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HomeMy WebLinkAboutMiscellaneous - 47 GREEN HILL AVENUE 4/30/2018 47 GREEN HILL q y 210/022.x01 ENUE -0000.0 Date.5vtt.i........................ NORTh TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION gBACMUg� This certifies thaJ. ................... `k.E.... `. L has permission for g�as/installation 1 .�GtG2- o-Jt e „ in the buildings of...�'..`� ......................................U .......................................... at....... .....CPr2"�`-�'�' �t��..... ..�...... ., North Andover, Mass. rr 5 1 }� Fee Lica No. ......................... .............................:................:......:........ i ,, �/ GAS INSPECTOR Check#01'06{l ` 9316 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY North Andover. MA DATE 5/2212014 PERMIT# u JOBSITE ADDRESS 47 Green Hill Ave OWNER'S NAME GOWNER ADDRESS Same TEFAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:E REPLACEMENT: PLANS SUBMITTED: YES® N0[:] 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 f POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER Replace 1 Gas Meter x INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASEINDICATE 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 application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. c PLUMBER-GASFITTER NAME Jose h Marino LICENSE# 8736 SIGNA URE f MP Q MGF® JP® JGF® LPGI® CORPORATION[j# 3285C PARTNERSHIP®# LLC®# COMPANY NAME: RH White Construction Co ADDRESS 141 Central St CITY Auburn STATE MA ZIP 01501 TEL (508 832-3295 FAX 508-926-4347 CELL 508-832-4614 EMAIL JMarino@RHWhite.com 3� ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# ��� PLAN REVIEW NOTES d;O�N{itVEAL.TH OF IUBASSr4` -- =F'LUIIjEERS AND GASF1 `I` .RSA •= :''j.'` ICM&'D AS F..Mai:�YER F!,� 'R-ING7 QN ST ~W`UR,GEST R MA O'Ac`�jr: WEALTH ®F C�i� 1� Sh P'L111U( ERS aRNQ GASFI7rrERS:; ' "` 1;('C f�i' `ED AS A JQURNSYMA-M-Ptl!: _ �-; TSSUES THE ABOV�'L2CEfV5E Td=?-, ='' • - --.�s�._;- - _ -. - _- -��;"aim' _ .� JT)S =RH_=D :MARINA GTON ~'`•-:; 6'4.15 05/01114 - Yom' - _ . . a. •, ,�. �•. -���-"1 CERTIFICATE OF LIABILITY INSURANCE Page 1 of J. =ATE 3 ,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 pOl 000s)murt be endorsed. If SU 13ROGATION IS WAIVED,subject to the terms and conditions of the policy,certaln policies may require an endorsement.A statement on this certificate does not conferrights to the certificate holder in 11eu of such endorsement(s). PRODUCER CONTACT willim of Maeadc$unotta, Inc. NAM I PHONE C/o 26 C2x)tvzy Blvd. Na-�T). 877-945-7378 PAX_NO)� 888-467-2378 P. 0. Box 305191 -MAIL Nnghville, TH 37230-5191I)DRFSS._4e-rt:ificate�9C�willie.COh1 INSURER(S)AFFORDING AFFORDING COVERAGE NAICr INSURED INSURERA:The Cbartor Oak Fixo Ineuranpg Company 25615-001 R. g• White Construotion Company, Xnc. INSURERS-TrELVOIArs property Casualty Cpn`gany of 2m 25674-003 41 Central Street INSURER C:Xati=Al union Firg Znsuranca P. 0. Box 257 Company of 19445-001 Auburn, MA 01501. INSURERD;TrpvelerB Indamnx ty Company 2565®-001 INSURER F; INSURER P; COVERAGES CERTIFICATE NUMBER.,20287680 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OPINSURANCE DD' SUB POLICY EPF POLICY NUMBER POLICY EXP �mmtnnLIMITS A GENERALLIA6ILITY VTC2000 977XD948-13 9/1./2013 9/1/,2014 EACH OCCURRENCE "h_ 2,000.000 X CQMMERCIALGENERALLIABILITY pDqq TORENTF,D PRB(Ee oceubnc,) _„"� 30a,QQ Q CLAIMS^MADE OCCUR MED EXP(Anyone person) $ 10�000 PERSONAL&ADV INJURY S 2 OD0,000 GENERAL AGGREGATE S 4,�Q Q 0,000 GEN'LAGGREGATFLIMITAPPLIESPER; PRODUCTS-COMPJOPACsG $ POLICY PRO LOC ,000 000 ]3 AUTOMOBILE LIABILITY VT,3CA2 977x955A-1.3 /1/2013 9/1/2014 OM81%DSING4,EI,1MIT $ 2,000,000 ANY AUTO �d ALI,QWNED SCHEDULED BODILY INJURY(Perperaon) $ ALT08 AUTOS BODILY INJURY(PeV41 X HIREDAUTOS X NON-OWNED AUTOS X Co Ded X Ce11 Ped araccldentC! UmenrLLALIAS 3C OCCUR BIa6766Z40 9/1/2013 9/x./2014 EACHOCCURREN0 EXCESS LIAB CLAIMS-MADEAOOREGATE}; RETENTIONS 10,000 0 D WORKFRBCOMPENSATI6N 'JT�tRUEI 8205A1a5-13 9/1/2013 9/1 207,4 g AND EMPLOYER8'LIABILITY y N TDf{Y LI D ANYPROPRIETORIPARTNFRJEJ(ECUTIVE� NIA VTC2RIM A203A71A-13 9/7,/2013 9/1/2014 E.L.FACHACCIDENT s 1,000,000 OFFICER/MEMBER EXCLUDED? UMyts6dte(Cy�fnNH) E.L.OIAEA9E-EAEMPI:pYF.E S 1,000,000 E�VK11181 ION OF OPI.RATIONS belo* E.L.DISEASE•POLICY LIMIT M 1,000,000 )ESCRIPTION OF OPERATIONS J LOCATIONS I VEHICLES(Attach Acord 707,Additonpl Remarks SeNvdula,II more epeea Is roquIng :ERTIFICATE HOLDER CANCELLATION 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 �xdenee of Inlpux&noe Co1144197604 7?p141694012 Cert:20287680 ©9988-2010ACORD CORPORATION.All rights reserved. ,CORD 25(2010105) The ACORD name and logo are registered marks of ACORD Lib��1 ` 1�1]`/�utue Liberty Mutual Insurance New England Region Central Property Unit INSURANCE 75 Sylvan Street Danvers,MA 01923 Tel:(800)566-0323 October 17,2014 Town of North Andover Attn: Building Inspector 120 Main Street North Andover,MA 01845 Re: Property Address:47 Green Hill Ave,North Andover, Ma 018.45 Policy Number: H3S21848987240 Underwriting Company: LM General Insurance Company Claim Number:030539595-0001 Date of Loss:9/6/2014 Attn: Town/City Official Pursuant to M.G.L. c. 139, § 313, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, § 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, §99, if you intend to initiate proceedings designed to perfect alien pursuant to Mass. General Laws, Ch. 139, � 3A &B, or Mass. General Laws, Ch. 143, 5 9, or Mass. General Laws,Ch. 111, § 127B. This letter should not be construed as a waiver or estoppel of any of the terms, conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address,policy number,claim number,and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323