HomeMy WebLinkAboutMiscellaneous - 34 BUNKERHILL STREET 4/30/2018L
AMML
Safety Insurance
Form 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 01845 NORTH ANDOVER, MA 01845
RE. Insured: STEVEN QUINN'and-,KEL
LY (�UINN
Property Address: 34 BUNKERHILL ST, NORTH ANDOVER, MA
Policy Number: HMA 0333942
Claim Number: BOS00045654
Date of Loss: 10/14/2014
Company: Safety 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, Chapter 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.
Justin Woodworth Claim Examiner 10/17/2014
Safety Insurance Company
Homeowners Claims Unit
P. O. Box 55098
Boston, MA 02205-5098
Phone: (617) 951-0600 EXT 3317
Fax: (617.) 531.-6655
Email: JustinWoodworth@SafetyInsurance.com
Date. ..............
�,ao ,eae O
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ..1.! ;1..f `nn ... �L'.. .� ............
has permission for gas installation ....................
in the buildings of ....� / �>
at . `.�.. 4.:' . !� :'.` .1: �. .......... , North Andover, Mass.
Fee. ..�.... Lic. No........... �} fit.. .......
GAS INSPECTOR
Check # ) i > ! `/
432
3G
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO,GASFITTING
(Print or Type)
P.ZN PEND( VEI` , Mass. Date AC>03 Permit # 467A i
Building Location,�� (�LIt�)K!_1211iLL �1 �Owntr's Name K11CH61-A3 SCOLA
". -- iD TH/�i )D 1/EP Md
Type of Occupancy PES 1 P E KJT l A L
New ❑ Renovation ❑ ReplacementYf Plans Submitted: Yes[] No ❑
Installing Company Name BAY STATE GAS COMPANY Check one: Certificate #
Address 55 MARSTON STREET
XJ Corporation 1862
LAWRENCE*, MA 01840 ❑ Partnership
Business Telephone -68.7-1105
❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter Francis X. Corkery
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes K 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 11 Bond ❑
OWNER'S INSURANCE WAIVER: 1 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 hereby certify that all of the details and information I have submitted (or entered) in abo plication are true and accui 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.
Tof Ucense: j
Title Plumber Signature of tensed Plumber or Gas
Gasfitter A-1 45
City/Town Master Ucense Number
9APPROVED O FIC S ON Journeyman
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Installing Company Name BAY STATE GAS COMPANY Check one: Certificate #
Address 55 MARSTON STREET
XJ Corporation 1862
LAWRENCE*, MA 01840 ❑ Partnership
Business Telephone -68.7-1105
❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter Francis X. Corkery
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes K 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 11 Bond ❑
OWNER'S INSURANCE WAIVER: 1 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 hereby certify that all of the details and information I have submitted (or entered) in abo plication are true and accui 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.
Tof Ucense: j
Title Plumber Signature of tensed Plumber or Gas
Gasfitter A-1 45
City/Town Master Ucense Number
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