HomeMy WebLinkAboutMiscellaneous - 27 ALCOTT WAY 4/30/2018N_
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LaMarche Associates
5 North Road, P.O. Box 250
Chelmsford, MA 01824
800-349-1525
Fax: 978-256-8590
March 19, 2015
Building Commissioner/Inspector of Buildings
NORTH ANDOVER, MA 01845
Board of Health/Board of Selectmen
NORTH ANDOVER, MA 01845
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: SHEILA BYERS
Loss Location: 27 ALCOTT WAY
NORTH ANDOVER, MA 01845
Policy Number: HP311975
Date of Loss: 03/19/2015
Cause of Loss: Water
LA File Number: MA -2-28058
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.
Robert Siscoe
Adjuster
LaMarche Associates, Inc. - 800-349-152S
Page I of I
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of
Date. �XMW7-�,
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
4SACHUS
This certifies that
has permission to perform
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plumbing in the,b u ildings pf, -�A-:1-1//h, h /—�
a t N--or-'t h- /"A��ned:o`v`e r',' M'' a- s's'.
0
Fee Lic. No./.�/�**�'
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PLUMBING INSPECTOR
Check 0
5799
MASSACHUSETTS UNIFORM APPLICA
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Location
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aid IL
Owner's Narne 01 In cc,
—Type of Occupancy
Replacement PlansSihmitted: Yes 0 No C
FIXT'URES
Check one: Certificate!
Inslalling Company Name 0 corpWation
Addless 5'(414- 00�APWJC 1� ,
+ 0 Partnership
I" loss Teephone _?R.1 - Fffmco.
Name of Ucertsed Plumber
INSURANCE COVERAM
I have a current: liability Policy or its substantial equivalent which meeft the requkernerris of MGL Ch. 142.
Ye" No C]
If you have checked Yes, Pftse indicate the type coverage by checking the appropnate boy -
A liability insurance policy -g Other type of indemnity C) Bond M
OWNM INSURANCE WAIVER: I am aware that the licensee om not the insurance coverage required
by Chapter 14 at the Mass. Cmeneral LTws, and thlilt my signature an this permi applicaWn wah-ves this requirerneft
Check om
of Owner or Ownees Agent Owner Agent 0
I hereby certify VW all Of the deWils and WdOMMUM I have submMW (Or eRN"M in above applicaum We true and a=wm to
the bW at my kr*wkW" and am all pkwrd*V wu and* I Wtms Performed under the pe.. d mm forV= application will
be in OWnPlilince with all Pertinent povesxx Ottne 203achuseft2thm7'=n9 42 of Ve Gerwai LawL
Type of Licirma Master Journeyman
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