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HomeMy WebLinkAboutMiscellaneous - 92 BUCKINGHAM ROAD 4/30/2018N O N N W ' O C O � Safety Insurance AddikkW PO Box 55098 Boston, MA 02205 Form of Notice of Casualty Loss to Building 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 RE: Insured: HELEN M FAYE Property Address: 92 BUCKINGHAM RD, NORTH ANDOVER, MA Policy Number: HMA 0005863 Claim Number: BOS00068690 Date of Loss: 3/17/2016 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 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 3/25/2016 Date... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION or c. This certifies thatfl . ......... for gas installation NV, has permission . ..... in. the buildings of ............................................................................ at ............. North Andover, Mass. ................ ..................... Fee.V.() . ...... Lic. No .... ..................................................................... GASINSPECTOR Check lS MASSACHUSETTS' UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY / MA DATE 07 I 12015 PERMIT # l� JOBSITE ADDRESS �,/ OWNER'S NAME IQ=� . GOWNER ADDRESS I Same CQJ I TEL_ —1FAX� TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIALE] PRINT CLEARLY NEW:E] RENOVATION: El REPLACEMENT: ® PLANS SUBMITTED: YES® N0F1 APPLIANCES 1 FLOORS, BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER x BSM 1 1 1 2 1 3 1 4 1 5 6 1 7 1 8 1 9 1 10 1 11 1 12 1 13 1 14 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Ej NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ® BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ® AGENT SIGNATURE OF OWNER OR AGENT El I hereby certify that all of the details and information I have submitted or entered regarding this 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 com liance wi all Pert' ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUMB ER-GASFITTER NAME Robert Josey_ LICENSE # 9185 IGNA MP EI MGF ® JP[j JGF ® LPG[ ® CORPORATION E]# 3788C PARTNERSHIP ®# LLC ®# COMPANY NAME: RH White Construction Co ADDRESS 141 Central St CITY I Auburn STATE MA ZIP 01501 TEL (508) 832-3295 FAX 508 926-4347j CELL508 245 7431 EMAIL .o / ^/ x ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES h Division of Professional Licensure: License Search The Official Website of the Office of Consumer Affairs and Business Regulation (OCABR) Division of Professional Licensure Mass.Gov Home State Agencies A -Z Topics Home > Division of Professional Licensure > ..................-.......... ........................ ..........-............ .....................-........................ ......................... .................................. I ............................. Check A Professional License By the Division of Professional Licensure LICENSEE Name: ROBERT A. JOSEY E DOUGLAS, MA NEW SEARCH **This Licensee has additional Licenses, click here to view them.** Licensing Board: PLUMBERS Et GASFITTERS License Type: MASTER PLUMBER License Number: 9185 Status: CURRENT Expiration Date: 5/1/2016 Issue Date: Exam Date: School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Wednesday, July 15, 2015 at 3:20:42 PM. © 2007-2011 Commonwealth of Massachusetts Page 1 of 1 Mass.Gov ONLINE SERVICES Check a License Locate a Licensed Professional Online Address Change Contact the Agency More... REFERENCES & RELATEDINFO Disclaimer Regarding Website License Searches Glossary of License Status Codes More... Site Policies Contact Us http://lic.ense.reg.state.ma.us/public/pubLicenseQ.asp?board code=PL&type class= _M&li... 7/15/2015 PO Box 55098 Boston, MA 02205-5098 617-951-0600 9 m Form of Notice of Casualty Loss to Building 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 RE: Insured: HELEN M FAYE - Property Address: 92 BUCKINGHAM RD, NORTH ANDOVER, MA Policy Number: HMA 0005863 Claim Number: BOS00055536 Date of Loss: 3/12/2015 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. Lindsey Hodgens Claim Examiner 3/16/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098