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HomeMy WebLinkAboutMiscellaneous - 55 Water Street BUILDING FILE ' Date. Yb./a. . . 8891 I V ",�RT" T:'� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING s i • ,SgACMUSEt This certifies that . . . . � 1i <<. . " e? . . .. . . . . . . . . . . has permission to perform . . . . . . t . � . . . . . . . . . . . . . . plumbing in the buildings of C : . . . . . . . . . . . . . at . . . .. . . . . . . . . . . . .. North Andover, Mass. k` PLUMBING INSPECTOR Check MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING a � City/Town: 6' • A('%v)t1 V Z( , MA. Date:N11A rCn Permit# s mal I Building Location: 11�10 Wf*-QC Sl Owners Name: A tom? Type of Occupancy: Commercial Educational❑ Industrial❑ Institutional❑ Residential❑ New:❑ Alteration: ❑ Renovation:& Replacement: ❑ Plans Submitted: Yes❑ No F FIXTURES DEDICATED Z SYSTEMS cc w Y y Ov W Vf VI Q N } J U F- W 5 Z C F- Y Q u1 J Q W z D Q W W Z a W Q Z H w Z ~ ti g p a � a N F a OG ° m W ~ N r D: OC z H V d X Z J Q 3 Q Q Z OC Z Z LL o LL 3 0 3 Y Q = = z W a� o � 3 F Ljj U a LA &A o C) > > ° ° o Z a a a ° a L Q Q oo m 5 S LL 2 Y s g a°c A in H ° 3 3 3 0, SUB BSMT. BASEMENT 1sT FLOOR 2ND FLOOR 3RD FLOOR TH 4 FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR �r Check One Only Certificate# Installing Company Name: �� V'1 C-c ❑Corporation Address: JQ� K gV'1 VC 1 t.➢ City/Town:��N 1 V CT S State: ❑ Partnership Business Tel: S-78, S OgS�ax: irm/Company Name of Licensed Plumber: KrC INSURANCE COVERAGE: I have a current liabiliinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owners Agent I hereby certify that all of the details and information I have submitted(or entered)regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: 9 0u4 Title ❑ Plumber Signature of Licensed Plumber Ci /Town Master APPROVED OFFICE USE ONLY ❑Journeyman License Number: OP ID: DH TE CERTIFICATE OF LIABILITY INSURANCE 01/19111(YY) 01/19/11 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). CONTACT PRODUCER 978-777-9394 NAME: Dan Hurley Insurance Agency PHONE FAX Chestnut Green,Suite 24 978-777-3306 ac No Ext): Seven Federal Street E-MAIL Danvers,MA 01923-3620 ADDRESS: Daniel J Hurley CUSTOMER ID#:OKEEMA1 INSURER(S)AFFORDING COVERAGE NAIC# INURED Mark O'Keefe INSURER A:Preferred Mutual 15024 23 Bay View Terrace INSURERB:AIM Mutual Ins. Co. Danvers,MA 01923 INSURERC: INSURER D: 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 TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY PAC0100114627 10/01/10 10/01/11 DAMAGE TO RENTED PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 JECT POLICY n PRO- LOC 1 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ; $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ EXCESS LIAB J CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X I WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMIT ER B ANY PROPRIETOR/PARTNER/EXECUTIVE VWC6013971012010 10/19/10 10/19/11 E.L.EACH ACCIDENT $ 100,00 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Sole proprietor is excluded from workers comp. CERTIFICATE HOLDER CANCELLATION FORINFO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For information purposes only. ACCORDANCE WITH THE POLICY PROVISIONS. Please contact agency for . individual certificate. AUTHORIZED REPRESENTATIVE Daniel J Hurley ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD `*�4 c usetts , Commonwealth of Mas '. r � e of R gistrati Division Board of Plumbl MARK L 23BAYV o DANVER T Master Plu �Q 004180 0510112012 z Serial No., PL15776-M Expiration Date. License No. r 177,t s k# F I n t a �r II Date.�..Sly....��....... x of vt oTM 1 " TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACNUSE� s.. '~ This certifies that G' r._ . ........................................................... has permission to perform—,,.."..... ............ .....'.......................................... 4 is wiring in the building of..... .......... ...j.. �'.......................... F at...-$.z . ...................................................,.::.`.............. ,North Andover,Mass. Fee........... ......... Lic.No..?,t5 .. tt .. .�` .................. ......................... ELECTRICALINSPECTOR Check # 5395 y' .Official Use Ordy s Permit No. srss > 04 fi _ BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12A0 Occupanicy&Fee am" APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massadmisetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all inforrnation) V. Date�I f To tl-.e Inspect&of mrsm Town of North Andover The undersigned applies for a permit to perform the electrical work described below °•�'' Location(steer&Number 5(D VJATSA ST Owner or Tenant I A N 1V 0'CQ eZ 1-E(\ Owner's Address -7 GR R L_-'(71J L.N• 7J • A-N DOy E Is this permit in conjunction with a building permit Yes o Check No ® ( Appropriate Box) Purpose of Buildi U Utility Authorization No. n Existing Service a 100 Amps 2 y0 1 Volts Overhead o Undgmd u No.of Meters New Service Amps Valu Overhead I Undgmd I No.of Meters Number of Feeders and Ampacity Location and Nature of Electrical Work S d t° dZne t 1 n ' , �'t l e rcgfe c/ s. CGI6�s�iN Of Ov awls{ r t6 /o�tcS K; chPn �E' r . Total Vo.at Outlets tom.of lint fuse No.of Transformers IWA Above 0 Io t do.of Ligt�rg Faderrcs Svvimmirm Pool gnw t wnd 1 Gereeralors MVA to.of Oullets No.of 07 Bunters Md of Lrghtnrg kw!r Units a of Switch Outlets No of Gas Bunters FIRE ALARM W.of Zone TOW No.of Detection and o.of Rariges No ofAirCond Tons ku mft Devices Heat TOW TOW �.of amosal No Punive Tars KW No.of Sounding Devices Imo./of Sell Q 11.of Distmeastuxs Area Heaft n a 16, 0Soradirig Devices r.of Dryers .Devices KW Local I G1 err kinicipail 1 0L No.of Na of Lcwvwbge -.of water Heaters KW I Skins t Tuds No.of Motors TOWHID eae%Y 4eTeCeim ce N1-'At-A dev� 10 Ver URANCE COVERAGE. Pumiant to Me requirerrre as of Massadn>setts General Lavin ve a current Liability Immune Policy mc#admg completed Operabons Coverage or its sutsiantid s submillea valid proof of same to the Office YES=too a If of c � 1RANCE a BOND a OTHER y have checked YES l indicate- lupe of coverage by oiling the appropriate box. +� �4.�/ o (6pi'ation Date) mated k to art or. Z? Inspection Date Resquested if C. RoyghC N��� Final ped under ena es ury ' A NAME h IJr_ /I� J �G�C / C "�� UC.NO. 1.4Vq,t,/11� W �/✓l4J signature V": n UC.NO. ass_!-h �3ra�l tie S,j[eNr lY i Btls Tel N0. r- 9 ^z23 9233 Ax Tel.Not r /, ERM WSU WAIVER: 1 am awa&that the Licenses does not have the insurance or its substantial equivalent as required by Massachusetts ral Laws_And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. M n'& 0 J INS NJ PERMIT FEE $!�` / Signature of Owner or ent) p Nd e ►e M /�({Y ©f 4> e pi^6po.Se &,i#,,L is "of* wvd(r) wry[ CtC o flN4( t) (eSS TNS-KvdeJ afhG2- W%5 t°.