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HomeMy WebLinkAboutMiscellaneous - 33 GREEN HILL AVENUE 4/30/2018b c m Date..... A.t . ................. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION Thiscertifies that ....................................................................................... ....................... has permission for gas installation .:t......!'..---—......`.` ...... inthe Wildingk of ............................... t.l.l. . ......... . ....................................... 3_2) Ak at................................................................................................. ; North Andover, Mass. Fee. ....6 ...... 6 .... ... Llic. No. ......... � ... .................................................... GAS INSPECTOR Check # 9.259 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK low " I CITY I North Andover MA DATE4/15/2014 PERMIT # v JOBSITE ADDRESSI 33 Green Hill Ave 7777D OWNER'S NAME I�v..•��"-'yam„ GOWNER ADDRESS I Same TEI FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW:® RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES[j NDE] 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 / SPACE HEATER ROOF TOP UNIT EEO=,= TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER -- — - --- ----------- - -- - - --------- ---- ZIPlace 1 Gas Meter x and Piping as Needed INSURANCE COVERAGE I have a current liabilit 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 0 OTHER TYPE INDEMNITY [j BOND E] 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 co li nce with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I Joseph Marino LICENSE # 8736 V 9IGNATURE MP [] MGF ® JP JGF ® LPGI CORPORATION E]# 3285C PART SHIP# LLC ®# COMPANY NAME: RH White Construction Co ADDRESS 41 Central St CITY Auburn STATE MA ZIPJ 01501 TEL (508) 832-3295 ��� FAX 508-926 4347 CELL508 832-4614 EMAILJMarino@RHWhite.com w H O z z 0 N U W a z w G ❑ a Z O H ❑ } W O w O F" a z LU w a w tx W d w � a � z a d o a a U x F a a Q � x w LL. W F� z 1 z o � N H U W a d � C7 O H I\ im ACcllt 'fie DATE (MMIDDryYYYI .� CERTIFICATE OF LIABILITY INSURANCE page 1 OQ z 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 13ETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder is on 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 certifleate does notconferrights to the certiflcate holder in lieu of such endorsement(s), willia of Masamehusetts, Inc. C/o 26 ce-Awry Blvd. P. 0. Box 305191 Nalghville, TN 37230-5191 R. X. white Construction Company, Inc. 41 Central Street P. 0. Box 257 Auburn, MA 01501 Z' L'LTJ Qf:7C INBURERA:The Charter Oak Fire Inauranoo Company 25615-001 INSURERS- TraVOIAX l Property Casualty co pany of Am 25674-003 INSURER C: Nati.Onal Union Firg Ineuraneo Company o£ 7.9445-001 INSURERD; Travelers IndmnAity Company 25658-DO1 INSURER F: vycRHuno GtKIIFFICATE NUMBER: 20287680 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 2 TYPE OP INSURANCE DDI SUB POLICY NUMBER GENERAL LIABILITY VTC2000 977X9948-13 X COMMIP,RCIALGENERAL LIABII.ITY CLAIMS -MADE OCCUR GEN'LAGGREGATF LIMITAPPLIES PER; POLICY PRO- 5_1LOC AUTOMOBILE LIABILITY VTaCAP 977R955A,-13 X ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS X Co Dad X Coll Ded UMBRELLALIAS $ OCCUR S1y0766140 EXCESS LIAR CLAIMS -MADE DED I $ IRETENTIONS 10,000 WORKERS COMPENSATION VTRKUB 62 0 5A19 5 -13 AND EMPLOYERS' LIABILITY ANY PROPRIETORtPARTWRIEXECUTIVE N NIA VTC2XUB 8203,A71A-13 5 OFFICER/MEM8EREX0LUDI!D7 LJ (Mvandator� fn NH) uue��tdtn6clYlury uFUt'FRATIONS below DESCRIPTION OF OPERATIONS/ LOCATIONS Evidence of Inmurance )/1/2013 -9/1/2014 1EACM one '/1/2013 9/1/2014 % 13 CED SI NGLELIMIT $ 2,000,000 BODILY I NJURY(Per person) `F tjODILY INJURY(Peraccldent) $ 3/1/2013 19/1/203.4 AGGREGATE /1/2013 9/1/2014}[ WGSTATU. 