HomeMy WebLinkAboutMiscellaneous - 53 HERRICK ROAD 4/30/2018 53 HERRICK ROAD
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MORTN TOWN OF NORTH ANDOVER g
3?pb`t�..ao �e,�OOL
o p PERMIT FOR GAS INSTALLATIOR
7SS^ NUSEt
This certifies that . . . . ... . . .. . . %� :.r . • • � .�G• • • • • • •�;
has permission for gas installation . . . . . . . . . . .
in the buildings of . , '! ! . -./. :�'`;!. . . . . . . . . . . . . . . . . . . . . . .
at . . .,./c /�l.�.l.� . . . . . . . . . . . . . . North Andover, Mass.
Fee. ..).r. - . . Lic. NO..;. . . . . .
AS INSPECTOR
WHITE:Applicant CANARY:Building Dept. PINK:Treasurer
Awl& Safety Insurance
Wo
PO Box 55098
Boston,MA 02205
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 Selectman
City Hall City Hall
NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845
RE: Insured: LINDSEY A SALLESE
Property Address: 53 HERRICK ROAD,NORTH ANDOVER, MA
Policy Number: HMA 0366412
j Claim Number: BOS00068601
j Date of Loss: 3/17/2016
Company: Safety Indemnity Insurance Company
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, Chapter 139, Section 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 number.
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Pat O'Sullivan Claim Examiner 3/21/2016
Safety Insurance Company
Homeowners Claims Unit
P. O. Box 55098
Boston, MA 02205-5098
Phone: (617) 951-0600 EXT 3549
Fax: (617) 531-8823
Email: PatOSullivan@Safetylnsurance.com
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT DO GASFITTING t
(Print or Type)
C NORTH ANDOVER Mass. f Date
4uilding Location �'�� Permit2A fz'
Owners Name_�LLL/.�/�lY
• :' New Renovation D Replacement Plans Submitted
FIXTURES
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BASEMEKT
IST FLOofR
2ND FLOOR
3110 FLOOR
4THFLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
(Print or Type) Check one: Certificate
Installing Company Name orp.
Address II&I - Partner.
Firm/Co.
Business Telephone: eolw_� J7
Name of Licensed Plumber or Gas Fitter �Of
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy E��rOther type of indemnity 0 Bond
Insurance Waiver: I , the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
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Signature of owner/agent of property Owner Agent
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I hereby certify tlut all of the details and information 1 have submitted (or entered)in above application are true and accurate to the best of my
knowledge and that aU plumbing work and insulation performed under Permit issced for this application will-be In compliance with all pertinent
provisions of tho Massachusetts State Cas Code and Qraptet 142 of tho General L►ws.
B TYPE LICENSE:
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Plumber
Title T Irasfitter- Signature of Licensed
City/Town- Z .aster Plumber
����fitter
Journeyman
APPROVED (OFFICE USE ONLY) License Number