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35 NORMAN ST - BUILDING INSPECTION (2) Commonwealth of Massachusetts Date: Sheet Metal Permit /) ll�l�l (� Permit# Estimated Job Cost: Permit Fee: $ 3 S Plans Submitted: YES NO Plans Reviewed: YES NO_ Business License# 3 Applicant License# Business Information: Property Owner/Job Location Information: NameGRIFFIN & MERROW, INC. Name: VEW-1 Rr5o 7 WALNUT STREET StreePEABODY, MA 01960-5695 Street: 3 S A10/ZIMi1- ) .571 — (978)531-0150 City/TownFAX:(978)531-0154 City/Town: SMCM , MA- Telephone: Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES_A/ NO J-1 /M-1-unrestricted license 46clil stafflnitial J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. Number of Stories: 3 Sheet metal work to be completed: New Work: Renovation: FIVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: l - H✓&C .SYS'7em t P Ur-TWO f'JC - 7-1" Floor t ] 57' FIDD r INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes)(No El If you have checked Yes, indicate the type of coverage by checking the appropriate box below: 777777�� A liability insurance policy X Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 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 Owner's Agent By checking this b0X0,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 sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: By ❑Master Title ❑ Master-Restricted City/sown ❑Journeyperson Sig ature of Licensee Permit# ❑Journeyperson-Restricted License Number: V Fee$ ❑ Check at www.mass.aov/dpl Inspector Signature of Permit Approval ..aav+vi.yr cty�In Ur-MAZiliACHUSETTS "•::.•°-fsCdM f637VWE1 i,.lH tJF NiflSS,AG1'tUSEi�fS':,�. SHEET METAL O ERS t AS A BUSINESS LICENSED AS A MASTER PLUMBER t ISSUES THE:ABOVE LECENSE Tii' (,WU S'-Ia UCE!+:'SE.TO R LORING MERROW RALPH L MERROW GRIFFIN AND MERROW INC 7 WALNUT ST �7 WALNUT ST , PEABODY MA 01960-0000 , - PEABODY MA 01960-5609 1`.' I 34 08/17/12 960896 9322 05/01/12 7546014 r ,.. r a ar • + n• r COMMONWEALTH OF MASSACHUSETTS r/a 'FoNa-xn meals(nr#� a<�ua«tf` a + r ••+ • :+ •+ + DEPARTMENT OF PUBLIC SAFETY SHEET METAL WORKERS 1 ��j1 Master PipefitterLicense AS AMASTER-UNRESTRICTED 1 Numtaar. PM 1 027447 t SOGS THE A9CJE LICENSP,Too r y.'t . o' Expires: 1 2/1 41201 2 Tr.no: 785.0 R LORING MERROW Restricted: GRIFFIN&MERROW INC GRIFFIN & MERROW' INC �''�a.� y RALPHLMERROW 7 WALNUT ST \^w. "� 7WALNUT ST PEABODY MA 01960-5695 f\� PEABODY, MA 01960 G 1 Commission 694 12/28/13 80062 %i a_T rc prH �J.ug Ati P-.avldV - itfi C Aa .F YE LTH OF M .� SAt BiU EY ut:: e REG/PROF SANITARY ENGINEER g r { sa `'� .t 2.. �✓ TT 1 "^ ''. IaaUrS fHc A2 5v yw�� DRI�IItltta, 1l R LORINt MERROW ^�0024010& � .i x al 7 WALNUT ST r 6 (� eca 44 2014 12.144i PEABODY ig 50 MA 0 1 960-560 9_ 7^ �¢yasstxesr3 xar ea 'J . 6R „ 30632 06/30/12 792692 � EVERLYOMtAv"VERROir � ACC>Ro• CERTIFICATE OF LIABILITY INSURANCE DATE (MM2011 YI �/ ,'A 12/01/ 011 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 endorsemenL A statement on this certificate does not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER phone: (7e1)2$7-1515 CONTACT NAME, Deland,Gibson Insurance Associates,Inc. NAME: DELAND,GIBSON INSURANCE ASSOCIATES,INC. PHC NONEa E (781)237-1515 E-MAIL uc.Nn: N P O BOX 81266 WELLESLEY HILLS MA 02481 ADDRESS. PRODUCER •j6309 CUSTOMER ID. INSURERIS) AFFORDING COVERAGE NAIC# INSURED INSURER Hartford Insurance Group GRIFFIN&MERROW,INC 7 WALNUT STREET INSURERS AmTrust Insurance Company PEABODY MA 01960 1 INSURER INSURER D: L LRER E NSURER F COVERAGES CERTIFICATE NUMBER: 64222 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 P MITS SHOWN MAY HAVE EFNRFT(IrPnPvPAIQrIAIM!Z INSR TYPE OF INSURANCE ADD'L SUER POLICY EFF POLICY BAR LTR NOR WJD POLICY NUMBER (MMIDINY'rl"I'l OUNCEn'YYTI LIMITS A GENERAL UABIUTT 08SBAPS7659 07/01/11 07/01/12 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY 1,000,000 PREMISES Ea accurence $ CLAIMS-MADE X OCCUR MED.EXP(Anyone person) $ 10,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY— PRO- LOC 5 A AUTOMOBILE LIABILITY OBMCCWL0613 07/01/11 07/01/12 COMBINED SINGLE LIMIT $ 1,0003000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS X BODILY INJURY(Per accident) g SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-ONMEDAUTOS $ A X UMBRELLA UPS X OCCUR 08SBAPS7659 07/01/11 07/01/12 EACH OCCURRENCE $ 1,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DEDUCTIBLE $ HX RETENTION $ 10,000 $ B WORKERS COMPENSATION TWC3281967 07/01111 07/01/12 WCSTATII am AND EMPLOYERS' LIABILITY YIN TORY LIMBS $ ANY PROPRIETORIPARTNERIEXECUTIVE — E.L.EACH ACCIDENT $ 500,000 OFFIOERIMEMBER EXCLUDED] NIA IMandaterr in NN) E.L DISEASE-EA EMPLOYEE $ 500,000 it yes descrIm under DESCRIPTION OF OPERATIONS be. E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE �-r THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Tov of Salem ACCORDANCE WITH THE POLICY PROVISIONS. 120 Washington Street Salem,MA 01970 AUTHORIZED REPRESENTATIVE Attention: 9j /�+;�_y4— C/� a es Glbs ACORD 25(2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD