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HomeMy WebLinkAboutMiscellaneous - 70 MILLPOND 4/30/2018N O O Po Box 55098 Boston, MA 02205-5098 817-951-0600 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS. Ch. 139. Sec. 3B To: Building Commissioner or Inspector of Buildings City Hall N ANDOVER, MA 01845 Board of Health or Board of Selectman City Hall N ANDOVER, MA 01845 RE. Insured: KERI L -STELLA Property Address: 70 MILL POND, N ANDOVER, MA Policy Number: HMA 0400959 Claim Number: BOS00049699 Date of Loss: 2/18/2015 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. Joshua Terenzoni Claim Examiner 2/19/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 5121 Fax: (617) 531-6648 Email: JoshuaTerenzoni@SafetyInsurance.com N �..vru- r.1-in.,r�•:•---,..--=�-.w-.-..''i tea- . > .. ,- :-.r..-.-�.-w-,...�.7�:....�,�..�„ _ ;, ,,,h-...._ __� . Date. rz� 3064 TOWN OF NORTH ANDOVER Ot . 1ti i?. `t��. •• O0 PERMIT FOR PLUMBING SA us This certifies that .. ,�? .G �c �.... ��. /� .............. has permission to perform .t •c .7. ......................... plumbing in the uildings of --.................... . at .. .O....Az''.......... , North Andover, Mass. Fee. . Lic. No..�. 77� .3 .. ... ....... . PLUMBING INSPE TOR 12/28/98 14:33 X5.00 PAID WHITE:. Applicant CANARY: Building Dept. IPINK: Treasurer r.•._�L..--..-wv++;.`r'."'."ro'{v». - r..:.r:.�F'�q'v]v�.r�..+'+C'1...�r't'.^%-�;-1::!ffv._�"�a4>'",Y",. lka :a ......y.ar��.@rat—ca 1., uamu"M AI'rU%.oA11UfY t-Ult1 t�Crtmaa ar v.+ . — (f ilnl Or type) �p NORTH ANDOVER, , Maas. Oats Bulldlna�� �%� Permll # �%6 Location_ Owner's t� Name C� fA- ' New ❑ Renovation ❑ Replacement Plans Submitted: Yes ❑ FIXTURES No ❑. Beck one: Certkicale Installing Company Name ANDOVER PLG. & BEATING CO.. INC. p'Corp. 2122 -Address_ 573 112 _%Q_ UNION ST ❑ Partnership ` LAWRENCE, MA. 01843 ❑Firm/Co. ©usiness Telephone 508 685-8383 Narne d Licensed Plumber GEORGE LAROSE INSURANCE COVERAGE:ecx e I have a current Ilabiny Insurance polity or Rs substantial equtv>ilenl. Yet r No Cl It you have checked y", please , Ica(e the type ccrverage by checking Ilia appropriate box. A Itabiny Insurance poticy Fk. Other type of Indemndy ❑ Bond ❑ ovymm3 INSURANCE WAIVER: 1 am aware that the licensee 0Qgj not have the Insurance coverage required by Ch -Wer 142 d Ilia hfass. t3enenl Laws, and that my signaltx• on this permit application waives this requirement. Check one: Owner ❑ Agent [Inature ol Nmef or (Nvner I AQenj I her csrtlty that all of the dat0a and W(mmallon I have tubmittad log enter" In abow sppfieatlon are true and accurate to the best of my 1naw4dpe and that all ptumbinp work and Inataltattons p*iamed undea the permA I"u*d for qgs applkal}on wilt bo in compliance with aA pertinent provisions of the Mauachuaetia Slate Plumbing Coda and Chapter 142 of the Ry Sym' Perm e Pile _ dty/town lJcsnaa (kxnbar 9983 at'tITIAD (rV rx:E USE OfILY1 Type of F'k�bin0 License:Journeyman w =W O ! x w r N J • ` U F<' • 7 4 • • Y = H r • p k J • S < Is >< IS O • IL k ad ac ad $Ua—**MT. SA8KMSNT ; IST FLOOR f1H0 FLOOR 3RD FLOOR ITH FLOOR ITN FLOOR aTHFLOOR 1TH FLOOR ITH FLOOR Beck one: Certkicale Installing Company Name ANDOVER PLG. & BEATING CO.. INC. p'Corp. 2122 -Address_ 573 112 _%Q_ UNION ST ❑ Partnership ` LAWRENCE, MA. 01843 ❑Firm/Co. ©usiness Telephone 508 685-8383 Narne d Licensed Plumber GEORGE LAROSE INSURANCE COVERAGE:ecx e I have a current Ilabiny Insurance polity