HomeMy WebLinkAboutMiscellaneous - 265 GRANVILLE LANE 4/30/2018K)
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Cunningham Lindsey U.S., Inc.
P.O. Box 703689
Dallas, TX 75370-3689
Telephone (888) 738-8714
CLCAT@CL-NA.COM
Facsimile (214) 488-6766
'**'***'***************AUTO**3-DIGIT 018
770 T3 P1 95000058960
Building Commissioner or
Inspector of Buildings
Ey.r: 120 MAIN STREET
6E� N Andover, MA 01845
07A
Cunning�am Va
indsey
Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS Ch. 139, Sec 3B
1815418
181541819
MERRIMACK MUTUAL FIRE INS
ICE DAM
3/2/2015
Mario Giordano
265 Granville Ln
Claim has been made involving loss, damage, or destruction of the above captioned property, which
may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be
applicable.
if any notice under Massachusetts General Law, Chapter 139, Section 313 is appropriate, please direct it
to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss
and claim number.
Section 313. No insurer shall pay any claims (1) covering the loss, damage, or destructions to a building or
other structure, amounting to the one thousand dollars or more, or (2) covering any loss, damage or
destruction of any amount, which causes the condition of a building or other structure to render section
six of chapter one hundred and forty-three applicable, without having at least ten days previously given
written notice to the building commissioner or inspector of buildings appointed pursuant to the state
building code, to the fire department or arson squad of the city or town and to the board of health or
board of selectmen of the city or town in which the same is located. If at any time prior to the payment
the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to
perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or
section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not
be made while the said proceedings are pending; provided, however, that said proceedings are initiated
within thirty days of receipt of such notification.
Claim Number:
Policy Number:
Company Name:
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Cause of Loss:
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Date of Loss:
insured:
Property Location
07A
Cunning�am Va
indsey
Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS Ch. 139, Sec 3B
1815418
181541819
MERRIMACK MUTUAL FIRE INS
ICE DAM
3/2/2015
Mario Giordano
265 Granville Ln
Claim has been made involving loss, damage, or destruction of the above captioned property, which
may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be
applicable.
if any notice under Massachusetts General Law, Chapter 139, Section 313 is appropriate, please direct it
to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss
and claim number.
Section 313. No insurer shall pay any claims (1) covering the loss, damage, or destructions to a building or
other structure, amounting to the one thousand dollars or more, or (2) covering any loss, damage or
destruction of any amount, which causes the condition of a building or other structure to render section
six of chapter one hundred and forty-three applicable, without having at least ten days previously given
written notice to the building commissioner or inspector of buildings appointed pursuant to the state
building code, to the fire department or arson squad of the city or town and to the board of health or
board of selectmen of the city or town in which the same is located. If at any time prior to the payment
the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to
perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or
section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not
be made while the said proceedings are pending; provided, however, that said proceedings are initiated
within thirty days of receipt of such notification.
Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and
forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall
extend to and may be enforced by the city or town against any casualty insurance policy or policies
covering any loss, damage, or destruction pursuant to which the proceedings to perfect the lien were
initiated.
No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other interested
party for amounts disbursed to a city or town under the provisions of this section, or for amounts not
disbursed to a city or town under the provisions of this section.
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.
Cunningham Lindsey
Catastrophe Department
cicat@cl-na.com
800-867-3885
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Date .. ..........
TOWN NORTH ANDOVER
This certifies that -7-4-. �..
has permission to perform �
PERMIT FOR PLUMBING
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plumbing in the buildinks of ... v. ..........
at ... z-- Andover, Mass.
......... 'A �'orth
Fee ......... Lie. No..
PLUMBING INSPECTOR
Check #
7350
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASF117ING
(Print or Typ
f Date Permit#, 910
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Building Location 7(cog Owner's Name
Type of Occupancy ci—::�L ynn� 6–Q2 t�4 A,
New Renovation [7j Replacement Plans Submitted: YeSE] No V/
Installing Company Name k:L -IC 4r
%:��--A,'Tlf-(�heck one: Certificate
Address 11 Corporation
C2 cy)—k F3 Partnership
Business Telephon LM Firm/Co
Name of Licensed Plumber or Gas Fitter Ej-
INSURANCE COVERAGE:
I have a current pablitty insurance policy of its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes @�r No 0
It you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy El Other type of indemnity 0 Bond D
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
owner[–' Agent 10
Signature of Owner of owner s Agent
I hereby cerlity that all of the details and information I have submitted (or enteied) in above application are true and accurate to the bett of my
knowledge and that all plumbing work and installations performed under the petmit issued for this application wili be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 ol the General Laws
By_ T)W
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mZ,nse &gnMuFeoI Licensed RV6er or Gas Fitter
Title hGastittef
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%:��--A,'Tlf-(�heck one: Certificate
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Business Telephon LM Firm/Co
Name of Licensed Plumber or Gas Fitter Ej-
INSURANCE COVERAGE:
I have a current pablitty insurance policy of its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes @�r No 0
It you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy El Other type of indemnity 0 Bond D
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
owner[–' Agent 10
Signature of Owner of owner s Agent
I hereby cerlity that all of the details and information I have submitted (or enteied) in above application are true and accurate to the bett of my
knowledge and that all plumbing work and installations performed under the petmit issued for this application wili be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 ol the General Laws
By_ T)W
t',�f U
mZ,nse &gnMuFeoI Licensed RV6er or Gas Fitter
Title hGastittef
Cit /Town F�! aster License Number SG6r—1
Journeyman
Date...'::��/� /It� ...
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that/ -2-&4 .. ......... .... �-A
has permission for gas installation J
in the buildings,of
.......... ......................
at 8-�4� -�� !'�CN&th Andover, Mass.
FeeP.-�A Lic. No..
Check. # GASINSPECTOR
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�LN MASSACHUSETTS UNIFORM
(Print or Type)
Building Location =40Q
Map: Lot:
Now J Renovation -3
ATION FOR PERMIT TO DO GASFITTING
'�w — 0? -- &C)?�e 5-27
Date Permit #
OwnseaNsme
Type Of occupancy
Replacement J Plans Submitted- Yes J No J
Installing company Name B. F Murphy Plbq. & Htg. Inc Cheek one: Certificate
Address 72 Holten St. Danvers. MA 0 1923 J Corporation
Eallniste Vsko of Work: U Partnership
atainess Telephone 978-774:3174 U Firm / Co.
Nanw of Licensed Plurriber at Gas Filter Brian F. Murphy
INWRANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes Ll No Q
ff you have chocked AL please indicate the " coverage by checking the appropriate box.
A liability Insurance polley U Other type of Indemnity -1
Bond U
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:
Ownw C3 Agent Q
signature at Owner or Owners Agent
I hereby certify that all of the details and Information I have submitted (or entered) In above applicadon are true and aocurate so 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 Stale Gas Code and Chapter 142 of the General Laws.
BY Ty o�fLkww: Z22�
Plumber S�n&ured Ucansed Plumbef or GuAlLef
Tide Gadner
ter I-loensla Numbir, 9352
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city / Town Journeyman
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