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Home My WebLink AboutMiscellaneous - 39 PARK STREET 4/30/2018N Date ... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... Al' x, ............ has permission for gas installation .... At. in the buildings of .... /—I .......................... at ... !V ......... North Andover, Mass. R. �� Lic. No.).-. e (, . .. L./GAS INS Ch-e�k--# ✓ a MASSACHUSETTS UNIFORM APPLICATION FOR PERMbT TO DO GASFITTING Iftnt or Type) G� r Mass. Date 19 Permit * Building Location G/ / ��C ST Owner's Name //✓� '�k IV — Type of occupancy New ❑ Renovation ❑ Replacement Plans Submitted: Yes❑ No ❑ Installing Company Name U��> i !.� • T'�` �� % Check one: Certificate Address 6 < ^--1^17 A 1 / ❑ Corporation J L % r nJ �9 5 ❑ . Partnership +. Business Telephone 2 7 ' ci la [Firm/Co. Name of Licensed Plumber or. Gas Fitter INSURANCE COVERAGE: I have a current I' bility insurance policy or As substantial equivalent which meets the requirements of MGL Ch. 142. Yes P No ❑ If you have checked Les, please indicate the type coverage by checking the appropriate box. 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 Mass. General taws. and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's Agent 1 hereby certify that all of the details and information 1 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 the permit issued for this application will be in co pliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gen a taY4� By T of license: �/Qn2L Plumber Signature of Licensed lumber or Gas ittec/ Title Master •—r' l Master License Number �) Ciry/Town Journeyman I ST FLOOR Installing Company Name U��> i !.� • T'�` �� % Check one: Certificate Address 6 < ^--1^17 A 1 / ❑ Corporation J L % r nJ �9 5 ❑ . Partnership +. Business Telephone 2 7 ' ci la [Firm/Co. Name of Licensed Plumber or. Gas Fitter INSURANCE COVERAGE: I have a current I' bility insurance policy or As substantial equivalent which meets the requirements of MGL Ch. 142. Yes P No ❑ If you have checked Les, please indicate the type coverage by checking the appropriate box. 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 Mass. General taws. and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's Agent 1 hereby certify that all of the details and information 1 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 the permit issued for this application will be in co pliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gen a taY4� By T of license: �/Qn2L Plumber Signature of Licensed lumber or Gas ittec/ Title Master •—r' l Master License Number �) Ciry/Town Journeyman A I d. _ V ; c D ; m 9 O � 3 a a m D 2 n�f m p O o a � � n1 O O O D s N a O 1 TS UNit~ORM AppLiCATION FOR PERMIT 70 DO gASFi (Print a Type) NORTH ANDOVER TTINQ ,Maas. Date 1�� Building 1g Location Permit # U Owner's Name New Renovation p Replacement [ plana Submitted:. . Yea [] No [] • aua—eaMT. t1AaEM.EHT IST FLOOR :NO FLO0R SAO FLOOR 4TH FLOOR 6TH FLOOR OTH FLOon 7TH FLOOR aTH FLOOR Insta"Ing Company rn s � w w a u x h aft a! z a ►- t>t .. y � to M ►N- a<C C_ O h w M < r1 O O F- d M M M V tl z o d r` Itt, o v aOc y a a o Business Telephone Name of Licensed plumber or Gas Fitter Check one: _ f}7 Corp. d Partnership ❑ Firm/Co. I Certificate INSURANCE COVERAGE: I have a current liability Insurance policy or fts substantial a ufvalent ' Check one If you have checked res, please indicate the q Yes ❑ No ❑ type coverage by checking the appropriate box. A liability Insurance policy {� Other type of Inde mnity El INSURANCE WAIVER: I am aware that the licensee doe '� t3 Chapter 142 of the Mass. General Laws, and that my signature on fhlan� have the Insurance coverage required by Permit aPPllcation waives this requirement, nature o Owner or Check one: Owneri ant Owner ❑ Agent ❑ I hereby certify that All of the details and d Inst atlon 1 have submitted (or entered) In above application are true and knowtedfle and that efl pplumbinQ work end Instellatlon�s.ppeerlormed under the Pertinent provisions of the Massachusetts Stale ass (sod rmit Issued for this accurate to the bell of my e and Chapter 142 of the (3WW*j lA� application will be (n compliance with all By T of License: We [� Plumber TF Oastitterna Futme cense u er or as e ty/Tovm Mosier tkense Number ❑ Journeymen `f'fTKNED (OFFICE USE ONLY) Bay State Gas Company GAS INSTALLATION AUTHORIZATION _q� L010000�j) Date Issued to Address For Installa BTU Input CIO/ 000 Restrictions .,� /-. A A BSG Representative �&Pu \, —F PERMIT ISSUED --By — INSPECTOR This Portion of Authorization To Be Returned to BSG. Inspection Has Been Made of the Following Gas Equipment: 0 Heating System (BTU Input 0 Range 0 Water Heater 0 Clothes Dryer [I Room Heater Location All Work Has Been Done In Accordance With The Massachusetts State Gas Code And Is Ready For Use. Iff NO POSTAGE NECESSARY IF MAILED IN THE UNITED STATES BUSINESS REPLY CARD FIRST CLASS PERMIT NO. 721 LAWRENCE, MA POSTAGE WILL BE PAID BY ADDRESSEE BAY STATE GAS COMPANY ATTN: SALES DEPT. 55 Marston Street Lawrence, MA 01840 Date.... 2343 to 6.6 TOWN OF NORTH ANDOVER 6 6 6 0 PERMIT FOR GAS INSTALLATION lo ov '7SACH This certifies that ?