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Home My WebLink AboutMiscellaneous - 160 KARA DRIVE 4/30/2018 (2) 160 KARA DRIVET � / 210/098.A-0096-0000.0 775 o$ Date. 7.: .2 '�. . .... . TM Of, o� h` '° TOWN OF NORTH ANDOVER FMO O 9 • PERMIT FOR GAS INSTALLATION �4SS^CMUSE This certifies that . .�,.e.��?. L '` - . .��.�. . . �^'!•. . . . 4 has permission for gas installation .?.Q��1 in the buildings of . .,.lc* ! . . . . . . . . . . . . . at . . 1.6 v. . .k`:' 5 . . . . . . . . . . . . . .. orth Andover, ass. Fee. .)S.C.? �� . . Lic. No.. j S. . . . . . f,! 1_.0 4. . .q- � GASINSPECTOR Check# I q 6-71 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: MA. Date 1 Perm't# l Building Location:1�Od � �r� Owners Name: Type of Occupancy: Commercial❑ Educational❑ Indstrial E] Institutional E] Residentia New: El Alteration:❑ Renovation: El Replacement: Plans Submitted: Yes❑ No�] FIXTURES to ui Lu rY ~ coU x a M vi TF z lx— o 1 W W ~ p w � O z a O w W 0 1- y j W Z o! m 0 Q a IW— p O W X W va w CO w Z = CO W 1W— o = LL Z W WW Z J F— F— O Z J (� LL lA x Z W W Lu 0 a 2 W W m > O z 0 W Z Z j-- I x V LL 0 O x x 0 IL IW- > > > O ' SUB BSMT. 02 BASEMENT 1 FLOOR cD 2 FLOOR 3 FLOOR � 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Installing Company Nameoat r,EN \ U-,%5 `—��, Check One Only Certifiiccate# �0��ws S�' Corporation �`, Address: City/Tow� State: �.��y- O\Q 3 ❑Partnership Business T�I. >8 `�C73b Fag, 13q- Lvjo ElFirm/Company Name of Licensed Plumber/Gas Fitter: VCS- J L.. Zcv>�L;, [INSURANCE COVERAGE:have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes No❑you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy] Other type of indemnity Y ❑ Bond ❑ OWNER'S INSURANCE WAIVER:1 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 Signature of Owner or Owner's Agent w Owner ❑ Agent ❑ By checking this box❑;I hereby certify that all of the details and information I 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 all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: EAPPROVECD ❑Plumber �rs�. Gas Fitter Signature of Lic sed PI �I/Gas FitterMaster pJourneyman License Number: �7 FICE USE ONLY ❑LP Installer 1f-LfrAA arts 03Z 2217 CROSS INSURANCE 1@002/003 A E" CEETIF(CAl"EF LIABILITY ttVSUtAN CE C DATE(MINDDfYrYY� PRODUCER (978)532-54+15 1fA%: (978)532-$219 1t,IG 8/19/2010 THIS CI_RTIFICA7E IS ISSUED AS A MATTER OF INFORMATION- 33-x- McCarthy insurance, Agency, =uc, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 10 Centennial Drive HOLDER. THIS CERTIFICATE DOES HOT AMEND, EXTENp OR West Entrance ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Peabody MA 01960 INSURERS AFFORDING COVERAGE INSURED MAIC# ANVER NIM ENGLAND GAS SYSTEM me INsumA;Nain Street America Assur. 29939 102 LOCUST ST INSURF�Ie:NatitaA81 Grange lltutual I�a Qp 19788 - INSURER C; gg INSURER DMA 01923-2204 INSURER E; COVERAGES _ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WIT}I RESPECT TO WHICH THIS CERTIFIGATI_MAY BE ISSUED OR MAY PERTAI�t•THE INSURANCE AFFORDED 8Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.IXCLUSIgtYS AND CONDITIONS OFSUCIi POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR on Lr- OF INSURANPOLICY NUMBER POLICY EFiECTNE FOLK MEXPIRATION ZXPOLICY L LcAeltdTY LIMITS MMERCIAL GENERAL LIABILITY EACH OCCURRENCE E 1 000.000 A UitxE`TOl�RTE� ACLAIMS MADE OCCUR 867478 P--Is S 500.000 8/18/2010 8/18/2011 mEDE�(Aoyrvns�rson) S 10,000 _ PEDNAL a ADV INJURY 8 1. 