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Home My WebLink AboutMiscellaneous - 374 CHESTNUT STREET 4/30/2018DelleChiaie, Pamela From: Sawyer, Susan Sent: Thursday, February 09, 2006 11:24 AM To: DelleChiaie, Pamela; Grant, Michele; Rillahan, Deb Subject: old well FYI Received a call from homeowner at 384 Chestnut St. On a walk behind her house, she found an old hand dug water well, surrounded by stone and fairly deep. She did not know whose property she was on, but thought we could help. I told her if needed we could assist in identifying the property owner with the assessors maps and suggested that she could contact them about the hazard. I did not offer to go onto this property to check it out, as that would be trespassing. I am also not inclinded to make an order to abandone it properly on the hearsay. I don not know if she take my advice or not. So, if she calls again, please just make a note and I will call her back. I don't mind assisting, but, we can not do everything and since I have already spoken to her, I don't want any other staff member to spend time on this. Thanks Susan Sawyer, R.S. Public Health Director office 978 688-9540 fax 978 688-8476 9800 Fredericksburg Road NZE San Antonio, TX 78288 USAW® 04664.2508C.JSS1157343221.01.01.107 TOWN OF NORTH ANDOVER 120 MAIN STREET NORTH ANDOVER MA 01845-2420 Reference: MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B Attention Building Commissioner, I am writing regarding the claim referenced below. Policyholder: Henry J Hamel Reference #: 001020792-11 Date of loss: February 1, 2015 Location of loss: North Andover, Massachusetts Address: 374 Chestnut St, 01845-5310 December 4, 2015 A claim has been made involving loss, damage or destruction of the property referenced above, which may either exceed $1000.00 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 my attention and include the reference #. You may submit correspondence or questions to me. My contact information is: Address: P.O. BOX 659468 SAN ANTONIO, TEXAS 78265 Fax: 1-800-531-8669 Phone: 1-800-531-8722 Ext: 42576 Sincerely, et� e) t"., Ya-v'-L� Ria B Jones Property - TFL Unit 14 United Services Automobile Association PO Box 33490 San Antonio, TX 78265 Phone: 1-800-531-8722 Ext: 42576 Fax: 1-800-531-8669 REM/RJJ 001020792 - DM -04664 - 11 - 4528 - 06 54577-0715 Page 1 of 1 Date ..... /Zk��..��............... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION P&S ZL �, �-Ac- This certifies that.:.........../........�1�........................................................................ has permission for gas ins llation ... � R.- '.G..�... .......................... inthe buildings of..............................................................:................................................... at ......J..... �\ PS� r`"'' .:............ North Andover, Mass. ........................................ Fee' ..`....... Lic. No. Nh.-1 f GAS INSPECTOR Check #. 26 0 G TYPE OR PRINT CLEARLY HUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE fZ / / PERMIT # JOBSITE ADDRESS OWNER'S NAMEI 1-( OWNER ADDRESS � e TE ) — — / FAX I OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL Ef NEW: ® RENOVATION: ® REPLACEMENT: APPLIANCES 1 FLOORS - BOILER BOOSTER CONVERSION BURNER FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROIDF TOP UNIT Ui ..T HEATER U VENTED ROOM HEATER WATER HEATER PLANSSUBMITTED: YES[J NO® BSM 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 1 10 1 11 1 12 1 13 1 14 I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 0 NO El I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E� OTHER TYPE INDEMNITY ® BOND El 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 4. 3 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submftted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compl th all Pertin rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME LICENSE # SIGNATURE MP El MGF El JP ® JGF E] LPGI CORPORATION 4# D�K:I PARTNERSHIPLJ# LLC []# COMPANY NAME: j Il ADDRESS Q n n , 10 Id 51, CITY ? STATE ZIP TEL FAX - ' 21 CELL EMAIL .1� ,�-VOW RO� /34/* Of The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Holden Oil, Inc. Address:91 Lynnfield Street City/State/Zip: Peabody, MA 01960 Phone #:978-531-2984 Are you an employer? Check the appropriate box: Type of project (required): 1.2 1 am a employer with 45 4. C3 I am a general contractor and 1 6. ❑New construction employees (full and/or part-time).* have hired the sub -contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub -contractors have g ❑Demolition working for me in any capacity. employees and have workers' comp. insurance.x 9. Building addition ❑ [No workers' comp. insurance required,) 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[] Roof repairs insurance required.] t C. 152, §1(4), and we have no 13.0✓ OtherGas Fitting employees. [No workers' comp. insurance reouired.l 'Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i l-lomcowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. I IF the sub -contractors have employees, they must provide their workers' comp.'policy number. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. insurance Company Name: HDI -Gerling America Ins, Co. Policy # or Self -ins. Lic. #:EWGCD000014511 Expiration Date: 12/31/201 Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). - Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this, statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert& !gder the P & and penalties of perjury that the information provided above is true and correct .9, .< 1� Offrcial use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 10 r.r Commonwealth of Mas usetts Division of Registrati Board of Plumbi JEFFRE fir,47 ' 286 NEW LOT 97 o PEABOD 4 LP Gas Inst F r �M W GF3096-LP 05/0112014 Sve 005177 License No. Expiration Date. Serial No.