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HomeMy WebLinkAboutMiscellaneous - 475 WOOD LANE 4/30/2018N ON N � $� og v z m 0 ARBE LLA® I NSU RANCE GROUP Elaine Dupuis -Lane, Claim Manager 04/12/2016 NORTH ANDOVER BUILDING COMMISSIONER 1600 OSGOOD STREET, BUILDING 20, SUITE 2035 NORTH ANDOVER, MA 01845 Claim -Number. 0337032071 Policy Number. 33611400002 Company Name: Arbella Mutual Insurance Company Date of Loss: 04/09/2016 Insured: RAYMOND WOOD Property Location: 475 WOOD LANE, NORTH ANDOVER, MA To Whom- It-MayConcern Claimlhas been in4de involving loss, damage, or destruction of the above captioned property, which may either eXc`e—Q-$1,000 br cause Mas'sachus'etts =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. Very truly yours, Steven Chartier Claim Service Specialist Property Claim Office 800-272-3552 ext. 7556 Fax 617-773-4760 1CC. NORTH ANDOVER HEALTH DEPARTMENT 1600 OSGOOD STREET, BLDG -20, STEM 2035 F� NQRTH__ _ANDCQyER, MA 01845 CC: NORTH ANDOVER FIRE DEPARTMENT 124 MAIN STREET NORTH ANDOVER, MA 01845 iioo Crown Colony Drive I P.O. Box 699x95 I Quincy, MA o2269-9195 I telephone fto) ARBELLA I www.arbella.com ARBELLA® INSURANCE GROUP Elaine Dupuis -Lane, Claim Manager 04/12/2016 NORTH ANDOVER BUILDING COMMISSIONER 1600 OSGOOD STREET, BUILDING 20, SUITE 2035 NORTH ANDOVER, MA 01845 Claim Number. 033703201 Policy Number. 33611400002 Company Name: Arbella Mutual Insurance Company Date of Loss: 04/09/2016 Insured: RAYMOND WOOD Property Location: 475 WOOD LANE, NORTH ANDOVER, MA To Whom It May Concern: 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. Very truly yours, Steven Chartier Claim Service Specialist Property Claim Office 800-272-3552 ext. 7556 Fax 617-773-4760 CC: NORTH ANDOVER HEALTH DEPARTMENT 1600 OSGOOD STREET, BLDG 20, SUITE 2035 NORTH ANDOVER, MA 01845 CC: NORTH ANDOVER FIRE DEPARTMENT 124 MAIN STREET NORTH ANDOVER, MA 01845 iioo Crown Colony Drive I P.O. Box 699i95 I Quincy, MA 02269-9195 I telephone (800) ARBELLA I www.arbella.com Date./ l . ./. L TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING This certifies that ........!.y''.': -: `'" �'� %'.. ............. . has permission to perform ..... P. ! .. .................. . plumbing in the buildings of ...P ! c. !"/c at ...3 S. ? .. �-5-. �. `.. ��.. �. ( .............. . North Andover, Mass. Fee..3.... Lic. No.. . ........ . PLUMBING INSPECTOR Check # 6SU IWIKbSACHUSETTS UNIFORM APPLICATION FOR -PERMIT TO DO PLUMBING (Print or pe) � v ,Mass. Date - ,�i � 20 / Perm i/ Building L cati n Owner' m y Lp Type of Occupancy New ❑ Renovation ❑ Replace menti J na�s Submitted.- Yes ❑ No ❑ FIXTURES • IN WMM MMMIN MM M ���� IN MINN W �■�WINININ -WNW now������i .stalling Company Name Check one:/ i // /�I . _11 MY, Certificate ■ Corporation isiness Telephone 2 ❑ Partnership Ime of Licensed Plumber or Gas Fitter tr Firm/Co. NRI IR a rJPC have a current Il bllity insurance policy or Its substantial equivalent, which meets the requirements of MGLCh. 142. Yes t No . ❑ f you have checked Yes, pleas .a indicate the type of coverage by checking the appropriate box. ' liability Insurance policy 'f Other tune IWNER'S INSURNACE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 42 of the Mass. General Laws, and that my signature on this permit a-pplicatlon waives this requirement. ignature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ In w w D w reby certify that all of the details and lnformatlon I have submitted (or entered) In above application are true and accurate to the best of cnowledge and that all plumbing work and installations performed u r the permit Issued for thi a Ileation will be In compliance with ertlnent provisions of the Massachusetts State Plumbing Code4dhto 42 of aL Law . IV, By Title of Licensed Plum City/Town A 00n /1X T- ri......___.__ _ T-_ .. . w