HomeMy WebLinkAboutMiscellaneous - 52 LISA LANE 4/30/2018 (2) 52 LISA LANE
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BUTTERWORTH & O'TOOLE, INC.
ADJUSTERS/APPRAISERS
FOR INSURANCE COMPANIES ONLY
P.O.BOX 8294
SALEM,MA 01971-8294
TEL. (978)741-5731
FAX (978)740-9109
claims(@butterworthotoole.com
05/06/2014
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B
TO: Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectmen
City/Town Hall City/Town Hall
ADDRESSES
North Andover, MA 01845 North Andover, MA 01845
RE: Insured: Wayne Guyer
Address : 52 Lisa Lane
North Andover, MA 01845
Policy No . : 2376307
Loss of: 05/03/2014 Mold
File or Claim No . : 47-0533
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 writer
and include a reference to the captioned insured, location, policy number, date
of loss and claim or file number.
If no reply is received from your office within ten days, we will assume
you have no liens of any type against this property and we will recommend to the
insuring company that this claim is paid.
David Vincent
Adjuster
"trrr
Member of
National Association of Independent Insurance Adjusters
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name
2. Street Address s e 1115A L ,4ti's
3. How many members are in your household? 4
4. What type of sewage disposal system do you have?
❑ cesspool
❑ septic tank and leaching area
X connection to municipal sewer
❑ other (describe)
❑ do not know
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
❑ yes ❑ no do not know, _
6. How old is your sewage disposal system?,X 0-5 years ❑ 6-10 years ❑ 11-20 years---,,',
i ❑ over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
,K yes ❑ no ❑ do not know
If yes, approximately how long ago? --:?,/ years. What was done?
cvnrr c s POr h.oec. _ . we
8. How frequently is your sewage disposal system pumped out? ❑ annually
❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never
9. Have you had any problems with your sewage disposal system? ❑ yes no
If yes, what problems?
t ❑ repeated pump-outs needed
❑ system clogs, backs up, or drains slowly
❑ odors
❑ sewage surfaces through ground
10. How many of each appliance are connected to your sewage disposal system?
washing machine dish*asher' garbage disposal
- dehumidifier drain sump pump toilet
roof/pavement drains shower/bathtub
11. Please state the bra d and pe (liquid or powder) of detergent you use for:
dishwasher
clotheswasher
12. Does your property have a lawn? I yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre 1/2 acre ❑ 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) acres
13. How often do you fertilize your lawn?
No. of applications per year
Season(s) of the year _
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
o.._7G0� tJr c!> fir-
❑ Check here if your lawn is maintained by a professional landscape contractor.