The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 26 GREEN HILL AVENUE 4/30/2018Date ....... �/ 1 ........... ; ............................. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This I certifies that,." ................................................................. ..................... ........... has permission for gas installation.:.!...VVI. o-:I�f ..... LA, in the buildings of ............................... ............... at ......... z Gc-�� ........... North Andover, Mass. .(0 .............................................................. Fee WQ.-..�.. Lic. No-$I.�� .....mb ........................................................... GASINSPECTOR Check# 9-255- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I North Andover MA DATE 4115/2014 PERMIT # (� JOBSITE ADDRESS 126 Green Hill Ave OWNER'S NAME GOWNER ADDRESS I Same TEL— FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL RESIDENTIAL[3 PRINT CLEARLY NEW: ® RENOVATION: El REPLACEMENT: PLANS SUBMITTED: YES® NDE] APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 1 9 10 11 1 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER (� DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM 1 SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER Replace 1 Gas Meter x and, Piping as Needed INSURANCE COVERAGE I have a current liability insurance policy .or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES []NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE 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 I have submitted or entered regarding this application are tr a 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 c pl ance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Joseph Marino LICENSE # 8736 j// 9169A URE MP MGF ® JP[] JGF LPGI CORPORATION # 3285C PART SHIP®# LLC ®# COMPANY NAME: RH White Construction Co ADDRESS 141 Central St CITY I Auburn STATE MA ZIP 01501 TEL (508) 832-3295 FAX 508-926-4347 CELL 508-832-4614 EMAIL12Marino@RHWhiite..com W F� O z z o H U W a, d z w - az°❑ z O N� W � ~ W O w O F a 4 z LU `"`) w j N a W w c4 ° W Q CW7 zz a a a c U x J a � N x w H LL W O z z ,N o H . U W p, cr C5 x 0 a ul. LL .0 LU I -! m ey le - XT LL>. u) M Wfu C3 -j LL, t'LLm. 9 UYI U-)1 GUlY LY. UY 11 I" —1 — I IN—I ; - CERTIFICATE OF LIABILITY INSURANCE page 1 of J. 08/29/20 3 THIS CERTIFICATE IS ISSUED ASA 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(les)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 cartifleate does notconferrights to the certificate holder in lieu of such endorsement(s). Willia *9 Massachusetts, Inc. C/o 26 cotta yyBlvd. P. 0. Box 305191 N&Mhville, TN 37230-5191 R. H. White Construction Company, rnc. 41 Central Street P. 0. Box 257 Auburn, MA 01501 4 V.1: uvaun Crc{� nrl•ul�uwr; 4VVERAGE NAICrt INSURERA:The ChArtar Oak rire Ineuranc9 Company 25615-001 INSURERS.TraVQ1ArE' Property Casualty Company o2 Am 25674-003 INSURER C:Nati0AA1 Union Fire Iasuranca Company of 7.9445-001 INSURER D; Travelers Indamnity Company 25658 -Dal INSURER F,: krKIIrItdAIr- NUIYII3C11:20297660 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. A B C D D TYPE Or INSURANCE II DO'wml SUB POLICY NUMBER GENERAL LIABILITY VTC2000 977109948-13 X CQMMFRCIALGENERAL UABILITY CLAIMS -MADE OCCUR GEN'LAGGREGATF LIMITAPPLIES PER; POLICY M PRO LOC AUTOMOBILE LIABILITY VTJCAP 977K955.A-13 1 X ANY AUTO NED AUTOS AUTOSSCHEDULED X HIRBDAUTOS X NON -OWNED AUTOS X Co Ped X Coll Deg 09 UMBRELLALIAB OCCUR BE8766140 X sxcrmss LIAR I CLAIMS -MADE DED $ RETENTIONS 10,000 WORKERS COMPENSATION VTRK1JB 82 0 SA10 5 -13 5 AND EMPLOYERVLIABILITY yN ANY PROPRIETORIPARTNFRIFXECUTIVEn VTC2XUB 9203A71A-13 5 OFFICERMIEMSEREXCLUDED7 LL}"JJ NIA (andatofv In NN) R UE��Kill 11UN U d UI'ERATIONS below DESCRIPTION OF Or CE )/1/2013'9/1/2014 EACFI 1/1/2213 9/1/2014 /1/2a13 19/1/2014 /1/207.3 19/1/2014 9/1/2014 /1/2013 -��•.