HomeMy WebLinkAboutMiscellaneous - 173 JOHNSON STREET 4/30/2018Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
To: Building Commissioner or
Inspector of Buildings
1600 Osgood Street
North Andover, MA 01845
RE: Insured: Lawrence & Deborah Kady and William & Nancy
Kady
Property Address: 173 Johnson Street
Policy Number: BBMMRM
Date/Cause of Loss: 4/6/2013, Water/Roof Leak
File or Claim Number: 27897-J
Claim has been made involving loss, damage or destruction of the above captioned property,
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 and claim or
file number.
Jim Taylor
On this date, I caused copies of this Notice to qe sent to the persons named above at the
addresses indicated above by First Class Mail.t ,
Sign
ANDERSON ADJUSTMENT CO., INC.
50 Nashua Road, Suite 303
PO Box 1098
Londonderry, NH 03053
LJ , .—
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING*'-/b s�
(Print or Type)
l NORTH ANDOVER Mass. Date a
W. Building Location/� j /Q��/I/�Q/!/ Permit #
Owners Name &0;r /
• New _ Renovation II Replacement Plans Submitted D
(Print or Type)
Installing Company
Address
Business Telephone:
l%
Check one: Cer ificate
[�KCorp.
Partner.
Firm/Co.
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 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 L1 Agent El
I hereby 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 aU plumbing work and installations pctfomtcd under Permit issued for this application wili-bqA compliance with all pertinent
provisions or tho Massachusetts State Cas Cade and Chapter 142 of the General Laws.
By YPE LICENSE:
Plumber
Title asfitter- ig ature of Licensed
City/Town: Masterr or Gasfitter
APPROVED (OFFICE USE ONLY Journeyman 2!jpjy,3
License- Number
V
MENEENEENNNENSIMMMEN
COURSE
NEES
mn�
MEMEEMENNOMMEMENNE
E01011
own
(Print or Type)
Installing Company
Address
Business Telephone:
l%
Check one: Cer ificate
[�KCorp.
Partner.
Firm/Co.
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 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 L1 Agent El
I hereby 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 aU plumbing work and installations pctfomtcd under Permit issued for this application wili-bqA compliance with all pertinent
provisions or tho Massachusetts State Cas Cade and Chapter 142 of the General Laws.
By YPE LICENSE:
Plumber
Title asfitter- ig ature of Licensed
City/Town: Masterr or Gasfitter
APPROVED (OFFICE USE ONLY Journeyman 2!jpjy,3
License- Number
1
Date.....................
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that .............................................
has permission for gas installation ............................
in the buildings of ..........................................
at .................................... North Andover, Mass.
Fee......... Lic. No........... ..........................
10/27/94 08:49 25.00 CA&SPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
y
Ll 03L
a
Bay State Gas Company
GAS INSTALLATION AUTHORIZATION
,gate a 6 _q Ll
Issued to
Address
For Installation of:
BTU Input
Restrictions
BSG Representativ
PERMIT ISSUED _ BY
INSPECTOR
L/))3L �
This Portion of Authorization To Be Returned to BSG.
Inspection Has Been Made of the Following Gas Equipment:
❑ Heating System (BTU Input ) ❑ Range
❑ Water Heater ❑ Clothes Dryer
❑ Room Heater
Location
All Work Has Been Done In Accordance With The Massachusetts
State Gas Code And Is Ready For Use.
INSPECTOR
NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES
BUSINESS REPLY CARD
FIRST CLASS PERMIT NO. 721 LAWRENCE, MA
POSTAGE WILL BE PAID BY ADDRESSEE
BAY STATE GAS COMPANY
ATTN: SALES DEPT.
55 Marston Street
Lawrence, MA 01840
Insurance Adjustment Service, Inc.
139 Billerica Rd
Suite A-1
Chelmsford, MA 01824
(978) 256-3334
Fax (978) 256-3354
UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 139 SECTION 3B
Date: July 3, 2006
TO: Town of N Andover
Board of Health/Building Inspector
N Andover, MA 01845
RE: Insured: Ruth Nelson
Property Address: 173 Johnson St
No Andover MA 01845
Date of Loss: 6/24/2006
Policy Number: BP02736246
Type of Loss: water
File or Claim Number: 34506
Claim has been made involving loss, damage or destruction of the above captioned property, which may either
exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6, to be applicable.
If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of the
writer and include a reference to the captioned insured, locations, policy number, date of loss and claim or file
number.
Thank you for your cooperation.
V ly yours,
Scott O'Neil
Adjuster
Ext. 129