-& ...... has permission for 9 s instaptio . .. .... ............ "0 in the b ildir�gs-pf .. ..f.. ul I w - at ... �Vl-z-vezlil ........ North Andover, Mass. Fee. L No....N� C, GAS INSPECTOR 25.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston, Massachusetts 02108.1904 (617)723-3800 Ma Only (800) 392-6108, FAX (8001851-8424 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec.36 NORTH ANDOVER BUILDING COMMOSSIONER NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 Re: Insured: WARREN F KELLEY Property Address: 39-41 PARK STREET, NORTH ANDOVER, MA 01845 Policy Number: 0880768 Type Loss: Fire (including Fire caused by Lightning Date of Loss: 03/29/2015 Claim Number: 336145 Claim has been made involving loss, damage or destruction of the above captioned property, 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 the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. MPIUA Claims Division CMA00021 3/31/2015 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston, Massachusetts 02108-1904 (617) 723-3800 Ma Only (800) 392-6108, FAX (800) 851-8424 NORTH ANDOVER HEALTH DEPT NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 Re: Insured: Property Address: Policy Number: Type Loss: CMA00021 Date of Loss: Claim Number: Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec.3B WARREN F KELLEY 39-41 PARK STREET, NORTH ANDOVER, MA 01845 0880768 Fire (including Fire caused by Lightning 12/02/2013 318760 Claim has been made involving loss, damage or destruction of the above captioned propert, 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 the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. MPIUA Claims Division 0 g ?ar3 TOWN OF NORTH AM \ HEALTH :-z I' 12/3/2013 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston, Massachusetts 02108-1904 (617) 723-3800 Ma Onlv (800) 392-6108, FAX (800) 851-8424 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch.139, Sec.36 NORTH ANDOVER HEALTH DEPT NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 Re: Insured: WARREN F KELLEY Property Address: 39-41 PARK STREET, NORTH ANDOVER, MA 01845 Policy Number: 0880768 Type Loss: Windstorm Other than Hurrcane or Tornad Date of Loss: 04/05/2011 Claim Number: 287562 CMA00021 4/8/2011 APR 11 [011 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Claim has been made involving loss, damage or destruction of the above captioned propert, 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 313 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. MPIUA Claims Division MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston, Massachusetts 02108-1904 (617)723-3800 Ma Only (800)392-6108, FAX 18001851-8424 NORTH ANDOVER HEALTH DEPT. NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec.36 TOWN OF NORTH ANDOVER HEALTH DEPARTnnPnIT Re: Insured: WARREN F KELLEY Property Address: 39-41 PARK STREET, NORTH ANDOVER, MA 01845 Policy Number: 0880768 Type Loss: Windstorm Other than Hun -cane or Tornad Date of Loss: 02/26/2010 Claim Number: 273320 Claim has been made involving loss, damage or destruction of the above captioned propert, 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 36 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. MPIUA Claims Division CMA00021 3/18/2010 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston, Massachusetts 02108-1904 (617)723-3800 Ma Only (800) 392-6108, FAX (800)851-8424 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch.139 Sec.36 NORTH ANDOVER HEALTH DEPT. NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 Re: Insured: WARREN F KELLEY Property Address: 39-41 PARK STREET, NORTH ANDOVER, MA 01845 Policy Number: 0880768 Type Loss: Water Damage: Plumbing Systems Date of Loss: 1210112009 Claim Number: 270104 CMA00021 111612010 JAN 25 2010 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Claim has been made involving loss, damage or destruction of the above captioned propert, 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 the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. MPIUA Claims Division