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Home My WebLink AboutMiscellaneous - 573 SALEM STREET 4/30/2018 (4) 574 SALEM STREET 210/03g�101 0000.0 I i PO Box 55098 Boston,MA 022055098 617-951-0600 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: JOHN REARDON and BEVERLY-REARDON Property Address: 574 SALEM STREET,NORTH ANDOVER, MA Policy Number: HMA 0327067 Claim Number: BOS00059852 Date of Loss: 4/1/2015 Company: Safety 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. Joshua Terenzoni Claim Examiner 4/23/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3287 Fax: (617)531-6648 Email: JoshuaTerenzoni@Safetylnsurance.com Safety Insurance 0 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:4' ' ` JOHN REARDON and BEVERLY REARDON Property Address: 574 SALEM STREET,NORTH ANDOVER, MA Policy Number: HMA 0327067 Claim Number: BOS00041482 Date of Loss: 2/7/2014 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. Daniel Olsen Claim Examiner 2/11/2014 Safety Insurance Company Homeowners Claims Unit P. 0. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3323 Fax: (617) 531-2762 Email: Danie101sen@Safetylnsurance.com Date... °.?. ... .. .. NORTH pf TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION 9SSACNUSEt This certifies that j�4 /?�- . . � . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . .�.y. . . .rt. - . . . . . . . . . . . . .. North Andover, Mass. k 'Fee. Lic. No..).<<.`! . . . . . . . s GAS INSPEC!TOR f Check# 2 311 "// " 6054 MASSACHUSETTS UNIFORM APPLICATIONLR PERMIT TO DO GASFITTiNG (Print or Type) _leo ,2 f Mass. Permit # Building Location 's Name Owner1,f�N Type of Occupancy 1Jew O Reo Ion [] Replacement Pians Submitted: Yesp No p An cc V) 0X W cc N rL. N cr F C O ut = V LU1LJ N W. }� U rn F '_ n 2 O v F- r ? Z "L .O F rt N s v1Lij ( us d _ uI= CC LIJ Ncc. a C W 7: > V7 v r- z Uj :� t- z f W W O.0 W y LL }- � .:j w a Uj W y CC W Z. < aC = - d a: 6 SU"B=BSMT. BASEMENT IST FLOOR 2ND FLOOR r 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name -CJS U__i4 f�/JIv �,�-� �`l" � Check one: Certificate # AddressS71p`-Cor oration- p ��. U y - ❑ -Partnership Business Telephone q f� �C/� 3 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter `fU% CALZ A///4 INSURANCE COVERAGE: I have a current flaUl,iiy"insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Q No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy Other type of Indemnity 0 Bond O OVYNER'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 I have submitted (or entered)In above application are true and accurate to the best of my knowledge and that all plumbing work and instatiatlons erformed under the ermit issued for this application M11 be In compliance with ali pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Genual Laws. T e of Ucense: Title Plumber Sig(• to e o ctfnse um er or Gas fitter astiller //� city/Town aster Ucense Number 3 yTd Af'f f1 r.DTOITTCE-UK('-07T7j Journeyman s Date.. . . NORTH 0 �p TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION SACHUSEt This certifies that . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . has permission for gas installation -P �'.'. . . . . . . . . . . . . . . . ft.� in the buildings of . . . . . . . . . . . . . . . . . . . . . . . at North Andover, Mass. Fee <.J >. . . . . Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR/ i Check# r f 4349 i MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS Ff nING (Type or print) Date NORTH ANDOVER, - L —� MASSACHUSETTS Building Locations _ s 7 /�� -!� Permit# L13`f Amount$ Owner's Name New❑ Renovation ❑ Replacement Plans Submitted ❑ t4n w � O w 0 a p ° z H w a c a > z o F o ' w 3 a v a° a° H o SUB-BASEMENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR ELL (Print or type) ec one: Certificate Installing Company NAme Corp. Address S� J k ❑ Partner. Business Telephone (yy n,� ❑']+irm/Co. Name of Licensed Plumber or Gas Fitter l U 6 ��j/�tl INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes [3— No❑ i� Ifyou have checked M,please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ f / i 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 I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installa' ns performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachhu tate ode and pter 142 o he General S. By: Signature of Licensed lumber Or Gas Fittcr Title 13-14urnber City/Town ❑ Gas Fitter eLmThber Master APPROVED(OFFICE USE ONLY) ❑ Journeyman