HomeMy WebLinkAboutMiscellaneous - 23 WRIGHT AVENUE 4/30/2018LaMarche Associates
5 North Road, P.O. Box 250
Chelmsford, MA 01824
800-349-1525
Fax: 978-256-8590
February 25, 2015
Building Commissioner/Inspector of Buildings
NORTH ANDOVER, MA 01845-1511
Board of Health/Board of Selectmen
NORTH ANDOVER, MA 01845-1511
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 $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be
applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate,
please direct it to the attention of the writer and include a reference to the captioned insured,
location, policy number, date of loss, cause of loss and LA file number.
Insured: ANTHONY FORZESE
Loss Location: 23 WRIGHT AVE
NORTH ANDOVER, MA 01845-1511
Policy Number: HP278542
Date of Loss: 02/19/2015
Cause of Loss: Water
LA File Number: MA -2-26833
On this date, I caused copies of this notice to be sent to the persons named above at the addresses
indicated above by first class mail.
Kevin Charlton
Adjuster
LaMarche Associates, Inc. - 800.349-1525
Page 1 of 1
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PERMIT FOR GAS INSTALLATION
This certifies that ...... & .............. ......................
has permission for gas installation ..........
in the buildings of
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at . ao ... 4A ..... :": .......... North Andover, Mass,
Fee. Lic
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Check # 1
4118
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
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Building Location.. /�i(/ Owner's Name )qR$LSE
Type of Occupancy �S 4epX44a
New ❑ Renovation ❑ Replacement Plans Submitted: Yes❑ No ❑
Installing Company Name BAY STATE GAS COMPANY
AddrCss 55 MARSTON STREET
LAWRENCE, MA 01840
Business Telephone -68,7-1105
Name of Licensed Plumber or Gas Fitter Pran(-i c X- rnrkary
Check one:
X3 Corporation
❑ Partnership
❑ Firm/Co.
Certificate #
1862
INSURANCE COVERAGE:
have a current 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 X 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:
Signature of Owner or Owner'sAgent Owner[] Agent ❑
1 hereby certify that all of the details and information I have submitted (or entered) in abo plication are true and accu�gte to the best of my
knowledge and that all plumbing work and Installations performed under the permit Iss f r this application will n mpliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. U i
Type of License:
Title Plumber Signature of Licensed Plumber or Gas
Gasfitter
City/Town
Master License NumberAPPPOVF
.Journeyman
O IC SE ONLY
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Installing Company Name BAY STATE GAS COMPANY
AddrCss 55 MARSTON STREET
LAWRENCE, MA 01840
Business Telephone -68,7-1105
Name of Licensed Plumber or Gas Fitter Pran(-i c X- rnrkary
Check one:
X3 Corporation
❑ Partnership
❑ Firm/Co.
Certificate #
1862
INSURANCE COVERAGE:
have a current 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 X 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:
Signature of Owner or Owner'sAgent Owner[] Agent ❑
1 hereby certify that all of the details and information I have submitted (or entered) in abo plication are true and accu�gte to the best of my
knowledge and that all plumbing work and Installations performed under the permit Iss f r this application will n mpliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. U i
Type of License:
Title Plumber Signature of Licensed Plumber or Gas
Gasfitter
City/Town
Master License NumberAPPPOVF
.Journeyman
O IC SE ONLY
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