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HomeMy WebLinkAboutMiscellaneous - 386 MARBLERIDGE ROAD 4/30/2018\� I N O O OO O O i Date..... ....................... .......... k TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .......................... .... ...... .................................. has permission for gas installation .... in the buildings of ......... QV,51if --, ...... . ..................... Mass. at ..... North Andover, Fee w):1) ..... Lic. No....%13,Le ... .. N.te .................... GAS INSPECTOR Check# 9456 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �r CITY N. Andover MA DATE 7/31/2014 PERMIT # "(-t (�(V (� JOBSITE ADDRESS 1386 Marble Ridge Rd OWNER'S NAME GOWNER ADDRESS Same_j TE FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ® RESIDENTIALL) PRINT CLEARLY NEW:® RENOVATION: REPLACEMENT: ❑ PLANS SUBMITTED: YES® NOQ APPLIANCES Z 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 TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER _ _ Re lace 1 Gas Meters x - and Associated Piping i INSURANCE COVERAGE I have a current liability 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 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 [j 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 iocoo liance withall Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Joseph Marino LICENSE # 8736 V SIGNATURE MP 0 MGF ® JP ® JGF ® LPGI ® CORPORATION Ej# F3 -28-5c---1 PARTNERSHIP ®#= LLC ®# COMPANY NAME: RH White Construction Co ADDRESS 141 Central St CITY I Auburn STATE MA ZIP 01501 �JTEL 508 832 3295 FAX 508-926-4347 I CELL 508-832-4614 EMAIL JMarino@RHWhite.com ROUGH GAS INSPECTION NOTES I THIS PAGE FOR INSPECTOR USE ONLY I FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT # PLAN REVIEW NOTES M G N c:i'L mi iin it IR .... ...... WLU w ti LL 0 zd.0 -M < LU < Cl'- 7Z U) < LU<4 w IpmN mi C ® LI DATE(MMIDONMI CERTIFICATE OF .ABILI 1 Y INSURANCEPage 1 of 3. OB/ -)9/20'3 T IS 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 Poliey(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 certificate does not conferrig hts to the certificate holder in 11eu of such endorsement(s). willia of MaeaschuaHtte, Ine. C/o 26 Contury Blvd. P. 0. Box 305191 Nftmhville, TN 37230-5191 R. g• White Construction Company, Inc. 41 Cmntra3, Street P. 0. Box 257 Auburn, MA 01501 E-MAIL NO),, 8813-46-i7-2378 .ADDREW Cext:ificat�5@willia _C-om INSURERS AFFORDING00VERAGE NAIC>r INSURERA:The Cbartar Oak vino Sueurancg COmpauy 25615-001 INSURERS:Tr2VQ1nr9 property Cagualty COZiFany oP Am 25674-003 INSURERC: Nati=Al Union Piro Zneuranca Company o£ 7.9445-001 INSURERD,Travelers Infl&=r ty Company 2565®-001 UVLKAGES CERTIFICATE NUMBER: 20287680 REVISION NUMBER, THIS IS TO CERTIFY THAT THE POLICIE=S 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. 6 A I GENERAL LIABILITY X COMMFRCIALGENERAL UAB11.17Y H__J CLAIMS -MADE OCCUR GEN'LAGGREGATF LIMITAPPUES PER; POLICY PRO LOC B AUTOMOBILE LIABILITY X ANYAUTO AUI Os NEDEC!oll AUT08ULED X HIREDAUTOS NON -OWNED Co DeflAUTOS X n1P ped C UMBRELLA LIAR OCCUR X RXCESB LIAB CLAIMS -MADE DED }; RETENTIDNa 10,000 D WORKERS COMPENSATION AND EMPLOYERS' LIA91 ITY YIN D ANY PROPRIETORIPARTNERIEXECUTIVEj� N(A OFFICERMIEM9EREXCLUDED7 +L_f Mandato fn NH) U��l;KIIB l IUN OF QP'.RATION3 b91GW OF Evidence of inmurance 977X9940-13 19/7./2013 1*9/1/2014 1EACM MED EXP 977R955A77.3 9/1/2013 9/1/2014 BODILY INJUAY(Perperaon) $ BODILY INJURY(PerAocidont) $ nE8766140 9/1/2013 19/1/2014 CUES 820SAlaS-13 9/3./203.3 9/1/2014 RUB 9203A71A-13 9/1/2013 9/1/2014 E.L. DWEASt-EA EMPLOYE, F.L. DISEASE, POLICY LIMIT epeea 2,000,000 1,000,000 1,000,000 1,000,000 SHOULD ANY OF THE ABOVE DE=SCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRE86NTATNE (7011:4197604 TP1:1694012 Cent:20287680 ©19813-2010ACORDCORPORATION. All rights reserved, CORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Date &....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING ........................... This certifies that..... .............. has permission to perform,.-.--< ...R. .............. .... .... ... ...... wiring in the building of .... ...................................................................... a -'�'k --- - - t . ......... ), I- ...... N9rth Andover, Mass. Fee<5s..''Lic. No . ..... ..... .............. ..................................... ELEcrRicAL INSPECTOR Check # 4827 (,omnWitweallk of ) aejachadetfa Official Use Only r t Q� Permit No. a % eLJeparlmen of rte S.rvicei Occupancy and Fee Checked" BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] (Icave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachriscus Electrical Code (NIEC), 527 CNIR 12.00 e (PLEASE PRINT IN INK OR TYPE ALL INFOR,IL 1710N) City or "l'own of: By this application the undersigned gives notice of his or her intention Location (Street R Number) Owner or Tenant JI'M n Owner's Address Date: To the Inspector of I•Yires: perform theAecn-ical work described below. Telephone N Is this permit in conjunct, ith a rouildin; pe -mit' Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building/,?.Utility Authorization No. 166 7 Existing Service Amps /��1'0ll OYerhead Undgrd El No. of Meters New Service �Z _ Amps���-Volts Overhead ®/_Undgrd ❑ No. of iVleters Number of Feeders and Ampacity No. of Detection and Location and Nature of Proposed Electrical Work: Com lesion ofihe foltable nna y be n•aived by Me lits ecta• -rIVi • No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans � c s. No. of Total Transformers KVA No. of Lighting Outlets No. of Ilot Tubs Generators KVA No. of Lighting Fixtures Swinnning Pool Above ❑ In- E:] ntd. Rrnd. o. o Emergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALAR11•IS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges Tot No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heatpump Number Tions KW I No. of Self -Contained Totals: Devices No. of Dishwashers S ace/Area Heating K`V p g IYlunicipal L::etec�,�n/Alerting Connection [I Other No. of Dryers Heating Appliances ^' pp Kati Security Systems: No. of Devices or Equivalent No. of Water K1V No. of No. of' Data Wiring: Heaters Signs BallastsNo. of Devices or Equivalent No. H}•dron assage Bathtubs No. of Motors Total IIP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required bt, the Inspector of Wires. INSURANCE COVER -AGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The Underdigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuin, office. CHECK ONE: 1NSURIWCE ❑ BOND ❑ OTHER ❑ (Specify:) % (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certifj•, under the pains and penalties of petjtiiy, that the information on this application is trite and complete. F1101 NAIVE: AWSW LIC. NO.: LIC. NO.: applicable, enter e.venrpt in�rcense rnunoer titre.) / / Bus. Tel. No.: Address: Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally re by law. By my si,nature below, i hereby, waive (his requirement. I am the (check one) ❑ ovv ncr ❑ ow'ner's zwcnt. OlY'nl'C/'. bCnt ere Telephone \o�� PI'RiVIT FEE: S� PL ASE FILL OUT BACK SIDE -/0 w Ir C) 0 Q Z Q U I— U w J w I— r w w I I 4 d - �" 13 Date 1, �.... < . . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that !t .. ! .....: ? �! :a.r� ►.� ........ ! .`.......... . has permission for gas installation ................. in the buildings of �� :'.�.-��°1....Ile .4. ....... . at ............. .�' 'GC.+'� .......... ,North Andover, Mass. Fee./.�. `:. Lic. No.... .i �. t.. GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File f MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTING (Print or Type) j NORTH ANDOVER Mass. Date �uilding Location�_/ f r— Permit # / 3. Owners Name�+�c • Y New '-1 Renovation Replacement dans Submitted 0 -r FIXTUPFS z;: (Print or Type) Installing Company Nam Address (rU i2 ) G� b�ntit_ AFEW Check one: Certificate Q Corp. Partner. U �2�1vi� �, ✓ e �ti' Firm/ C o . Business Telephone: l9 U Ly Name of Licensed Plumber or Gas Fitter a) Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy her type of indemnity rj-7, Bond Ej Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner U Agent 0 1 hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations perforated under Permit iuued for this application will be in compliance with all pertinent provisions of tho Massachusetts State Cas Code and Chapter 142 of tho Genetai Laws. 1--) 1 A '�) Z' By Title City/Town: APPROVED (OFFicE USE ONLY] TYPE LICENSE: Ti -1 umber / Gasfitter (� ,aster Journevman Signature of Licensed Plumber or G//asfitter Licen e Number N W N N t» 0 a H C N ta tL W0 N Q .Ok- x N Z CC s M N ul i' Q y4j _ yaj O V.. O v, 0. CL W y 4 N W Q t,t 0 w z d "' � °1 cc `w d "C ca Q w c w r z to s H zt= 1 z i, r a? o F' w o i z a w e� .-. Q m z 5 (4 Q, yr > Z w Z G 4 O 6 O O w > O w F - Q 2 O cs u. o [3 .a U SUR -8S MT, t BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR (Print or Type) Installing Company Nam Address (rU i2 ) G� b�ntit_ AFEW Check one: Certificate Q Corp. Partner. U �2�1vi� �, ✓ e �ti' Firm/ C o . Business Telephone: l9 U Ly Name of Licensed Plumber or Gas Fitter a) Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy her type of indemnity rj-7, Bond Ej Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner U Agent 0 1 hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations perforated under Permit iuued for this application will be in compliance with all pertinent provisions of tho Massachusetts State Cas Code and Chapter 142 of tho Genetai Laws. 1--) 1 A '�) Z' By Title City/Town: APPROVED (OFFicE USE ONLY] TYPE LICENSE: Ti -1 umber / Gasfitter (� ,aster Journevman Signature of Licensed Plumber or G//asfitter Licen e Number