HomeMy WebLinkAboutMiscellaneous - 90 CROSSBOW LANE 4/30/2018N
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W14� 9800 Fredericksburg Road
110 San Antonio, TX 78288
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04664.20RYD.JSS1095357258.01.01.988
NORTH ANDOVER
120 MAIN ST.
NORTH ANDOVER MA 01845-2420
Reference: MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B
Attention Building Commissioner,
I am writing regarding the claim referenced below.
August 10, 2015
Policyholder: Harold W Rines
Reference #: 000592914-11
Date of loss: June 25, 2015
Location of loss: North Andover, Massachusetts
Address: 90 Crossbow Ln., 01845
A claim has been made involving loss, damage or destruction of the property referenced above,
which may either exceed $1000.00 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 and include the reference #.
You may submit correspondence or questions to me. My contact information is:
Address: P.O. BOX 659460
SAN ANTONIO, TEXAS 78265
Fax: 1-800-531-8669
Rhone: 1-210-531-8722 Ext. 41788 .
Sincerely,
Christian Harding
Property - TFL Unit 2
United Services Automobile Association
PO Box 33490
San Antonio, TX 78265
Phone': 1-210-531-8722 Ext. 41788
Fax: 1-800-531-8669
ARR/CH
000592914 - DM -04664 - 11 - 8029 - 02
54577-0715
Page 1 of 1
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FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from '
Boards,and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION******�`****************
APPLICANT ,Q2D
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LOCATION: Assessor's Map Number�PARCEL old l
SUBDIVISION� LOT (S)
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******************************OFFICIAL USE ONLY******************************�`�`
RECOMMENDATIONS OF TOWN AGENTS: y x C2
CONSERVATION ADMINISTRATOR
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TOWN PLANNER
COMMENTS
FOOD INSP.5CYOR-HEALT
DATE APPROVED
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DATE REJECTED
DATE APPROVED
DATE REJECTED_
R -HEALTH DATE APPROVED Z
DATE REJECTED
COMMENTS c <- ti-►
PUBLIC WORKS - SEWER/WATER CONNECTIONS.
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR t5 C . L` _ _ ` DATE
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Revised 9197 jm j p(! JUN 0 Ic g
MORTGAGE PLOT PLAN
EK SURVEY INC.
MORTGAGOR _ NA&0r P0Va(5 PINES DEED REF. �9VQ PG. ego
ADDRESS OF PRINCIPLE BUILDING PLAN REF. 63tL/
90 DATE OF INSPECTION :�KW e , 1Q99
Ab 4M1 W, 0 4 664dwo
NOTE This mortgage Inspection was prepared �� ` I FURTHER SATE THAT IN MY PROFESSIONAL
spscit cdiy for mortgage purposes and Is not to oT1 OPINION the principle struoture/s and accessory
be refled upon as a surveys EK SURM accept* ' -4 outbuildings,
RUDEL
no responsibllty for damagqes No. 3888a `^ with the setback requirements of the local
ralianc�r by anyone other thon the acid mortgagee zoning ordinances, and that no enchroachmenfs
and Its assigns In connectlon vU Its proposod'rECIS1EaE� �a of major. Improvements either way carats
mortgage fhanoing to said mortgagor. Y `r�oH�l LA4J property Imes except as slsayerr.
CERTIFlCATION T0: .
LEADER MORTGAGE COMPANY, INC. O1. Property is not In a Flood Hazard Area
This csttlfication V �'
based on the location of markers 132. Property Is In a Flood Hazard Area
90"y mark" p 3. IAfotmation is thauffidsnt .tb Aetsrmins Flood Hazard.
of others, and dons not represent d Propat{Y survey, therefoN food Hazard detel'mined *ow !!� bAest Federal Flood
off3et3 shown are not to be p*td for the establishment of . Insurance Rate Map panda
property linea.
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Date. - -
N° x1-79
TOWN OF NORTH ANDOVER
p PERMIT FOR PLUMBING
This certifies that , . :. :................... .
has permission to perform .: ���� �.<.✓...............
plumbing in the buildings of ..................
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at .:'.. .. .......!� . .. ...... ,North Andover, Mass.
Feer_....... Lic. No...9:3 2..( / .��a . ......... .
