HomeMy WebLinkAboutMiscellaneous - 125 SUTTON HILL ROAD 4/30/2018 / 125 SUTTON HILL ROAD
210/060.0-0073-0000.0
I
LaMarche Associates
5 North Road, P.O. Box 250
Chelmsford, MA 01824
800-349-1525
Fax: 978-256-8590
April 9, 2015
Building Commissioner/Inspector of Buildings
NORTH ANDOVER, MA 01845
Board of Health/Board of Selectmen
NORTH ANDOVER, MA 01845
NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B
Claim has been made involving loss, damage or destruction of the property captioned below, which
may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be
applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate,
please direct it to the attention of the writer and include a reference to the captioned insured,
location, policy number, date of loss, cause of loss and LA file number.
Insured: LEV &SVETLANA ZINLAND PUKHOVITSKY
Loss Location: 125 SUTTON HILL RD
NORTH ANDOVER, MA 01845
Policy Number: PHD0044814N1301
Date of Loss: 03/20/2015
Cause of Loss: Water
LA File Number: MA-2-28661
On this date, I caused copies of this notice to be sent to the persons named above at the addresses
indicated above by first class mail.
Chris Norton
Adjuster
LaMarche Associates,Inc.-800-349-1525
Page 1 of 1
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING t�-
(Print or Type)
NORTH ANDOVERMa s. Date
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-eC Owners Name81
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3 New .Renovation Replacement Plans Submitted
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IST FLOOR
2ND FLOOR
3110 FLOOR
4TH FLOOR
STH FLOOR
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6THFLOOR
7TH FLOOR
8TH FLOOR
(Print or Type) Check one: Certificate
Installing Comp ny Na I Corp.
Address r - � Partner.
Ea Firm/Co.
Business Telephone:
Name of Licensed Plumber or Gas Fitter CeV-t,e--,$ /L/1/4
Insurance Coverage: Indicate the type of iisurance coverer e by checking the
appropriate box:
Liability insurance policy 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 Agent
1 hcreby certify that all of the details and information f have submitted (or entered)in above application are true and accurate to the best of my
knowledge and tttat all plumbing work and installations performed under Permit issued to: this application will be in compliance with all:pertinent
provisions of tho Massachusetts State Cas Cude and Chapter 142 of tho Genera!L►ws.
By TYPE LICENSE:
Plumber
Title Gasfitter ignature of Licensed
City/Town- Master Plumb Qr ,Gasfitter
Journeyman �Cf
APPROVED (OFFICE USE ONLY) License- Number
s
Date.. . . . . . .. ... . .. . . . .. .
NORTH TOWN OF NORTH ANDOVER
pF t��ao ,67'40
0 ya a pA PERMIT FOR GAS INSTALLATION
�9SSACHUSE�
This certifies that . . . . . . . .'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
has permission for gas installation ... . . . . . . . . . . . . . . . . . . . . . . . ... .
in the buildings of . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . .
at . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass.
Fee. :. . . . . . . Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GASINSPECTOR
WHITE:Applicant CANARY: Building Ddpt. PINK:Treasurer GOLD:File