HomeMy WebLinkAboutMiscellaneous - 5 Harwich Street U-L 5 HARWICH STREET U-L
210/023.0-0009-0000.E
Claim # 1430753
Advantage Claim Services
522 Chickering Road #B AdJuster Assi
North gned: Glenn Guarente
Andover, MA 01845
Form of Notice of Casualty Loss
Under Mass. Gen. Lawto Building
s, Ch. 139, Sec. 3B
To: Building Commissioner
Inspector of Buildings Board
Town of Health or
Hall Board of Selectmen
North Andover, MA 01845 Town Hall
North Andover, MA 01845
Re: Insured:
Bel-Gold Insurance Trust
Property address: 5 Harwich St.
North Andover, MA 01845
Policy #;
1430753
Loss of: 2013/09/03
File or Claim No. AD 9877
Claim has been
captioned made involving mag loss, damage or
Mass._Gen._Laws,_yCh Chapter 143, either exceed $1d00pructorn u the above
notice under Mass — _Section , 00 cause
direct it to the _Gen—Laws,_Ch._139 SeC6 to be applicable. If an
captioned attention — the w _38 is appropriate y
insured, location, writer and include please
file number, policy number, a reference to the
date of loss and claim or
Glenn Guarente
Title: Adjuster
On this date, I caused copies
named at the addresses p Of this notice
indicated above b to cl sent to the persons
y first class
mail.
4,49nature and date. 09-18-13
Date. .
0'<".��7:1�o TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
,S ;`thai
SACNus
This certifies that . . . . . . .�f?6�.��? �'. �l'!'c. . . . . . . . . . . . . . . .
has permission to perform . . . ., .!-� . . . . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of . . . .�-. . s. : .t. . . . . . . . . . . . . . . . . . .
r. l
. . . . . . . . . . . . . . ... . . .. North Andover, Mass.
Fee. ). ,'. .-. . .Lic. No.'-.,. ..77. . . . . . . . . . . C!... .�.T '?.. . . . . . . . .
/ PLUMBING INSPECTOR
Check #
4 ;' 55
MASSACHUSETTS UNIFORM gppLICATION FOR PE
•\ (Print or Type) RMrr TO
DO PLUMBING �^-
_ Mass.
Building Date "%owl Permit t� -- r
ing Location 0�)
fawners
�^ ���
Type Of Occupancy
New p Renovation ❑ r _'� 5 , ti T� r-I C_
Replacement � Pians Submitted:
FD(TURES Yes ❑ No ❑
y Z w _
Z Y
W r y O Z r-
y
O W
F v ¢ of = O = y am
V = Q m y Q < W y Y < 0! rV Z d O
K
r- d0
3 y s = rr 4
O416
= 0 Y
0 y 2 Z < W r; W
m y D O r 3 Y ~ -+ < ¢ ¢ < O x
r�
"a— F-
BSMT. p
BASEMENT
1ST FLOOR
•
NO FLOOR
3RD FLOOR
4TH FLOOR
I
3TH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
Installing Company Name
�;
Address � r T LJ ��.�, „
Check one: Certificate
,rE -
❑ Corporation
Business Telephone v ❑ Partnership
Name Of Licensed Plumber /CO
INSURANCE COVERAGE:
1 have a curre-n-t pI' bkity Insurer
Yes [a ns ❑nce sky Or its substantial equiva)ent „�h
If You have checked
Y.S . please Indicate the meets requirements Of MGL Ch. 142.
tYpe coverage by checking the a
A liability Insurance policy appropriate
box.
Other type of Indemnity, ❑
OWNER'S INSURANCE W Bond ❑
Chapter 142 Of the Mass. General Lays.aware that the licensee does not
and that my signature on this lave the Insurance coverage required by
Pem1)t aPP11cat1On waives this requirement.
Signature of Owner or Owners Check one:
ent Owner ❑ Agent❑
I�bY certify that all a!the details and
kna qg and that all l the information I have submitted(or entered)in
Pertinent provisions of fhe ng work and installations onned u �01'e application are
BY Massachusetts State Plum ' under the permit' for this on and accurateto the best of my
and apter of the application will be in Compliance w�all
err Laws.
Title
e° um r L
CitY/Town L Type of license.- Master Joumeyrnah
License Number ❑
BELOW FOR OFFICE USE ONLY
FINAL INSPECTIONS SK TE CHES PROGRESS INSPECTIONS
FEE
NO.
J
APPLICATION FOR PERMIT TO DO PLUMBING
NAME i TYPE OF BUILDING
f
LOCATION OF BUILDING
PLUMBER
oy
PERMIT GRANTED
DATE 19
PLUMBING INSPECTOR