HomeMy WebLinkAboutMiscellaneous - 74 ELMCREST ROAD 4/30/2018r�t
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Wr INSURANCE
May 22, 2013
Town of North Andover
Attn: Building Inspector
120 Main Street
North Andover, MA 01845
Liberty Mutual Insurance
New England Region Central Property Unit
75 Sylvan Street
Danvers, NIA 01923
Tel: (800)566-0323
Re: Property Address: 74 Elmcrest Rd, North Andover, Ma 01845
Policy Number: H3S21867616740
Underwriting Company: LM General Insurance Company
Claim Number: 026416679-0001
Date of Loss: 3/28/2013
Attn: Town/City Official
Pursuant to M.G.L. c. 139, § 3B, please be aware that a homeowners insurance claim has been made
involving loss, damage or destruction of the above captioned property, which may either exceed
$1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch.
143, § 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with
Mass. General Laws Ch. 175, §99, if you intend to initiate proceedings designed to perfect alien
pursuant to Mass. General Laws, Ch. 139, § 3A & B, or Mass. General Laws, Ch. 143, § 9, or Mass.
General Laws, Ch. 111, § 127B.
This letter should not be construed as a waiver or estoppel of any of the terms, conditions or
defenses afforded by the policy or applicable law.
Please direct your notice to the attention of the undersigned and include a reference to the. above
captioned property address, policy number, claim number, and date of loss.
Sincerely,
Liberty Mutual Support
Liberty Mutual Insurance
New England Region Central Property Unit
1-800-566-0323
Date ......
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ..... 1-- . �-" �1?.4e ....................
Ihas permission for gas installation .............
........................
1n,the buildings of ... > "A-. T.
at North Andover, Mass.
3
Lic. No..5 . 3 ...... ......
GAS INSPECTOR
Check #
0
MASSACHLfSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type) V-11, }
A�)Ooj'o Mass. Date 20 ) Per i �p v
Building l. alfon owner's Name t°
Type of occupancy
New ❑ Renovation ❑ Replacements Pians Submitted: . Yes ❑ No ❑
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VAi.eaU@TolmmmmmmmmmmmmmmmmMMMME
Noun e e •
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Installing Company Name 6b_ � Q' ms, imA91JOW-Check one: Certificate
Address X !Du ye n jmV ❑ Corporation _--_ -
2 � � ❑ Partnership
Business Telephone
irm/Co.
Name of Licensed Plumber. or Gas Fitter
INSURANCE COVERAGE:
I have a currentll billty insurance policy or Its substantial equivalent, which meets the requirements of MGL Ch. 142.
Yes No p •,
If you have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy+ Other type of indemnity ❑ Bond ❑
OWNER'S U45URIME WAIVER: 12m 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.
Sigiature of Owner or Owner's Agent
Check one:
Owner ❑ Agent ❑
I ho-reby certify that all of the details and Information 1 have submitted for entered! Ina application are true and accurate to the best of
my knovNedge and that all plumbinp work and installations performed under the pe tis ued for this a ation Will be in compliance with
all pertinent provisions of the Massachusetts State Cas Code and Chapter 142 oftie Ws.
Type of License
By ❑ Plumber re of Llt0thsed Plumber or Cas Fitter
Tide 0 Gasfitter
cityrrown g,prfer License Number ELM
APPROVED (OFFICE USE ONLY) ❑ Journeyman