PLUMBIN ECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
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Mass. Date permit #
aj
Building Location 10 UQSS60w [-A) er's Name 4S W-6AAA • P-Aw-JoA)
&abO V ef-L I M A 4 Type of Occupancy �i S i17 E �J TI 41 L -
New ❑ Renovation ❑ Repl ement lH" Plans Submitted: Yes ❑ No ❑
FIXTURES
Installing Company Name � L� r�i£�T • � Am m 4 TA jei7 Check one: Certificate
Address Co qC 4 m'4f') P ' ❑ Corporation
❑ Partnership
Business Telephone 7 p-A�/Co. `-
Name of Licensed Plumber ':�f; i 3 7- <A/nM A r,.<1)0 in
INSURANCE COVERAGE:
I have ayes curre
ility insuran
❑ ce Policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
If
If you have checked ves. please indicate the
type coverage by checking the appropriate box
A liability insurance
Policy Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 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 Aaent Owner ❑ 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 installations performed under the permit issu for this application will be in compliance with all
Pertinent provisions of the Massachusetts State Plum " g e and apter of the oral Laws.
ZL L
Title S(Omre of UcensedPlumber
Type of License: Master Joumeymar C]
�APPFK NM OFFIC US ONL License Number
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NONE
Installing Company Name � L� r�i£�T • � Am m 4 TA jei7 Check one: Certificate
Address Co qC 4 m'4f') P ' ❑ Corporation
❑ Partnership
Business Telephone 7 p-A�/Co. `-
Name of Licensed Plumber ':�f; i 3 7- <A/nM A r,.<1)0 in
INSURANCE COVERAGE:
I have ayes curre
ility insuran
❑ ce Policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
If
If you have checked ves. please indicate the
type coverage by checking the appropriate box
A liability insurance
Policy Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 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 Aaent Owner ❑ 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 installations performed under the permit issu for this application will be in compliance with all
Pertinent provisions of the Massachusetts State Plum " g e and apter of the oral Laws.
ZL L
Title S(Omre of UcensedPlumber
Type of License: Master Joumeymar C]
�APPFK NM OFFIC US ONL License Number
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r <",O R'" TOWN OF NORTH ANDOVER
° PERMIT FOR PLUMBING
�SSACMUS� p /
This certifies that !•?l�. 5 �...1. !�• .� �.` • /•�'• c • • • • • • •
has permission to perform .... .' ............................ .
plumbing in the buildings of .. �.�.� k' s ...................... .
at. y.s a� ��' D `�-.. `, N-..... ,.... ,"h Andover, Mass.
.r ..
Fee �.7.. '... Lic. No.. � 3. � . ? . ...... .. ... ..... .
PLUMBING� INSR
08/23/99 13:43 27.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
1%
t
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
_ Mass. Date 0 19Permit #
's lr Building Location 90 -05S� ^"'`Owner's Name R1 etitS
I&
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Type of Occupancy Residential
New ❑ Renovation ❑ Replacement N Plans Submitted: Yes ❑ No ❑
FIXTURES
Installing Company Name Heritage Htg.•.&Plg. Co. Inc. Check one: Certificate
Address 35 Pleasant Street IX Corporation 714
Stoneham, Ma 02180 n Partnership
Business Telephone 781 -43 8-773-6— n Firm/Co.
Name of Licensed Plumber Gordon Switzer .
INSURANCE COVERAGE:
1. have a current liability insurance policy o; its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ® No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy IX 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 ❑
I hereby certify that all of the details and information I havit 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 the permit issued for this application will be in compliance with all .
pertinent provisions of the Massachusetts State P!vmbing 90de and Chapter 142 qf1he Gen al Laws.
By
Title ign—aMM of Eiciensed Plumber
City/Town Type of License: Master [X Journeyman ❑
APPROVED (OFFICE USE ONLY) License Number 8 3 2 2
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Installing Company Name Heritage Htg.•.&Plg. Co. Inc. Check one: Certificate
Address 35 Pleasant Street IX Corporation 714
Stoneham, Ma 02180 n Partnership
Business Telephone 781 -43 8-773-6— n Firm/Co.
Name of Licensed Plumber Gordon Switzer .
INSURANCE COVERAGE:
1. have a current liability insurance policy o; its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ® No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy IX 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 ❑
I hereby certify that all of the details and information I havit 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 the permit issued for this application will be in compliance with all .
pertinent provisions of the Massachusetts State P!vmbing 90de and Chapter 142 qf1he Gen al Laws.
By
Title ign—aMM of Eiciensed Plumber
City/Town Type of License: Master [X Journeyman ❑
APPROVED (OFFICE USE ONLY) License Number 8 3 2 2
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