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HomeMy WebLinkAboutMiscellaneous - 242 LACY STREET 4/30/2018Date. ....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .../..:../T.�!�� ............. has permission for gas installation .....�S �::,�...... in the buildings of ...... �?f�!!`� ..................... at Zy2 �4�'P .. ?�............. . North Anyd�over. Mass. Fee . AO .4c . Lic. No.. /,0 &4 f GAS INSPECTOR Check # r 7928 -C�- MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING Ur' City/Town: Al 4 n U 1NL 1r" , MA. Date: 111 2-1 /// Permit# Building Location: 2 -LA 2 LaC.2\k S+ Owners Name: M&C ) �et 5cu Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residentialj] New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ If you have checked Y� please in 'cate the type of coverage by checking the appropriate box below. A liabilityinsurance policy 7 Other a of indemnity ❑ Bond P Y type tY ❑ 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 ❑ Sicinature of Owner or Owners Aaent 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: BY ❑ Plumber ❑ Gas Fitter Title h ® Master Signature of Licensed Plumber/Gas Fitte Cityrrown ❑Journeyman License Number: 9325 APPROVED OFFICE USE ONLY ❑ LP Installer Cd UJ Z Lu to U = u m 2 O w O = W y 30. QQ 0�} 00 Z No�W� O vt W U) w w m I— ~ a LLI Q G W O w K cn v W O W z = W In W = I— o W Q > Z U w W �- Z IY U) J H J Q I— Q O m Z -� (� W O Z u- O~ CO) W H W 1-- d V 5 0 C9 C7 2 2 > O O O Z Z W Q F=- O a IZ I- > > > SUB BSMT. BASEMENT 1 FLOOR I 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR -Y'—FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate # Installing Company Name: B.F. Murphy Plumbing p Y 9 & Heating 9 Inc. ® Corporation 2903C Address: 72 Holten Street City/Town: Danvers State: MA ❑ Partnership Business Tel: 978-774-3174 Fax: 978-774-8709 ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: Brian F. Murphy INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ If you have checked Y� please in 'cate the type of coverage by checking the appropriate box below. A liabilityinsurance policy 7 Other a of indemnity ❑ Bond P Y type tY ❑ 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 ❑ Sicinature of Owner or Owners Aaent 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: BY ❑ Plumber ❑ Gas Fitter Title h ® Master Signature of Licensed Plumber/Gas Fitte Cityrrown ❑Journeyman License Number: 9325 APPROVED OFFICE USE ONLY ❑ LP Installer A ' , A Massachusetts - Department of PtjI)IiC SjfCtj. BW1'*d of Building Regrulittion.s Stand, (Is Construction Supervisor License License: cs 73375 BRIAN F MURPHY 11 KENMORE DR DANVERS, MA 01;923 Expiration: 9/3/2012 Tr#: 1799 ✓T1. Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR Registration: z�1.93611 Type: Expiration: 4, 9141912 Private Corporatio BR WN'S KITCI-CS0'- Aff-H-f-id­ R BRIAN MURPHY 72 HOLTEN ST. Danvers, MA 01923 Undersecretary MAT ISSUES THE A80Ve LICENSE T0 Al led 41' -Ai A .4 'd aut A , , e OP ID: CR .4CORlO `,.,�- CERTIFICATE OF LIABILITY INSURANCE DATE (MWDDNM) 09/13/11 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 Thomas Gregory Associates Inc. 781-246-2601 601 Edgewater Drive S235 Wakefield, MA 01880 Chris Hawthorne NAME CT PHONE FAX AIC Ne Ext : AIC No E-MAIL ADDRESS: PRODUCER BFMURPH CUSTOMER ID #: INSURERS AFFORDING COVERAGE NAIC # INSURED BF Murphy Plumbing & Heating, Inc &Browns Kitchen & Bath Inc 72 Holten Street Danvers, MA 01923 INSURER A:Arbella Protection Ins. (A) 41360 INSURER B: Associated Employers Ins. Co. INSURER C: INSURER D: INSURER E: INSURER F: rnvcowr_cc !