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Home My WebLink AboutMiscellaneous - 36 HOLBROOK ROAD 4/30/2018Date... ...... ....... 1.1 ............ ............ . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission forWstall gas ation ............. . ....... in the buildings of ............. ao� r- .. .... .................................................................................. at.................................................... �* -:;� .... 3(,,5;L --MA ............................ ................... . North Andover, Mass. Fee�6� ...... Lic. No.Z! O ....... HA ....................................................... GASINSPECTOR Check # 9199 G TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY North Andover MA DATE 3/2412014 PERMIT # 1,C`- �C JOBSITE ADDRESS 36 Holbrook St OWNER'S NAME OWNER ADDRESS I Same TEL FAX OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL® RESIDENTIAL NEW:0 RENOVATION: El REPLACEMENT: APPLIANCES Z FLOORS— 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 ;BEST _UNIT HEATER INVENTED ROOM HEATER WATER HEATER OTHER PLANS SUBMITTED: YES® NO BSM 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 1 10 1 11 1 12 1 13 1 14 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q 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 Ej 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 beginpliance with all Pertinent provision ofthe Massachusetts State Plumbing Code and Chapter 142 of the General Laws. MYPLUMBER GASFITTER NAME Joseph Marino LICENSE # 8736 SI ATURE MP MGF� JP® J.GF LPGI CORPORATION [j# 3285C PARTIP®# LLC EI# COMPANY NAME: RH White Construction Co ADDRESS 41 Central St CITY Auburn STATE = ZIPI 01501 TEL (508) 832-3295 FAX 508 926 4347 CELL 508 832 4614 EMAIL JMarino@RHWhite.com w F 0 z z 0 E- U W a cc z a d z w a z z o w } ~ w o W o H z LU z < W > � a W O W d W co a C7 Z a d � p., a cc U x J F a a a cn w x w H LL rA v \ F o z z 0 , UCA n z rti � c d C7 C7 O �:��: • 'lil :':r�'. ''f•if•' .�,1i. .�I ji S:i 11" ''• i •M ILJ LLI Q LLIX fnLu tzg LL. •'a w tJa N rLLI • �� co ...:�.. .F • rl�, . rIY . , f:l1,q. : �:' iil 'Li1 :u�lir 5:1iu 'it�•�5::' :•j{�..�i:,t, .'•.�fY,,.I..,tt"�. fjM".: •I !li:i:4'f�n: �.:i(+ :b.,. �::;..+i.ir ., �:.''f:'i I.'.....�,'�:•jf', '�,f' 1.'r i�J: , f \ t 4 1• w � COLU w • LL C7fl ..Lu O OM "'o ~' cz . W umse� � i��. r. � ,,moi::: • :fn i Lfl ('`w i,: !�i�'S �iaf'.,f•.. ,Yi,' tiff I7 i::5 , � +� i, :f:'.. �? fflr.%fiLi, ij 'j`IFi .. .��;j •: �:i .�•�'�rir 'i:' '::;; ..t'. I' :�••i`r,�/;�'fi�i,'..+:��'.z<<:.:,,.,itflt.::,l!' 04/03/2014 14:04 5088326751 RH WHITE CONSTRUCT PAGE 02/02 CERTIFICATE OF LIABILITY INSURANCE page 1 ot? [�OATEMMMDN 29/2013 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDCR. 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 on ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain polioies may require an endorsement. A statement on this certificate does not confer rights to the Certificate holder in lieu of such endorsement(s). williq o£ Maeaachuaetts, Inc. 0/0 26 CoAltury Blvd. P. 0. Box 305191 X110h-111, TN 37230-11141 R. X. White Construction Company, Inc. 41 Central Street P. 0. Box 257 Auburn, MA 01501. �L'LTJ INSURER(s)AFFORDINGCOVERAGE NAICrr INSURERA:The Charter Oak Fire Inauranco Company 25615-001 INSURERS:TravclgrLi property Casualty CO%�pany 02 Am 25674-001 INSURERC:NatiOnal Union Fire Sneuranao Ccmpany o£ 19445-001 INSURER 0; Travelers Indamn,ty Company 25659-DO1 ----....----•- %,Lr%Pirn.Kir_ Ivumar=rV.2U297560 REVISION NUMBER: TWIS 15 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 - NSR TYPE Or - INSURANCE DD SUB NRR VVM POLICY NUMBER POLICY EFF POLICY EXP LIMITS A GENERAL LIABILITY VTC20CD 97759998-13 9/l/2013 '9/1/2014 EACHOCCURRENCE 6 2 _nnn _ nnr IMFRCIAL GENERAL LIABILITY I I I I I ROM CLAIMS^MADE OCCUR DED I X IRETENTIONS 10.000 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N OFFICER/MEMBEREXCLUDED7 D ANVPROPRIE70RlPARTNERIEXECUTIVEjX N(A I� I Myendetor(dvy} In NN) Ut�VtKill I IUN uF UPERATIONS below CE Evidence of InOUXAnce 977K955A-13 9/1/2013 9/1/2014 BE8766140 19/1/207,3 19/1/2014 VTRKUB 8205A185-13 19/1/20:.3 19/1/2014 9/1/2014 VTC2XUB 8203A71A-13 9/1/2013 more spsea ny one person) &ADVINJURY PRODUCTS - 2,000,000 BODILY I NJURY(Per person) IS I BODILY INJURY(Peraceldent) $ E.L. EACH ACCIDENT s 1, 000 000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L.DISEAS[-POLICY LIMIT S 1,000,000 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 Col1:4197604 Tp1:1694012 Cert:20287680 Q1988-2010ACORD CORPORATION. All rightsreserved. ACORD 25 (2010/05) The ACORD name and 1090 are registered marks of ACORD GEN'L AGGREGATE LIMIT APPLIES PER; POLICY PRO LOC a AUTOMOBILE LIABILITY ANY AUTO ALI. OWNED SCHEDULED AUTO$ AUT08 IX X HIREDAUTOS X NON -OWNED AUTOS C911 Deg Co Defl X Iigop X C X OCCUR HumBnel-LALIAS EXCESS LIAB CLAIMS -MADE DED I X IRETENTIONS 10.000 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N OFFICER/MEMBEREXCLUDED7 D ANVPROPRIE70RlPARTNERIEXECUTIVEjX N(A I� I Myendetor(dvy} In NN) Ut�VtKill I IUN uF UPERATIONS below CE Evidence of InOUXAnce 977K955A-13 9/1/2013 9/1/2014 BE8766140 19/1/207,3 19/1/2014 VTRKUB 8205A185-13 19/1/20:.3 19/1/2014 9/1/2014 VTC2XUB 8203A71A-13 9/1/2013 more spsea ny one person) &ADVINJURY PRODUCTS - 2,000,000 BODILY I NJURY(Per person) IS I BODILY INJURY(Peraceldent) $ E.L. EACH ACCIDENT s 1, 000 000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L.DISEAS[-POLICY LIMIT S 1,000,000 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 Col1:4197604 Tp1:1694012 Cert:20287680 Q1988-2010ACORD CORPORATION. All rightsreserved. ACORD 25 (2010/05) The ACORD name and 1090 are registered marks of ACORD