Loading...
HomeMy WebLinkAboutMiscellaneous - 67 MILLPOND 4/30/2018 67 MILLPOND 210/095.A-0067-0000.0 LaMarche Associates 5 North Road, P.O. Box 250 Chelmsford, MA 01824 800-349-1525 Fax: 978-256-8590 January 9, 2018 Building Commissioner/Inspector of Buildings North Andover, MA 01845 Board of Health/Board of Selectmen North Andover, MA 01845 NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B Claim has been made involvingloss damage or destruction of the property captioned � 9 P P Y P below, which may either exceed $1,000.00 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, cause of loss and LA file number. Insured: Wendy Hollis I Loss Location: 67 Millpond North Andover, MA 01845 Policy Number: FP096569 Date of Loss: 01/09/2018 Cause of Loss: Freeze Up I LA File Number: MA-2-34080 On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. John Anderson Adjuster LaMarche Associates,Inc.-800-349-1525 Page 1 of 1 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTIU' G (Print or Type) 1 C NORTH ANDOVER Mass. Date, t, /7 J� E13uilding Location � f5SS� Permit � �C(] D Owners Name-jr/ - New Renovation Replacement L] Plans Submitted 9 s=1X—Lro=_ N vs U C F- C y 02 F W � Q! = I G1 �_ C !- < �- O F rL O W < C4clC Q O _ W d tII N N " W O y t7 W _ H U 4 N W C W V W 79 < G D W W C7 '- d = = = UJ U- t- GJ }- to d W C C r- }- m O = C O us a rs > SU8-3SS.1T. I I ( # I # I I I 1 # i I ( ! t I I •I SASEldE:LT I I I ! I I I I I I# I I ! I I I I I I I I I IST FLOOR I I I I I I ( I I ! I I # I I I I I ( I I ZILo FLOOR sRn FLOOR 4TH FLOOR STH FLOOR ( I I ( I I I I I I ( # I ! ! I ! I ( I ( I 6TH FLOOR TTI{ FLOOR BTH FLOOR (Print or Type) Check one: Certificate Installing Company Name C��'/f Q Corp. Address - Partner. Firm/Co. Business Telephone: Name of Licensed Plumber or Cas =fitter /r� �d Insurancr- Coverage: lndica_e ;ne ,ype of- insurance coverage by checking the appropriate box: Liability insurance policy C.^er tvpe of indemnity Q Bond Insurance Waiver: I , the undersigned, have been made aware that the licensee of this appiication does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner = Agent Q I hc:e3Y ee:tirY that atl of the details and information l have submitted (ar entered)in aLmve appReation are true and accurate to the best of my kno-tcd;e and Usat all plumbing work and tnstattatia= -=O=cd under ftrmit isried ror this appuat:en will be in COtnpiiaaea With am pertlnctt proTixiona of Lho Sesssae.'tusettz State Cas Gide susd C:%.aptcr!4"=c t-%0 CrRt=3.i Lawn. By T'_'P= LICZNS' r Z,�z Title I Gas fitter Signature of Licensed City/Town: ! Master Plumb O Gasfitter Journeyman APPROVED (OFFICE USE ONLY) Lic�Nui/per s ��� rpa Date. � ;- 2055 pORT1y TOWN OF,NORTH ANDOVER - r O?O6`„f0 •d,MO� PERMIT FOR GAS INSTALLATION y t'. This certifies that . . ���? �. i . . . . . . . . : . has permission for gas installation/ i 1�L!1.�g r in th buildings of . . �'. ./. ./. . i�G� -�. . . . . . . . . . .c. at _ . .� � �? !% . ., North Andover, Mass. Fee d.----. Lic. o..//./ � . . . . . . . . . . . . . . ..... . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NO.ANDOVER,MA , Mass. Date zp/—A '_lg� Permit Win Building Location44 MILLPOND Owner's Name NO.ANDOVER,MA Type of Occupancy RES New ® Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ N I W N N h V !LV\ y ¢ W 6 O N 2 F W WU1 LU rt O U fn S of d m N F- ¢ O O = O p F- ¢ W < = Z F- h UA C C W N C7 W W ¢ j Z ! �. W V S N ¢ e SII C7 F — J t r W Y N m 2 O = W 0 _W j W ¢ W O < G < O O W a' 0 }� F• ¢ = O tl LL O 3 O O J V ¢ Y a 6 F- O SUB—BSMT. BASEMENT I 1STFLOOR V 2ND FLOOR J . I EE 3RD FLOOR '' I V I 4TH FLOOR STH FLOOR I 6TH FLOOR I , 7TH FLOOR STH FLOOR Installing Company Name CALLAHAN AIR CONDITIONING. Check one: Certificate u i Address 91 BELMONT STREET I3 Corporation NO.ANDOVER,MA. 01845 ❑ Partnership Business Telephone 508-689-9233 ❑ Firm/Co. Name of Ucensed Plumber or Gas Fitter JOSEPH KEVIN CALLAHAN INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes R] No ❑ ' If you have checked ye, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy ZI 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of towner or Owner's Agent I hereby certlfy that all of the details and information I have submitted (or entered)In 4bove applicatlon are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit sued for this applicatl will b In pflance with all pertinent provisions a(the Massachusetts State Gas Code and Chapter 142 of the neral law ®Y 7 e of Ucense: umber gnatur o c nse um a or Gas atter Title stiller aster Ucense Number M-3440 ArY Journeyman 0 . Ott`c"x'-r"b'""'"m�rw`v....' �..: ':f' .�:arn�/T�`r`•e.w�, N1n�t Date....../�.: f? 2048 TOWN OF NORTH ANDOVER a 3 PERMIT FOR GAS INSTALLATIOP� Y, I" This certifies that . :� ' '� � ,1 has permission for gas installations a in the buildings of . . . . c.. at . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. ' Fee. �-"_' NO.Jr.3Y.1/0 j ��� f GAS INSPECTOR WHITE:Applica �l AWAMY: Building Dept. PINK:Treasurer GOLD: File Date.. . .. ..`4. ©� HpRTH o= TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION h AC HU # This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . at�.T. . � � North Andover Mass. Fee .`. . . Lic. No".�4�a. . . . . . . . . . . • r GAS INSPECTOR Check# ��� 5564 yam. MASSACHUSETTS uNiFORM ARPI_iCATiC]N FO PERMiT TO DO GASFiTTiNG` (Pnr Or Type) j �, ':-` "�� � , t. Mass Date tT.� Permit #- � -� la� Bultdtng Location 0. .% .-, I� Own�i's Narrie f�) l�!� TYpe at Occupancy'. 11 Newer Ienovatlon p Freptaceinent ❑ Plans Submitted Yeso„ NQ ❑ N , N -fC 41 N X `;� `s Si1': v1 N ti rt - N fC O to X N W, J Ca L .#� u ,:(n }- Jr x a �r :.o �' r �„ N 0 yr T 1"' to p W W r w Z ,ui !'- w h = aY O Fi _ J Y X }. 'w W-. O <> u. F tUir_ J W < yi a s w Z x :< < a o. o w o f- sve=BSMT 8As£FlEt1T 7STFLOOR w_ ;21iQ FLOOR ; - t '.` ARD FLOOR 4TH FLOOt3 = STti F00R 6TH F.LOBR, TTi� F 00R. BTtt FLOOR !ns#aiting Company Name Gf `�L l�-f�I(� Cfieck one Ceriiticate #' ,Address L ''Lllt' i — t -corporatlor .. �� A495 Q: rarinershlp Business TelephoneD jp.:� G�- 3 Q' Fir 1Co :,. ._, Name''of Licensed Plumber or Gas Fitter s C/�L- SNStJRANCE COVEI;AGE _ i have'a current Iabfltty insurance policy or its;substantial equivalent which meets the requirements;of MGL CM 142 Yes. L"7 No ❑ - Ii you fiave.cfiecked yes please lndtcate the type coverage by c6,p; ng the appropriate box ,, A liability Insurance:policy �- Other_type of indemnity-C] Bond ❑ OWN.Efl S tt�St,PAt�iCE VlA1VElt i am aware that the iicei�see does riot have;'the insurance cove age required by Chapter 142 of the Mass. General Laws; and That trtiy signaEure on-tfils,.permit applicatl.on waives tfils regtilrerrierzt Cheek one S+gnat�re of tJyvner or Qwner s Agent Owner❑ Agent ❑ 1 hereby certtty hal al(•o'i the deiarls and'Iniormatron 1 have submltied (o> enierei)In above application,ale true and accurate io the bast<ol my , knowledge and:that aI plurnbir.9 work and ln3ta latloni 'eriormed uncle the permll Issued lot lhls application wilt be!ri compliance wiih,a6 pertli�ert pronsons of the Massachuseits State.Gas Coe and giapiet f42 of ire Geri -;a1 La►vs. ,L e of license ''?rile Plumber Sig to e o c nsa uin er or; as rt er frsiiilor Crty/7ovm aster !cense Number 3 �� IU'f'fK7Nf 0�O iC O Journeyman �..:::,