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� Safety Insurance
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: JOSEPHINE LAGRIMAS
Property Address: 610 ALDER WAY UNIT#610,NORTH ANDOVER,MA
Policy Number: HMA 0383583
Claim Number: BOS00041196
Date of Loss: 1/13/2014
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.
Allan Leavitt Claim Examiner 1/22/2014
Safety Insurance Company
Homeowners Claims Unit
P. O. Box 55098
Boston, MA 02205-5098
Phone: (617)951-0600 EXT 3213
Fax: (617) 531-8891
Email: AllanLeavitt@Safetylnsurance.com
Date.1
NORTp
0
TOWN OF NORTH ANDOVER
' PERMIT FOR GAS INSTALLATION
SSACMUSE�
!tet
This certifies that . r. ... . . . .. . .. . ./. . . � . . .
has permission for gas installation . 5:IL. . . . tel.
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in the buildings of . . . . . . . . . . . . . . . . . . . . . .. . . . . .
at . . .tA.
Fee.3 U:4 . . Lic. No.. .P
GAS INSPECTOR
Check#
797 !
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
*0jCity/Town:-2AtJ /1vtt-c-�� MA. Date:—Li: /i Permit#
Building Location: COQ ���>a I,Q/�s�✓l, Owners Name: (d tw (. US t, C. A;�
G . Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential
New: ❑ Alteration:❑ Renovation: ❑ Replacement:❑ Plans Submitted: Yes❑ No El
FIXTURES
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SUB BSMT.
BASEMENT
1 FLOOR
2N FLOOR
3 FLOOR
4 rff FLOOR
5 FLOOR
6 FLOOR
7 FLOOR
8 FLOOR
n Certificate#
� Installing Company Name: /`, � S� /,P��. P �-� Check One Only Certi
"�
Address:�.Gj'6dx S V City/Town.--Yo . A-41�estate: WIA �orporation
Business Tel:_% 7�b�U �E� ❑Partnership
K Fax: J` `? —�
� w ❑Firm/Company
Name of Licensed Plumber/Gas Fitter: S �/
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes ❑
If you have checked Yes,please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy g-- 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
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and
accurate to the best of Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in
compliance with all Pe irient-provision of the Massachusetts State Plumbing Code and Chapter 142 of th General Laws.
[APPROVE����
` Type of License:
[-4'9lumber
e a ❑Gas Fitter Ignature of Lice ed Plumber/Gas Fitter
[�FMaster
�Town ❑Journeyman License Number:
❑LP Installer n�i
C
Town of
NORTH ANDOVER
BUILDING PERMIT INSPECTION REPORT
PERMIT NO.: PROJECT: Lq,e Q`-1INSPECTION DATE:
UNIT NO.: FLOOR: WING: BUILDING NO.:
REMARKS: �� P�., GT,2.G 1 �
Excavation-depth and soil conditions Framing- Other:
Date: Date: Date:
Inspector Inspector Inspector
Footings and foundations and drains- Insulation- Other:
Date: Date: Date:
Inspector Inspector Inspector
Electrical-rough- Plumbing and/or gas-rough- Other:
Date: Date: Date:
Inspector Inspector Inspector
Electrical-final Plumbing and/or gas-final Other:
Date: 3 — z - O C Date: Date:
Inspector 6; : S Inspector Inspector
Fire Dept.-
oil
ept-oil burner,tank,stove,smoke detectors Final inspection Certificate of Use and Occupancy
Date: Date: Date: -Cof 0#
Inspector Inspector Inspector
Form#995 Action Press,885.7000
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CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
::-Building Permit Number 779 (6/23/05) Date: Apri15, 2006
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 2357 TurneStreet-=VaRgy Realty Dev
LLC for Units #601 =61.2 (12 Units) 600 Adler Way
MAY BE OCCUPIED AS Town Houses Bldg 6 IN
ACCORDANCE WITH THE PROVISIONS OF THE MASSA'CHUSkTTS STATE''
BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY.
Certificate Issued to: Valley'Realty Dev LLC
23`1;Sutton Street Ste IB
Noith.Andover MAP 1845.