000•,000 GREMIE LAMIT APPLIES PER: GENERAL AGGREGATE S 2,000,00 0 PRO- LOC PRODUCTS-COMPATPAGG S 2+000,000 AUTOMOBILE LIAeUtrY ANY AUTO COMBINED SINGLE LIMIT H ALL OWNED AUTOStEa entddeht) S 11000,000 93367470 8/18/2010 8/18/2011 X SCHEDULED AUTOS BODILY INJURY ; XHIRED AUTOS (Per pC Yvn) X NON-OWNED AUTO$ 8061LY INJURY (Per a6Yident) 9 PROPERTY DAMAGE (Per accident) S GARAGE LIABIt.m• ' ANY AUTO AUTO ONLY-EA ACCIDENT S . OTHER THAN SA ACC S EXCESS!UMBRELLA LIABILITY AUTO ONLY: AGG S (I OCCUR r CLAIMS MADE EACH OCCURRENCE 5 AGGREGATE DEDUCTIBLE RET&moN 5 S 8 WOWERS COMPENSAnON s AND EMPLOYERS•LIAjNUTy Yin WC STATU. OTH- ANY PROPRIETORRARTNERIEXEGUTIVE S aKFICEWMEMSER EXCLUDED? EL EACH ACCIDENT (MandamgibeUn) 2H67g78 0/113/x010 8/18/2011 E.L,DISEA3E-EAEtaPLO S lOb,000 S 9 aLsaiba under 10 0,0 0 0 SPECIAL PROV15IONS below OTHER E.L.DISEASE-POLICY LIMIT S 5001000 ESCRIPTTDN OF OPE Refer RATIDNS 1 L AnONS/VEHICLES t tDCCLUSmON$ADDED BY ENDORSEMENT I SPECIAI,PROVISIONS Refer to Fo"CY Lpr OXCluaionalry endorae"nts and special provisions, CERTIFICATE HOLDER (978)688-9547 CANCELLATION Town of N. Andover- S"OLLIDANyOTHEA30YEFD $CRIBEDPOLICIES BECANCELLED SEMETHE EXPIRATION , INSURER WILL ENDEAVOR TO MAIL 10 James Diozsi, P1tlmbiAg & Gas y�pector DATE THEREOFTHE ISSUING nays wwrrEN i6 0 0 Osgood St-, Ste #2-36 NOTICE T4 THE CERTIFICATE HOLDER NAMED TTI THE LEFy; BUT FAILURE TO DO SO SHALL Aad �1Cig off IMPOSE NO OBLIGATION OR LIABILMY OF ANY IONO UPON THE INSURER,ITS AGe"OR N- Andover, MA O1$4g REPRESENTATIVF,� AUTHDR12Ep REPRESENI/ITIVE Timothy Tramonte/DC4 ACORD 25(2009101) IN5025(zT>a9ol) The ACORD name and 1099 are registered marks Of ACORD RD COi2PORATION. Ail rights reserved. ` Datg-.`S. . . . . . . . . ` = 3695 A TOWN OF NORTH ANDOVER cc cc PERMIT FOR PLUMBING g ,SSAGMUSE� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . This certifies that { has permission to perform . . . . . . . . . . . . . . " r � plumbing in the buildings of . . �1�3' ev � 5'�'a rth Andover, Mass. FeeLie. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer m^QQAU"UJtl is UNIFORM APPUCATlON FaR PERMIT TO' DU PLUMBING -.\ (Print a Typal NORTH ANDOVER, Maas, Dais .19-9— feuA�f—lBMfuifslidYMinTTg . i P�earimoit f /Irrl�ss 9 l0IC�Y?S Location Owner's Name New ❑ Renovation Replacement Plans Submitted :o Y,$eEs❑ No ❑ FIXTURES J a31 Us a16 u = i : y s . < s_ uY a w s> I. o Fo U s �No ! 