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HomeMy WebLinkAboutMiscellaneous - 580 OSGOOD STREET 4/30/2018 / 580 OSGOOD STREET ` J 210/101.0-0003-0000.0 \` J ARBE LLA® INS U RAN C E G R O UP Charles Wadland,Claim Manager 07/30/2013 North Andover MA Building Department Gerald Brown 1600 Osgood Street North Andover,MA 01845 Claim Number. 033366332 Policy Number: 61056400004 CompanyName: Arbella Mutual Insurance Company Date of Loss: 07/08/2013 Insured: ANASTASIOS KOULOPOULOS Property Location: 580 OSGOOD ST,NORTH ANDOVER,MA Dear Building Official: Claim has been made involving loss,damage, (Roof) 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. Include a reference to the captioned insured,location, date of loss and claim number. On this date,I sent copies of this notice to the person(s) named at the addresses indicated above by first class mail. Very truly yours, Robert Wojtczak Claim Service Specialist Property Claim Office 617-328-2800 ext.2456 Fax 617-773-4760 iioo Crown Colony Drive P.O.Box 699195 Quincy,MA oa269-9195 telephone(800)ARBELLA www.arbella.com Date. . . NORTH OF 3= °` TOWN OF NORTH ANDOVER 0 P • ° PERMIT FOR GAS INSTALLATION µ,SSACMUSEt This certifies that .4a-, . . . . . . . . . . . . . . � .. .. .. .. . has permission for gas installation . . . . . U � in the buildings of . . . . . !r... . . . . ; .. at 14 North Andover, Mass. Fee . . . . . . Lic. No.f 3 . . . . . . . . . . . . . . . . . . . . .GAS INSPEty OR Check# c9z/x r 7 � MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING fJ) (Print or Type) Vd�/iUAlutio+- , Mass. ,Date--/oh . 20 LI Sy Permit V -- Building Location np asz 00'-p sy- Owners Name Type of Occupancy1> New Renovation❑ Replacement❑ Plans Submitted: Yes ❑ No©/ w � o' � O N U OLU � .� O U m z 0 0' w O Oo_ O wcQC Y Ln � wLU ~ Ct z U > z w o _ LU O 0 a>O 1 W1 O . SUB-BSMT BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR �. STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR nstaliing Company Name 3 P10,ab;)Jefc Check one: Certificate Wdress j &A�IQ r, ❑ Corporation y ��y� �� r ` .7 ❑ Partnership lus)ness Telephoney (O ® - ,� _ `` ❑ Firm/Co. tame of Licensed Plumber or Cas Fitter [ ZAi'YCP.L1L7/�7�/ t INSURANCE COVERAGE: 1 have a currentilabiiity insurance policy or its substantial equivalent, which meets the requirements of MCL Ch. 142. Yes No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability Insurance policy, Other type of Indemnity ❑ Bond ❑ OWNER'S INSURNACE 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 o Owner or Owners Agent Owner ❑ Agent ❑ hereby certify that all of the details and information I have submitted for enured)In above application are true and accurate to the best of iy knovNedge and that all plumbing work and Installations performed under the permit Issued for thl$applicatio HAII be in compliance with II pertinent provislons of the Massachusetts state Gas Code and Chapter 142 of the Gene Type of License: By -e-Plumber tore of L censed iumber or Gas Fitter Title ❑G as fitte r City/Town @,Master License Numbed APPROVED(OFFI❑E USE ONLY) �rneyman d i