HomeMy WebLinkAboutMiscellaneous - 47 MARBLEHEAD STREET 4/30/2018 (5) r
/ 47 MARBLEHM STREET
J210/008.0-0019-0000.0 ,
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- PERMIT FOR GAS INSTALLATION
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- This certifies thatk-- �-^�'�� ..r �. . . . . . . . .
has permission for gas(in tallation
r' in the buildings of c. .. . . . . . . . . . . . . . . . . . . . . . .
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at . . . . . . . . . . . . . . . . . . . . . . . ... . , North Andover, Mass.
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Fee,-?P. . .. Lic. No.. . . . . . . . . . . . . . . . . . .
GAS IN.„EC�T R
Check# /31/7/ (�f
4986
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
_0DOVF, C , Mass. Date/_ DE(', 27�; 26Dq permit #
Building Location.. E HA LEN RQ / i�i Owner's Name JA MET LEE S
y. t_M_TD DOlIE Type of Occupancy k ES/0 F_i g 1 AL,,
New ❑ Renovation ❑ �Jplacement�j Plans Submitted: Yes[] No ❑
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SUB—BSMTm
BASEMENT
1ST FLOOR
2ND FLOOR
X 3RDFLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
Installing Company Name BAY STATE GAS COMPANY Check one: Certificate #
Address 55 MARSTON STREET XO Corporation 1862
LAWRENCE, MA 01840
❑ Partnership
Business Telephone .687-1105 ❑ 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 K No ❑
If you have checked yes, 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 Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent , Owner❑ Agent El
hereby certify that all of the details and information I have submitted(or entered)in abo plication are true and accu�te to the best of my
knowledge and that all plumbing work and installations performed under the permit Iss f r this apprcation will n mpliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. (j i
Type of License:
Plumber Signature of Ljoen Plumber or Gas
Title Gasfitter
Master license Number
City/Town
9Journeyman
O IC S ONL
i.
BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHESPROGRESS INSPECTION
FEE
N0.
APPLICATION FOR PERMIT TO DO GASFITTING
t'. NAME & TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER OR GASFITTER
LIG NO.
PERMIT GRANTED
DATE
GASINSPECTOR
MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617) 723-3800, Ma Only (800) 392-6108, Fax (617) 557-5675
12/28/04
Form of Notice of CasualtyLoss to Building
9
Under Mass. Gen. Laws, Ch. 139, Sec.313
NORTH ANDOVER BUILDING COMMOSSIONE
NORTH ANDOVER TOWN HALL
NORTH ANDOVER MA 01845
Re: Insured: JANET LEES
Property Address: 47 MARBLEHEAD STREET, NORTH ANDOVER, MA 01845
Policy Number: 0698897
Type Loss: Furnace/Boiler
Date of Loss: 12/23/04
Claim Number: 212715
Claim has been made involving loss, damage or destruction of the above captioned property,
which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143,
Section 6 to be applicable. If any notice under Massachusetts General Laws, chapter 139,
Section 3 B 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
RECEIVE®
JAN 4 2004
BUILDING DEPT.
CMA00021