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Home My WebLink AboutMiscellaneous - 350 WINTHROP AVENUE 4/30/2018 (5)Location � 0,— /h W& _ _ I No. Check # Date o/� /�7 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ , TOTAL $ f / ' Building Inspector Commonwealth of Massachusetts Sheet Metal Permit Date: Estimated rob Cost: X00 00 Plans Submitted: YES NO Business License # �1 0 3 Permit # Permit Fee: $ Plans Reviewed: YES NO Applicant License # _ 5 2 9Z Business Information: Property Owner / Job Location Information: Name: C,h Q Q:C i, S e Name: Ges-4 � e- -DecTO � DC (-. tF, Street: �r, `fi S Q. M p (�"( Street:a `��- City/Town: 0 z", r/4Q City/Town: Telephone: 5fO$'N3 �� 0� — Telephone: Photo T.D. required / Copy of Photo I.D. attached: YES NO Building Type: Residential: 1-2 family Multi -family Condo / Townhouses • office Retail Industrial Educational Institutional Commercial. 0 Building Cubic Footage: under 35,000 cu. ft. V over 35,000 cu. ft. Sheet metal work to be completed: NewWork:y Renovation: HVAC Metal Roofing Kitchen -Exhaust System Provide brief description of work to be done: 0 Chimney / Vents INSURANCE COVERAGE: I have a current liability insurance policy or Its equivalent which meets the requirements of M.G.L. Ch. 492 Yes V'/No ❑ If you have checked Yes, Indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the Insurance coverage required by Chapter 412 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 Owner's Agent 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 sheet metal work and installations performed under the permit Issued for this application will be In compliance with all pertinent provision of the Massachusetts Building Code and Chapter 972 of the General Laws. Date Date Progress Inspections Comments Final Inspection By Type of License: Master ❑ Master -Restricted Title Cityrrown ' ❑Journeyperson Permit # ❑Journeyperson-Restricted Fee $ Inspector Signature of Permit Approval Comments /V ' M - jx___ Signature of Licensee License Number: _ -5 2 4 7 - Check at www.mass.clov/dpl CERTIFICATE OF LIABILITY INSURANCE N -MW MVff"' 112122128116 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(Sh AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: N the certificate holder is an ADDITIONAL INSURED, the poilcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the cartificate holder In lieu of such endorsement(s). PRODUCER Dacey Insurance Agency, Inc. 631 Main Street East Greenwich RI 02818 CONTNANIMACT Michael T. Dace FHONE -4-J4811 398.8020FAX 401 3984017 'MAIL • mikedidaceyinsurence.com INSURER A • Utica National Ins. G JRe ublic Franklin Ins. INSURED WAYNES'S SHEET METAL, INC. 1ST TREMONT STREET REHOBOTH MA 02769 INAURER 0: IMSURGROU INSURER It! 08103117 L;Uvr AUES CERTNFICOTE MIIMRFR- t7awalnu u"Unno 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. INSR TYPE OR INSURANCE D POLICY NUIANER POLICY EFF 08103/16 EXP L1MIT8 A X COMMER=LOENERALLaBILITY CLAIMS"E 0 OCCUR CPP 4679804 08103117 EACHOCCURRENCE......._�$1,000,000 DAMAGE TO RENTEo BMW $100,080 om 6 000 PERSONAL & ADV NAM 31.000.000 OENL ADORE UMIT APPLIES PER POIK:Y Mpim a LOC OTHER: AGGREGATE 2 000 000 PROD A)P AGO *2.000,000 $ A AUTOMOSILE UAS LITY ANYAUTO OWNED 7 HIREDAUTOS X N 4679906 08!03116 08t03117 =SINGLE LrdIT $1.000.000 E0DILYWIURY0WP&M) $ 90OLY aNJURY 0W=a wq s PROPERTY DAMAGE S S A X UMORM" Lae EXCESS we OCCUR CLAIMs.NIADE CULP 4834576 08/03116 08/03/17 E$6,000,000 000,000 X 1$10.000 A WORKERS COMPENSATION ANO EMPLOYERV UABUJ TY ANY PROPWE ORIPARTNERIEXECUTP E OFFICERIMEMBER EXCLUDED? (MandsIM In NN) D S destxbs NIA 4869801 08103!16 08103/17 X PER 000 E L EACH ACCIDENT $600,000 E.L DISEASE500,000 E.L DISEASE -POUCYUMIT $600,000 OESCRW=N OF OPERATIONS I LOCATIONS I VEKICLES (ACORD 10H, AddWenQ Rems"M acme M6 may he MUdied N mon epwe b nqutm) Evidence of Insurance Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01645 AUTNNORREO REPRESENT ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD 41 9 SHEET METAL WORKERS. ISSUES THE FOLLOWING LICENSE AS A BUSINESS WA.YNE M. GAUDREAU la WAYNE'S SHEET. METAL, INC. f�.� ►x 157 TREMONT STREET P�•. �y�'.ti l Z '�. REHOBOTH, MA 02769 h g t1 U 703 05/26/2017. 1255 `d