HomeMy WebLinkAboutMiscellaneous - 75 JEFFERSON STREET 4/30/2018L
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NORTH
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' TOWN OF NO ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ........................
has permission for gas installation ..r. `..................
in the buildings of ..................................
at t . F.. s ................ . North Andover, Mass.
Fee. .? .. Lic. No..........
GAS INSPECT R
Check #
5583
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J$lness Telephone
Irne of Licensed P1
p Corporation
CAV nau%M
a eurnitll blilty Insurance policy or its substantial equivalent: which
yes &o --No Q the e requirements of MGL Ch. 742.
f you have checked yes, please Indicate the
type of coverage by checking the appropriate box
1.liability insurance policy &/ other type of indemnity p 110M
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)WOWS IWSURNACE WAIVEIr I am aware that the licensee does not have the insurance coverage required by thap0er
142 of the Mass.Oeneral Laws, and that my signature on s per ap�lca0on valves this requirement
R re o Wier or wne spen
Check one:
Owner p Agent p
!neby Car" IV that aA of the details and Informadon I have submitted for enteredl In above a pllcatlon are true and accurate to the best of
ltnovstedge and that ail plumbing wort and Installations perfornad under the pertnit r t2mis
aertinent provisions of tris MaessChusetts S latae Gas Code and chapter 142 of the o L appllcatlon be in compilance with
8r Type of License:
Tide •--� o Plumber re o conga P u er or G as F tter
o C220tter
A�own
APPROVED {OFFICE USE QNp,Master
LY} License Number
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CLAIMS DEPT.
March 15, 2002
Commerce Insurance
The Commerce Insurance Company
Citation Insurance Company
Members of The Commerce Group, Inc.
11 Gore Road, Webster, Massachusetts 01570 (508) 949-1500
BUILDING COMMISSIONER or
INSPECTOR OF BUILDINGS
TOWN/CITY HALL
NORTH ANDOVER MA 01845
www.Commerceinsurance.com
Board of Health or
Board of Selectmen
Town/City Hall
RE: Our Insured: THERESA A NEVANS / MARK P NEVANS
Property Address: 75 JEFFEROSN ST UNIT 64
Policy#: 429264
Date of Loss: 01/19/2002
File#: MX7257-HCH888
Claim has been made involving loss, damage, or destruction of the above captioned
property which may exceed $1,000, 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 my attention. Please reference the above captioned insured, location,
policy number, date of loss, and file number on any correspondence.
SUSAN BUTLER
Claim Adjuster
Telephone: (508)949-5588
Toll Free: 1-800-221-1605, Ext: 5588
On this date, I cause copies of -this notice to be sent to the persons indicated above, at the
address above, by first class mail.
March 15, 2002
CcmmGrc Companies
CIC 254 (Rev. 4/95)
COME GROW WITH US
MAIL
E49