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Home My WebLink AboutMiscellaneous - Exception (93)i CRAWFORD AND COMPANY 1001 SUMMIT BLVD ATLANTA, GEORGIA 30319 RAY CALVETTI 830-734-0235 ray_calvefti@us.crawco.com 4/7/2015 Inspector of Buildings Town of North ANdover 1600 Osgood Street North Andover, MA 01845 Re: Insured: FREDERICK D PETERSON and JOAN T PETERSON Claim Number: KATM03 Policy Number: E32208 Our File: 6776-2590569 Date of Loss: 3/16/2015 Type of Loss: Weight of Ice & Snow Location of Loss: 19 DEWEY ST N ANDOVER, MA 01845 Insurance Company: Mapfre Insurance To Whom It May Concern: Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Very truly yours, Ray Calvetti Claim Representative CC: Inspector of Buildings Town of North Andover Date ..�! " ...... °" TOWN OF NORTH ANDOVER *00 9 -K i Us PERMIT FOR GAS INSTALLATION G This certifies that .. ....... �...X.. . has permission for gas' installation�!�.i�... . in the buildings of ..... at .. �,?. .... �... ........ , North Andover, Mass. Lic. No ......... - f GAS INSPECTOR Check # ! 33 7 4701 MASSACHUSETTS UNIFORM APPLICA (Print or Type) _�)6).TN L001)K 2 • Mass. Building Location . New ❑ Renovation ❑ FOR PERMIT TO DO GASFI/TTI NG / D �1 t Permit # D `ir� Owner's Name ck606R1Ce 1"rTt)2Sv Type of Occupancy RC S I DiE OT I A L Replacement Plans Submitted: Yes❑ No ❑ Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 01840 Check one: Certificate # X3 Corporation 1862 ❑ Partnership Business Telephone .687-1105 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: havre a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No ❑ If you have checked ve, please indicate the type coverage by checking the appropriate box. A liability insurance policy 1$( 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: Signature of Owner or Owner's Agent Owner[] Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in&DOp,,,ca,,,,Pon are true and acc ui ate to the best of my knowledge and that all plumbing work and Installations performed under the permit plication will n mplianoe with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Ge (/ i BY Type of License: Plumber Signature of Licensed Plumber or Gas Title 9 Gasfitter 3-1,45 L Master License Number City/ Town I Journeyman APPPOVE6To-FF—IC-ETS—F--ON—L—YT— Y • rrrrrrrr�rrrr rrrrrrrNl ■rrr,,�►�rrrrrrrrrrrrrrrrrrrrr� ..- NINE■ . ... rrrrrrrrrrrrrrrrrrrrrrrrrrr ... ■rrrrrrrrrrrrrrrrrrrrrrrr■ ... ■rrrrrrrrrrrrrrrrrrrr■ rr■ . ... ■rrrrrrrrrrrrrrrrrrrr■ SEE ... ■rrrrrrrrrrrrrrrrrrrrrrrr■ ..- ■rrrrrrrrrrrrrrrrr��rrrrr■ Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 01840 Check one: Certificate # X3 Corporation 1862 ❑ Partnership Business Telephone .687-1105 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: havre a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No ❑ If you have checked ve, please indicate the type coverage by checking the appropriate box. A liability insurance policy 1$( 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: Signature of Owner or Owner's Agent Owner[] Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in&DOp,,,ca,,,,Pon are true and acc ui ate to the best of my knowledge and that all plumbing work and Installations performed under the permit plication will n mplianoe with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Ge (/ i BY Type of License: Plumber Signature of Licensed Plumber or Gas Title 9 Gasfitter 3-1,45 L Master License Number City/ Town I Journeyman APPPOVE6To-FF—IC-ETS—F--ON—L—YT— N w z U H W Y N Z O 1- U Z_ 1 Q Z LL 1, I o, 1 W H z a w a 0 I- a a w CL a z F= - a N J � CJ z O O - -- �]... W - N O f - W U iz cc LL O W 0 z a a ¢ O O W LL 3 z G 0 W w f - m Q � J CL CL Q w w LL. N w z U H W Y N Z O 1- U Z_ 1 Q Z LL 1, I o, 1 W H z a w a 0 I- a a w CL Date... //��/O� . . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .............. .. I has permission for gas installation 1�e--�.�.. in the build,ifigs of . ........................ at &.At'....�. I North Andover, Mass. Fee. Lic. 440..&A�0 .. .......................... GASINSPECTOR 1, Check # 49-14 MASSACHUSETTS UNIFORM APPUCATON (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations New ❑ Renovation ❑ Replacement PERMITTODO GAS FfITWG Date Permit # Amount $ A, s Name f C�vG k Plans Submitted ❑ (Print or type)/ / Check one: Certificate Installing Company Namel 5, ��L e.. �f f7 Corp. Address � �% tqy X Partner. Busines one U � rm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 1:1 No If you have checked yes, please indica a the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 1 Bond 0 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 0 Agent El I hereby certify that all of the details and intormatton 1 have subrruttea (or enterea) in aoove appucauon are true anu accurate to me best of my knowledge and that all plumbing work and installations performed under Permit Issued f r this application will be in compliance with all pertinent provisions of the Massachuset at�s Code and C�pter 142 0Gen Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of .Plumber ® Gas Fitter L -6wi r ® Journeyman sedAumber Or Gas Fitter C Z-03�. Icense um er U z o a z o z w w CA' W CW7 H U) H z W W C7 O R. H U „a v'T z O w z 3 a a t5 Q a o o° x w ;>a 4 O° a w F H o SUB -BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR STH. FLOOR (Print or type)/ / Check one: Certificate Installing Company Namel 5, ��L e.. �f f7 Corp. Address � �% tqy X Partner. Busines one U � rm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 1:1 No If you have checked yes, please indica a the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 1 Bond 0 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 0 Agent El I hereby certify that all of the details and intormatton 1 have subrruttea (or enterea) in aoove appucauon are true anu accurate to me best of my knowledge and that all plumbing work and installations performed under Permit Issued f r this application will be in compliance with all pertinent provisions of the Massachuset at�s Code and C�pter 142 0Gen Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of .Plumber ® Gas Fitter L -6wi r ® Journeyman sedAumber Or Gas Fitter C Z-03�. Icense um er