HomeMy WebLinkAboutMiscellaneous - 35 BONNY LANE 4/30/2018Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
To: Building Inspector
1600 Osgood Street
North Andover, MA 01845
RE: Insured:
Property Address:
Policy Number:
Date/Cause of Loss:
File or Claim Number:
Jeanne Contarino
35 Bonney Lane
HP0447922
7/21/2008, Lightning Damage/Power Surge
19095-R
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.
Ryan Werner
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.
Signat and Date
ANDERSON ADJU MENT CO., INC.
54 Stiles Road, C-106
Salem, NH 03079
Date. `..`/�.....
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that `. . .................... .
has permission to perform ... L!4 ... ..................... .
plumbing in the buildings of .!' �" ` `:
�..` ` ............C'.Iyorth Andover, Mass.
at ....?.} ....L.......��
—
Fee ....3 .... Lic. No.. �1.� �. ?. ........ ...... ........ .
PLUMBING INSPECTOR
Check #
8441
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I have a current liabilityinsurance-policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes No
If you have checked Yes, please indicate 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 ❑
Signature of Owner or Owners Agent
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
.�_...im —4 8—f� tt�tsnns nwrfnrmed under the hermit Issued for this application will be in compliance with all
Pertinent provision of the Massachusetts State Plumbing code and uypier i4z or uie %3ermi4l a ---
BY Type of License:
Tide ❑ PI ber &ureofum er
cityrr'ov+m - - _ _ _---- i�i.Mastem vrrian License Number: � �
9
MASSACHUSET- 1 S UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
,IIIA. Da � ermit#
Cityfiown: 1 'n
Bt hiding Location: v `' �' ( Owners Name
Type of Occupancy: Cammecial ❑ Educational ❑ Industrial Institutional ❑ Residential
New: ❑ Alteration: ❑ Rnovation: ❑ Replacement: Pians Submitted: Yes ❑ No ❑
nV."liJIV4�Ya.c vvr �:v+va�. -
I have a current liabilityinsurance-policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes No
If you have checked Yes, please indicate 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 ❑
Signature of Owner or Owners Agent
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
.�_...im —4 8—f� tt�tsnns nwrfnrmed under the hermit Issued for this application will be in compliance with all
Pertinent provision of the Massachusetts State Plumbing code and uypier i4z or uie %3ermi4l a ---
BY Type of License:
Tide ❑ PI ber &ureofum er
cityrr'ov+m - - _ _ _---- i�i.Mastem vrrian License Number: � �
9
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Check One Only Certificate #
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Installing Company Name:
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Name of Licensed Plumber. �ee,r"f
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I have a current liabilityinsurance-policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes No
If you have checked Yes, please indicate 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 ❑
Signature of Owner or Owners Agent
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
.�_...im —4 8—f� tt�tsnns nwrfnrmed under the hermit Issued for this application will be in compliance with all
Pertinent provision of the Massachusetts State Plumbing code and uypier i4z or uie %3ermi4l a ---
BY Type of License:
Tide ❑ PI ber &ureofum er
cityrr'ov+m - - _ _ _---- i�i.Mastem vrrian License Number: � �
9