HomeMy WebLinkAboutMiscellaneous - 65 BEVERLY STREET 4/30/2018 (2) / moEVE LYSTREET \
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C MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
City/Town: Nod' AUt�,OU�ec2 MA. Date: � 2-0l/ Permit#'
Building Location:[✓ & Owners Name: ^� J
Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential e"
New: ❑ Alteration: ❑ Renovation: ❑ Replacement: [Plans Submitted: Yes❑ No❑
FIXTURES
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15T FLOOR
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3 FLOOR
4 FLOOR
5TH FLOOR
6 FLOOR
VH FLOOR
8 FLOOR
Installing Company Name:
ccNN Check One Only Certificate#
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El Partnership
i Business Tel:9���3T Fax:
❑Firm/Company
Name of Licensed Plumber/Gas Fitter:
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YesEI'No❑
If you have checked Yes,please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy e--/ 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
❑
Signature of Owner or Owner's Agent Owner E] 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 my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in
compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
TTy�p�e, of License:
By 8Plumber
Title ❑Gas Fitter Signatur of Licensed tuber/Gas Fitter
CWaster
❑Journe man
City!town License Number:
APPROVED OFFICE USE ONLY El LP Installer
/ Date.!/`��! :.�. . .... .. . .�
NORTH
of �` TOWN OF NORTH ANDOVER
• PERMIT FOR GAS INSTALLATION
SSAC HUSEtt
This certifies that . . . `s. . . . . . . . . . . . . . . . . . ./ . . . . . . . . . . . . .
has permission for gas installation �?�!??c„
in the buildings of . . . '? -5. . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . Is-
�. . . . .r/�- . . . ... ., North
yAndover,j�ass.
Fee4o:�'"1. . . Lic. No 8 ?2 . . . .
GAS INSPECTOR
Check#P�Q'F 8aS/
COMMONWEALTH OF
A T CL EISS
i'6.a*lIJIMERPLUMSEk
ISSU8,S THS LICENSE TO
I. �ij
1 ALFRED A SPOLIDORO
23 CHAMPA RD f�+
BILLERICA MA 01821=2914,
8326 05/01/12 753849,
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MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108,FAX(800)851-8424
513012009
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws,Ch.139,Sec.313
RECEIVED
NORTH ANDOVER HEALTH DEPT.
NORTH ANDOVER TOWN HALL JUN - 4 2009
NORTH ANDOVER MA 01845 %' TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Re: Insured: ROBERT SANATONIO
Property Address: 65 BEVERLY ST#2,NORTH ANDOVER,MA 01810
Policy Number: 1063423
Type Loss: Other Section I LossesDate of Loss: (."All
512512009
.•—
Claim Number: 263949
Claim has been made involving loss,damage or destruction of the above captioned propert,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