HomeMy WebLinkAboutMiscellaneous - 432 SALEM STREET 4/30/2018 (2) 432 SALEM STREET `
210/037.B-0052-0000.0
J
Cunningham Lindsey U.S.,Inc.
P.O.Box 703689 Cunning=
Dallas,TX 75370-3689 Lindsey
Telephone(888)738-8714 Facsimile(214)488-6766 /}
CLCAT@CL-NA.COM
***********************AUTO**3-DIGIT 018
763 T3 P1 95000058953
Building Commissioner or
Inspector of Buildings
120 MAIN STREET
N ANDOVER,MA 01845
Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS Ch. 139, Sec 3B
Claim Number: 1339126
Policy Number: 1339126 24
Company Name: MERRIMACK MUTUAL FIRE INS
0 Cause of Loss: ICE DAM
Ln
Date of Loss: 2/27/2015
0
Insured: ROBERT&SHARON BROUSSARD
Property Location: 432 SALEM ST
Claim has been made involving loss, damage, or destruction of the above captioned property, which
may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be
applicable.
If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate, please direct it
to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss
and claim number.
Section 3B.''No insurer shall pay any claims (1) covering the loss, damage, or destructions.to;a-building or
other structure, amounting to the one thousand dollars or more, or (2) covering any loss damage or
destruction of any amount, which causes the condition of a building or other structure to render section
six of chapter one hundred and forty-three applicable, without having at least ten days previously given
written notice to the building commissioner or inspector of buildings appointed pursuant to the state
building code, to the fire department or arson squad of the city or town and to the board of health or
board of selectmen of the city or town in which the same is located. If at any time prior to the payment
the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to
perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or
j section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not
be made while the said proceedings are pending; provided, however, that said proceedings are initiated
within thirty days of receipt of such notification.
Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and
forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall
extend to and may be enforced by the city or town against any casualty insurance policy or policies
covering any loss, damage, or destruction pursuant to which the proceedings to perfect the lien were
initiated.
No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other_interested
party for amounts disbursed to a city or town under the provisions of this section, or for amounts not
disbursed to a city or town under.the provisions of this section.
On this date, I caused copies of this Notice to be sent to the persons named above at the addresses
indicated above by First Class Mail.
Cunningham Lindsey
Catastrophe Department
cicat@cl-na.com
800-867-3885
Date.
' U 3666
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
SSACNUS�
This certifies that . . . erq!?.4. . . . . . . . . . . . S
.M
has permission to perform . . .:. .Lett. . . . . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of . .}3.&O.c. S.S ka.oe. . . . . . . . . . . . . . . .
at. . . S.1-. . . . . . . . . . ., North Andover, Massal
Fee—)-P,. Lic. No.�3.3.3 . . . . . . . . . . . . . . . . . . . . . . . .,�,
PLUMBING INSPECTOR
o
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer.
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING v
(Print or Type
d06v'—, Mass. Date 19� Permit * 3 C C C'
Building Location J ,!�a Owner's Nam�/�
. Type of Occupanc"t- 5 I -D&ti tl
New ❑ Renovation ❑ Replacement 2Plans Submitted: Yes ❑ No ❑
FIXTURES
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3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
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Installing.Company Name t'SOMe-r Q -cj',4(r M A 7 A e-0 Check one: Certificate
Address ? C:46/4mt4n) s-P J ❑ Corporation
lY) E!i.4 o c--A) . v)'1 A r T c/L/ ❑ Partnership
Business Telephone �k1f, Z-197 1 91516/co.
Name of Licensed Plumber ,
INSURANCE COVERAGE:
I have a current jAbility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes Er No ❑
If you have checked ves, please/indicate the type coverage by checking the appropriate box
A liability_insurance policy 1d 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 application are true and accurate to the best of my
knowledge and that all plumbing work and installationspoormed under the permit is
su for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum ' g e and apter of the eral laws.
BY vLL
re of Ucensedum rTitle
Type of License: Master % Joumeymab❑
City/Town
APPROVED(OFFICE NL License Number 1_3 3 5
BELOW FOR OFFICE USE ONLY
FIKAL INSPECTIONS SKETCHES_ ` PROGRESS INSPECTIONS
FEE
NO.
APPLICATION FOR PERMIT TO DO PLUMBING
NAME &TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER
PERMIT GRANTED
DATE 19
i
I
PLUMBING INSPECTOR ,
t +
Date./-. .,,
. .. . ..i. . ... ..
i
NORTH q
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
SACMUSES
This certifies that . .:(f. l�: . . . . .
" has permission for gas installation . . . . t. . . . . . . . . . . . . . . . . . . . .
in the buildings of . . 3? U S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . X/: 34 . . SZ6; :. . .��� .. . . . . . . . . .. North Andover, Mass.
Fee. f}:' . . Lic. No..`".'.'.`.'. . . . P . . . . . . . . . .
