HomeMy WebLinkAboutMiscellaneous - 20 PLEASANT STREET 4/30/2018, el
Insurance Adjustment Service, Inc.
936 Roosevelt Trail Unit 5
Windham, Maine 04062
207-892-0522
Fax 207-892-0526
UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 139 SECTION 3B
Date: April 27, 2011
TO: Board of Health/Building Inspector
RE: Insured: Cheryl Mayr
Property Address: 20 Pleasant St.
No. Andover, MA
Date of Loss: 4/16/2011 NAY � h �(� 1 �
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Policy Number:
Type of Loss:
File or Claim Number: 72421
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. 38 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.
Very Truly yours,
Matt Martin
Adjuster
Ext. 109
Date .0 . . .
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
-%W� /
This certifies that
has permission to perform .-`-�!-�..•:,-/a"%= .......... .
plumbing in the -buildings of ...."?`'`�tJ............... .
.......... ........ North Andover, Mass.
Fee ..... Lic. No:7: '� 4?. \/cry-�!�� /
�\ PLUMBING INSPECTOR
Check #'
t
4
MASSACHUSETTS UNIFORM APPLICA
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location
'gg19i-17— Jj Owners Name e
N FOR PERMIT TO DO PLUMBP 1,
Date 2 1/16 ^%
Permit # �^
Amount
Type of Occupancy
NewRenovation Replacement ® Plans Submitted Yes No 1:1El
FIXTURES
(Print or type) p
Installing Company Name HA L to R69 �/ 1 L UM 6r'rU G
Address $a� 1ze S,)—
A&&'
,TNen Tr7 "/eD!/G
Check one: Certificate
El Corp.
ElPartner.
11 Firm/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy ® Other type of indemnity BondEl
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 El 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 Plumb]_ ng Code and Chapter 142 of the General Laws.
By SignaLure or Licensea rtumner —
Type of Plumbing License
Title yBJ�
City/Town Mcense 1,45MM-7 Master Journeyman
APPROVED (OFFICE USE ONLY .
�-V
7C
"4 r�
Date.., -P --:,7:1l7.... .
of TOWN OF NORTH ANDOVER
1-
4.
PERMIT FOR GAS INSTALLATION
This certifies that
has permission for gas installation—,, �.. .......
in the buildings of.......... .............................
. .
atm..L!5 ......... North Andover, Mass.
...................
Fe..Lic. Nor��R-1-3.
..........
Check#
,v ASSACHL;SEM UNUDRNI APFUCATON FOR PERM TO DO GAS FTrnNG
(Type or print) Date 2 Zlje
NORTH ANDOVER, MASSACHUSETTS
Building Locations ® PL S 5 Aqui S -T Permit #
Amount ZC�
J' e qm LM Owner's Name
New Renovation ❑ Replacement Plans Submitted 0
1:1 F91
(Print or type) ClleQk one: Certificate Installing Company
Name r//Q� O/A/�/✓ /OGU/a1t�/ /?✓�� Corp.
Address 8d G %J)9`4E' Sf Partner.
"Ve"f Tr! 1)N 0,-vz5,L '" 4 dry y 5�
Business Telephone 6y5-- 915—e �/ E] Firm/Co.
Name of Licensed Plumber or Gas Fitter %1110104' '
INSURANCE COVERAGE • Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes Ga No[],
If you have checked yt�s, please indicate the type coverage by checking the appropriate box.
Liability insurance policy ® Other type of indemnity 0 Bond 0
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
t 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 Gas Code and C apter 142 of the General Laws.
�41 r l
by:
Title
City/Town
APPROVED,CFFTE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber
Gas Fittertc>✓ e e Hurner
Master
Journeyman
�6,
7TH. ]FLOOR
(Print or type) ClleQk one: Certificate Installing Company
Name r//Q� O/A/�/✓ /OGU/a1t�/ /?✓�� Corp.
Address 8d G %J)9`4E' Sf Partner.
