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HomeMy WebLinkAboutMiscellaneous - 166 North Main Street fS enrol✓ yf�/�/v 9�1a' Date. . °f,NORT:�Mo TOWN OF NORTH ANDOVER + ° F p PERMIT FOR PLUMBING SAC04USE� This certifies that 7'. . . . . . . . . . �.C�"` 'l• has permission to perform�:,.!'2,:�� -�!��• :�"�'`"~- . • • • • plumbing in the buildings of ._._, �. . . . . at . .fG.�. . ?.». .�' U?^ n�y�. -�!. ,. . �� North Andover, Mass. Fee. 5. !. .Lic. No..1d. f -Zr. . . . . . . . . . . . PLUMBING INSPECTOR Check # �� � � V I %'F-- MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING w (Print or Type) ttT�� a .,er Mass. Date 9_28 0Q Permit # 1'� 166 north Main Street Building Location Owner's NameSimply Spa ~ Z Type of Occupancy Commercial New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES I— to to O � :- `n - - LW Y J to Q U U7 0C I �� 4 Z O Z V) _ CI CD w N F- U c Y Q N w J n N n n c ¢ w C- ` z a r x _ a Q o c c Oai LL' 11 - a a ¢ = Yw C t > F O n F' p 00 v7 Z _ w E 0 V w ¢ Q _ 4 Q O Q J J ¢ C C Q C ¢ J N in J 3 r- n u. 3u8—BSMT. BASEMENT I I I I I I I I I IST FLOOR 2N0 FLOOR I I 3 R C FLOOR I I I I I I I I y. 4TH FLOOR I I I I II I I 57H FLOCR --L-1 1 11 1 #1 o T� FLOOR 7TH FLOOR I I I I I I I I I 8TH FLOOR I I I Installing Company Name Nurotoco of MA D.B.A Roto—Rooter Check one. Certificate Address 175 Maple Street Corporation 2549—c u Stoughton MA, 02072 ❑ Partnership Business Telephone 781-297-7049 ❑ Firm/Co. Name of Licensed Plumber Daniel Huntress INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes '.-x No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy lR1 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. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature or v^.vner or C^.vner s Agent Owner El Agent C I hereby certi;,,that all of the details and information I have submitted entered) in above application are true and accurate to the best o`my knowledge and that all clumbirg work and instal tions perfcrTmied under .he p r it issu d for this application will be in compliance with all pertinent crovisions of the Massachusetts State Plu ing Code and C `a'pter 1 2 of the General La S. By JJ�n 1 �` I Q9 -7 tore of Lcensed Plumb r Title City/Town Type of Ucense: Master 21-11- Journeyman ❑ marsh, inc . ;3/bl7 ZUUb Z : U4 PM rAl.t Z/UU'Z pastern 'Time Zone ..����1�1���� l"�C [1�1 �p��C�� CERTIFICATE NU M1iBER ;: .,,.., .: �<>:..._,.. CLE 001460263-01 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION-ONLY AND CONFERS MARSH USA INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE 525 VINE STREET,SUITE 1500 POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE CINCINNATI,OH 45202 AFFORDED BY THE POLICIES DESCRIBED HEREIN. Attn:STEPHANIE KNAPP PHONE:513 287 1650 COMPANIES AFFORDING COVERAGE COMPANY 0408-RRSC-P&C-06/07 00015 A ZURICH AMERICAN INSURANCE COMPANY INSURED CCMPANY ROTO-ROOTER SERVICES COMPANY B AMERICAN ZURICH INSURANCE COMPANY 175 MAPLE STREET STOUGHTON,MA 02072-1130 COMPANY C TRAVELERS PROPERTY CASUALTY CO.OF AMERICA COMPANY D NATIONAL UNION FIRE INSURANCE CO OF PITTSBURGH G4YERAf3E8 .::,, ;[hlser#fia2�auLtpetseslesarttfreplacesany,pTeTlLtsEylsurhficatitrti�epctil�yj3OTI1,fiefEdlel ?t .,., . .:€ THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWTHSTANDING ANY REQUIREMENT,TERM OR CONDITICN OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TOWHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN ISSUBJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIES AGGREGATE LIMITS SHOVbN MAY H AVE BEEN REDUCED BY PAID