2D FLETCHER WAY - BUILDING INSPECTION U,
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101 HIGH STREET, PO BOX 40, NORWICH, CT 06360 FOUNDED 1840
INSURANCE COMPANIES
(860)887-3553 — TOLL FREE 1-800-962-080011-800-243-4080 — FAX(860)866-62701(860)887-2898
www.nicinsurance.com
July 16, 2015
Inspector of Buildings
120 Washington Street - 31d Floor
Salem , MA 01970
RE: Insured: William P Pray
Property Address: 2D Fletcher Way
Company Policy Number: H5170997
Date of Loss: 05/01/15
Claim Number: C55697
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, Sec 3B is appropriate, please direct
it to the attention of the writer and include reference to the captioned insured,
location, policy number, date of loss, and claim number.
On this date, copies of this notice have been sent by first class mail to the
municipal officials named above at the address shown.
Sincerely,
Linda M. Fahey
BUTTERWORTH & O'TOOLE, INC.
P.O. BOX 8294
SALEM, MA 01971-8294
ADJUSTERS/APPRAISERS
FOR INSURANCE COMPANIES ONLY
TELEPHONE (978)741-5731 FAX (978)740-9109
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 Selectmen
City Hall City Hall
ADDRESSES
Salem, MA 01970 Salem, MA 01970
r.
RE:. Insured - .. William P'rav
Address : 2d Fletcher Way
Salem, MA 01970
Policy No. :HO 9374980
Loss of : 8/12/98
File or Claim No. : 86-1334
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, Ch. 139, Sec. 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.
If no reply is received from your office within ten days, we
will assume- you,have no liens of any type against this property and
we will recommend to the insuring company that this claim is paid.
Robert L. Smith, Jr.
-Adjuster