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Home My WebLink AboutMiscellaneous - 30 HEWITT AVENUE 4/30/2018iiiTIMW i=rAwq_% r - Date c7.� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .... //-Zfl ............. has permission to perform plumbing in the buildings of, ........................... at North Andover, Mass. Fee,�� Lic. le ............ PLUMB Check # PI; 2/ I'N�I PECTOR 8567 Safelyinsurance Fonn of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall NORTH ANDOVER, MA 0 1845 NORTH ANDOVER, MA 01845 RE: Insured: Property Address: Policy Number: Claim Number: Date of Loss: Company: NISHIT S OZA 30 HEWITT AVE, NORTH ANDOVER, MA HMA 0006497 BOS00030721 7/6/2012 Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chqpter 143, Section 6 to be applicable. If any notice under Mass. Gen. 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 number. Allan Leavitt Claim Examiner Safety Insurance Company Homeowners Claims Unit P. 0. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3213 Fax: (617) 531-8891 Email: AllanLeavitt@Safetylnsurance.com 7/16/2012 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVEI?, MASSACHUSETTS Date 3— 10 Building Location3o 0 ... erName, Permit Amount Type of Occupancy New Renovation Replacement El Plans Submitted Yes No MV E] =j FIXTURES R1 it Z re 171 pure I 11; riFf rke rks Trint or type) Check one: Certificate Installing Company Name ft11-0,t,4A1 11PZ,1,11ffA,, 6 El Corp. Address OCZL tN1,&,- IST- /—,,a/?7-/-/ 4,,—,t),oaPf2— 1-1 Partner.' Business Telephone JF;7 V C, %' 5-- 1 5—to El Firm/Co. Name ofLicensedPlumber:. 70/4 11,14,1044,0L-1 Insurance Coverage: Indicate the type of insurance coverage by checking the appmpiia-te box: Liability insurance policy El Other type of indemnity 11 Bond Insurance W I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature 1. . I Owner 1:1 Agent 11 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumb�i Chapter 142 of the General Laws. By: !Signauuv Or 1ACenSO(I FIUMDer Title Type of'Plumbing License City/Town uccriseiNumoer--� Master Journeyman APPROVED (OFFICE USE ONLY Date... ......... TOWN OF NORTHANDOVE/R PERMIT FOR GAS INSTALLATION This certifies that . . .... . . . . . . . . ... . . . . . . . . . has permission for gas installation . in the buildings of ... 6�9-"' ....... I North Andover, Mass. at Fee-.- Lic. ......... GAS INSPECTOR Check # 7 1 37 MASSACHUSETrS UNIFORM APPUCATON FOR PERNffF TO DO GAS FrrnNG (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations 0 )L) I Owner's Name New Renovation Replacement Plans Submitted 1:1 1:1 r—j Date 2-2-3-1,0 Permit Amount $ C61P (Print or type) Che k one: Certificate Installing Company Name )0fz4�A4AI Pzlwvelcovz�, Corp. 91c;1L Address 6 1, Partner. 778- 6k�s-- El 7usiness Telephone Firm/Co. Name of Licensed Plumber or Gas Fitter _7511 1WU40A41qA1 INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes In No1:3 If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy M Other type of indemnity =j 13 Bond 13 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 13 Agent 13 1 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code an �qapter 142 of the General Laws. � By: Title City/Town JAPPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter 0 Plumber C2�(�;Zz [3 Gas Fitter License Number Master Joumeyman U U U z z z z Z > G W4 U CA z W z z z cc > z Z 0 U > z SU B-BASEM ENT 4 U U W > BASEM ENT IIST. F L 0 0 R 2 N D . F L 0 0 R 3 R D . IF L 0 0 R 4 T H . IF L 0 0 R 5TH. F L 0 0 R 6 T H F L 0 0 R 7 T H F L 0 0 R 8 T H F L 0 0 R (Print or type) Che k one: Certificate Installing Company Name )0fz4�A4AI Pzlwvelcovz�, Corp. 91c;1L Address 6 1, Partner. 