HomeMy WebLinkAboutMiscellaneous - 77 SUGARCANE LANE 4/30/2018 (3)� Safety Insurance
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
RE: - -Insured:
Property Address:
Policy Number:
Claim Number:
Date of Loss:
Company:
Board of Health or
Board of Selectman
City Hall
N ANDOVER, MA 01845
CATHERINE M SHAW and EDWARD F SHAW
77 SUGARCANE LN, N ANDOVER, MA
HMA 0259367
BOS00028485
11/16/2011
Safety Indemnity 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.
Allan Leavitt Claim Examiner
Safety Insurance Company
Homeowners Claims Unit
P. O. Box 55098
Boston, MA 02205-5098
Phone: (617) 951-0600 EXT 3213
Fax: (617) 531-8891
Email: AllanLeavitt@Safetylnsurance.com
1/12/2012
310 CMR 10.99
Form 8 DEP File No. 242-812
(To oe orovioed by DEP)
r ciiv Town North Andover
-_ Commonwealth
st= of Massachusetts Aooucant Scott Giles
Lot 11, 77 Sugarcane Lane
Certificate of Compliance
Massachusetts Wetlands Protection Act, G.L. c. 131, §40
North Andover Conservation Commission Issuing Authority
From
50 Deer Meadow Road
To Scott Giles North An MA 01845
(Name) (Address)
October 1, 1997
Date of Issuance
This Certificate is issued for work regulated by an Order of Conditions issued to
Catherine & Edward Shaw
dated 7/11/96 and issued by the NACC
It Is hereby certified that the work regulated by the above -referenced Orger of Conditions has
been satisfactorily completed.
2, ❑ It is hereby certified that only the following portions of the work regulated by the above-
refer-enced Oroer of Conditions have been satisfactorily completed: (If the Certificate of Compliance
does not include the entire project, specify what portions are included.)
Q It Is hereby certified that the work regulated by the above -referenced Order of Conditions was
never commenced. The Order of Conditions has lapsed and is therefore no longer vaiid. No future
worx subject to regulation unser the Act may be commenced without filing a new Notice of Intent
anc receiving anew Order of Conditions.
............................................................................................ ..:
(Leave Soace Blank)
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