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Home My WebLink AboutMiscellaneous - Exception (138)�� r ® MAPFRE The Commerce Insurance Company" Citation Insurance Company1m Commerce" Gore Road, Webster, Massachusetts 01570 INSURANCE- 508.949.15001 www.commerceinsurance.com February 04, 2015 BUILDING COMMISSIONER or Board of Health or INSPECTOR OF BUILDINGS Board of Selectmen TOWN/CITY HALL Town/City Hall NORTH ANDOVER MA 01845 RE: Our Insured: ADOLPH A ANTONELLI / SUZANNE M ANTONELLI Property Address: 105 FARRWOOD AVE #8 Policy#: BDJGDJ Date of Loss: 12/22/2014 File#: JTRK94-HKJMV6 Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, 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. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. GREGORY CRANNEY Telephone: (508)949-1500 Ext: 15857 Sr Claim Representative, Property Toll Free: 1-800-221-1605, Ext: 15857 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above, by first class mail. February 04, 2015 CIC 254 (Rev. 4/95) MAIL N34 Date. u TOWN OF -WORTH ANDOVER 0 PERMIT FOR PLUMBING This certifies that ..... P,.,Pq. L. ..� ....f...t.. . t has permission to perform ...... t-!�.. .................. . plumbing in the buildings of .....��.(". ./.�.r..��.% .......... . at...�(�. ��!��..�``? %4.!� v.4.?.....'North Andover, Mass. Fee l U..... Lic. No.. 55 .......... .� ... �. �... . PLU BING INSPECTOR Check # Q �� 8609 *A MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or Pte) NORTH ANDOVER, MASSACHUSETTS Building Location In 3 lo s, --Date S- % —/ a Permit 77 i i►I ` c i Owner t `t \ P �Q I Y V Amount New Renovation 0 Replacement 1..J Plans Submitted -Yes No ❑ kr=or type) S Name �'� D tS' f 1�0. q Check one. Certificate Address ❑ AC,y O 26 Partner. Business Telephone I®yq y Fnm/Co. Name of Licensed Plumber;yj-r-, 1 ) Insurance CoverW Indicate the type of msuaa coverage by chi the apptapriate bore Liabititq insurance policy �— Other. type of indemnity Bona lnsmmwW three insurance- L the undersigned, have been made aware that the licensee of this application does not have arty one of the above Owner o Agent o I hereby ca* that all of the details and information I have submitted (or entered) m a best of my knowledge and that all plumbing work d ' tiPP oa are true and accurate to the compliance with all pertinent provisions of the Mas o State P this application will be in I of the General Laws. igna o kens Title Type of Plumbing Li City/Town 9 l'9 5/ APPROVED (OMCE USE ONLY r ieense um Master �/�' Joumeynman a Date. /1.`� .�.U...... . o= TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION, ,O � 9SSACNUSEt This certifies that ............................. has permission for gas installation ...N . ...................... in the buildings of ... C at &A .L4. , North Andover, Mass, Fee.. . Lic. No.. `7 S S �� . � .:.... ........ GAS INSPECTOR Check # 1 o 11 c 7215 MASSACHUSETTS UNIFORMAPPUCATON FORPERMrr TiO DO GAS FITTING (Type or print) Date— ezz u NORTH ANDOVER., MASSACHUSETTS -�-' Building Locations -/ 0 . :+A.iz P, w 0,0 j- Permit # oust $ 2t()— —Owner's Name A I�� I -/ e. (%—_ New 0 Renovation Replacement Plans Submitted (Print ortYP Check one: Certificate Installing Company (�❑ Corp. Address 6,6.s— ElPartner. /S7—'W71m PS7;;-:At7 n1 -3eTZ(, usiness a ep one -z2 F A7-6 9 -09y% �'Fnm/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 No If you have checked 3es, please indicate the type coverage by checking the appropriate box Liability insurance policy 13 Other type of indemnity Bond 13 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 0 I hereby certify that all of the details and information I have submitted (or entered) in above appli ' n are true and accurate to the best of my knowledge and that all plumbing work and inons perfo ed under permit Is for is application will be in compliance with all pertinent provisions of the Massac ,� etts tate Ga;pd"d Chir 14 ft1p&eneral Laws. . 'APPROVED (oEncEusEoNLY) Signature of ®. Plumber Gas Fitter Master Journeyman ged Plumber Or Gas Fitter 972 License Number w � � 0 a c z y av w x z �- in c a .. a =' > a Z e a a o w e SUB-BASEM ENT .a U o° a > o a � o BASEM ENT 1ST. F L 0 O R 2ND. FLOOR 3RD, FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8-T.H. FL00R .9 1 1 —T FT (Print ortYP Check one: Certificate Installing Company (�❑ Corp. Address 6,6.s— ElPartner. /S7—'W71m PS7;;-:At7 n1 -3eTZ(, usiness a ep one -z2 F A7-6 9 -09y% �'Fnm/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 No If you have checked 3es, please indicate the type coverage by checking the appropriate box Liability insurance policy 13 Other type of indemnity Bond 13 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 0 I hereby certify that all of the details and information I have submitted (or entered) in above appli ' n are true and accurate to the best of my knowledge and that all plumbing work and inons perfo ed under permit Is for is application will be in compliance with all pertinent provisions of the Massac ,� etts tate Ga;pd"d Chir 14 ft1p&eneral Laws. . 