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Home My WebLink AboutMiscellaneous - 30 HAMILTON ROAD 4/30/2018Date............ I ..................... TOWN -OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION Ly;qL 'This certifies that.. 00 (A 'g** 'a- *s* �'t a*'*]']* * a** t"" *o'* has permission for n ........ ....... . . .......... in the buildings of �7. V; I ........... ................. ....................................................................... at .... C� North Andover, Mass. t ... ....... N ................ ......... .. .... .. .... . ......... Fee �70 ....... I, i c. No. S.13� ......... ........... G . AS . W . SP . E . CTOR .............................. Check # (0 ��)3 L+ vl(-,7 .01' 1 � j 'A MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE14/1/14 P E RPM 11 T # JOBSITE ADDRESS, - 3-0— H a. kd OWNER'S NAME [ 11 / GOWNER ADDRESS I Same I; TE r/ FAXI TYPE OR OCCUPANCYTYPE COMMERCIAL[] EDUCATIONAL [j RESIDENTIALE] PRINT CLEARLY NEWIJ RENOVATION: REPLACEMENT: PLANS SUBMITTED: YESF1 NO[] APPLIANCES -1 FLOORS- BSM 1 2 3 4 5 1 6 7 8 9 10 1 11 12 13 14 BOILER L --j F ---j [—.] ED E.— 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 / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHERI ........... ------ - ----- - - ------ ------------------ _Leplqce dw Meterf .@nd-Piping,gs Needed I IL 1= 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 Ej OTHER TYPE INDEMNITY Ej 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. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER E] AGENT[j 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 ii c mpliance with ai�Peainent provision ofthe Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I Joseph Marino LICENSE # 8736 SIGNATURE P0 SHIPCI# LLC E]# MP El MGF [:1 JP [j JGFE] LPGI [j CORPORATION D# j 4PARSHPI #E COMPANY NAME] RH White Construction Co ADDRESS 141 Central St CITY I Auburn STATE�ZIP101501 ITELF (568) 832-3295 FAX 1508-926-4347 j CELLI 508-832 EMAIL MarinoQRHWhite.com i u w PO OR z rl cn w > w z I -- IL) iL Lii LU F- U- co� z -N. —N, a M uj LLM (B Lzu- LL z J -q -W LU LUm W 0 x Ru ji, Vu vb,; AalrPu 18� 49L, if" AW LL U)LU LL, <z > C.) -z- V) LU ofu) Uj< LD 4b� ii"; m 04/03/2014 14:04 5088326751 RH WHITE CONSTRUCT PAGE 02/02 ,--"IN AiCC)RD' 7— DATE �(MMIDDNYYYJ (mm 081 CERTIFICATE OF LIABILITY INSURANCEP... 08/29/2013 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. A B C D D IMPORTANT: If the certificate holder Is on ADDITIONAL INSURED, the policy(jes)must be endorsed. If SU13ROGATION IS WAIVED, subject to the terms and conditions of the policy, certain POliCies may require an endorsement. A statement an th is certificate does notconferrig hts to the certificate holder in lieu of such andorsoment(s). willia ot massachugotts, Inc. C/o 26 ao%ltury Blvd. P. 0. Box 305191 N11chville, TN 37230-5191 R. H. White Construction company, rnc. 41 Central Street P. 0. Bcx 257 Auburxx, MA 01501 �-Xww� INSURER(S)AFFORDING COVERAGE NAIGrt INSURERA! The ChArtOr Oak rixo lneuranC!o CoMpany 25615-001 INSURERS: TrELVOIArEi Property CQGualtY C*tWanY of Am 25674-061 INSURER C: 1qati*MAl ftion Piro Ineuranca CcmpaxLy of 19445-001 INSURER 0; TravalexB Indamnity CoMp&ny 2SG58-Dal THIS IS To CERTIFY THAT THE POLICIES OF INSURANCE LISTED 13ELOW HAVE BEEN ISSUSD TO THE INSURI INDICATED, NOTWITHSTANDINO ANY REQUIREMENT, TERM OR COND17ION OF ANY CONTRACT OP OTHER I CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRI13E EXCLUSIONS AND CON0171ONS OF SUCH POLICIES, LIM17S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE Or INSURANCE ADO" URE SUBf U POLICYN MI;RR GENERAL LIABILITY ip-J, 000 PERSONAL &ADV INJURY 8 8— 14S VTC20co 977X9949-13 X COMMERCIAL GENERAL LIABILITY CLAIMS-MADET OCCUR PRODUCTS -CQMPJOP�iqS 4.nnn nA0 QOMBIrED SINGLE LIMIT _�h"CCJSnt) S — 2,000,000 BODILY INJURY(Pervemon) s GENLAGGREGATE LIMITAPPLIES PER; ,y IR POUr T LOG r� 0 P 4r— gr (Tld�tTAMA' 9 EACH OCCURRENCF.: AUTOMOBILE LIABILITY AGGREGATE L_& _00- 0 0 0 0 0 0 VTJCAP 977K955A-13 ANYAUTO E.L. DISEASE- EA F!MP4QYP.E S E.L. DISEASE -POLICY LIMIT S 1,000,000 1,000,000 ALI.OWNED SCHEDULED AUTOS AUTOS X HIRECIAUTOS X NON -OWNED AUTOS CQJ Ded _ftJJ !2.9 6 _ x VS00 UMBRELLAUAS X OCCIIJR BES -766140 .1 x r=xcrmas LiA CLAIMS -MADE E NTIONG 10,000 WORKERS COMPENSATION VTRKTJB 820SAI85-3,3 AND EMPLOYrRS' LIABILITY ANYP 2 ROPRIETORIPARTNEPIFEXECUTIVE �Y�N NJ`A VTC2XUB 9203A71A-13 5 11 OFFICER/MEMSER EXCLUDI!D? N f MaridetoalnNN) IrS,deal,lbadnikir U CS KfI1_ UNUI-QPURATIONISbelaW Evid6nce of Ing%ttance - ... I ---- 1. -11 ......... � " au"VUU1 I )/:L/;2013 9/1/2014 /1/2ol3 19/1/2014 )/1/202.3 19/1/2014 /1/203.3 9/1/2014 /2./2013 19/l/2014 speca UMBER; !D NAMED ABOVE FOR THE POLICY PERIOD OCUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS EACM OCOVIRRENCE ' "' 0 CLO 2, )00, TO RENTPI) $ 301 Eta�� J :y ip-J, 000 PERSONAL &ADV INJURY 8 8— 14S 2 2 _ 0 _ 0 --..,()00 GENEPALAGGREGA E ,00( 4,000,000 PRODUCTS -CQMPJOP�iqS 4.nnn nA0 QOMBIrED SINGLE LIMIT _�h"CCJSnt) S — 2,000,000 BODILY INJURY(Pervemon) s BODILY I NJ URY(Per accident) $ r� 0 P 4r— gr (Tld�tTAMA' 9 EACH OCCURRENCF.: -5- 1-0 0 00 AGGREGATE L_& _00- 0 0 0 0 0 0 _Ki.r'v��'ATU- I IOTH- _0 . QMITS I I F. E.L. �ACH ACCIDENT $ 11000000 E.L. DISEASE- EA F!MP4QYP.E S E.L. DISEASE -POLICY LIMIT S 1,000,000 1,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THERE -OF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE — I Coll:4197604 TPI:1694012 Cert:20267680 @ 1988-2010 ACORD CORPORATION. All irights reserved. AGORD25 , (2010105) The ACORD name and 1090 are registered marks of ACORD