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NEW ENGLAND CLAIMS SERVICE. INC.
F Incorporated 1985 F-1
Reply To Reply To
Mansfield, MA 02048 a4, 131 Dodge Street, Suite 6
P.O. Box 345 Beverly, MA 01915
- NCKPTNMNT
SNS` TEL. {978} 927-3000
TEL. {508} 337-8058
FAX {508} 339-5835 FAX (978) 927-3002
wrandall@newenglandclaims.com
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
North Andover, MAO 1845
RE: Insured: Eleanor G. Rockwell % Carolyn Rockwell
Property Address: 968 Salem Street North Andover MA 01845
Cause of Loss/Date: Ice Dam/ 2/15/2015
File or Claim No: BOS053600
Claim has been made involving loss, damage or destruction of the above captioned property,
which may either exceed $1,000.00 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 the attention
of the writer and include a reference to the captioned insured, location, policy number, date of
loss and claim or file number.
Section 3B. No insurer shall pay any claims (1) covering the loss, damage, or destruction to a
building or other structure, amounting to one thousand dollars or more, or (2) covering any loss,
damage or destruction of any amount, which causes the condition of a building or other structure
to render section six of chapter one hundred and forty-three applicable, without having at least
ten days previously given written notice to the building commissioner or inspector of buildings
appointed pursuant to the state building code, to the fire department or arson squad of the city or
town and to the board of health or board of selectmen of the city or town in which the same is
located. If at any time prior to payment the said city or town notifies the insurer by certified mail
of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to
section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B
of chapter one hundred and eleven, the said payment shall not be made while the said
proceedings are pending; provided, however, that said proceedings are initiated within thirty
days of receipt of such notification.
Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and
forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall
extend to and may be enforced by the city or town against any casualty insurance policy or
policies covering any loss, damage, or destruction pursuant to which the proceedings to perfect
the lien were initiated.
No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other
interested party for amounts disbursed to a city or town under the provisions of this section, or
for amounts not disbursed to a city or town under the provisions of this section.
On this date, I caused copies of this Notice to be sent to the persons named above at the
addresses indicated above by First Class Mail.
Very Truly ours,
Mark Randall
Adjuster
m.randallnecs@comcast.net
{978} 223-7332 cell
Location
No. Date �—
ca
TOWN OF NORTH ANDOVER
Certificate of Occupancy $ S
M-
Building/Frame Permit Fee $
Foundation Permi Fee $
Other Permit Fee$
Sewer Connectio"Fee $
Water Connection Fee
C
Building Inspector
Div. Public Works
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OFFICES OF: ' "~~ _. �TOWll Of Main
u. u ►2o cree:
T _ _ _$ F North Andover,
APPEALS
..: NORTH ANDOVER
BUILDING mass6ehU ettsO1845
CONSERVATION DIVISION OF
HEALTH -
PI-ANXING PLANNING & COMMUNITY DEVELOPMENT
.. KARE:` KP. NELSON. DIRECTOR _.
In accordance with the prcvisi;, r-5 of MGL c -C. S 5:, a condition of Building Permit
Number =S s that the debris resulting from this work shall be
disposed of in a ottbperiy :iceaw solid waste `ac;;ir;
L:QA. as „ .::MGL+c cd by GL c lll, S
The debris will be disposer{ of in:
N
i.dca ion cf Fac. -ii, -;i
9
Sicnature of Per it Applicant
Date
:TOTE: Demolition permit fram the Torn of North Andover must be obtained for
this project through the Office of the Building Inspector.
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Date 6-30
Building Location �p� � 5/ � Owners Name ZZ6-4141 Ar wAIL Permit #
Amount J
Type of Occupancy
New Renovation ®Replacement / Plans Submitted Yes No
FIXTURES
Date . —.. .A.
NORTI� TOWN OF NORTH ANDOVER
O� ,neo ,e,iC
PERMIT FOR PLUMBING
This certifies that ....Vd1f? A.
has permission to perform ... . , ..........
t
plumbing in the buildings of ...
at ... C)( J- .. P.-? 6?:::.. <r ..... , . , ... , North Andover, Mass.
Fee. Lie. No;/.,*G.?.. ..... .
30PLUMBING INSPECTOR heck One: Certificate
Check # Cep
pParer.
5644 D Firm/Co.
Name of Licensed Plumber: �,� �. IL 20352
Insurance Covera e: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policyEl Other type of indemnity 4 Bond
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner ❑ Agent 11
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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts StatePhzmbing Code and Chapter 142 of the General Laws.
�__ ��_�
V
Cityrrown
(OFFICE USE ONLY
Type of Plumbing License
1/0.2 7
=se AUMDer Master Journeyman