HomeMy WebLinkAboutMiscellaneous - 39 SALEM STREET 4/30/2018j
Michael Winston & Associates, LLC
Innovative Risk Specialists
Sit
4%%, POB 10721
Bedford, New Hampshire 03110
Tel: 603-494-2366 - Fax: 888-306-8106 - E-mail: michaelwinston@comcast.net
October 30, 2012
Building Commissioner/Building Inspector
Board of Selectman/Board of Health
400 Osgood Street
North Andover, MA 01845
RE: Eric & Michelle Bosco
39 Salem Street
North Andover, MA 01845
Type of Loss: Wind/Tree
Date of Loss: October 29, 2012
Policy: HO12337197
Claim number: HC187551
Our File #: MW 12-271 Location of Loss: Same
To whom it may concern:
The above captioned clam has been made involving damages or destruction of property which may exceed
$1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice
under Massachusetts General Laws, Chapter 139B is appropriate, please direct it to the attention of the
undersigned and include a reference to the captioned insured, location, policy number, date of loss, cause of
loss and claim or file number.
On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated
above via first class mail.
Sincerely,
Michael Winston
Adjuster
Date. R -. !� . --�- - - - -
TOWN OF NORTH ANDOVER
0
PERMIT FOR GAS INSTALLATION
This certifies that
has permission for gas installation
.................
in the buildings of ... ........................
at ...
........... North Andover, Mass.
Fee.)-.)-..-. Lic. No..n . . . . . . �7 �� . . . . . .
�.i�INSPECTOR
Check # )_ ) t k(
4264
MASSACHUSLTIN UNIFORM APPUCATON FOR PERAHr TO DO GAS FMING
(Type or print) Date
NORTH ANDOVER, MASSACHUSETTS
Building Locations 39 Sa kevn S t1 Permit # Li 2 e y
Amount $
Owner's Name
New Renovation Replacement 10 Plans Submitted El
(Print or
Name
Name of Licensed Plumber or Gas Fitter Cgga A o La 9-p se
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Check one: Certificate Installing Company
11 Corp. 2122
F1Partner.
E]Firm/Co.
INSURANCE COVERAGE Check on .
I have a current liability Insurance policy or it's substantial equivalent. Yes No
If you have checked Les, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 1:1 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 Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner 13 Agent ❑
I hereby certity 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 Cqfif�e and Chapter_142 of the General Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
ignature of ]
Plumber
Gas Fitter
Master
M
Journeyman
sed Plumber Or Gas Fitter
91 lb3
tcense Number
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SUB -BASEM ENT
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3 -RD. FLOOR
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5TH. FLOOR
6TH. FLOOR
7TH. FLOOR
8 T H. F L O O R
(Print or
Name
Name of Licensed Plumber or Gas Fitter Cgga A o La 9-p se
tj
Check one: Certificate Installing Company
11 Corp. 2122
F1Partner.
E]Firm/Co.
INSURANCE COVERAGE Check on .
I have a current liability Insurance policy or it's substantial equivalent. Yes No
If you have checked Les, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 1:1 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 Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner 13 Agent ❑
I hereby certity 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 Cqfif�e and Chapter_142 of the General Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
ignature of ]
Plumber
Gas Fitter
Master
M
Journeyman
sed Plumber Or Gas Fitter
91 lb3
tcense Number