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HomeMy WebLinkAboutMiscellaneous - 245 BRENTWOOD CIRCLE 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: Property Address: Policy Number: Date/Cause of Loss: File or Claim Number: Robert & Vivian Pangione 245 Brentwood Circle HP0154898 7/15/2013, Toilet Overflow 28260-W 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. Wade Anderson 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. ,, -,1,41, i ature and Dat ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 73`!4 w "ORTM O ; 9 SACMUSE4 Date.../. `.� . !.� ..... TOWN OF NORTH ANDOVER PERMIT FOR GAS II This certifies that ...0.4 � �. ./�....... . has permission for gas installation (11K .Q ......... in the buildings of ............ at Lt`s.. ,rwQ. P,���t . _ ,North Andover, Mas. Fee. �? �.r . Lic. No.. ...`��... . GAS INSPECTOR Check # 7 �� 17, C FIXTURES ILLI MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING Cit own, MA. Date: hS_ a Permit# Building Location:Oc __/o d.+yf �/Il!/flad / it Owners Name: fjk Q I1 OrJ I Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ ReplacementY Plans Submitted: Yes ❑ No W_ FIXTURES ILLI W Y tri = Z D Lu m x0 0-1 U W - 0 Op QQ W W Z o I- W cn W z 9 O m o W Q z a Q: L'D 0 t- O w n X m> W W a z W W W z t" w rn x W o� W x z x w o: > z U W W Z >. W O 0 J J H Q F Q O m z J W O o z u_ O~ m W 2 H W h- W G 0 o o LL 0 i= O a W H>>> 3 O b`kiaB9M�. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8Tm FLOOR Check One Only Certificate # �l Installing Comany Name: r Work Q Corporation Address/�J� FCla t`� City/Town: p State: ❑Partnership /� �- Business Tel: !ZN la� � � �% Fax: 7 �-Crj �- ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: 5- ' INSURANCE COVERAGE: 11 I 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 indi to the type of coverage by checking the appropriate box below. 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Siqnature of Owner or Owner's Aaent By checking this box ❑;1 hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations perf med under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code a9dZhapter 142 of the . n ral�,aws. Tyne of License: By plumber Titre Gas Fitter Sign r i used umber/Gas F e asterr City/Town []JourneymanSrNumber: APPRnVFn /nFFIr:F I ICF nNI V1 ❑ LP Installer _ z . 0 j & & Ln \ 3 2 � ) , [ ± . _ � \ \ LL c \ � / ) \ \ � w z @ \ § & � a & w . . . 0 Lol Date.fl... ��: d�. 0'.".O RT :'� TOW OF NORTH ANDOVER 3 •` ` i°1- PERMIT FOR PLUMBING ,SSACNUS(c� 7 / (_�/ This certifies that ... Y `...... . .`............ 1.. . has permission to perform. � .:--._—�................. plumbing in the buildings of :j .. ............... . at. L -!<�-f��.�, North Andover, Mass. ............ . G PLUMBING INSPECTOR Check #.4 8259 r FIXTURES tY MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town Al i ys,�k`�C Date: /O �� � -Permit# Building Locatica� ��% 4%�� Owners Name D,6 Type of Occupancy: Commercial Educational Industrial Institutional Residential New:'Alteration I` Renovation M Replacement:' Plans Submitted:. Yes No FIXTURES tY Q m= OF 0 Orn U IX I— ~ rn w U) (0 w W z 1— Q 0-Lu wW z -1 ro O Z IY O F Ill 0 Z X ]: ZNW W 16- W U w J z W = W - O w _ W _jvi> a u - WQ W > W z z w� lY cn H J Q 2 H Q 2 O to Z J (� W O z > O LL 0~H O W W W Q W W H H Q Q f— U 0 LL U (9 Z O a t- > > O SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 RD FLOOR 4 FLOOR 5TH FLOOR FLOOR 7 " FLOOR 8 , FLOOR Installing Company Name:M (j1 t211t Check One Only Certificate # µ _ Addgl ss: % �C� 1 City/Town: c� j/ State MA C orporation r � I Partnership..s.. Business Tel: Fax: . �x Name of Licensed PlumberlGas Fitter - -J2,i,„ ,'� x INSURANCE COVERAGE: I- I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes'),(, If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indernnityl, Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only OwnerAgent Sianature of Owner or Owner's Aaent By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 19 of the General Laws. Type of License: Y!Plumber Title' ✓ Gas Fitter Signatur of Licen a Plumber/Gas Fitter -•� Master City/Town,, nA , _ ,__ " s Journeyman t License Number APPROVED (OFFICE USE ONLYI LP Installer 41 Of `"ORTH 1.�. Q ' D SACMUSE� Date.'J... ........ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ' " This certifies that has permission for gas installatioi ........... in the buildings of . .:,-°.... `!................... at�:.r S...f� :��-_:.:-!�-��-. -�':! ., North Andover, Mass. Fee,:�t?. Lic. No..�f '.,0.... l`�,.4-_: 3 ........... GAS INSPECTOR Check # ho f/ 5560 MASSACHUSMS UNUMM APPUCATON FOR PERAW TO DO GAS FfFnNG (Type or print) NORTH ANDOVER, MASSACHUSETTS Date �n Building Locations �Z ,5 / /t�/� �' 'v ��G�` " Ali%, e � �-- Permit # Amount $ 36 Owner's Name New ❑ Renovation ❑ Replacement Plans Submitted !I❑� (Print or type) ,�C❑ orp: C e i�te llingmpany /�6Name ✓k -s oz ©C Address Partner. 13Qra o./ /`o, t -, /17 BusTess Telephone �� _ _ g 9 yp y�1 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No ❑ If you have checked Les, please indicate the type coverage by checking the appropriate box. 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: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i nereoy cerury mat an or me aetaus ana mrormauon 1 nave submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and i 7qlations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massacpuscftts Stay¢ Gas96d—endOapter 142 of the General Laws. (Title City/Town APPROVED (OFFICE USE ONLY) C— Signature of Licensed Plumbs 1r Gas Fitter Plumber 3 i� Gas Fitter License um er Master Journeyman v� Cn a o 9 h x H a a H ° Gw w W HCAo a a a> w G7 F+ m z F z F a F a W W c7 p N w w H U x a W W H a o a > A a F o SUB -BA SEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type) ,�C❑ orp: C e i�te llingmpany /�6Name ✓k -s oz ©C Address Partner. 13Qra o./ /`o, t -, /17 BusTess Telephone �� _ _ g 9 yp y�1 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No ❑ If you have checked Les, please indicate the type coverage by checking the appropriate box. 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: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i nereoy cerury mat an or me aetaus ana mrormauon 1 nave submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and i 7qlations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massacpuscftts Stay¢ Gas96d—endOapter 142 of the General Laws. (Title City/Town APPROVED (OFFICE USE ONLY) C— Signature of Licensed Plumbs 1r Gas Fitter Plumber 3 i� Gas Fitter License um er Master Journeyman