`CDTICtCATF Al11MRPR• RFVISION 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. IICY LTR TYPE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF ANDOVER POLICY NUMBER MMIDDY EFF MWDD EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I -X-1 OCCUR S � V 8500025389 06/01/11 06/01/12 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTEET— PREMISES Ea occurrence E 300,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICYLI PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,000 Emp Ben. $ 1,000,00 A AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 99770400002 06/01/11 06/01/12 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ E A X UMBRELLA LIAB EXCESS LIAS X OCCUR CLAIMS -MADE 4600025390 06101/11 06/01/12 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,000 X DEDUCTIBLE RETENTION $ 10,000 $ $ B WORKERS COMPENSATIONWC AND EMPLOYERS' LIABILITY TI ANY PROPRIETOR/PARTNER'EXECUtiE Ya OFFICERIMEMBER EXCLUDED? (Mandatory In NH) Kes, describe under DESCRIPTION OF OPERATIONS below N / A CiC5010092012011 06/01/11 06/01/12 STATUOTH- X T RY IMIT- ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYE $ 500,00 E.L. DISEASE - POLICY LIMB E 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) f`cOTlcl/'ATc LV11 nco CAIJCFI 1 ATInM ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. 978-623-8320 AUTHORIZED REPRESENTATIVE 36 Bartlett Street Andover, MA S � V ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD a s r APPROVED Dat -Y-9 NORTH AIdDWV R BMRD Or H UTH INSTALLAHOId CH_CK LIST DISAPPROVED ` -- EXCAVATION OK Date: /z -Z f . -77 - - Reason: - 1. As Built mitted eck: Lot location, dimensions. of system, location in regard to percolation tests, depth of system, i•ra.ter table 2. Distancet Wetland Areas, Drains, Street & House, Drainage Easement and Wells. 3. Water Linecation 4. No /C Pipe lav It _ C , 5. Septic Tank t' to Tank Joints on both side.�T2 of � mow_ ---_' 6. Distribution Box - No cracks in box or cove all 1' s flotir cually m box.��� 7. Leach Fields - Dim1�4_ons, Stone/pths, Capped ends, Clean double-y�shed stone 8. Leach Pits - Dimensions, Depth of Stone, Splash padytees, Cement -pipe to tank - joints on both sides of -tank, Clean double -washed stone 9. No_Gar-bage Disposals Final Grading &,barricading of sub -surface system, TO: NORTH ANDOVER, MASS 19-7 19 77 BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at Lc 7- % L19Cy -57-- SITE LOCATION North Andover, Mass. The grades and construction are as specified in my plans and specifications dated 19 . 7 OAC � x 1 ST/NG ,7) 7'//VC- -7) U-1 -e. / //A/ � '%C/- J411-- is I 9-7 S-7 ✓ 7 OAC � x 1 ST/NG ,7) 7'//VC- -7) U-1 -e. / //A/ � '%C/- J411-- is I v 0 � 1 SOIL PROFILE & PERCOLATION TEST DATA TownCi�t POu� No. &Street /_/_Q c4_1 Lot No. / (� Loc./Subdiv. Plan Owner c/ G0� Investigator �Q.,-/jGt ����j Observer SOIL PROFILES -DATE 3' Elev. 26 Elev. 3' Elev. 4. -Elev. 5977j`— 0 , 0 07 1 2 3 4 5 3 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 10 �---� 10 �� 10 —_� 10 Benchmark Location Elevation Datum Percolation Tests -Date _T/A 77 Pit Number 1 2 3 4 5 Start Saturation Soak -Mi: -ns. Start Test -Time 3.55 Drop of 3" -Time ; Drop of 6" -Time Mins.lst 3"Dro ;3 Mins . 2nd 3"Dro lvvzes & Z>xetcnes on Back Frank C. Gelinas & Associates, North And. ✓� x bo L O T /8 p° / Z-07— 17 o DSD p szo o / 2 7¢ ,q. h D��` ` �l 00 �o L O T /6 145- ° zo , 9°k3l �- LOTi /.095 A. � L j ?o cor ' rJ _LOTS Vol 3 N19 o 2 a 2001 V .eE.� EDEN CIE iVO e T1V D/ST,e/CT ES.S'EX �E"G/ ST2 Y DEEDS. 800.E 1299 l P. PL A A/ AVO TES `/. LOTS //-A, /2-A i� /9 7-1-I eo s `fit LIA N I MLL -11. c ; 4 b Zi (A �! a o o fk 0 i w 0;7K i m g R -i r � 17,1P �� �q AL4 m g R -i r jq