HomeMy WebLinkAboutMiscellaneous - 755 WINTER STREET 4/30/2018o 'i
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Date. . -19:1 .-...
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
SSACHUS
This certifies that ..................
has permission to perform .........
plumbing in the buildings of..... ..... �
..........
at. . .............. North -Andover, Mass.
Fee ......... Lie. N6:7
PLUMBING NMP R
Check # �4c3/—
7716
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Q MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
/� Date
Building Location /1 J 5 (il%infef 5T Owners Name III V1iU �`t° Permit
/'
Type of Occupancy e'1i 1'�'*% c Amount
New r1' Renovation E Replacement � Plans Submitted Yes ❑ No ❑
' (Print or type) 11% r Check one: Certificate
Installing Company Name L Uxeo M 6 ! li �J O h,S Corp.
9
Address f� U' -26k /,�S orh 'A" 4/ �lc
Partner.
Business elephone -77,? -774 -ya Firm/Co. Co
Name of Licensed Plumber: .,_/ea"" -G Uf fo' ,+
Insurance Coverage: Indicate the a of insurance coverage by checking theappropriate box:
Liability insurance policy Other type of indemnity El Bond ❑
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature IOwner ❑
I hereby certify that all of the details and information I have submitted (or enI
best of my knowledge and that all plumbing work and installati pert ed
compliance with all pertinent provisions of the Massachuset to P in
By: igna ur o Ll ea f1jurnDti
Type of Plumbing License
Agent ❑
in above application are true and accurate to the
Permit Issued for this application will be in
Und Chapter 142 of the General Laws.
Titled z
or
City/Town cense um er Master ❑ Journeyman
APPROVED (OFFICE USE ONLY 01/1
` I --.M-..--M-.--.O--M
-.�
I .. • OMMMMOM
=MNNW701
�0���r
11, 1 0M3WMMMMWMMM
' (Print or type) 11% r Check one: Certificate
Installing Company Name L Uxeo M 6 ! li �J O h,S Corp.
9
Address f� U' -26k /,�S orh 'A" 4/ �lc
Partner.
Business elephone -77,? -774 -ya Firm/Co. Co
Name of Licensed Plumber: .,_/ea"" -G Uf fo' ,+
Insurance Coverage: Indicate the a of insurance coverage by checking theappropriate box:
Liability insurance policy Other type of indemnity El Bond ❑
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature IOwner ❑
I hereby certify that all of the details and information I have submitted (or enI
best of my knowledge and that all plumbing work and installati pert ed
compliance with all pertinent provisions of the Massachuset to P in
By: igna ur o Ll ea f1jurnDti
Type of Plumbing License
Agent ❑
in above application are true and accurate to the
Permit Issued for this application will be in
Und Chapter 142 of the General Laws.
Titled z
or
City/Town cense um er Master ❑ Journeyman
APPROVED (OFFICE USE ONLY 01/1
From: Kim 978-750-6606 To: Sara Luscomb Date: 10/17/2007 Time: 1:19:26 PM Page 2 of 3
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"ALCOR
I • a� DATE (�AMIDDlYYj
;p :: , ;, t,;, W ,,,,;,���,.,,,::.TM a,l :. , _•
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e' �> 10-17-2007
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
PRESTIGE INSURANCE AGENCY
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
,INC
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
14 NORTH MAIN STREET
ALTER THE COVERAGE AFFORDED BY THE POLICI BEL
MIDDLETON, MA 01949
.._ COMPANIES AFFORDING COVERAGE
CO6A"`
ATHE HARTFORD
A
INSURED
COMPANY
DEAN LUSCOMB
Q
DBA DEAN LUSCOMB & SONS
— -
P.O. BOX 135
COMPANY
MIDDLETON, MA 01949
C _
COMPANY
D
{� a T
Mill
'I
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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 B Y 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.
-T TYPE OF INSURANCE
LTR POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
LIMITS
DATE(MMIODIYY) DATE(MWDD/M
GENERAL LIABILITY
A -'
OBSBALW1813
9/28/07
9/28/08
GENERAL AGGREGATE 8 2,000,000
PRODUCTS-COMP1pPAGG s 2,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
PERSONAL
&ADV INJURY S 1,000,000
OWNER'S & CONTRACTOR'S PROT
j EACH OCCURRENCE $ 1,000,000
; FIRE DAMAGE (Any one fin) SQ00
— —
MED EXP (Any one parson) S 10,000
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT $
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY S
(Per Person)
HIREDAUTOS I
I
NON -OWNED AUTOS
I
I
i
8001LY INJURY g
(per ems)
PROPERTYDAMAGE S
_
I
GARAGE LIABILITY
I
AUTO ONLY -EA ACCIDENT $
ANY AUTO
OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $ M
EXCESS LIABILITY
EACH OCCURRENCE s
UMBRELLA FORM
AGGREGATE
OTHER THAN UMBRELLA FORM
$
WORKER'S COMPENSATION AND
WC BTATU a
ER I
EMPLOYERr LIABILITY
EL EACHACC1DENT $
INCL
THE PROPR STOWEll
PARTNER4ff-KEGUTIVE
EL DISEASE •POLICY LIMIT ; S
__Y„•^.� _
EL DISEASE - FA EMPLOYEE i S
OFFICERS ARE: EXCL
OTHER
i
I
DESCRIPTION OF OPERATIONSA.00ATIONWEHICLEWSPECWL n MB
SUBJECT TO POLICY PROVISIONS CONDITIONS AND EXCLUSIONS, FOR INSURANCE VERIFICATION ONLY.
SHOULD ANY OF THE ABOVE DESCRIBED POLX= BE OANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
110
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO ORUGATION OR LIABIUTY
OF ANY KIND UPON THE COMPANY ITS AGENT'S OR REPREsgnATIVM
AUTHORIZED REPRESENTATIVE
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