HomeMy WebLinkAboutMiscellaneous - 166 GRANVILLE LANE 4/30/2018 166 GRANVILLE LANE j
210/106.C-0075-0000.0 f
3564 TRAVELERS J�
The Travelers Indemnity Company
P.O. Box 1450
Middleboro, MA 02344-1450
03/17/2016
City of North Andover Building Inspector
120 Main Street
North Andover MA 01845
Insured: Louis G Maglio
Claim Number: HYS1388
Policy Number: OMR617-947129720-633 -1
Date of Loss: 03/15/2016
Loss Location: 166 Granville Ln North Andover MA
To: Board of Selectmen
Building Commissioner
Inspector of Buildings
Board of Health
A claim has been made involving loss, damage or destruction of the above captioned property
which may either exceed $1,000 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 my attention and include a reference to our insured, the policy
number, the claim/file number, the date of loss, and the location.
If you have any questions, please feel free to contact me at (508)946-6643 or email me at
VDAVIDSO@travelers.com.
Sincerely,
Victoria Davidson
Claim Professional
(508)946-6643 Ext. 9466643
Fax: (877)786-5584
Email: VDAVIDSO@travelers.com
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.
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d" MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTING
(Print or Type)
NORTH ANDOVER Mass. Date .�
�uilding Location /� 6r�! C� Permit # 13 3
.� Owners Name tau -
• New Renovation Replacement Ej Plans Submitted D
FIXTURES
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IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR '
5TH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
(Print or Type) Check one: Certificate
Installing Company Name Corp.
Address / Q f /17 Partner.
Firm/Co.
Business Telephone:
Name of Licensed Plumber or Gas Fitter
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy Other type of indemnity Q Bond
Insurance Waiver: I , the under • ed, 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 U Agent El
i heteby certify that all of the details and information 1 have submitted (or entered)in above application are true and accurate to the best of my
knowledge and that ata plumbing work and lnsgUations perforated under Permit iuued for this application will-be in compliance with all pertinent
provisions of tho Massachusetts State Cas Code and chapter 142 of the General Laws.
By TYPE LICENSE:
er
Title10/
Plumb asfitter Si ature of Licensed
City/Town: Master Plum er oGasfitter
Journeyman
APPROVED (OFFICE USE ONLY) L i:eA�RNmber
Date. . . . ' .. . . . . . ..I. .. :...
„ORT" TOWN OF �LQADIOVEP
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O PERMIT FOFVGAS INSTALLATION
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This certifies that . . . .I�.t: .;!!. .-. . . . Jr�. . . . . . . . . . t . . . . . .'
has permission for gas installation ..y% y` /. . . . . .. . . . . . . . . . . . .
in the buildings of.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
�.r
at . . . . , !.�f. . . . ... .+. . , North Andover, Mass.
Fee. . .!_ . . . Lic. No.!C•,/. j. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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, � ' GAS INSPECTOR
WHITE:Applicant CANARY: Building Ddpt. PINK:Treasurer GOLD:File