or Rs substantial equtv>ilenl. Yet r No Cl It you have checked y", please , Ica(e the type ccrverage by checking Ilia appropriate box. A Itabiny Insurance poticy Fk. Other type of Indemndy ❑ Bond ❑ ovymm3 INSURANCE WAIVER: 1 am aware that the licensee 0Qgj not have the Insurance coverage required by Ch -Wer 142 d Ilia hfass. t3enenl Laws, and that my signaltx• on this permit application waives this requirement. Check one: Owner ❑ Agent [Inature ol Nmef or (Nvner I AQenj I her csrtlty that all of the dat0a and W(mmallon I have tubmittad log enter" In abow sppfieatlon are true and accurate to the best of my 1naw4dpe and that all ptumbinp work and Inataltattons p*iamed undea the permA I"u*d for qgs applkal}on wilt bo in compliance with aA pertinent provisions of the Mauachuaetia Slate Plumbing Coda and Chapter 142 of the Ry Sym' Perm e Pile _ dty/town lJcsnaa (kxnbar 9983 at'tITIAD (rV rx:E USE OfILY1 Type of F'k�bin0 License:Journeyman MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTiNG (Print a( Type) a .y G NO . ANDOVER , MA , Mass. Date l "�= -i.19 "OV Permit #T . Building Location ` &1 MILLPOND Owner's Name ScmL)" NO . ANDOVER , MA Type of Occupancy " RES New ® Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ • No ❑ Installing Company Name CALLAHAN AIR CONDITIONING Check one: Certfficate - Address 91 BELMONT STREET 13 Corporation NO . ANDOVER , MA . 01845 ❑ Partnership Business Telephone 508-689-9233 ❑ Firm/Co. Name of L)censed 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 10 No ❑ ' It you have checked Les, please indicate the type coverage by checking the appropriate box. A liability insurance policy f1 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 C3Srgnalure of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) In ove appfcation are true and accurate to the best of my kncwiedge and that all plumbing work and Installations performed under the Permit sued for this appllcatl will b In compliance with all pertlnent provisions of the Massachusetts State Gas Code and Chapter 142 of the neral Law ®Y T e of Ucense: A' 11 0� umber g naturorof Lic nse um a or Gas filter Title sfrtter aster Ucense Number M-3440 Y Journeyman O . N N W N N N Y U ¢ Vf N W ¢ w rA ¢ R 0 O U m c7 J N ¢ to1 C p, + 'L O m rn H < rt C o Z , O1- tt Yl < _ = > W W O C LLA J f W H ?. N > U. _ < W W > ¢ .� W ¢ O Z ¢ < W < O OF- ¢ S O v W Z O O J U d i O ri F O SUB—aSMT. BASEMENT I I ST FLOOR v 2ND FLOOR Y 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name CALLAHAN AIR CONDITIONING Check one: Certfficate - Address 91 BELMONT STREET 13 Corporation NO . ANDOVER , MA . 01845 ❑ Partnership Business Telephone 508-689-9233 ❑ Firm/Co. Name of L)censed 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 10 No ❑ ' It you have checked Les, please indicate the type coverage by checking the appropriate box. A liability insurance policy f1 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 C3Srgnalure of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) In ove appfcation are true and accurate to the best of my kncwiedge and that all plumbing work and Installations performed under the Permit sued for this appllcatl will b In compliance with all pertlnent provisions of the Massachusetts State Gas Code and Chapter 142 of the neral Law ®Y T e of Ucense: A' 11 0� umber g naturorof Lic nse um a or Gas filter Title sfrtter aster Ucense Number M-3440 Y Journeyman O . r��c-�_ �.-rc• .:.:vim-��,ab,.