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Home My WebLink AboutMiscellaneous - 8 HIGH WOOD WAY 4/30/2018 (2)f " Safety Insurance form of Notice of Casualty Loss to Building 4 " Under MASS. GEN. LAWS, Ch: 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845 4 RE: Insured: ROSEMARY YOUNG and STEVEN YOUNG w Property Address: 8 HIGH WOOD WAY, NORTH ANDOVER, MA Policy Number: HMA 0326872 Claim Number: BOS00039865 Date of Loss: 10/24/2013 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. Allan Leavitt Claim Examiner 10/29/2013 Safety Insurance Company Homeowners Claims -Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617),951-0600 EXT 3213 Fax: (61.7) 531-8891 Email:. AllanLeavitt@Safetylnsurahce.com V. !_J 'T1 7 Date, OE HORTM TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION ". S SACMUSE; S This certifies that . ................ . has permission for gas installation .. �� ` L '�`. `... `..... . in the buildings of . A I ...................... . at .. . �/r. s..... . . ? .............. . . North Andover, Mass. Fee .... }..... Lic. No..4,..).7 �...; �-- r� �-.. . IS - INSPECTOR Check # 5256 MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) Date -2- � ��v s MASSACHUSETTS Building Locations Owner's Name New ❑ Renovation d Replacement ❑ Permit # Amount $ — 6- 1 e -Ila r- h 10 Z tii Plans Submitted ❑ (Print or type) C�k one: Certificate Installing Company Name , ✓t y vw 1 Corp. Address �"� � (� Q ❑ Partner. "( 1 L 04A - Business Telephone - zn Lf— — j 1 Y ® Firm/Co. Name of Licensed Plumber or Gas Fitter :!S W-41 0� Py (? � � �� S V- Y INSURANCE COVERAGE CheckLSI� -on�e:^ . I have a current liability insurance policy or it's substantial equivalent. Yes No❑ If you have checked ,des,, please in 'tate the type coverage by checking the appropriate box. Liability insurance policy IT Other type of indemnity ❑ Bond ❑ i 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: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all ofthe 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 installations perfo and r PerniOssued for this application will be in compliance with all pertinent provisions of the Massachusetts State CC fid r leff the General Laws. (OFFICE USE ONLY) Plumber Gas Fitter Master Journeyman Plumber Ot Gas CQ SUB ENT FLOOR 3RD. FLOOR 5TH. FLOOR .0• (Print or type) C�k one: Certificate Installing Company Name , ✓t y vw 1 Corp. Address �"� � (� Q ❑ Partner. "( 1 L 04A - Business Telephone - zn Lf— — j 1 Y ® Firm/Co. Name of Licensed Plumber or Gas Fitter :!S W-41 0� Py (? � � �� S V- Y INSURANCE COVERAGE CheckLSI� -on�e:^ . I have a current liability insurance policy or it's substantial equivalent. Yes No❑ If you have checked ,des,, please in 'tate the type coverage by checking the appropriate box. Liability insurance policy IT Other type of indemnity ❑ Bond ❑ i 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: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all ofthe 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 installations perfo and r PerniOssued for this application will be in compliance with all pertinent provisions of the Massachusetts State CC fid r leff the General Laws. (OFFICE USE ONLY) Plumber Gas Fitter Master Journeyman Plumber Ot Gas CQ 7.7 Date .. %.... i R `—" OWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ..CrG.'�'�. ��/: �.�..� `l ......................... has permission to perform ...tT. 4..... . plumbing in the buildings of . A. s./. at .. .. . ` ...`�......... ,Forth Andover, Mass. Fee.?P.—. . . . Lic. No.. l U 3.�.`.y .: L!�-- :�........ ipw MBING INSPECTOR Check # , � � � 6627 0 �w ff i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMRINr, (Print or Type) w , Mass. City, Town Building AT: Location Date- j Permit Owner's fite" NameU�vff'c )uk Type of Occupancy:_S d _ New ❑ Renovation Replacement ❑ FIXTURES Plans Submitted Yes ❑ No ❑ (Print or Type) ( r Installing Com any Name C � SAS '� �' f�vi�1 k16y�- VI 4q, Address 12i )c l "j C I Bus' T �) �' Check .One: ❑ Corp. ❑ Partnership ❑ Firm/Company Certificate mess elephone - % �% j j T , --,--� Name of Licensed Plumber or Gasfitter I be -by 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 installations performed under 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. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Signature of Owner/ Agcnt I have a current liability insurance policy to include completed operations coverage. 1� BY Tittle ature of Licensed Plumber City/Town`� `�� Type of Plu;'Zaster iLicense APPROVED (OFFICE USE ONLY) / ❑ Journeyman License Number FORM 1240 uR.w u�oo� o tnr oo� , OWN 0 Monson IMEQN NONE IMEMNIMflMM .. IMENIMER 0 MENOMONEE iMI«IMMEME MEMO 0 NONE IMIMEEMEMIMEME mono so 0 mom MEMEEMEMINIME ,• ■��MM«NMMMMM§MM MENOMONE■ (Print or Type) ( r Installing Com any Name C � SAS '� �' f�vi�1 k16y�- VI 4q, Address 12i )c l "j C I Bus' T �) �' Check .One: ❑ Corp. ❑ Partnership ❑ Firm/Company Certificate mess elephone - % �% j j T , --,--� Name of Licensed Plumber or Gasfitter I be -by 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 installations performed under 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. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Signature of Owner/ Agcnt I have a current liability insurance policy to include completed operations coverage. 1� BY Tittle ature of Licensed Plumber City/Town`� `�� Type of Plu;'Zaster iLicense APPROVED (OFFICE USE ONLY) / ❑ Journeyman License Number FORM 1240 uR.w u�oo� o tnr oo� , �* 6114 Date.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ A755Y A C. -;,17s. - .................................................................................... has permission to perform ...... A...................................................... wiring in the building of ........ ................................................. at ......1 .... !!�c woo ................................................. . North Andover, Mass. fir- ....... Lic. No. ......... Fee... ................................ ELECTRICAL INSPECTOR Check # DFA A MWOFP NX941t'6fY Permit Na BOARD OFFIREPREMM1lOrVRBGt1,fA7fmjvadR iza Occupancy R Fen Checked APPIUCATTONFOR PERMIT'TO PERFORMELECTRICAI, WO All, WORK TO BE PERFORMED 94 ACCORDANCE WrM THE MASSACHUSSTS PLECM CAL CODE, 527 12:00 (PLEASE PRINT IN INK OR TYPE ALL WORMAMON) Da O� Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes[n No (Check Appropriate Box) Purpose of Building Existing Service Amps /Volts Overhead New Service Volts Overhead Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Utility Authorization No. Underground No. of Meters Underground No. of Meters No. of UghdM Outlet No. of Hot Tobi No. of Tmsbaftr Told Na of Uahtiaa Ritua Swimadns Pool. Above Below amerstae No. of Emerseoey Ughtins B09my UOiu KVA KVA Na of Receptsek Outbq No of OU Bneners No. of Switch NOW No. of On Boeoers FIRE ALARMS No. of ZOM N0. ofDantm and No. of Rm*n No. of Air Cond. TOW Toon No. of Dispossb No. of Hat TOW TOW Pamol Ton Kw Wdathog Deviom Na of Souodns Devices No. of Dishwuhen Space Ma Heaft KW NO. of SON Cmombted Demcdan/3o [ ocdoonnec� - O No. of Dryers Homing Devices Kw dom No. of Wow Hea m KW No. Of NO. of sismBallast No. Hydro Mamase Tabs Me of Moron Told HP WodrbSM Sfledurikl FEMNAME lot Cft YM DOPMmad Itl� if)uuhatedlededZPhWiI**lIIArfflofWv=vby ft=Iqfa* Roo »nrt�dvaltcfEbMW Waar S � &sk=TTK C1012 a Licarrm � f� LiomseNo Alt 979 - ya. 7 -8 � '' owlmt IIVSURAI�wA1VQt;lanawaedletlheii�l�dleiraaalaear�at�antileq�ivt�mtatgz� bpMa�finebCslaalLatts xddWnr+*p*=ond6pa ritappk--yala ftIMPA MI (Please check one) Owner Agtint Telephone No, M, FEE L. (.®