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Home My WebLink AboutMiscellaneous - 58 GREEN HILL AVENUE 4/30/2018 58 GREEN HILL AVENUE 210/022.0-0101-0000.0 ' Date t. �r 40RTN TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �BACHuS� This certifies that ..................................... :........................... .5..................................i has perrrussion for gas installation .. .....P'... inthe-buildings of....................... ................................................................................. at %...............(moi P '°� '1 ....../✓Q . , North Andover, Mass. '................... ..... Fee . .:Lic. No. � .. M ................................................... 09 � GAS INSPECTOR Check#9(04 9258 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY North Andover MA DATE 4/15/2014 PERMIT# JOBSITE ADDRESS 58 Green Hill Ave OWNER'S,NAME GOWNER ADDRESS Same I TELT FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL RESIDENTIAL[ PRINT CLEARLY NEW:® RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES® NDE] APPLIANCES-1 FLOORS BSM 1 2 3 4 5 6 7 8 1 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 R OF TOP UNIT TEST UNIT HEATER LJ LWVENTED ROOM HEATER WATER HEATER OTHER Re lace 1 Gas Meter x and Piping as Needed INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES [3 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 t and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will ben co pli nce with all 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 MGF JP® JGF LPGI CORPORATION # 3285C PARTNERSHIP®# LLC®# COMPANY NAME: RH White Construction Co ADDRESS 141 Central St CITY I Auburn STATE MA ZIP 01501 TEL (508)832 3295 FAX 508 926-4347 CELL 508-832-4614 EMAIL JMarino@RHWhite.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLV FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES L� //V I tJX1liMO'iViNEAL.TH OF i1flAW, ._I1Us _Tw.,,�, 1 . fC:l &'E® AS•P�•-lUfe ITER - I SUES TA-G-%lBClVE"LIC6NSE l'b =;3 FARI'1aGT11N ST 1/14 :_GlOmroo[�IWSAL.TH OF€I�ASSA3.S.El�i S i _:-- BERS AND GASFIT IL4 AS A JOURNEY UES THE ABOVE u0EMSE = _ _ - 3 Fi4_RRZ>NGTGN §T- _--_ _ €r( W10—C MA a 16'0:[r :3•X0s9 I _ . i • i 174/b:i/11714 14:U4 5171 8J2b 151 KH WH1It UUNSIKUUI rHut aunZ A~pRLD® DATE(MMIDDJYYYY) CERTIFICATE OF LIABILITY INSURANCE page 1 of 1 08/29/2013 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLYAND 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 on ADDITIONAL INSURED,the polioy(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 notconferrights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT willim of Massachugetts, Inc. PMoNE C/o 26 ce:htury Blvd. NO FM. 877-945 -7378 PX NO). 868-46'7-2378 P. 0. Box 305191 L cextificatearrwdllis.cam Nanhville, TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIO 1f IN9URERA: The cbaxtea Oak Fire Insurance Company 25615-001 INSURED R. H. White Conetraction Company, inc. INSURERS:Trdval9CB Property Casualty Co%hpany of Am 25674-003 41 Central Street INSURERC:Nati=&l Union Firs Ineuranea Company of 19445-001 P. 0. Box 257 Auburn, MA 01501 INSURER D;Travelers inda=ity Company 25658-DOl INSURER F; INSURER F; 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. Iim NSR TMpEOFINSURANCE DD' SU6 POLICYNUMBBR POLICYEFF POLICY EXP LIMITS A GENERAL LIABILITY VTC2000 977X9948-13 9/1/.2013 '9/1/2014 EACH OCCURRENCE 6 2,000,000 X COMMERCIAL GENERAL LIABILITYTO RENTFp �� (Eeoca,mncrf R 300,Q00 CLAIMS-MADE OCCUR MED EXP(Any one person T 10�000 PERSONAL&ADV INJURY S 2 000,000 GENERAL AGGREGATE S 41 000 000 GEMLAGGREGATFLIMITAPPUESPER; PRODUCTS-COMP/OPAGG JOOO 000 POLICY PRO LOG s a AUTOMOBILE LIABILITY VTJC:AP 977K955A-13 9/1/2013 9/1/2014 OMBI