HomeMy WebLinkAboutMiscellaneous - 395 WOOD LANE 4/30/2018bate......1... �. �.�........................ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .J .!... :.? :e-C.�" S� Ck P `� ............................................................................ has permission for gas installation ....�!! �..tl +� �..e..:P..... 4,0:1Va-j in the buildings of ....1..4�-r.......................................... at .... .....�. ; tic ....tom N.c..................................... I North Andover, Mass. FeeW..'. ..... Lic. No. �.....�.......�............................................................... Check # LP � `C GAS INSPECTOR 9224 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK \ CITY I North Andover MA DATE 3/24/2014 ] PERMIT # JOBSITE ADDRESS 395 Wood Lane OWNER'S NAME LJohn Fay GOWNER ADDRESS I Same TE 978 688 0345 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL[] EDUCATIONAL ® RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: ® PLANS SUBMITTED: YES❑ NO❑ APPLIANCES'l 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 I SPACE HEATER ROOFTOP UNIT TEST UNIT HEATER • UNVENTED ROOM HEATER WATER HEATER OTHER Replace Gas Meter x and Pi ino as Needed 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 ❑ 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 applicat4PARTSHIPF—i# iance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws- PLUMBER-GASFITTER NAME Joseph Marino LICENSE #SI E MPLA MGF ❑ JP ❑ JGF ❑ LPGI ❑ CORPORATION ❑# 3285C LLC ®# COMPANY NAME: RH White Construction Co ADDRESS 141 Central St CITY I Auburn STATE MA ZIP 101501 TEL 1 (508) 832-3295 FAX 508-926-4347 1 CELL 508-832-4614 EMAIL JMarino@RHWhite.com 1. w H O z z 0 H c� w a z a Zo❑ z o W❑ w �- O w w o W o E' a z a F- W rA to W w a w Q w N w d ZO 0" a a H U x CL F a CL a c w x w F w cc F O z z 0 w W 96 \ rA z z rA o a° V i:�•[it �h. :,'�' P ri. .,' 'rel '��ri. �3: _ A�qqaa�� �,• ,m:. .: t tomn LLu z' G 0. -j 4 Et1lz a� z� W EL LU Q', Cowes <Z 0, t7� LLZd yiN a t• ` 'f' ,1, �,• ,m:. .: t 4 Et1lz W EL Q', Cowes <Z 0, t7� LLZd _ ❑� o LLI � j . J 1 J..• ga- ..h'. L:'. `ii:1' 'Ji':',a Iil;'tlJ::'li�',,':d.:,,i''Jt,:.�::JJ.4�}• 04/03/2014 14:04 5088326751 RH WHITE CONSTRUCT PAGE 02/02 AC00 ® DATE (MMIDDYYYY)CERTIFICATE OF LIABILITY INSURANCEpage 1 of 1 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 BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of tFle policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). willia of Massachuaette, Inn. c/o 26 CUAL-Ury Blvd. F. 0. nor- 305191 N11011ville, TN 37230-5191 R. H. White Construction Company, Inc. 41 Cmneral Street F. C. Box 257 Auhurn, MA 01501 v:L'LZI ZZ.WC I NSUR ER(8)AFFORDING COVERAGE NAIC rt INSURERA:The CHartar Oak Pira Tneurancg Company 25615-001 INSURERB:Travolors property Casualty Company o4 Am 25674-001 INSURERC:NatiOnAl Union Ffro Tneurancg Company of 7.9445-001 INSURERD;Travelers Infl&=ity Company 25698-DO1 vw�nnv�a LaK I 11-1cATE NUMBER: 20287680 REVf510N NUMBER THIS IS TO CERTIFY TWAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN [$SUED 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. LzLNSR TYPEOFiN8URANCE QD'L SUER POwuvnLICY POLICYEPP POLICY EXP LIMITS A GENERAL LIABILITY VTC2000 977109948-13 9/1/2013 '9/1/2014 EACMOCCURRENCE F 2 000 QO( X COMMERCIAL GENERAL LIABII.ITY pq C� TO RENTF,D S(Eeoccuroncrl $ 300.00( CLAIMS -MADE PR��Ig T OCCUR MED EXP(Anyoneoemon) R in nnr PER: D AUTOMOBILE LIABILITY X ANY AUTO AUTOS NED AUT08ULE❑ X HIREDAUTos At3cf) ON -OWNED UTOS g Co Ded oll Ped C UMBRELLA LIAR X OCCUR X EXCESS LIA6 CLAIMS -MADE DED I X RETENTION0 10,000 D WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YEN RI D ANY PROPRIETOPARTNIEWEXECUTIVEn NIA OFFICERrMEMSEREXCLUDErn LNI (Mendelm In NNj tvee, dea lbs tlnilm UttSUKIII I lUN Uf OPERATIONS below Evidence of inmurance VTJCAE 977K955A-13 9/1/2013 19/1/2014 EX8766140 9/1/2013 9/1/2014 VTRZUB 820SA105-13 19/1./207.3 19/l/2014 9/1/2014 VTC2KDH 8203A71A-13 9/7,/2013 Remarks GENERAL AGGREGATE 15 4,_000, 000 PRODUCTS-COMPIOPAGG 1D 4 . nnn nnn BODILYINJURY(Peracoldent) S S E.L. ❑18EASE-EA EMPLOYE_ F.L. DISEASE. POUCYLIMIT 2,000,000 1,000,000 1,000,000 1,000,000 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 REPRESENTATIVE Colli4197604 Tpl:].694012 Ce7:t:20287680 ©1988-2010ACORDCORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and 1090 are registered marks of ACORD w 4007 117 Date ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... 4-- .... .. ............... ............ has permission to perform ............ ..................................... wivft in the building of ......... M ............................................... at .......... ........ ( er, ............ �orth Andov do FeeW5.." Lic. No. .... . ....... ............... E cr LE RICAL NSPECTOR Check # Commonwealth of Massachusetts Official Us O ty a v.�F Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEQ),527 MR 12.00 (PLEASE PRINT IN INK OR TYP AL INFORMATION) Date:_ pA City or Town of: To the Inspector of Wires: By this application the undersign "g es notiicce f his r r intention to perform the electrical work described below. Location (Street & Nuixiber) '�J Owner or Tenant Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes ❑ No Q (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters lumber of Feeders and Ampacity Location and Nature of Proposed Electrical Work: stallation of Security system Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures AboveIn- Swimming Pool rnd. EDrnd. ❑ 0.0 mergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners of Detection and o. Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers p Heat Pump Totals: Number Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equi No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: 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 undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify: (Expiration Date) Estimated Val*thpa icaall Work: (When required by municipal policy.) Work to Start:�l/ 1 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, undeandpen alties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: 15=q 3(' Licensee: John S. Bassett Signature --431149 LIC .NO.: 1533C (Ifapplicable, enter "exempt" in the license number line.) Bus. Tel. No.: 603 594 5928 Address Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Li , see does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ `'