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Home My WebLink AboutMiscellaneous - 1060 OSGOOD STREET 4/30/2018 (9) /0(PC) I RIE �r f i E Date...... t3llq..... f0 � 1 � `"OpT" do TOWN OF NORTH ANDOVER 03r�•• `` •• Op PERMIT FOR PLUMBING 88�cMus� This certifies that..... e `s.. .`........../....................................................................... 4 has permission to perform...... (. .b�'fi..............................:.............................. plumbingin the buildings of............................................................................................. �� .. ........................:%1..6�... V Fee `' Lic. No. �3 ........ .., .........VPECT0R Check# MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY[ MA DATE i PERMIT# JOBSITE ADDRESS• S OWNER'S NAME; OWNER ADDRESS �j u i TEL,ij�- TYPE OR OCCUPANCY TYPE COMM RCIAL I, j EDUCATIONAL{ RESIDENTIAL PRINT CLEARLY NEW:}..._( RENOVATION. i REPLACEMENT:�_J PLANS SUBMITTED: YES NV FIXTURES 7 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE _�' _ I 1-� --�-- DEDICATED SPECIAL WASTE SYSTEM {- --- --- DEDICATED GASIOILISAND SYSTEM __- , I -- i M. I }^-711 DEDICATED GREASE SYSTEM _ DEDICATED GRAY WATER SYSTEM ^� - �_ �_ --t DEDICATED WATER RECYCLE SYSTEM i t_ _! r ' - f - ---} _ DISHWASHER DRINKING FOUNTAIN --, - ---i FOOD DISPOSER - - } - - - _ FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY _i-�-I T^I _.I. 1�-i - --- Ij ROOF DRAIN n SHOWER STALL SERVICE I MOP SINK TOILE URINAL J- } }-- - I ---'--- - 1—�--� --I WASHING MACHINE CONNECTION _._( t- I - I --1.��{ WATER HEATER ALL TYPES WATER PIPING OTHER { ;*--= -}-- - i } { i I _ i INSURANCE COVERAGE: I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES;! NO �} IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY'J!} 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 this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information 1 have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with allRenineoision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME`I Kevin Scott - -� `I LICENSE# 13258- j SIGNATURE MPi% JP CORPORATION: #;2438 --'PARTNERSHIP, #f �-� ~------.�—____-�_i ADDRESS'P.0 P.0 Box 446 — COMPANY NAME 1 Kevin Scott Plumbing&Heating INC. CITY I Wilmington i STATEy MA ZIP i 01887 i TEL:978-988-3632 i FAX 978-694-9977 I CELL 978-479-8966 }EMAIL kevplumbing@comcast_net KEVIN-1 OP ID:JD '4� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYtfY) 05112/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 781-914-1000 E Kelly Sturtevant TGA Cross Insurance,Inc. PHONE Fax 401 Edgewater Place,Suite 220 Arc •781-914-1000 I(Xv No):781-246-2601 Wakefield,MA 01880 E-Mal. Chris Hawthorne aODRESS:ksturtevant@t acroS&com INSURER AFFORDING COVERAGE { NAIC# INSURER A:Excelsior Insurance Company 111045 INSURED Kevin Scott Plumbing and INSURER B,Nelreriands Insurance Co 24171 Heating,Inc. P.O.Box 446 INSURER c:Peerless Insurance Co ! Wilmington,MA 01887 INSURER D: INSURER E: f INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN TYPE OF INSURANCE AODL S POLICY NUMBER MMIIDCY EFF MNA/DDmY t LIMITS GENERAL LIABILITY { � EACH OCCURRENCE �$ 1,000,00 B X-11_CO COMMERCIAL GENERAL LIABILITY ( iCBP 3185448 05/15/14 05/15/15 —P �ES Ea o, ) is 300,00 t CLAIMS MADE { X "OCCUR I !MED EXP(Any one person) f s. 15,000 i PERSONAL&ADV INJURY is 1,000,00 f } I GENERAL AGGREGATE Is 2,000,00 } GEN'LAGGRE�GGAAT—E LIMIT APPLIES PER: � � � i PRODUCTS-COMP/OPAGG $ 2,000,00 a }POLICY 17Ca LOC {g AUTOMOBILE LIABILITY I I COMBINED SINGLE LIMIT j (Ea accident) ;g 1,000,00 A ±ANY AUTO } !BA 3185445 05115/14 05/15/15 BODILY INJURY(Per person) is j I ALLOWNED SCHEDULED AUTOS X AUTOS { BODILY INJURY(Per accident)i s _X}HIRED AUTOS j X TNON-OWNED i {PROPERTY er ent DAMAGE is is XI UMBRELLA UAB I X I j r `_OCCUR i I f L EACH OCCURRENCE is 1,000,00 C }EXCESS uaB ?CLAIMS-MADE } ICU 8777929 05/15/14 05/15/15 (AGGREGATE is _ 1,000,00 DED ': X I RETENTION$ 10'� I ;s WORKERS COMPENSATIONI { WCSTATU- OTWI AND EMPLOYERS'LIABILITY YIN i s X I TORY UMRS I i ER C ANYOFFPROP IiEroFRPARTNEXCLUOE/°�C�a f N/A j IWC 3185445 05/15/14 05115/15 ;E.L.EACH ACCIDENT i$ 500,00 (Mandatory In NH) !( i EL DISEASE-EA EMPLOYEE$ 500,00 If yos,de T')O'under ! I DESCRIPTION OF OPERATIONS below. } t 1 E.L.DISEASE-POLICY LIMIT!s 500,000 f I ; i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEWCLES(Attach ACORD 101,Addhkma)Remarks Schedule,If more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I01988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD l Date. .. �' G �....... NORTp °f Sao ,°,BYO o� TOWN OF NORTH ANDOVER ~ .00 p ' PERMIT FOR GAS INSTALLATION M SACHU`'Et This certifies that7.?/��t. . . . . . . {. y r . . . . . . . . . . . . . has permission for gas installation . . r4i? . . .`. . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . .. North Andover, Mass. Fee. . . Lic. No. �. GAS INSPECTOR V Check# } 5443 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING _ (Print or Type) Mass. Date -ao-6 b 19 Permit # Building Location C��CG Q � \S�. Owner's Name � — J Type of Occupancy_ y� Plans matted: Yesp No New p Renovation Replacement N a IN W N X z N N N V cc x W L7 it O ;? U1 M N ¢ O V m X 0 J W 1`- Y = O t laiJ 2O W ¢ 0 0 f- < 6i N F- :111 W d C < S Z N O i W N (t W Z V W 6 N W 6 W ~ W = h a W W J < = W W O > LL H V J H W } y Om Z L 2 d O N X X < W W 7 �. < W OCC W < W > O W LL J U C > D 6 O it tt T. SUB—BSMT. BASEMENT iST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR a 5TH FLOOR 6TH FLOOR 7TH FLOOR sTH FLOOR H-I Installing Company Name Cljsdk one: Certificate um rng an eating,Inc. ,l{��/Corporation Address Manchester MA 01944 p. Partnership Business Telephone_` � "�— Cc> D Firm/Co. Name of Licensed Plumber or,Gas Fitter INSURANCE COVERAGE: I have a current ' Ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked Yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy Qll� 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 tnis permit application waives this requirement. OwnerCh k one: 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 permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State.Gas Code and Chapter 142 of the Gener law gy T license: Plumber g re of Licensed lumber o Gas Fitter Title Gasfitter Master License Number Qty/Town Joumeyman APPROVED(OF ICE USE ONLY1