"Ve"f Tr! 1)N 0,-vz5,L '" 4 dry y 5�
Business Telephone 6y5-- 915—e �/ E] Firm/Co.
Name of Licensed Plumber or Gas Fitter %1110104' '
INSURANCE COVERAGE • Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes Ga No[],
If you have checked yt�s, please indicate the type coverage by checking the appropriate box.
Liability insurance policy ® Other type of indemnity 0 Bond 0
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
t 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 Gas Code and C apter 142 of the General Laws.
�41 r l
by:
Title
City/Town
APPROVED,CFFTE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber
Gas Fittertc>✓ e e Hurner
Master
Journeyman
�6,
Location r� L �-S /07
No. 12-(, Date 1/hf
r
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
�IvE® Pgf%TConnection Fee
$
Water Connection Fee $
��QTAL $
pP�
No. Andover collector
512J
Building Inspector
Div. Public Works
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Town of North Andover
BUILDING DEPARTMENT
Homeowner License Exemption
(Please print)
DATE 41201q
JOB LOCATION
Number Street Address Section of town
'HOMEOWNER" Kathryn Latourelle 682-2867
Name Home Phone Work Phone
PRESENT MAILING ADDRESS -2 n- Pi oa�qant: Rt-,_
01845
City Town State Zip code
The current exemption for "homeowners" was extended to include owner
occupied dwellings of six units or less and to allow such homeowners to
engage an individual for hire who does not possess a license, provided
.that the owner acts as supervisor. (State Building Code, Section 109.1.1)
DEFINITION OF HOMEOWNER:
IPerson(s) who owns a parcel of land on which he/she resides or intends to
',reside, on which there is, or is intended to be, a one to six family dwell-
ing, attached or detached structures accessory to such use and/or farm
structures. A person who constructs more than one home in a two-year
period shall not be considered a homeowner. Such "homeowner" shall submit
to the Building Official, on a form acceptable to the Bulding Official,
that he/she shall be responsible for all such work performed under the
building permit. (Section 109.1.1)
The undersigned "homeowner" assumes responsibility for compliance with the
State Building Code and other applicable codes, by-laws, rules and
regulations.. _
The undersigned "homeowner" certifies that he/she understands the 'Town of ---
North Andover Building Department minimum inspection procedures and
requirements and that he/she will rnply with said procedures and
requirements.
'HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING OFFIC
Note: Three family dwellings 35,000 cubic feet, or larger, will be
required to comply with State Building Code Section 127.0, Construction
Control.
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Location',��`
No. / 55 4- Date
N°"T"
TOWN OF NORTH ANDOVER
3? • _ • �L
A
Certificate of Occupancy $
*
Building/Frame Permit Fee $
+� ,ssACMUSEt�
fidation Permit Fee $
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Other Permit FeeO?z-Vv $ 7-0""`
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eower Connection Fee $
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"l�o� Sim Building Inspector
Div. Public Works
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In accordance with the provisions of NIGL c 40, S 54, a condition of Buildinl; I'cri,rit
Number �is that the debris resulting from. this work shall be
disposed of in a roperly licensee! solid waste disposal facility as dclincd by I.EGL c l ll, S
150A.
The debris will be disposed of in:
h
(Location f Facility)
i
S' atute of l'ctntit Al,�,licant --
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector.
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OFFICES OF:
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Town Of
APPEALS
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NORTH ANDOVERNo
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BUILDING
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CONSERVATION
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HEALTH
PLANNING
PLANNING
& COMMUNITY DEVEsLOPl111?NT
KAREN I I.P. NIA-SON, I ARFI : l ()Ii
In accordance with the provisions of NIGL c 40, S 54, a condition of Buildinl; I'cri,rit
Number �is that the debris resulting from. this work shall be
disposed of in a roperly licensee! solid waste disposal facility as dclincd by I.EGL c l ll, S
150A.
The debris will be disposed of in:
h
(Location f Facility)
i
S' atute of l'ctntit Al,�,licant --
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector.