HomeMy WebLinkAboutMiscellaneous - 475 WOOD LANE 4/30/2018N
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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 #
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IWIKbSACHUSETTS UNIFORM APPLICATION FOR -PERMIT TO DO PLUMBING
(Print or pe)
� v ,Mass. Date -
,�i � 20 / Perm i/
Building L cati n
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Type of Occupancy
New ❑ Renovation ❑ Replace menti
J na�s Submitted.- Yes ❑ No ❑
FIXTURES
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Ime of Licensed Plumber or Gas Fitter tr Firm/Co.
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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 ❑
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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
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