�. •_�.��=a,.�ItM1nn6or01.1,Roo,canelmemamaacnoaum,lrmoreepee* Evidence of Inmurance LIMITS ny one person) &ADV INJURY I PRODUCTS -COMPIOPAGO IS 4 , nen _ nn n BODILY INJURY(Per Demon) Is BODILY INJURY(Peracsldont) S DI8EA9E-EA EMPI,OYF.I DISEASE • POLICY LIMIT 2,000,000 1,000,000 1,000,000 1,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCEI.LED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE Co11:4197604 Tp1:1694012 Cert:20267680 ®1988-2010ACORD CORPORATION. All rights reserved. ACORD 25 (2010!05) The ACORD name and logo are registered marks of ACORD Date..................... TOWN OF NORTH ANDOVER D PERMIT FOR GAS INSTALLATION This certifies that .. ............ . has permission for gas installation ..�% ..................... in the buildings of ... �,5 !? .��.. ? ........................... . at ?.0 .. - %: -! Lam/ , North Andover, Mass. Fee../.)..... Lic. No....:.:... �)....f... ..::.. .......... ASINSPECTOR Check # / , / , 3657 MASSACHUSETTS UNIFORM APPLICATION (Print or Type) C FOR PERMIT TO DO GASFITTING N_' i , Mass. Date Permit # 3 � f 2 Building Location -Owner's Name '80keE Type of Occupancy_ _,YzC'/C%jl� New ❑ Renovation ❑ Replacement Plans Submitted: Yesp✓"No ❑ Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 01840 Business Telephone -687-1105 Name of Licensed Plumber or Gas Fitter Francis X. Corkery Check one: certificate # XO Corporation 1862 ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy D( 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 this permit application waives this requirement. Check one: Signature of Owner or Owner's/gent Owner❑ Agent [I hereby certify that all of the details and information I have submitted (or entered) in abo plication are true and aaxi�te to the best of my knowledge and that all plumbing work and installations performed under the permit Issu for this application will n mpiiance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gegerd s. (j i T of Ucense: Title Plumber Signature of ceased Plumber or Gas Gasfitter City/TownMaster Ucense Number 8697 Journeyman APPPVVEff O IC S ONL Y • Y • • Of. Em#��Sii OMEN •• ■��s��son soy •• ■IMONIONOMME®EEMs-m-E-MONK■®n® ONORKSON Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 01840 Business Telephone -687-1105 Name of Licensed Plumber or Gas Fitter Francis X. Corkery Check one: certificate # XO Corporation 1862 ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy D( 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 this permit application waives this requirement. Check one: Signature of Owner or Owner's/gent Owner❑ Agent [I hereby certify that all of the details and information I have submitted (or entered) in abo plication are true and aaxi�te to the best of my knowledge and that all plumbing work and installations performed under the permit Issu for this application will n mpiiance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gegerd s. (j i T of Ucense: Title Plumber Signature of ceased Plumber or Gas Gasfitter City/TownMaster Ucense Number 8697 Journeyman APPPVVEff O IC S ONL I I r n z• r w N J n 2 O O N N = O Q O W. m 9 n o w 0 a a a O O O U. a 3 z G O w Wca a Q - J 'ew 0 - O CL a w .Q w D w (I N) 01 w z 7- a I I r W ' z 1I a z a jl N � = Q O m n Q O cc y, o o a 'ew O m .Q U D (I 01 z a W ' z 1I a z a jl