EDSINGLF_I.IMIT S 2,000,000 X ANYAUTO BODILY INJURY(Per person) $ ALLAUTOS NED AUT08ULED BODILY INJURY(Peraceldenl) $ X HIREDAUTOS X NON-OWNED AUTOS arsccldsnt $ X Com Ded X Coll Ped I S C UMBRELLALIAB X OCCUR BES766140 /1/2013 9/1/2014 EACHOCCURRENCE Is q'000'000 X PaXCESS LIAB CLAIMS-MADE AGGREGATE $ Sr 000,000 DED I X IRETENTIONS 10,000 D WORKERS COMPENSATION VTRKUB 8205AI05-13 9/1/207.3 9/1/207,4 X o H- AND EMPLOYER$'LIABILITY TJJClY 1) ANY PROPRIETORIPARTNERIEXECUTIVE NIA VTC2XUB 9203A71A-13 9/7,/207.3 9/1/2014 E.L.EACH ACCIDENT !S 1,000 000 OFFICER/MEMBER EXOLUDED7 (Myandato In NH) E.L.DISEASE-EAEMPLOYF-E Is 1,000,000 U is Kill ION UFOPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS)LOCATIONS f VEWICLES(Attach Aeord 707,Addltonal Remarks Schodula,If more ep deo Is rcequlrad) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPREaENTAVVE Evidence Of IMMUZAnce co11:4197604 Tp1:1694012 Cert:20267680 ®1988-2010ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type)N� nau� Z , Mass. Date 19 Permit # 1226 `f 12' Building Location ",��C'�t/�7`�` Owner's NameI�/N�� moi! / 641 U2(q •• �� n d.� Type of Occupancy New ❑ Renovation ❑ Replacement L/ Plans Submitted: Yes[] No ❑ N N . Y W N ' N H V Z CC N CC 0 tL N m 0 N = FZ- W W W V m IM W O J z0 m � Q } z x O Qm m N H Q ¢ Cr 0 = O Z h W 6 '� W F N a °� Q y a N O V W = H x Q t% o. Q > W W W W J 2 Q Z a W LC W F W X H a C7 f- Z J F x W W O > W I- V J �+ W X Q W a z H r N m x 0 Z QW,. O try I Q LC = O O Y W O d J U D d O SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name Check one: Certificate # Address .�. poration l ❑ Partnership Business Telephone & 4 ,� ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter X r INSURANCE COVERAGE: I have a current liability insuran policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No If you have checked ves. please indicate the type coverage by checking the appropriate box. A liability Insurance policy ❑ Other type of indemnity❑ Bond ❑ OWNER'S.INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. eneral Laws, and that my signature on this permit application waives this requirement. Check one: 'A, PL" ..41 - (,#�,i L Owner❑ Agent ❑ Sijna'furtrof Own tor Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in 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 application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General ws. r` BY T License: Plumber Signature of Licensed u or Gas Fitter Title _ G er mtr �,f� ter License Number Cit /Town APPFlONE O FICE SE ONLY urneym an Sri OW g=sO ' 3�r ';:s ONLY Fl- 1,L INSPECTICN SKVTCME� .. APP -,�,s IOU POP „O Oil wilf r?RG r.. ..v..rgdiV,:yw.:�•��.>t b,.r-..i�..f-'+i:�.+4a mss.:..'L.iaa4+.ae. a....mns-wn..n✓. .r::m e.Nw "t.+...r.ter. •.r' .:a. •. v ... - po Qyylwp :i 4.f�� ri sttac 1 r • r a n-x.me atavaaSx.rw. .vmwv w. a,.unwtlar�.iY.�LW .u. ..vnrw.., Oa r.�'-sung,s.. .n �e'La +Gs.n.:ssi9.YiA.+M.e� .rw.�msTr!'P.v:rzs.��'s�'�3iv..•m...itvn.t. wbFSY..a r.. - w ' I.. Bay State Gas Company GAS INSTALLATION AUTHORIZATION y Date 6� 'a Issued to C L� f Z� Address For Installation of: ff BTU Input Restrictions BSG Representative PERMIT ISSUED _ BY INSPECTOR This Portion of Authorization To Be Returned to BSG. Inspection Has Been Made of the Following Gas Equipment: ❑ Heating System (BTU Input ) ❑ Range s ❑ Water Heater 3 ❑ Cloth es=Dryer Room Heater 'f 7! Location } All Work Has Been Done In Accordance With Th-6Vassachusetts State Gas Code And Is Ready For Use. j F F i t ) J # INSPECTOR k I ` P r NO POSTAGE NECESSARY IF MAILED IN THE UNITED STATES BUSINESS REPLY CARD FIRST CLASS PERMIT NO.721 LAWRENCE,MA POSTAGE WILL BE PAID BY ADDRESSEE BAY STATE GAS COMPANY ATTN: SALES DEPT. 55 Marston Street Lawrence, MA 01840