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HomeMy WebLinkAboutMiscellaneous - 52 PRESCOTT STREET 4/30/2018 -52 PRESCOTT STREET - -- 210/068.0-0001-0000.0 Date...... ..... ..4.1................... V40 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION CHU This certifies that .... .......46 ........... has permission for gas installation .............Vw...t ..... e.-T. ..I................. inthe b U,ildips Of...... ......................................................................... at.... ...........f *7 6 .............. North Andover, Mass. Fee.. ....... Lic. No. . 46... . ........ ...................................................... .... ........ GAS INSPECTOR Check# 09893 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK : CITY IJoatN. =1a�Do _ - MA DATE'(��y { PERMIT# w . l3-• G JOBSITE ADDRESS �- Pr Gtr ST OWNER'S NAME OWNER ADDRESS TELL —_ ��(FAX TYPE OR OCCUPANCY TYPE COMMERCIAL J EDUCATIONAL RESIDENTIAL PRINT CI,EAItLY NEWT—1 RENOVATION:�l REPLACEMENT:�'' PLANS SUBMITTED: YES© NO[]'" .. APPLIANCES 1 FLOORS BSM 1 2T 3 ._ 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER _ CONVERSION BURNER COOK STOVE _ DIRECT VENT HEATER �r DRYER FIREPLACE i FRYOLATOR FURNACE GENERATOR — GRILLE INFRARED HEATER _ LAB ORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROCS TOP UNIT TEST. UNIT .EATER UNVENTED ROOM HEATER WATER HEATER OTHER Ih,etea move 6O INSURANCE COVERAGE have a currentliability Ila- b Ilty insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES �'I�0 El I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ® BOND r 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: 0ER AGENT SIGNATURE OF OWNER OR AGENT A T /F 1 hereby certify that all of the details and information I have submitted or entered regarding this application are acc to est of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in is a wit ert' t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME -Daws ��� LICENSE# I5'6Y SIGN TURE MP E3,MGF 0 JP-® JGF© LPGI® CORPORATION PART RSHIP13#1 LLC E COMPANY NAME: ee 8l o € SE2,, e ADDRESS CITY STATE' f1t ZIP Z i Z 2 TEL FAXI CELL s r1d6'IQg4�EMAIL SI ���h�� i I N1M0 r • • EAL:FaI OF MAS 1CF j11S� t TTS V PL'UMBERr3 • K -slSUrFl FO; :, SFIT7E► S9 M` _ 3����CE11l• rD As LLOWIrIVG 1-1 ENSE A MASTER p LUMBER `r f GARf I�E;L`pic 2;1 !�/I LLp tY�wt i { W 5 J564, � s oMA 0`2 14 L n> 2264.42 v*COMMONVIG l TH�OF MA 51 GNlTS�T`TS.' r r • • • .. IM gOARD�QF PLUMBERS,, � 'Gi15Fti1 �C�BR��p LSSUES THE 'FOL,LOWINN"TAPt;EN'SE t• REQfST'ERE£D AS AsPCUMB`I CCQRP� GARP I ELDh � EEENEY BRQtff ft5t SERVICE, LC Z, )3RDEtCON ,.;, MA 02301 A. 36Tg `�$�05%O1/]'6 ,max, 221 41.3 FEENBRO.01 SMORAN OATE(MMIDDIYYYY)-- ----_._- ctRTSCATE OF LIABILITY INSURANCE 1130/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER.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(tes)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 confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER CONTACT Roggers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 hCUNo Exti: INC,no):(877)816-2156 South Dennis,MA 02660 ADDRESS:- INSURER(S) DDRESS: INSURER(S)AFFORDING COVERAGE MAIC 6 INSURERA:OId Republic General Insurance Corp. 24139 INSURED INSURER B Feeney Brothers Services LLC INSURERC: 103 Clayton St PO Box 220801 INSURER D: Dorchester,MA 02122 INSURER E: IN SURER F: COVERAGES CERTIFICATE NUMBER: 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. ILTR TYPE OF INSURANCE DD SBR POLICY NUMBER MMJrDDIYYYY MM D LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 CLAVAS-MADE a OCCUR 2CGO7501501 02101/2016 02/01/2016 PREMISES Ea occurrence $ 300,00 MED EXP(Any one person $ 10,00 PERSONAL BADVINJURY $ 1,000,00 GEN'LAGGREGATELIMITAPPUESPER: GENERAL AGGREGATE '` $ 2,000,00 POLICY aJEC QLOC PRODUCTS-COMPIOPAGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALLO"AUTOS AUTOS LED AUTOS BODILY INJURY(Per accldenI) $ NOWOl%`NED PROPERTY DAMAGE HIREDAUTOSAUTOS (Per e"We t $ — I H . $ UMBRELLA UAB HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEO RETENTIONS $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER A ANY PROPRIETORIPARTNERISXECUTNE A2CW07601601 02/01/2015 02/01/2016 E.LEACHACCIDENT $ 1,000,00 OFFICER4.10.18EREXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EM PLOYEC $ 1,000,00 Ues descnbe under SCRIPTIONOFOPERA71ONSbekrN E.LDISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached It more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS, North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. 1! (a ACORD 26(2014101) The ACORD name and Iogo'are registered marks of ACORD, ,r h"'\ MASS AntUF-Sor TSS 8FORM APPLICATION FOR PERMIT TO DO^GASFITTIN(3 NORTH ANDOVER. , Mass. Date,? —c;2 . . ` Building Permit #_ _ �v Location J�� /`—'i',�S Ccss 51�b Owner's r Name New► Renovation ❑ Replacement m Plans Submitted: Yes ❑ No EI a v C I! h w h tC 0 ; N Y h d ,a h W M V !4 x N : o ic If- t *4 s C ►- CC ar 44 d N t =Id t» 0Id X ` s 1 sus–dSMT. ®AGIMENT ! ' IST FLOOR IND FL0011 A I q !HO FLOOR 4TH FLOOR 8TH FLOOR 6TH FLOOR 7TH FLOOR 0TH FLOOR Check one: Certificate ' Installing Company Name FP Corp, Address_ 13 4/(?a [] Partnership ❑ Flrm/Co. Business Telephone � 6 _ E07 Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: Check one have a current liability Insurance policy or Its substantial equivalent. Yes 41— No ❑ If you have checked yes, please indicate the type coverage by checking the Appropriate box. A liability Insurance policy Other type of Indemnity ❑ gond ❑ OWNER'S INSURANCE WAIVER: I em aware that the licensee oe ds not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: na ure of Owner or Owner's en Owner ❑ Agent ❑ I hereby certify that an of the details and Information I have submitted(of entered)M above 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 appl tion will be In compliance with all perUnenl provisions of the Massachusetts State Gas Code and Chapter 142 of the Generel Lew: Two of License: TNIeumber 510nature of licensedPlumber or Gas Filter Gasfllter /C3 Master License Number C;)O h'1Town . 0� 11oumeyman MP110NE0(OFFICE USE ONLY) Date. . .tF.'.. „ORTH TOWN OF NORTIR'ANDOVER Of<"ED 'a 1ti0 PERMIT FOiOAS N _ ALLATIONO ♦ i f SA U This certifies that r r ' . . .r�. .�.r. . . . . has permission for gas installation . . . . J in the buildings of . fir t `, .? . . . . . . . . . . . . . . . . . . . . . . at . . . . fx .. . .,. .)L% ,.North Andover, Mass. Fee.,-;�F.' . . Lic. No. �.,�1! . '. f f,!. :: .t. . . . Aid GAS INSPECTOR WHITE:Applicant, CANARY: Building Dept. PINK:Treasurer . GOLD: File