CLAIMS. co TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTTRR DATE(MMIDD/YY) DATE(MMIDD/YY) A GENERAL LIABILITY GLO9379365-02 04/01/06 04/01/07 GENERAL AGGREGATE $ 5,000,000 X COMMERCIA-GENERALLIABILITY PRODUCTS-COMPIOPAGG $ 4,000,000 CLAMSMADE O OCCUR PERSONAL&ADVINJURY $ 2,000,000 0VvNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 2,000,000 FIRE DAMAGE(My we Pre) $ 500,000 MED EXP(Any are persm) $ 5,000 A AUTOMOBILE LIABILITY BAP 9379363-02(AOS) 04/01/06 04/01/07 COMBINED 9NGL`-LIMIT $ 2,000,000 A X ANY AUTO BAP 9379482-02(HI) 04/01/06 04/01/07 ALL CANED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILYINJURY $ N CIN-OVW ED AUTOS (Per aoddent) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY•EAACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY - EACH ACCIDENT $ AGGREGATE $ t D EXCESS LIABILITY BE 4485294 04/01/06 04/01/07 EACH OCCURRENCE $ 25,000,000 X UMBRELLAFCRM AGGREGATE $ 25,000,000 OTHER THAN UMBRELLA FORM SIR $ 25,000 B WORKERS COMPENSATION AND VbC9379366-02(AOS) 04/01/06 04/01/07 X WCIATU- OTH EMPLOYERS'LIABILITY TORY LIMITS _ER _...........:.................::.' A WC 5919232-00(HI) 04/01/06 04/01/07 EL EACH ACCIDENT $ 1,000,000 B THE PROPRIETOR/ X INCL WC 9379367-02(STOPGAP) 04/01/06 04/01/07 EL DISEASE-POLICY LIMIT $ 1,000,000 PARTNERSEXECUTIVt OFFICERS ARE EXCL EL DISEASE-EACH EMPLOYEE $ 1,000,000 OTHER C PROPERTY KTJCMB297T300305 10/15/05 10/15/06 "ALL RISK"OF DIRECT PHYSICAL, LOSS OR DAMAGE PER THE TERMS, CONDITIONS AND EXCLUSIONS. DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/SPECIAL ITEMS - CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED ON THE GENERAL LIABILITY POLICY WHERE REQUIRED BY INSURED CONTRACT,BUT ONLY WITH RESPECTTO LIABILITY ARISING OUT OF THE.NAMED INSURED'S PREMISES,'WORK"FOR THE CERTIFICATE HOLDER,OR ACTS OR OMISSIONS OF THE CERTIFICATE HOLDER IN CONNECTION WITH THE GENERAL SUPERVISION OF THE NAMED INSURED'S"WORK". CEE t€>tiG ,T t OLCEE�:> GANCEI LF:fit?N SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO FAIL .10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HCLO"ER NAMED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SIAL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER A-ORDING COVERAGE,ITS AGENTS OR REPRESENTATIVE S,OR THE ISSUER OFF THIS CERTIFICATE MARSH USA INC. By. John F.Schultz .09 SAM1',{Sf1Y} '; VALID AS OF .03/31/06 (+ est::;:;w,. °, a':t ;r`i:g' 911 DF "f�Eo' $ TH OF All ASS t�G�40"'- IN PLUMBE"RS AND GASFIITERS IN PLUMBERS AND GASFITTER IC.ENSED AS A JOURNEYMAN PLUM REGISTERED �PS.1-HI��,PLtUMB€_.�NG CO ISSUES THIS LICEP�sETo 'DANIEL HUNTRESS \ DANIEL HUNTRESS ": NUROT000 OF MASSACHUSETTS G BENNETT ST 6 BENNETT ST -IrAUNTON MA 02780-26 7 TAUNTON MA 02780-261 20339 05/01/08 259 05/01/08 24298 253871 411 ., ?' o Edo E . f '��' ' 13c�51c:ra,Ns s: 110 oz.I_t9 AND GASF ITTER`S ' -.. R PLUMBER Jhis is to cenify thct lia;�i 1 Huntres j js! P L�J MB'E'RS i D ASu t �LEi_.T i has beenissbed"IDraini.,aF•, ,se LICENSE wafer&SCIVer Commission validCe�i/p6Y dte L'-uston I - 1'er.•nnt#069.3312,i,/(1r, i)ANIEL HUNTRESS ,r�. .., EnLy. Ctist,rrer$e(�tce - t� BEtSNE tT ST CMA 027:80-26.1 'fAUNrON 7 - TRA/N/NG CERT/F/C.4 T , " American Backflow Prevention Association t # DANIEL HU,NTRfSS Backflow Prevention Assembly Tester Has successfutly completed a. 47hoar Exp Date: J�tCf/[ski Cert No. �'� i�kOf)-;: Occupational Sa€t3ty Tralung.;Course .in: I Hanel Huntress 6'.13ennett Street ' i' TRENCHING AND LAVATION SAFETY Taunton, MA. 02780 � l by 8, 1999.:. ---�-YC_� Instr ayton D.:Rose,CSP Adminis rator