAuSetts State Plu ing Code and Chapter 42 o the General Laws. By Type of License O Plumber Title IGasfitter nature of Licensed Plumber or as Fitter Master City/Town ❑ Journeyman License Number APPROVED OFFICE USE ONLY) __-_-=- t Date. . . . . ...r�. . . x NORTH TOWN OF NORTH ANDOVER O D - PERMIT FOR GAS INSTALLATION . 9 SSACMUSE.( This certifies that . . . . . . . . has permission for gas installation . . . . . . . .=.•. . . . ::--:-. . . . .... . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . North Andover, Mass. teeLic. No. . . . . . . . . . . . . . . . . . . . "•GAS INSPECTOR' i Check# 37 9 Date. . 9. Z- a� Of NO DT.t 1h o� TOWN OF NORTH ANDOVER ti D PERMIT FOR GAS INSTALLATION to 9 . 9 �9SSACM�•.Et< This certifies that .C;- -J+2r 01 A.N. �'� . . . . . . . . . . . . . . . . has permission for gas inls_tallation !) ��. .�`. . . . . . . . . . . . . in the buildings of `dig r at . . . oS 7�dN. . . . . . . . . . .. North Andover, Mass. Fee. .�? . Lic. No.F3.7. . . t GAS INSPE OH Check# 4123 7 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (((PPriint or Type) ; Mass. Date(f q �� 20 01 Permit# _ Building Location 1625 Q5&—>� Owner's Name adanc- Type of Occupancy New CYl Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No cc w vi UZ Q U7 U7 Cr �_ cr U) w U) Cr is O 0 m t_ = (n Z O w Q cc Cr Z Z) 0 = w � m Cl) Q W W O n- Cr W Q 2 Z O > W W W U) W Z Q = X jr W 2 W ~ � f- _ U) a U` 1-- Z -� F- Z W W O > W W J W J f- Z W w ¢ w Q � Q 00 O O w Cr O w I cC I = O c7 Z W Z) 3: o (D U a: > O W I— O SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR Y 8TH FLOOR Installing Company Nam�e ��Z � ✓�G� Check one: Certificate Address l) St d Corporation LUf° l vao0. ❑ Partnership Business Telephone P60—W— 9q5& ❑ Firm/Co / . Name of Licensed Plumber or Gas Fitter ► l Q�t e, 6o ldi� INSURANCE COVERAGE: I have a curvet liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. v i Yes No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy t Other type of indemnity ❑ Bond ❑ OWNERS 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: Owner ❑ Agent G Signature of Owner or Owner's 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 permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws, By Type of License J r2aster lumber Title asfitter Sig ature o censed Plumber or Gas Fitter 25 Cl [Town ❑ Journeyman License Number J APPROVED OFFICE USE ONLY)