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Home My WebLink AboutMiscellaneous - 2214 TURNPIKE STREET 4/30/2018Form of Notice of Casualty Loss to 'Building Under MASS. GEN. LAWS, Ch. 139, Sec. 313 To: Building Commissioner or Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Insured: Property Address Policy Number: Date/Cause of Loss: File or Claim Number: Judith A. Perline 2214 Turnpike Street PK2624 9/23/2010, Water Damage 23323-R 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. Ryan Werner 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. 14 y Signature,ind Date ANDERSON ADJUSTENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 n Date%l,--rl tioo� TOWN OF NORTH AND OV p PERMIT FOR PL ING NtSACHUS . .This certifies that ....:.:............ ... ........ ti ;has permission to performer'—- _.. plumbing in the buildings_o .. ..... ./�. s'.......,. at .11AC-2k'71. ................ . North Andover, Mass. Fee4... Lie. No. . . . . PLUMBING INSPECTOR 11103/98 11:47 15.00 PAID WHITE: Applicant. CANARY: Building Dept. PINK: Treasurer /L i ' 0'0-11/-5 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Mass. Date )' ®- °ri 19 Permit # a e - _ Building Location °� a q �v��K� Owner's Name 8 -es Type of Occupancy f , 2T, i e G' New ❑ Renovation ❑ Replacement Plans Submitted: Yeso N No - [3 WWuWWW:3SUBA JB—asmT. 1ST FLOOR 2ND FLOOR 3RD FLOOR 4THFLOOR STH FLOOR INESSINEN 6TH FLOOR NUNN MEN TTHFLOOR STH FLOOR Replacement Plans Submitted: Yeso No - [3 iNNSu■n■�un�n loom INNS INESSINEN NUNN MEN Installing Company Name �sstern Propane -Gas Inc Check one: Address 131 Water Street Corporation DAnVers. NA 01923 ❑ Partnership Certificate Business Telephone CS(�' = �-� n ClFirm/Co.Name of Ucensed Plumber or Gas Fitter c v\ Z� r`� INSURANCE COVERAGE: 1 have a curr t liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ 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: A Owner❑ Agent ❑ ' 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 Massachusetts State Gas Code and Chapter 142 of therm .(� By T&eofficense: •✓{ber St ature of licensed PluTitle tter er License Number City/Town neyman APPROVED US ON MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFI.TTING (Print or Type) In U V�t 'A Mass. Date be C 14 Permit # A 35 6 Building Location �`�1'�� Ve Sr Owner's Name 75-c—,FS Oe`v:, R Map: Lot: Zone: Type of Occupancy' G New ❑ Renovation Replacement ❑ Plans Submitted: Yes ❑ No Installing Company Name EASTERN PROPANE GAS INC Address 131 WATER STREET DANVERS MA 01923 Estimate Value of Work: Business Telephone '( 5 0 8) 774-1930 Name of Licensed Plumber or Gas Fitter C GCZC Qi• 1, c -(— Check one: Certificate Corporation ` ❑ Partnership Firm / Co. '�.e'I�::::II:�P.:: 'SSC:MMMMMMMMMMMMMMMMMMMMMMMMMMMN Installing Company Name EASTERN PROPANE GAS INC Address 131 WATER STREET DANVERS MA 01923 Estimate Value of Work: Business Telephone '( 5 0 8) 774-1930 Name of Licensed Plumber or Gas Fitter C GCZC Qi• 1, c -(— INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YesU No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy N Other type of indemnity 0 Bond ❑ 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 El Agent El 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 permitissued this plication will in plianoe with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gen al By Type of License: '� .� Plumber Sig ure of Licensed Plumber or Gas Fitter Title a Gasfitter Master 'cense Number City / Town Jourreyman APPROVED (OFFICE USE ONLY) ` Check one: Certificate Corporation ` ❑ Partnership Firm / Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YesU No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy N Other type of indemnity 0 Bond ❑ 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 El Agent El 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 permitissued this plication will in plianoe with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gen al By Type of License: '� .� Plumber Sig ure of Licensed Plumber or Gas Fitter Title a Gasfitter Master 'cense Number City / Town Jourreyman APPROVED (OFFICE USE ONLY) ` T m m o C m � O a A o z O T m a a � 9 m m r Q a N a m C 1 o T > O 1 � T o r Q T A I � O 1 C m I 1 O � = z r r I T m m i 9 m m r a 1 T > O 1 � I z o 1 T A I m C 1 N m I 1 O = 1 r I 9 a 0 Q a rn N N 2 N 9 • m A Commonwealth of Massachusetts W City/Town of NO. ANDOVER RECEIVE® a - System Pumping Record DEC o S 2009 Form 4 ;M TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Other for s NT information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. rab Henan A. Facility Information 1. System Location: 2214 TURNPIKE ST. Address NO.ANDOVER City/Town 2. System Owner: JUDY PELRINE Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ 11/21/09 Date Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No 5. Condition of System: 6. System Pumped'By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD MA State State Telephone Number 01845 Zip Code Zip Code — 2. Quantity Pumped: 1000 Gallons Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 11/21/09 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1