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HomeMy WebLinkAboutMiscellaneous - Exception (668)z 221 Date..1 !.4.+.0......... ,,ORTPI TOWN OF NORTH ANDOVER pf tta° ,^1ti0 PERMIT FOR MECHANICAL INSTALLATION 9 � a ��jj t -� f --i ` : This certifies that!. 4?: - ... s .. • . . has permission for mechanical installation . in the buildings of ..� at .� ... •t,.. x .'.�. (�°'f' ..�'�.�'�•• •, North Andover, Mass. Fee. —61—.. Lic. No;2 `/ ... ................... . GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer f Commonwealth of Massachusetts Sheet Metal Permit Date Estimated Job Cost 3, so O Plans Submitted: YES NO jk Business License # Business Information: Permit # !i Permit Fee: $ 6 Plans Reviewed: YES J NO Applicant License #d— Property Owner / Job Location Information: Name: 30M A % �it� �`/ CName: Street: l f l& Cit/ C2'��' City/Town: _ 16,Y4 Ak� Telephone: d? 71 y— Gw Street: 5° City/Town: Telephone: ` 70 Photo I.D. required / Copy of Photo I.D. attached: YES NO Building Type: Residential: 1-2 family Multi -family Condo / Townhouses Commercial: Office -A Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. X_ over 35,000 cu. ft. Sheet metal work to be completed: New Work: Renovation: HVAC _k Metal Roofing Kitchen -Exhaust System Chimney / Vents Provide brief description of work to be done: Yes No Sheet Metal Commercial Guidelines / Life Safety / Critical System_ s Inspection Checklist N/A / Y Set of stamped engineering documents and detailed description of mechanical system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper journeyperson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation Smoke and combination fire / smoke dampers with access doors properly installed - actuator checked for proper operation (May also be verified by fire department during fire alarm testing) / Duct smoke detectors with access doorsro erlY located p P ,,(May also be verified by fire department during fire alarm testing) _Z Smoke / atrium exhaust systems installed and operation verified ,(May also be verified by fire department during fire alarm testing) J/ Stair pressurization systems installed (where required) and operation verified (May also b erified by fire department during fire alarm testing) Grease / kitchen hood exhaust system installed with all seams and connections welded ai ight with properly located cleanouts. Proper clea`arices, fire rated enclosures and ressure testing required. r rig?:rig rer,i-aintb rnstal't(,it ,V)i6;t-d tequired 'ofi equipment and dii,ty. orik Duct penetrations in fire'rdt& wall and flaors sealed ��Metal roofing systems installed watertight using proper materials and fasteners xible duct nuns installed 6'-0" maximum length Ductwork installed using proper hanger spacing, hanger stock, threaded rod and angle iron Dqctwork / plenum connections sealed substantially airtight uctwork insulated by means of external covering or internal lining ume dampers installed for each supply air branch duct XTew/clean - properly sized filters installed (final inspection) Testing and Balancing report complete (final sign -off) BUENDA OP ID: JY ,4coRoCERTIFICATE OF LIABILITY INSURANCEDATE(MMIDD/YYYY) 07/15/13 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(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 not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone: 978 688 8829 CONTACT NAME: Michaud, Rowe And Ruscak Ins.Fax: 978 557 2130 P.O. Box 188 North Andover, MA 01845 Mark S. Rowe, CIC PHONE FAX AIC No Ext): A/C No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Commerce Insurance Company 34754 EACH OCCURRENCE $ 1,000,00 INSURED Victor Buendia INSURER B: Guard Insurance Group Buendia Sheet Metal 18 Andrew Circle INSURERC: GENERAL AGGREGATE $ 2,000,00 North Andover, MA 01845 INSURER D: $ A INSURER E: INSURER 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS B GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_1 OCCUR X Business Owners BUBP303473 11/20/12 11/20/13 EACH OCCURRENCE $ 1,000,00 DAMRENTED—50,00 PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL &ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEML AGGREGATE LIMIT APPLIES PER: PRO LOCECj POLICY F PRODUCTS - COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X NON OWNED HIRED AUTOS AUTOS BBCM25 03/19/13 03/19/14 COMBINED SINGLE LIMIT 1,000 00 Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDT I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y� OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC STATU- OTH- TORY LIMIT ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ PROPERTY 5,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) UILK 111-1(:A I t HULUtK 9,ANL r_LLH I IVIV NORTH13 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Building Inspector 384 Osgood Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD COMMONWEALTH OF MASSACHUSETTS MM SHEET METAL WORKERS AS ASER ER -UNRESTRICTED IICTTED�Ago VICTOR M BUENDIA 18 ANDREW CIR" NORTH ANDOVER MA 01845-5260 32 34 ,. 1 " �3