HomeMy WebLinkAboutMiscellaneous - 362 MARBLERIDGE ROAD 4/30/2018 (2)11 Date... ..................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies thatT "6�. .. ......... U .... .... e .......... has permission for gas installation 6'A 6S /O&PA in the buildings of ....... ........................ at .... t ...... H CA -A 6je- ............................................ ......... . North Andover, Mass. CID Fee(06 .............. Lic. No. e 3.k .......!!....1 : .................................................... GAS INSPECTOR Check# qkol vh_ 9454 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I N. Andover MA DATE 7/31/2014 PERMIT #-11 1,"f JOBSITE ADDRESS � 362 Marble Ridge Rd OWNER'S NAME _ G OWNER ADDRESS Same TEL= FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIALQ PRINT CLEARLY NEW: ® RENOVATION: Ej REPLACEMENT: ® PLANS SUBMITTED: YES❑ N0F,1 APPLIANCES -1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE i 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 ' OTHER ---------------- Re lace 1 Gas MeteWHI rs x and Associated-Piping INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Q NO I 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 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 cpliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 'j yY7 PLUM BER-GASFITTER NAME I Joseph Marino LICENSE # 8736 SIGNATURE MP 0 MGF ® JP ❑ JGF ® LPGI ® CORPORATION Q# 3285C PARTNERSHIP®#LLC ®#= COMPANY NAME: RH White Construction Co ADDRESS 141 Central St CITY I Auburn STATE MA ZIP 01501 =TEL508 832-3295 FAX 508-926-4347 CELL 5088-832-4614EMAIL JMarino@RHWhite.com ROUGH GAS INSPECTION NOTES I THIS PAGE FOR INSPECTOR USE ONLY IFINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES I\ ' b/f %"i!; i::•: !�Il�iit ::h i:i !�'i ' i'I.. 4, .7;1 t7[ �1irt;' 1,�' ':1 ry'1 i� f �f•'vr;�]tlil • � �!' �:1:i:; ilii • �'. `" i.,� .liEi�' !y -j ��tl ttl!'{( , 1�nnrli w+:.� ?..dr.-. �•i' .^r. i'!:•"`:'I, 'lr• t:tiiti-.i t�''s y • :�i:,- ..p :•�;. ,,,. �}i: ,F:il. l;i:,, j ��:{�;i:t�l:'�`fi7 f • �IJ " ''F f•.' �' ;"' iiiil. '4� � a '1%tri%: .pr R COLU Z • • ® Qac:.. �- F7. •' H • �d ��$ F �C Ci ' � W Lu< LD ! r'=-!'� �: '�`a-'.rr j�'`r, •v�!�:.' err' �` i,p;�.l•.,'>,:.:t4�i'%ti1;4(lat-�(:j�ief";lit i; > ;,',, r> ::!i: '�i�•i!! t.:11� 1 ti.P i t�:l:: � �:... �}It,. ji `: t" �.: .t;"' .r 'L•'' i.�i•:':y - ...l�:i!li�;;•,1tn:•:i�,'i .ihi:�.itli� �intf'idft✓<!.?t �C��D►® • CERTIFICATE OF LIABILITY INSU ►NCE page i of FATE zMiaois THIS OERTIFICATE 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. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the PolicAes)must be endorsed. If SU 13ROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does noteonferrights to the certificate holder in 11eu of such endorsement(s), 97illiq 02 Maeaetchusotta, Inc. C/o 26 C2ntuay Blvd. P. 0. Box 305191 Nftmhville, TN 37230-5191 R. H. White C0n5l:raeti0n Company, Inc. 41 Central Street P. 0. Box 257 Auburn, MA 01501 NO QM ar, -"Z -1673 I 'r6i6D); 888-467-2378 UDIR s certrificate�r�willis.Gom INSURERS AFFORDING COVERAGE NATO R INSURERA:The Cbaxtor Oak T£Xe Zneuranco Company 25619-001 INSURERS.Travo7,gra Property Casualty Company of Am 25674-003 INSURERC_Nati=Al Union Piro Insuranca Company o£ 19445-001 IhSURERD; Travelers Indamnity Company 25659-DOl INSURER F.; L.VYCKHCiC.7„-i CERTIFICATE NUMBER: 20267660 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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN 0 N MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSFtqD' TYPE QFINSURANCE SUB pOI.IGYNUMBBR POLICYEFF I POLICYEXP GENQiALL1ABILITY LIMITS VTC20C0 977R999B-13 'A 9/3./2013 '9/1/2014 EACNOCGURRENcE F 2.t1n0-Dir B C D D )FSC RI PTION OF OP mvidonce of Inlaurance %- "'l l nFu(0"lu"1. Nuulwntll &ADVINJURY IPRODUCTS -COMPIOPAGO Is 4.nnn_nnn /1/2013 9/7/2014 �ag�reD51NGlFnt),I.IMIT $ 2,000,000 BODILY INJURY(Per person) 6 BODILY INJURY(Peraceldent) S /1/2(113 )9/7./2014 /1./2013 9/1/2014g WGSTATU. um- T/r.