HomeMy WebLinkAboutMiscellaneous - 60 PARK STREET 4/30/2018 / 60 PARK STREET
210/085.0-0050-0000.0 �.
I .
h
MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(617)723-3800 Ma Only 18001392-6108,FAX(800)851-8424
12/13/2017
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws,Ch.139,Sec.36
NORTH ANDOVER BUILDING COMMOSSIONER
NORTH ANDOVER TOWN HALL
NORTH ANDOVER MA 01845
Re: Insured: PAUL AND SUSAN LAURIN
Property Address: 60 PARK STREET,NORTH ANDOVER,MA 01845
Policy Number: 1436488
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 10/29/2017
Claim Number: 420108
Claim has been made involving loss,damage or destruction of the above captioned property,which may either
exceed$1000.00 or cause Massachusetts General Laws,Chapter 143 section 6 to be applicable. If any
notice under Massachusetts General 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.
MPIUA Claims Division
CMA00021
Date. �
JJ J tr .. . .. ... .. . . ........
NORTH TOWN OF NORTH ANDOVER
pf ��ao ,a,'�'O
3? ��
O PERMIT FOR GAS INSTALLATION
A
41 6
F 9
°�.rm rrr�45
ISS CH
This certifies that . . . .
/ \�� . • . . . . . .. . . . . . . . . . . . . . .
has permission for gas installation . . . . . . . . . .
in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . .
at .l! :. :,.; . - . . . . . . . . . . . . . . . ..
North Andover, Mass.
Fee/`'. .'':� . Lic. . . . . . ....... ... . . . . . . . .
GAS INSPEQ70R
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING J , '
(Print or Type)
Lo LfH L/Dov e4e , Mass. Date ab 19-!2— Permit #
Building Location 60 rJl:'2 K ST Owner's Name /)t S IVS,11 n) ,q/Lp TrA
MIA 6(N-J Type of OccupancyI �•N T t rP
New ❑ Renovation ❑ Replacement Plans Submitted: es❑ No ❑
N
N ¢
H N V z ¢ ¢
N ¢ vl ¢ 0 ¢ y ~ ¢
� S f•
W J y W O V m ~ S fA
Z o W I- < ¢ 0 =
< ¢ O
< m y r- y W o � 'o � ►-
N ¢ y M V W = Z ~ H ¢ > <
W W h J = < _ ¢ N W < ¢ tu N =
L7 W ¢ O ¢ W W V h ¢
J F 2 �„ W O > W *- J �.. W
< ,W > ¢ W O Z, < ¢ < m Z O W O to =
¢ S O t7 S 4. D d J V ¢ > G d H 0
SUB-8SMT.
BASEMENT
1 ST FLOOR '
2ND FLOOR f
3RD FLOOR _
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
Installing Company Name12(A (zT m MA i r1 f2 Check one: Certificate
Address_ � nr1 N/h,a IQ i,NJ ❑ Corporation
Al ' 7 HA)-E n) 01 A U l k�� ❑ Partnership
Business Telephone /d, 2 -9 q-7 1 2--Arm/�
Name of Licensed Plumber or Gas Fitter �t r (AE -T AMr}1►9 T r� r
INSURANCE COVERAGE:
1 have a current Ipbility Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes 1Z No ❑
If you havb checked yes, please Indicate the type coverage by checking the appropriate box
A liability insurance policy '
Other type of indemnity❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 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 installations performed under the pe ' � ed for this application . be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ne Laws.
T;0,,.er
f License: t`3
lumber n ure of licensedu _ or atter
Title tter
License Number �33 )
APPF0VEffTG�'�OW" oeyman
f
BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES PROGRESS INSPECTION
FEE
NO.
APPLICATION FOR PERMIT TO DO GASFITTING
i
NAME S TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER OR GASFITTER
LIG NO.
PERMIT GRANTED
DATE 19
•, J GAS INSPECTOR