�-�-��.,_�: „�;,s�.i`--:oma . _ ,.;y,,;�m:+* . �n4 Date...204 ... . Vu 'a of Na oT "1 ^ TOWN OF NORTH ANDOVER a p PERMIT FOR GAS INSTALLATION <> • N Q This certifies that .....Com........ .�-... . has permission for gas installation .. in the buildings of .... . . at .. Q.. . .......I North Andover, Mass. Fee. ... D 49 GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File r" r� U �v1 � IASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Mass. Date /-zd Y 19 Z6 Permit # .? Z Q ' Building Location///Jam Owner's Name 0,4W S'e�c2w' . f Type of Occupancy GO�ylJ New U/ Renovation ❑ Replacement L,. Plans Submitted: Yes ❑ No ❑ Installing Company Name AE/1) 11'7ed-/�/t/%e1iZ � Check one: Address 5-71312 ('02 6/ 1la,kJ S7� L�' Corporation ��/. ,-2, 1Z eer /%/�' ❑ Partnership Business Telephone Odd /b0- i �❑l Firm/Co. Name of Licensed Plumber or Gas Fitter L aLi� Jam- �Jf /- Certificate # INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. Yes No ❑ If you have 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: I am aware that the licensee does not have the insurance coverage required by Chapter 1Q of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's 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 installation performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. FB -y— Type of License: ❑ Plumber Title Gasfitter City/Town Master APPROVED (OFFICE USE ONLY) LJ Journeyman Signature of Licensed Plumber or Gas Fitter License Number &Syler Ce. 0 1 ST FLOOR MENEM EMIIC� 2ND FLOOR MEMEMEMEMEMMEM 3RD FLOOR 4TH FLOOR M MEN ME ME 0 EMMEMOMMEMEMOMM MMMMMMMIM 11MEMEMEMMEME 00, MEMNON MEN ME EMMMMEMEMME Installing Company Name AE/1) 11'7ed-/�/t/%e1iZ � Check one: Address 5-71312 ('02 6/ 1la,kJ S7� L�' Corporation ��/. ,-2, 1Z eer /%/�' ❑ Partnership Business Telephone Odd /b0- i �❑l Firm/Co. Name of Licensed Plumber or Gas Fitter L aLi� Jam- �Jf /- Certificate # INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. Yes No ❑ If you have 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: I am aware that the licensee does not have the insurance coverage required by Chapter 1Q of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's 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 installation performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. FB -y— Type of License: ❑ Plumber Title Gasfitter City/Town Master APPROVED (OFFICE USE ONLY) LJ Journeyman Signature of Licensed Plumber or Gas Fitter License Number &Syler z 0 In to c_ 5 z 0 N mX n x m N m I m a I m 0 r0 0 c m M 0 � o m m .� � m N m .. ,z v c N m 0 z � m z 0 In to c_ 5 z 0 N mX n x m N m m m a X m 0 r0 0 c m M 0 m m .� � m N m .. ,z v c N m 0 z � m a 0 m D � N N m n i . I I z 0 In to c_ 5 z 0 N mX n x m N T m 0 0 N N z N '0 Am -�1 O z N -rC m m m a X m z r0 0 c m M 0 m m .� � m N m .. ,z c N m 0 z T m 0 0 N N z N '0 Am -�1 O z N -rC z m a X F 0 c N M m m .� � m N 0 .. ,z T m 0 0 N N z N '0 Am -�1 O z N -rC 4..`�7F.--.t�'-y�:r'«Fil�n.�+tr.y-►tT..wr.y..w _ .. �.,�.. ��.r�,..-�—t'Y'---�..;,v...,,.,i„i•.>.,�:�a�... .,�. -.".�r / qa 1-12 2106 Date. ........ / a HORTly TOWN OF NORTH. ANDOVER 0 5• � PERMIT FOR GAS INSTALLATION- 40 NSTALLATION-4 N This certifies that r. ! . has permission for gasinstallation CU in the buildings of ......................... at ...7©.,01 ! X L Z.' yT. ....... , No Andover, MaQ. CU Fee. 9? Lic. No.34 .. GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File