GAS INSPECTOR
Check# 1
3919
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTIN_ G
(Print or Type)
Date �Z Z/UL '
Building S Permit # '�lS
7
Location
Owner's .
New ❑ Renovation ❑ Replacement El-, Plans Submitted: Yes ❑ No Com-
Building Permit No.
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IST FLOOR
2ND FLOOR
3RD FLOOR I I I I I I I_IIIIIII I I I I I I I I I_I I_I
s 4TH FLOOR I I I I I I I I I I I I I I I I I I
5TH FLOOR I I I I I 1 1 1 1 1 1 1 1 1 I I I I I I I I III I I
6TH FLOOR ( I I I I I :IIIIIIII ( I I I I I I I I '
7TH FLOOR 1 1 1 1 1 1 ;:IIIIIIII I I I I• I I I I I I I I I I
8TH FLOOR ( I I I IIIIIII ' ( I I I I I I: I , I I I I I I I I
Check one: Certificate
Installing Company Name WATER HEATER INSTALLER-$= ecorp.
14 DARTMOUTH STREET ❑ Partnership
VAMEN, MA 02148
❑ Firm/Co.
Business Telephone 791- -�-
Name of Licensed Plumber or Gas Fitter S�-n�S , �✓
i
INSURANCE COVERAGE: Checkon
I have a current liability insurance policy or its substantial equivalent. Yes No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy H 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:
.Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted (or entered) in the 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 compliance with all pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
Type of License:
Fee ❑ Plumber
Check # ❑ Gasfitter Signatur of Licensed Plum r or Gas Fitter
Date Er Master �/J7�L
APPROVED (Office Use Only) [:I Journeyman License Number
BELOW FOR OFFICE USE ONLY
FINAL INSPECTIONS SKETCHES
PROGRESS INSPECTIONS
FEE
NO.
APPLICATION FOR PERMIT TO DO GASFITTING
NAME AND TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER/and or GASFITTER
PERMIT GRANTED
DATE 1g a
1 '
PLUMBING AND GAS INSPECTOR ;
Date. I
".0 RT:�h, TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
,SSACNUSE�
This certifies that . . . . . . .
has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of . . N).L� . . . . . . . . . . . . . . . .
at. . . . . . . . . North Andover, Mass.
Fee. . 14/. ". .Lic. No..'.�a. . . . . . . . . . . . . . . .
C LUMBING INSPECTOR
Check # p 4 c
5125
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING GO
(Print or Type)
Date z /o L
Building ` Permit # S 2_ J
Location
Owner's ✓ ati �,
Name
New ❑ Reno
vation ❑ Replacement ° PlansSubmitted Yes-:-❑ No p—
FIXTURES Building Permit No
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IZ N i
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3 !Y in V1 O O J 2 F I LL (� I C 1 3 ! C m C
SUB_BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR I I I I I I I I I I l I I I I I I I I I I I I I III
6TH FLOOR
- 7TH FLOOR . -
8TH FLOOR
Check one: Certificate
Installing Company Name WATER HEATER INSUt t.ERr, Corp.
14 ARTMouTH STREET El Partnership
Address r MA 02148
❑ Firm/Co.
Business Telephone
Name of Licensed Plumber T '�
INSURANCE COVERAGE: Checkone
,. i.hove a current liability insurance policy or its substantial equivalent. Yes INo ❑
If you hove checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy L9, 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 Moss. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted (or entered) in the 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 compliance with all pertinent
provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
Fee Sig ature of Licensed PKmber
Check # P57
License Number
Date Type or Plumbing License: Master
I APPROVED (Office Use Only) Journeyman ❑
I
BELOW FOR OFFICE USE ONLY
FINAL INSPECTIONS SKETCHES
FEE PROGRESS: INSPECTIONS
-
NO.
APPLICATION FOR PERMIT TO DO PLUMBING
NAME & TYPE OF BUILDING
LOCATION OF BUILDING
r �
PLUMBER
PERMIT GRANTED
i
DATE t
PLUMBING INSPECTOR
Claim # 1339126
Advantage Claim Services Adjuster Assigned: Glenn Guarente
522 Chickering Road #B
North Andover, MA 01845
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch. 139, Sec. 3B
To: Building Commissioner or Board of Health 0/
Inspector of Buildings Board of Selectmen
Town Hall Town Hall
North Andover, MA 01845 North Andover, MA 01845
Re: Insured: Dr. Robert F. Broussard
Property address: 432 Salem Street
North Andover, MA 01845
Policy #: 1339126
Loss of: 2011/10/29
File or Claim No. AD 9628
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,_Sec'--ion_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 writer and include a reference to the
captioned insured, location, policy number, date of loss and claim or
file number.
Glenn Guarente
Title: Adjuster
On this date, I caused copies of this notice to be sent to the persons
named at the addresses indicated above by first class -mail.
11-2-11
Signature and date