HomeMy WebLinkAboutMiscellaneous - 40 PEMBROOK ROAD 4/30/2018 40 PEMBROOK ROAD
210/021.0-0052.0000.0
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MetLife Auto&Home®
Homeowner Operations Field Claim Office
Attention:Claims
P.O.Box 6040
Scranton,PA 18505
(800)854-6011
MeWf
February 16, 2015
North Andover Building Inspection
1600 Osgood St, Suite 2035
North Andover, MA 01845
Our Customer: Justin and Kerry Elderkin
Claim Number: JDE90405 OG
Date of Loss: February 12, 2015
Dear North Andover Building Inspection:
Pursuant to M.G.L. 139 § 3B, please be advised that a property loss at the address referenced below has =_
been estimated to have damage to the dwelling or other structures that will exceed one thousand dollars.
Please let us know within ten (10) days if there is a pending or existing lien against the property as
provided by M.G.L. 139 § 3B, or if there is an intent to initiate proceedings to perfect such a lien.
Loss Location: 40 Pembrook Rd, North Andover, MA
Sincerely,
Home Ops CAT Team Sarah Lackey
Metropolitan Property and Casualty Insurance Company
Claim Adjuster —_
(800) 854-6011 Ext. 7440 —
Fax: (855) 411-6689
Email: MetLifeCatTeam@metlife.com —_
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MetLife Auto&Home is a brand of Metropolitan Property and Casualty Insurance Company and its affiliates,Warwick,RI.
MPL MA-REGDEPT Printed in U.S.A 0698
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has permission for gas installation . . . . . . . . . . . . . . . . . . . . .
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at Pc .c.o if. . . . . . . . . . . .. North Andover, Mass.
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
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Building Location PQ Owner's Name f 1 C HAA-L C,c I ti) —x,
K1012`CII .AN0()tf6�* I-1A Type of Occupancy i2 ES510E- ;l�
New ❑ Renovation ❑ ReplacementX Plans Submitted: YYes❑ No ❑
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Installing Company Name BAY STATE GAS COMPANY Check one: Certificate #
Address 55 MARSTON STREET U Corporation 1862
LAWRENCE, MA 01840 ❑ Partnership
Business Telephone 7!B-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 No 171
If you have checked ye, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy X( 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[] Agent ❑
I hereby certify that all of the details and information I have submitted(or entered)in above pplication are true and accur,4te 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. / (/ .%
By T e of License:
Plumber Signature of Licensed Plumber or Gas
Title Gasfitter
Master License Number
City/Town Journeyman
APPROVED 0 FIC SE ONLY)
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BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES PROGRESS tNSPECTION
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APPLICATION FOR PERMIT TO DO GASFITTING
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NAME & TYPE OF BUILDING
Y; LOCATION OF BUILDING
- PLUMBER OR GASFITTER
LIG NO.
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PERMIT GRANTED
DATE .19
GASINSPECTOR