HomeMy WebLinkAboutMiscellaneous - 411 SUMMER STREET 4/30/2018 411 SUMMER STREET i
210/107.A-0081-0000.0
Bunker Hill Insurance Company
695 Atlantic Avenue
P.O. Box 129120
Boston,Massachusetts 02111
(617)956-1777
November 09, 2011
Building Commissioner
City or Town Hall
North Andover,MA 01845
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GENERAL LAWS,CH. 139,SEC.3B
OUR INSURED: JOHN LIVESEY
PROPERTY ADDRESS: 411 SUMMER ST,North Andover
POLICY NUMBER: BHH1 0001129355
DATE OF LOSS: 10/30/2011
CAUSE OF LOSS: All Others(non-theft)
CLAIM NUMBER: 353300125533
Claim has been made involving loss, damage, or destruction of the above-captioned property,which may
either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, section 6,to be applicable. If any notice
under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate,please direct it to the attention of the
undersigned and include a reference to the above-captioned-insured, location, policy number, date of loss,
and claim number.
If no reply is received from your office within ten days,we will assume that you have no lien of any type
against this property, and we will proceed to pay this clafill if!full.
Jeanine Potens
Claim Service Supervisor
Date. . . . .. .. ..
/ All
NORTH r
OF
.441
°
TOWN OF NORTH ANDOVER
on
} PERMIT FOR GAS INSTALLATION
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44
This certifies that . . . ':.J. . Sle? . . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . .
in the buildings of . . . . . • . . . . . . . . . . . . . . . . . . . . .
at . . .1-! E. . .��. . . . . .4. . . ?`""-: . , Nocrth�Andover, Mass.
Fee. . �4 . Lic. :�. . . . .
INSPECTOR
Check#
5516
ivIASSACHL SETCS UNIFORM APPIICATON FOR PEILM TO DO GAS F MI NG
(Type or print) Date /�(�U 6
NORTH ANDOVER,MASSACHUSETTS
Building Locations f U kLv yvi- C 2 �� Permit#
Amount$
Owner's Name LI(v
New❑ Renovation ❑ Replacement L.J Plans Submitted ❑
oCal
0
R A 1z 004
a
t SUB •BASEvt ENT
BASEM1 ENT
IST. FLOOR
2ND . FLOOR
3RD . FLOOR
4TH . FLOOR
5TH . FLOOR
6 T H . F L O O R
7TH . FLOOR
STH . FLOOR
(Print or type)./f
one: Certificate Installing Company
Name /S - [!Corp.
Address J� 1y ❑ Partner.
--ZI-v �;g amu-d v ✓�2 -u. .
usiness a ep one T 7 L-/,2Z22 iz 1'Firm/Co.
Name of Licensed Plumber or Gas Fitter
LNSURANCE COVERAGE Check�—o—n�e/:
I have a current liability Insurance policy or it's substantial equivalent. Yes L2 Noll
If you have checked Les,please indicate the type coverage by checking the appropriate box.
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 Laws,and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent 13
I hereby certify 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
ccmpliance with all pertinent provisions of the Massachuset , ate r Code and Chapter 42 of t e General Laws.
Signature of License Plumber Or Gas Fitter
By:
Title Plumber S77)�2
City/Town . Gas Fitter license : um e
Master
APPROVED;OFFICE USE ONLY' Joumeyman