0TH_ - _— TAI.y _ /1/2013 9/1/2014 E.L. EACH ACCIDENT $ 11000,000 E.L. DISEASE -EAEMPI,OYP-E S 1,000,000 El, DISEASE- POLICY LIMIT $ 11000,000 hnacn ncoro IU1, AQQI[on(II nemarKe scnoaula, It more epaea 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 C*11t4197604 Tp1:1694012 Cent:20287680 ©1988-2010ACORD CORPORATION. All rights ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD OV Location `?3 No. Date f' J ORT►r TOWN OF NORTH ANDOVER � a Certificate of Occupancy Building/Frame Permit Fee $ $ Foundation Permit Fee $ Ac US Other Permit Fee"i $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $'� Building Ins6bor s 3214-.07 00 PAID 06/23/99 1#:47 Div. Public Works _ 1, y . — ' J — Y � � f � Vi Y. ✓; N—. •-`i ✓ — J- ✓ � ` I _ r7 Ln Ln ol� 0 _ C ? z it p rh i 1 I V. 0 0 N N Y o o o z n z- - M m o = nLn Ll T_ r r 1 � �� IN, z V Cr nr Z U, N Ili 0 I � W • 2 � r7 Q It r Y 71 sz r�r m m C m Cl) Cl) m v y m B CA co Z co O O -0 r �• CL O O C-3 CD O CD O c� �sm CD CD® CD ca w 9. C CD CO) CD O CO) tG COD CO) O CD z O P, O CD a O oc CD I =1 Cl Z o_ 0 N 0 to O CO C CD to C d C3• Vl C O a Cos CD Nf �• N 0Q y F A CA d o n f m = d d— CO) m _a?a 0 ® y O Cm m 0 n O C O ® y n A ® . 7a: O �t0 O � � m m H O ®. m O CA d y d y Q _ O � CD C � CD y y a O_ m � cy 'O Cc�is ,�w O CD o; o 0 CD• C CD O O = W d d ='o S. .O+ y O : C O O r = CD CO2 n m m C#* i Cn O c b7 'r1 �7 ?7 (n O O 7i n p O cn p w C m OQ M w ov C C m b O L1. Z -(i hi f D �i C� p :7, C d p i-rCD n p �-• o O d n z z y y 0 Oy RAYMOND E. DA16HOOSSE, JR. AND SONS ROOF19G CO., INC. ` BOX 431 LAWRENCE P.O. + MA. GONSTRUGTION LAWRENCE, MA 01842 SUPERVISOR LIG. #046636 HOME IMPROVEMENT REG. #101862 ; TEL: 683-4588 ROOFING — SIDING — INSULATION From: - r-3 G., r, �• (Name) Date (Address) To: BATKOND E. DAMPROUSSE, JR. AND SONS ROOFING CO., INC., BOX 431 LAWRENCE P.O., LAWRENCE, MASSACHUSETTS 01842 I (we) hereby authorize the Contractor to furnish all materials and labor necessary to install,, construct and place the Improvements described below in -on building located at No. 6'� / L Street, City !�/ /• _ /'/ ? o .� -� State �'�' f ( in accordance with the following specifications: a-,� !=l i i^ �( ::fi r ! a. /'I •�7 r 5 Q 15-1 r) r i'3 -7.... �- (.. fs..� / / �t /1 _ _ C.•iu _ i! ,' ti�'t'Il.l 7`ac.,C .v_`,.r Lj-... / 4 NI of the above work to be done in a good and workmanlike manner. All men and equipment insured. Premises to be left clean upon completion of work. -For the total sum of Entire Sum to be paid immediately upon completion in accordance•with plan TOTAL CASH SELLING PRICE .......... S `L DOWN PAYMENT IN CASH ............. DEFERRED BALANCE UPON COMPLETION .................. _ dollars. — as shown below. r The undersigned agrees to keep property mentioned in this agreement properly insured against loss by fire including the Contractor's interest therein. This agreement shall become binding only upon the written acceptance hereof by said Contractor, and upon such acceptance this shall constitute the entire contract and be binding upon the parties hereto, there being no covenants, promises or agreements, written or oral except as herein set forth. It is the intention of the parties hereto that this contract shall be binding upon their respective heirs, executors, administrators, successors and assigns. Customer agrees to pay a reasonable sum as attorney's fees and Court Q15sts if placed in hands of attorney for collection. The owner further agrees that in event of cancellation of this contract after acceptance by the contractor and before the work is commenced the OWNER agrees to pay 20% of the total consideration herein named as liquidated damages for breach of contract. Said contractor shall not be responsible for damage or delay due to strikes, fires, accidents, or other causes beyond his reasonable control. We, the undersigned, certify that we are the sole owners of the property herein described on which said work or repairs are to be performed. IN WITNESS WHEREOF, the undersigned has (have) hereunto set his (their) hand(s) and seal(s) the day and. year written above. Accepted By Husband R OND E. DAMPH SE, JR. AND SONS Wife RO IN CO. INC. . Mail Address (if different from above) ura and Title of ciaq - TOWN OF NORTH ANDOVER u ,s Building Department « 1600 Osgood Street '� •�t�iswt� �4 Building 2- Suite 2-36 Building Dept"Ssgc►+u5 North Andover MA 01845 Tel: (978) 688-9545 Fax (978) 688-9542 COMPLAINT FOR INVESTIGATION DATE: - '� — C-3)0) TEL#:q2,— Q b NAME OF COMPLAINTANT: 1 �Oa f ADDRESS:3 zL COMPLAINT TYPE: Electrical: Plumbing: t Gas: Building: Property Owner: Address: Other: E `I A "C " .4 y N O � N O 0. `I A "C " .4 y fD N C. � as o w ° wCL ' 0 a b m° CD O O A 'u o z oc —m' pr 'O. n O Q1 N rr. 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