778- 6k�s-- El 7usiness Telephone Firm/Co. Name of Licensed Plumber or Gas Fitter _7511 1WU40A41qA1 INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes In No1:3 If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy M Other type of indemnity =j 13 Bond 13 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 13 Agent 13 1 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code an �qapter 142 of the General Laws. � By: Title City/Town JAPPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter 0 Plumber C2�(�;Zz [3 Gas Fitter License Number Master Joumeyman 6*3 7 6 Date--.-�e "-* ..... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION T�is certifies that ..... .............. 4as permission for gas installation ............. in the buildings of ...... ................... at North Andover, Mass. ............. ............ Fee. ...... Lic. No. ... ...... ....... -2'-1 7 / - -�'GAS INSPECfO'R��e WHITE: Applicant CANARY: Building Dept. PINK: Treasurer . -C-N MASSACHUSETTS UNIFORM APPUCATION FOR PERMIT TO DO GASFITTING irmnx lypej 04 -r(-4 A /JD L9 ��f . Mass. Date gL� Permit* -3371�7 Building Location 0 1-42--W A 1/-e- Owner's Name /HS IV' 6Q D F-- A f V () e T -t4 y1A A�/jD 0 , / Q M rA Type of Occupancy- R E51 -1--)C7N 7-1 P L New 0 Renovation 0 Replacement 2--**' Plans Submitted: Yeso No [] Installing Company Name Ae g T :!AM Al A T �Q Check one: Certfficate Address ODA C H/'V� fA fQ i -NI, 0 Corporation 7* H U e tj t1l rl ?qq 0 Partnership Business Telephone la 92- -7 47 -7 ( 2--firm/Co. Name of Licensed Plumber or Gas Fitter -.-��?oAEP-T A-5ALyjt"j4-Fy-jJ?(-) INSURANCE COVERAGE: I have a current jability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes hd' No n If,you have checked Yes, please Indicate the type coverage by checking the appropriate box A liability insurance policy 0' Other type of Indemnity 0 Bond 0 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: &gnature of Owner or 5We—rs Agent OwnerO 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 knowiedge and that all plumbing work and installations performed under the Pe - ed for this application will be in corn I ti" pertinent provisions of the Massachusetts State Gas Code and Chapter 142 o LxN3 pliance with all Tj o'f".i. �E V"' --�' of License: Plumber Tdle ft, %4Khiture of Ucensed PluffiBWO-RETFi—tter tter er Uoense Number Journeyman MM Installing Company Name Ae g T :!AM Al A T �Q Check one: Certfficate Address ODA C H/'V� fA fQ i -NI, 0 Corporation 7* H U e tj t1l rl ?qq 0 Partnership Business Telephone la 92- -7 47 -7 ( 2--firm/Co. Name of Licensed Plumber or Gas Fitter -.-��?oAEP-T A-5ALyjt"j4-Fy-jJ?(-) INSURANCE COVERAGE: I have a current jability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes hd' No n If,you have checked Yes, please Indicate the type coverage by checking the appropriate box A liability insurance policy 0' Other type of Indemnity 0 Bond 0 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: &gnature of Owner or 5We—rs Agent OwnerO 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 knowiedge and that all plumbing work and installations performed under the Pe - ed for this application will be in corn I ti" pertinent provisions of the Massachusetts State Gas Code and Chapter 142 o LxN3 pliance with all Tj o'f".i. �E V"' --�' of License: Plumber Tdle ft, %4Khiture of Ucensed PluffiBWO-RETFi—tter tter er Uoense Number Journeyman 31- .j z w 0 c 0 Cp .j w m z 0 ui IL to cr cr M w w to z 0 w Z�x U. "I LLI LL cc 0 z I 30- I-. 49 U, I 4K z , I I c