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Home My WebLink AboutMiscellaneous - 56 MILK STREET 4/30/2018 56 MILK STREET 210/060-A-0002-0000-0 Amhk WoSafety Insurance Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B 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(s): DANIEL J COLLINS&CATHERINE A COLLINS Property Address: 56 MILK ST,NORTH ANDOVER MA 01845 Policy Number. 0007320 Claim Number. BOS00007621 Date of Loss: 02-25-2010 Company: Safety Insurance 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 or file number. Bill Jones,Adjuster 03/02/10 Safety Insurace Company Homeowners Claims Unit P.O.Box 55098 Boston,MA 02205-5098 Phone: (800)951-2100x3461 Fax: CC012.001 Date. . . . .. . . . .. .. . . . .... . ,AORTsI of °` TOWN OF NORTH ANDOVER F 9 a PERMIT FOR GAS INSTALLATION a i r s • y,SSACMUSEt This certifies that . . . . . . . . . . ... . . . . . :. . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . ... . . . . . ... . . . .: . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . at.. . . . . . : . . . . . . . . . . . . . . North Andover, Mass. Fee:,. . . . . . . . Lic. No.. . . . . :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GASINSPECTOR Check# / 1 MASSA I APP CATON FOR PERMIT TO DO GAS FITTING °Type or print) PARCEL Date NORTH ANDD Building Locations /lk \ Permit# Amount S t5 Owner's New❑ Renovation ❑ Replacement Plans Submitted ❑ rn �• :L u .�. N C z z z C Z E.. G " w .t pr C csr. Z v .rJ C w FZ -! i v cam„ z -t w — %r z C w V V .SS I r., ! r .� �• Su 8 -8ASE,rt ENT B A S E M ENT 1sT. F L 0 0 R 2ND . FLOOR 3R 0 . FLOOR sTII . FLOOR ST 11 . FLOUR 6T 11 . F1, 00 R 7•rlt . FLOOR s'rn . FLOOR (Print or type) Chec ne: Certificate Installing Company Name Ando � r P1 b4• f 14 tA. (n., TAO_ • Corp. 2121 ,Address 20 IAeAec n Mr. 116 t At In ❑ Partner. en Business Telephone1Q7B0 /eR5-P383 ❑ Firm/Co. Name ufLicensed Plumber or Gas Fitter GeorA INSURANCE COVERAGE Check one: I have a current liability Insurance poli or it's substantial equivalent. Yes No ❑ If you have checked ves,please in ' ate the type coverage by checking the appropriate box. Liability insurancepolicv 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 ❑ i hereby certify that all of the details and information [ have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued For this application will be in compliance with all pertinent provisions of the Massachusetts State G• Code and Chapte 42 General Laws. By: S' ature o' rcensed Plumber Or Gus Fitter Tide Plumber19 R;3 CiryiTown ❑ Gas Fitter License N umoer rErrvv [aster APPROVED(OFFICE USE ONLY) ❑ Journeyman MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NORTH ANDOVER Mass. Date 1huilding Location Permit # 0 19 Owners Name 1-e�/ 's New '7 Renovation Replacement ti Plans Submitted D FIXTURE- as a: � se z tz as ttl Ot O 0 t17 t S N O t�si ~ 4 a o = p F W d til H t� a tL 0 0 O z W t= to d w " y; y 4 cc w z v us y d a to `m -K Q t0- o w w r z W d = a oc a w w r� s n F- x �- z F. w w o 0 > u I- 2 d W < 4' r r Y- N 0 ' O Uj O N S d to > C W O < G 4 d O O W O tv 0 a z 0 t7 'l u. O A t7 .t U > O SUB–as TAT. BASEMEMT 1ST FLOOR 2ND FLOOR 31112 FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR TTK FLOOR STH FLOOR (Print or Type) Check one: Certificate Installing Company Name/o)p`ere e /�dl;rla e-llg,- T Q�Corp. /a�-- Address Partner. Firm/Co. Business Telephone: Name of Licensed Plumber or Gas Fitter �Q��,',e0�s'E Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy EdOther type of indemnity Q 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. Signature of owner/agent of property Owner F] Agent El I hereby certify that ail of the details and information I have submitted (or entered)in above application are true and accurate to the best of mY knowledge and that aU plumbing work and installations pufomied under Permit issued for this application wiU-be to compliance with all pczftent provisions of the Massachusetts State Cas Code and Chapter 142 of us*Genetai Laws. By PE LICENSE: Plumber Title sfitter Sig1rature of Licensed City/Town: Master Plumher or Gasfitter Journeyman APPROVED (OFFICE USE ONLY) License Number 14 r 0 Date.�."/. i.r........ .. HpRT1, TOWN OF NORTH ANDOVER Of�.,,ao ,n 1ti0 o .._ p PERMIT FOR GAS INSTALLATION �9SSACHUSEt This certifies that has permission for gas installation . . . . . . . . . . . . . . . . . . . in the buildings of . . .D f?H. . .e o A t.r r. . . . . . . . . . . . . . . . . . . at . . . ,lei. !l i. . . S''. . . . . . . . . . . . . North Andover, Mass. Fee. /DJ ` . Lic. No.17.7k �. .1 12/22/9 15% j�"co PAID GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File