1jN ° iI A IWAS 1STFLOOR SHO FLOOR l9i 2110 FLOOR 4TH FLOOR a i ITH FLOOR eTH FLOOR. -� TTH FLOOR eTH FLOORMA—Ff I Check one: Cert)ncate Installing Company Name AND O V E R P L B G & H T G C 0 I NC . p, 2122 Address .9731 .0 • 11N T fl N S T R F F T ❑Partnership l A W R F N f F MA 011843 ❑Firm/Co. Fluslness Telephone q7A FmRr,-8383 Name of Licensed Plumber_r,F O R ,F I A R(18 E INSURANCE COVERAGE: ec 1 have a current IlablRy Insurance policy or Its substanII&I equM anL Yee No ❑ If you have checked yM, pleaseIndicatethe type coverage by checking the appropriate box. A liability Insurance policy h7 Other type d Indemndy ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am #,were that the licenies does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my slgnaitme on this permft application waives this requirement. Check one: nature of Ownef or Owner a Mani owner ❑ Agerd ❑ I hereby certify that all of the delaNs and Inlormallon I have aubrtmMod fou entered)in above appl atlon are true and accurate to the best of my knowledge and that all plumbing work and Inslallaltons periorrned udder the pamrft iasued for a application wfl be in compliance with all partlnani provisions of the MauachuaaHa Stale Plumbing Coda and Chapter 112 of 9w el lswa. TRW ur•of Licensed bef City/Town Ucense Number 9983 !lfT"rJAD (OFFICE USE ONLY) Type of Plumbing License: Master Journeyman ❑ �► .' U56 Date.. ..... ... ... ......Q ell MORtM TOWN OF NORTH ANDOVER pF 4�Ia° ,61ti0 3? °� 0 f. PERMIT FOR GAS INSTALLATION 3 p O SACM15Et •..• 07 T This certifies that . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S . has permission for gas installation . . . . . . . ... . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . at . . . . .. . . . . . ., North Andover, Mass. Fees . . . . . . Lic. No.. . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR P RMIT TO DO GASFCCTIN (Prirtit or Type) ; NORTH'ANDOVgR Maass. Date ` Ouilding L.oc:ation_ //� /f�Gir's/ • — - Permit Il` ^` Owners Name_ ' New "'1 Renovation D Replacement Plans Submitted �] -- , Y FIXTIlID,-c i as .. W 39 to Q N R' .O to W CC Ai W .[ .W. Ul +C f W WJ d — Cr.W C3 0: w k.- us h x ¢ to tar > W , Z d c < m ` O N Z1 Y 9C Z O O Y U. 3 Q O .ter V W y a d h O Sun—asIIT. BASEMENT M.. 1ST FLOOR 2ND FLOOR k a t 9RO FLOOR it 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR - �. (Print or. Type),,,,!i p Check one: ;. Certificate II'stailing 'Compan: y._Name ANDOVER PLBG. & HTG. Co. , INC® Corp." 2122' Address ____$731`' $0. UNION STREET Partner. _ LAWRENCE, MA. 01843 Firm/Co. Business Telephone: 978 685-8383 f Name of L.icensed•Plumber or Cas Fitter GEORGE I AROSE '' c t�ranC byMoat . `,; indldkethe ,type of insurance coverage, by cheCit hg this bafyill ane_e4. clic '' ° ty 4ih ur p y'` Other type of indemnity'E] Bond Insurance Waiver i , the undersigned, have been made aware that the ,ilcensei,of this application woes not have any one of the above three insurance coverages. Signature o owner agent of property u Owner 17 Agent 1 hereby certify that Ali of the details and information 1 have submitted (or entered)in above application are true and accurate to lh!bett of my knoarkdge and that OR plumbing work And InstaWtion$ performed under't'ermit issaed for this application will-be In mpiLnce wi1R dl pediment provisions of the blatachwetts State Cat Cade and Chapter 142 of the General l awa. By TYPE LICENSE: J . Plumber Title_ Gasfitter- Signature i`Of,lLiOensed City/Town: Master Plumber o ;Gasfitt.er, Journeyman 9983 ' - APPROVED (OFFICE USE ONLY) License Number