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Home My WebLink AboutMiscellaneous - 75 PRESCOTT STREET 4/30/2018Date ...... :*�.k.............. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .......... ' ..Q.............. L'' ......................................... :. has permission for gas installation ...... t4Q ..-.-�.........., .., •� int�h-e7 b *Idiiws of ..........�. j.........../..,.�.................................................................................. at ......1. ...... f.Q. ! P. Cr........'.. ................... ....... , North Andover, Mass. Fee... .'" ..... Lic. No. .�.�............................................................................. GASINSPECTOR Check # 32� 051 00 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY NaR:N /a�.aDa -MAI(PERMIT-1 OtAXt JOBSITE ADDRESS CO7j" ST OWNER'S NAME lJ OWNER ADDRESS TELT~ FAX: TYPE ORPRINT OCCUPANCY TYPE COMMERCIAL Ej EDUCATIONAL RESIDENTIAL CX,EAR ,Y NEW: Q RENOVATION: REPLACEMENT: [3 -PLANS SUBMITTED: YES ❑J N0ER'" FLOORS- ► I BSM ,..I., . 1 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 INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN LOOM / SPACE HEATER ROOF TOP UNIT UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER IMcTr�twa�e oar INOUKANUL 6VVCKAUr_ ' have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL. Ch.142 YES [WO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY- OTHER TYPE INDEMNITY BOND O 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 0 AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and acc rate to t b of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be in complia all ne oVision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME LICENSE # I S6 Y SIGNATURE MP [3'MGF 0 JP 0 JGF [=-] LPGI ® CORPORATION PARTNERSHIP LLC [39= COMPANY NAME:I }'eek $ro-� Seip c es II ADDRESS CITY STATE'/1'I FAX qELL s°� r1d6-IRq EMAILfn 6 _1L eNNe y QAC O � 1 -- Co �e-1-ee.PvL 41�1� k 'L oi Z OVWa 6 'Is 4.r 3 TAU S AA N hJUV P M, T i"KV a V, s 3:n prm..O�Iloi 5,N33 IV� t'.NliL�Ivl! I syp 4 FEENEIR0.01 SMORAN CERTIFICATE OF LIABILITY INSURANCE DATE 1 1113030!2201501611)1-- THIS CERTIFICATE IS ISSUED AS A 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 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 Rogers & Gray Insurance Agency, Inc. 434 Rte 134 South Dennis, MA 02660 CONTACT NAME: PHONE FAX (877} 816-2156 A1C No Exit: AIC No ADDRESS: INSURERS AFFORDING COVERAGE NAIC 0 0210112015 INSURER A.Old Republic General Insurance Corp. 24139 EACH OCCURRENCE $ 1,000,00 INSURED INSURER B: INSURERC: Feeney Brothers Services LLC 103 Clayton St PO BOX 220801 INSURER D: INSURER E: Dorchester, MA 02122 INSURER F: r0VFRAC,FR CFRTIFICATF NIIIMRFR- RFVISIC m NIIIMRFR- 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, TERRA 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 D SBR POLICY NUMBER MM1LDID EFF POLICY M1DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR A2131307501501 0210112015 02/0112016 EACH OCCURRENCE $ 1,000,00 PREIAISES Ea occurrence $ 300,00 MED EXP (Any one person) $ 10,00( PERSONALE.ADVINJURY $ 1,000,00 GEN 'L"AGGREGATELIMIT APPLIES PER: RPOLICY JEC a LOC OTHER: GENERALAGGREGATE $ 2,000,00 PRODUCTS -COMPIOPAGG $ 2,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALLOY&N£D SCHEDULED AUTOS AUTOS HIRED AUTOS AUTOS CEO - COMBINED SINGLE LIMIT $ Ea accident 6001 LY INJURY (Per person) $ BODILY INJURY (Peraocidenl) $ PeOaoEciRdTMDAr,1AGE $ $ UMBRELLA LIAe EXCESS LIAB HoccvR CUMM&MADE EACH OCCURRENCE $ AGGREGATE $ OED I I RETENTION$ r $ A WORKERS COMPENSATIONPER ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETORMARTNERIEXECUTiVE OFFICER11.1FMSEREXCLUDEDT FRI (Mandatory In NH) If yyes descn'beunder OESCRIPTIONOFOPERATIONSbelon NIA 2CW07501601 02/0112015 02/0112016 OTH- X STATUTE ER E.L. EACH ACCIDENT S 1.000,00 E.L.DISEASE-FA EMPLOYEE $ 1,000,00 E.LDISEASE -POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) Town of North Andover 1600 Osgood Street North Andover, MA 0845 4 - II07►1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE. WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1988-2014 ACORD CORPQRATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo"are registered marks of ACORD Date. �� !�.�!�...... E. o TOWN OF NORTH ANDOVER _ • io}�-ate. • PERMIT FOR GAS INSTALLATION ,SS�CHUSE� This certifies that ...��. �f f`?.G! ..�................. has permission for gas installation .�.... %�................... F in the buildings of ............................. at ........... ........... North Andover, Mass. Lic. No.. ... ;...... { GAS INSPECTOR Check # 5910