'APPROVED (oEncEusEoNLY) Signature of ®. Plumber Gas Fitter Master Journeyman ged Plumber Or Gas Fitter 972 License Number Date././ l/. 5 A 5........ . r' t �2 ' TOWN OF NORTH ANDOVER � 1 P • PERMIT FOR GAS INSTALLATION c ✓�� q9 SACK 5Et �� L2 This certifies that ... ................ . has permission for gas installation ..7). A ;/t (^............... in the buildings of .................................... at �%�.� .. !��. ..... `�............. North Andover, Mass. Fee. 2` Lic. No:. ? . ... .- .......... . ~GAS INSPECTOR Check # ;6 3 ! S 70 1 BIT. MASSACHUSETTS UNIFORM APPLICATION R PERMIT TO DO GAS FITTING CitylTown:o, 1�CY1W 0 OLS' MA. Date: � `� �� _ Permit# 70q Building Location: �0 S �C a1K' V� KxAL Owners Name)&V Type.of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential 91 New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No Qtiq,4 FIXTURES Ui Z W fn U) V 0 m 2 0 W W 0 Cn H 0 0 2 W W z I— z 0 F' uj D W O Q z N op 0 a o w rn W W W F- w O Q W_ LL F>- N 0 W W W Z 9 0) 2 W I— W Z w z >- (nJ .Q Q m W O z 0 y 1= > z Q H SUB BSMT. BASEMENT Tr -FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5 IH FLOOR 6 FLOOR 7 FLOOR 8 FLOOR (7 ` Check One Only Certificate # Installing Company Name L.y `mob t Corporation Address3 �t�rh(��1ce CitylTownf-& �c+3�a n State_ ❑ Partnership Business Tel: X01 103°1 ��l �� Fax: E]Firm/Company Name of Licensed Plumber/Gas Fitter: IF T%Q.c QW -V tCc INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes g,] No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 9 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 Massachusetts General Laws, and that my signature on this permit application waives thisCheck One Only Owner ❑ Agent ❑ Si nature of Owner or Owner's A ent By checking this box ❑; I hereby certify that all of -the informa etails and tion i have submitted (or entered) regarding thls applicai;ccat on true II be n p accurate to the best of my Knowledge and that all plumbing work and installations erformed under the permit issued for this app compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By ®Plumber ❑ Gas Fitter Signature of L censed PlumberlGas Fitter Title Master p� Journeyman License Number: - `� �1 City/Town [-1 LP Installer APPROVED (OFFICE USE ONLY III I i C ITI to a b b r D 0' r O 0 tri M O O � O 0 C) .� 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 No. Andover, MA 01845 RE: Insured: Mark Balfour Property Address: 105 Farrwood Ave Unit #9, No. Andover, MA 01845 Policy Number: H012199349 Date/Cause of Loss: 7/4/2004,Water Damage File or Claim Number: 13804-R 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 36 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. Rene Archambault 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. Signature and Date ANDERSON ADJUSTMENT CO., INC. 54 Stiles Road, C-106 Salem, NH 03079 RECEIVED AUG 0 5 2004 BUILDING DEPT. Ob Date.... "., 0/0/..... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission for gas installation in the buildings -of .12- e-,- & at Fee. Lic. No. Check # 7A 44z f.b37 j1> 7"' .. ........... ........... Nirth Andover, Mass. .......................... GAS INSPECTOR MASSACHUSETTS UNIFORM APPLICATION (Print or T Mass. Building New ❑ Renovation ❑ PERMIT TO DO GASFITTING 'Owner's Nam � r%Y Type of Occupancy, 1R "I E) N Ti rl L Replacement Plans Submitted: Yes❑ No p Installing Company Name :2r^ T A • ` AM Al A T A 40 Check one: Certificate Address 30 066 C H M A ry i -NI . ❑ Corporation IYl E T H U E fJ 01 rl 0 ❑ Partnership Business Telephone 10 -9 - 17 9 "l 1 @�-Fi rm/Co. Name of Ucensed Plumber or Gas Fitter R1)13EPT A- 5AMM>q i ARr-) INSURANCE COVERAGE: f have a current I billty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. 4 Yes No ❑ 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 WAVER: 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 ❑ Signature of Owner or Owner's 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 pe • i ed for this applicatiTc� on be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ner Laws. By T of License: Plumber n ure of n u _ or Gas atter Title tter er License Number 933 -,,.W/Town Journeyman O IC N HEMEMEENNEEMEMIN REM MENEREM .. EN MEN«5 Installing Company Name :2r^ T A • ` AM Al A T A 40 Check one: Certificate Address 30 066 C H M A ry i -NI . ❑ Corporation IYl E T H U E fJ 01 rl 0 ❑ Partnership Business Telephone 10 -9 - 17 9 "l 1 @�-Fi rm/Co. Name of Ucensed Plumber or Gas Fitter R1)13EPT A- 5AMM>q i ARr-) INSURANCE COVERAGE: f have a current I billty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. 4 Yes No ❑ 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 WAVER: 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 ❑ Signature of Owner or Owner's 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 pe • i ed for this applicatiTc� on be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ner Laws. By T of License: Plumber n ure of n u _ or Gas atter Title tter er License Number 933 -,,.W/Town Journeyman O IC N LL v Z_ F ' 1- W N a - 0 O 0 O _H ¢ O Z d ' O W z O P V J d d < W W LL