�a:u, _ /7/2023 9/1/x014 E.L.FACHACCIDENT T 1,000 000 E.L.DI$EA9E-EAEMPLQYF.E S 1,000,000 FJ.,DISEASE -POLICY LIMIT S 1,000,000 epeeo SHOULD ANY OF TWE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATNE 0011:4291604 TP1:1694012 Cert:2028700 ©1988-2010ACORD CORPORATION. All rights reserved. CORD 25 (2010105) The ACORD name and logo are registered marks of ACORD X CpMMFROIALGENERAL LIABII.IT( CLAIMS-MADET OCCUR GEN'LAGGREGATE LIMITAPPUES PER; POLICY PRO LOC AUTOMOBILELTABILITY VT,TC:AP 977R955A-13 XX ANYAUTO ALI. OWNED SCHP.DULED AUT08 AUTOS X HIREDAUTOS X NON -OWNED AUTOS g Co Defl 9SOX C911 Ded UMBRELLALIAB X OCCUR BE8766140 X EXCESS LIAR CLAIMS -MADE DED }; IRETENTIONS 10,00() WORKERS COMPENSATION Vx�tRUB g2o51s1as-13 a AND EMPLOYERV LIABILITY ANY PROPRIETORIPARTNFRIEXECUTIVENIA VTC2XuB A203A71A-13 9 OFFICER/MEMBEREXCLUDED7 I�`�"" f1 (Mandato In NH) U���Kn+ I IUN uF UNFRATIONS below )FSC RI PTION OF OP mvidonce of Inlaurance %- "'l l nFu(0"lu"1. Nuulwntll &ADVINJURY IPRODUCTS -COMPIOPAGO Is 4.nnn_nnn /1/2013 9/7/2014 �ag�reD51NGlFnt),I.IMIT $ 2,000,000 BODILY INJURY(Per person) 6 BODILY INJURY(Peraceldent) S /1/2(113 )9/7./2014 /1./2013 9/1/2014g WGSTATU. um- T/r.�a:u, _ /7/2023 9/1/x014 E.L.FACHACCIDENT T 1,000 000 E.L.DI$EA9E-EAEMPLQYF.E S 1,000,000 FJ.,DISEASE -POLICY LIMIT S 1,000,000 epeeo SHOULD ANY OF TWE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATNE 0011:4291604 TP1:1694012 Cert:2028700 ©1988-2010ACORD CORPORATION. All rights reserved. CORD 25 (2010105) The ACORD name and logo are registered marks of ACORD . N2,1844 Date....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING ; (ec� R I ccI Sf ej This certifies that ...... .................................................... has permission to perform ..... -.f :........0 IQ,...................... wiring in the building of ........ M. - r.PJ.. . [A. 1. :. I �. - ........................................... at ........ -- -..........1'1. . ..... . North Andover, Mass. '�........ D ............................................... Fee., ................ Lic. No. � .. ....... ELECTRICAL INSPECTOR C 066/-A'*'8':56 35.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer J r�� eo�tazzaf.�r,� or �ss�Gr>,nrsE?7s Dyewrr.�r � r��fLe SaScW BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 ---------- 0ffice Use Only Permit No_ Occupanc/ & Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Town of North Andover Date --4` / 9' F8 To the Inspector of Wires: The undersigned applies for a permit to perform the electricai work described below. Location (Street $ Number 61r /'Y9"I_ur Owner or Tenant Owner's Address JaE tS/igrr h�/ �7Di�•t/SD�' SI• /✓0/I�1'J//Er Is this permit in conjunction with a building permit Yes ❑ No q (Check Appropriate Box) Purpose of Building Utility Authorization No. So y�8 Existing Service 45D Amps Volts Overhead Undgmd ❑ No. of Meters New Service 420 Amps o?i'J Volts Overhead )C Undgmd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed E!ectncal Work /OLW -9,6-get-Ice in.Sw- aty-C OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts pt Massachusetts General taws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YESf NO = have submitted valid proof of same to the Office YES*, NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE )F- BONO = OTHER = (Please Specify) ��77 (Expiration Date) Estimated Value of Electrical Works /700, 00 Worts to Start Inspection Date Resquested Rough Final NO. X336 NO. Bus. Tel No. Address Y.r!�77F S✓: �yJE/✓Fti �'y Alt Tei. No. OWNER'S INSURMCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General taws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)/ Telephone No. PERMIT FEE 5 (Signature of Owner or Agent) Total No. of Light8nq Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In Cl No. of Ugntinq Fixtures Swimminq Pool gmal G gmd 0 Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Svntch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total. Total No. of 0100821 No. Pumas Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Soace/Area Heating KW Detecdcn/Sounding Devices Q Municipal Q Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Batlases Winn No. Hydro massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts pt Massachusetts General taws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YESf NO = have submitted valid proof of same to the Office YES*, NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE )F- BONO = OTHER = (Please Specify) ��77 (Expiration Date) Estimated Value of Electrical Works /700, 00 Worts to Start Inspection Date Resquested Rough Final NO. X336 NO. Bus. Tel No. Address Y.r!�77F S✓: �yJE/✓Fti �'y Alt Tei. No. OWNER'S INSURMCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General taws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)/ Telephone No. PERMIT FEE 5 (Signature of Owner or Agent) Code End