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Home My WebLink AboutMiscellaneous - 320 MASSACHUSETTS AVENUE 4/30/2018 320 MASSACHUSETTS AVENUE 210/016.0-0063-0000.0 Date...... ...... ......................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... .......... .......................................................................J�....................... has permission for gas installation A ...... in the buildings of .......................................................................................... at.-32— P�A- e r'10— North Andover,Mass. ................... ..................................................................... Fee(PQ ..... Lic. No.@!—?�., Hkr..................................................... .............. GASINSPECTOR Check# 3 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I North Andover I MA DATE 3124/2014P RMIT# JOBSITE ADDRESS 3�O AIA S' G, U S> AVL OWNER'S NAME GOWNER ADDRESS I Same TEL -- FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL❑ RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NOQ APPLIANCES-1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 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 I SPACE HEATER OF TOP UNIT TEST 'tINIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liabilitv insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 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 c liance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Joseph Marino LICENSE# 8736 t16NATURE MP MGF❑ JP® JGF® LPGI® CORPORATION Q# 3285C PARTN SHIP❑#= LLC❑# COMPANY NAME:j RH White Construction Co ADDRESS 141 Central St CITY Auburn STATE MA ZIP 01501 ]TEL (508 832-3295 FAX 508-926-4347]CELL 508-832-4614 EMAILI JMarino@RHWhite.com / ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES _--=;C �ViNiO�iVWEAL.TH OF MASSA` US, `T 'P UIG�BERS AND GASFIM SE® AS:A-M-A-,$TSR P.L11°M��R- f SUES.TA.E.AgQVE LiC6NSE7dt=-:" MA-R.I N.0 ARi?.INGTON ST 05/01/14 IN- - _...-• > =_G:Qi1MfJNWEALTH OF MIASSC`t#tJ:S:E'Ii'S : Pf;UNf-$ERS AND GASFITTS;; :` t > > L:f' ENSED AS A JRIVEYIII�, N=-�?�11I1Q I ' TSSUES THE ABOVLLICENSE t4 0 i4FtRI=NGTON - 4�j f STE R MA 0 15 w6`. :4fi 05/01/14 _; ; - = s_y. _.� _ .._•_ i - I 04/03/2014 14: 04 5088326751 RH WHITE CONSTRUCT PAGE 02/02 A CERTIFICDATE(MM/DbNy"ATE OF LIABILITY INSURANCE page 1 of 1 08/29/20 3 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS �RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE ES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING N URER(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,certaln 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 CONTACT W'lliq of Massachusetts, Inc. PHONE TE FD C/o 26 Century Blvd. No_Exr} 877-g45-7378 FAX P. 0. Box H05191 -MAIL -No)- 888-46_7-2378 Nashville, TH 37230-5191 D.DRE"�S ce�tificate�c�wil1�>3.com INSURER(3 AFFORDINGCOVERAGE NAICV INSURED INSURERA: The Charter Oak Fire Insurance Company 25615-001 R. X. White Construction Company, Inc. INSURERS:TrevalsorH property Casualty Company of Am 25674-003 41 Cetarr&7 street IN SURER C:NnCio>aa1 Union F. Ineurnnca Company o£ 79445-001 P. 0. Box 257 Auburn, MA 01501 INSURER D;Travelers Indmmuxty Company 25658-001 INSURER F; INSURER F; COVERAGES CERTIFICATE NUMBER:20297680 REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN [$SUED 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. IJzL NSR TYpE OF IN8URANCE DD' SUB POLICY EFF POLICY NUMBER POLICY EXP LIMITS A GENERAL LIABILITY VTC20CD 977X9948-13 9/1/2013 9/1/2014 EACH OCCURRENCE X COMMERCIAL GENERAL LIABILITY a%r�ETO RENTF,D (Eeoeauronc�1 $ 300_000 CLAIMS-MADE 0 OCCUR Mm EXP(Any one ereon --,()00 PERSONAL&ADV INJURY $ 2 DOQ,000 GENERAL AGGREGATE $ 4.06 0 000 RGEN'LAGGREGATF LIMIT APPLIES PER; - PRO- PRODUCTS-COMP/OP AGO, $ ,000 000 POLICYtpo LOC B AUTOMOBILE LIABILITY VTJCAP 977K955A-13 /1/2013 9/1/2014 s OMBI lent) LE LIMIT $ 21000,000 X ANY AUTO a dent ALI.OWNED SCHEDULED BODILY INJURY(Perpereon) $ NXAUTz AUTOS BODILY INJURY(Peraccldenl) HIRED AUTOS X NON-OWNED AUTOS Co Ded. X Coll Deg erScGdent A $ C UMBRELLA LIAS $ OCCUR BE8766140 /1/2013 9/1/2014 EACHOCCURRENCF X EXCESS LIAR CLAIMS-MADE $ S"000'000 DED I $ ]RETENTIONS 10,000 AGGREGATE $__5'000'000 D WORKERBCOMPENSATION S AND EMPLOYERB'LIABILITY Y/N VTRKIJB 8205 185-13 /1/207.3 9/1/2014 g U - D ANVPROPRIETORIPARTNERIEXECUTIVEn NIA VTC2fiuB B203A71A-13 9/7/201,$ 9/]/x014 E.L.EACHACCIDENT 1,000 000 OFFICERiMEMBEREXCLUDED7 LL`}""JJ Mee Kill a U)-O E.L.DI8EA9E-EAEMPLOYEE $ 1,000,000 u�esultn•I UNU)-OPERATIONS below E,L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Atl(wh Acord 101,Addltone l Remake Sehedula,It more ep eco to nequlrgd) 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 EvxdArzce of Insurance Col1:4197604 Tpl:].694012 Cert:20287680 ®1988-2010ACORDCORPORATION.All rig reserved. 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