1 PERSHING RD - BUILDING INSPECTION (4) D t:
RECEIVED
€ Conunonn'ealth of �(as�. P NAL SERVICES
ip j IfusCTte�ts
Sheet Metal Permm14 DEC 15 P 1- 00
Il:,tela/Js
Estimated Joh Cost .S
Pem,it Fee: S
'� flans Submiucd: 1'F.S _ NO V — ----
Plans Reviewed: YES NO
Business License# d-- ---
l Applicant License # f sp3�
n(� Business Infi,nnation: Property Owner,/Job Location Information:
-
Name:: Q0 La- a 6 � ��C N:unc:
M i S
n
Street: street: u CQ�P
City/Town: � {Q�j1u2.t� l� 01 S'fqty
Ci /"Poon: p
Telephone: (Q 1-j 3,3r-/-4-1 Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES
NO
J-1 /-M-1-unrestricted license
J-2 /Al-2-restricted to dwellings 3-stories or less and commercial up to 10,000 Al. ft. /2-stories or less
Residential: 1-2 family—Z� Multi-fantil
Y_ Condo/Townhouses_ Other
Commercial: Office Retail -
--- Industrial_ Educational_
Institutional_ Other_
Square Footage: under 10,000 sq. R.-Z over 10.000 sq. fl._ Number of Stories:
Sheet metal work to be completed: New Work:
Renovation: _
HVAC Vl' Metal Watershed Roofin
b _ Kitchen Exhaust System _
`Ictal Chimney/ Vents_ Air Balancing—
I'rovidc detailed description of work to be done:
1 ne s -f brLO he f 6,i r .6rn6( 62- 4-
-T
-f I ZI 11 -
I
12/15/2014 13: 43 19786859460 HASBANY INSURANCE PAGE 01/01
AC & CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD'YYYY)
THISERTIFICATE IS ISSUED AS q MATTER OFINFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS 4
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 8Y 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: H the cerOficate holder N an ADDITONAL INSURED,Ste PONCA109) must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions Of the POlisy,certain Policies may require an Endorsement. A stalameld on this Dartifieste does not confer rights to the
certificate holder In lieu Of such endarsemen g
PROWCER
Hasbany & Regan insurance NES Eric Saxasen
254 Pleasant Street L 978 685-3188 N ; (978] 685-9460
Methuen, DIA 01844 AIBss: Eric@hasban .com
INSURERLS)APPORDINO COVERAGE NAICe
INSURER A:Safe ndamrll tY_
RBURED INSURERB:Guartl Insurance Group
Sucnaguri0 HVAC INSURER C:
C/o Stanley Buonagurio NSURER D:
I -
9 Campbell St ANSURERE:
Methuen, MA 01844 INSURERP. -
COVERAGES CERTIFICATE N UMBER: 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. _
.. . .. A -..... ._-,
L R TYPE OF INSURANCE POUCY NUMBER MM M
xYYrr LIMITS
OENERALUABILfTY BP0005927 7/19/14 7/19/15 EACH OCCURRENCE $ 1 O00 000
X COMMERCIAL GENERAL LIABILITY DAMAGE TOR to $ lOtl_�DOD
EMISES-IEA-Murr tical
CI-AIMS 7NADE DCCGR MED E�IAny SrA parern) $ 30 000
_. PERSON4LAADVIWURY $ Z,.,OpQ QOO
GENERAL AGGREGATE $ 1,000,000_
GEN'LAGGREGATF,I.M$TAPPLESPER P PRODUCTS AGG $ 1 000,000
POLICY LOC $
AUTOMORILE LIABILITY C -419—F
ANYAUTO &DOILY INJURY(Por
ALLOYJPED SCHEDULED
AUTOS AUTOS BODILY INJURY(PSf=dent) S
HIREDAUTOS NON-OWHFD PRDPr eE RTY DAMAGE $
AUTOS ersitlan! _
UMSRELLALIAa OCCUR EACH OCCURRENCE $
15MCESSLIAB CLAIMS-MADE
AGGREGATE -g. ..
ED RETENTION S
B %NURKBTS COMPENSATION STWC358826 7/22/14 7/22/15 WC STATU- CrH-
ANDEMPLOYERS'LIASILnY YIN TORY LPN X
ANY PROPRIEfORIPAR NERIEXF.CUTNE
OFFICE RTAEMBER EXCLUDED) NIA E.L FtACN ACO DENT SDD,000
ffp3 myinNHl E-L—QaEASE-EAEMP'LOYEE 500,000
It yea RIP-gOe untler
DESGARIPTION OF OPE RATIONS OSIS. E.L.DISFASE POUCYLIMIT $ 500 000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHCLES IAaecn ACORD 101,AlMmond Rpnvft Sehowle,If mora Spam In Mgd.ed]
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
TOWS? OF SALEM, MA ACCORDANCEWITH THE POLICY PROVISIONS.
FAX N 978-740-9846
AUTHCR¢ED REFRESENTATIVE
Pntt---v Fairbrother
W 1988.2010 ACORD CORPORATION. All rights reserved.
ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD
Phone: Fax: E-Mail,
J
CONTROL # J343662
IMPORTANT
If your license is lost,damaged or destroyed; is inaccurate;or
needs to be corrected,visit our web site at mass.gov/dpi for
instructions to ensure the proper mailing of your Renewal
Application and any other correspondence.
This license is subject to Massachusetts General Laws and
regulations.Your license is a privilege,and cannot be lent or
assigned to any person or entity under penalty of law. Keep this
license on your person or posted as required by law and/or
regulations.
J
!,..�.WCOMMONWEALTN.'OP�MASSACHU
,^SHEET-METAL WQ�1fEl «
� .1$SUE$ `7HE 0LLQWiNGa L'.I CEN
SFANLEY `P,BUONAGURIO�q� �.
9 CAMPEL4
MCTHUEN ' ` MA 01844
Sall
INSURANCE COVERAGE:
I have a current Ilabili Insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes No❑
If you have checked Yes, Indicatet a type of coverage by checking the appropriate box below:
A liability Insurance policy
Other type of Indemnity ❑ Bond Cl
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 walves this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By chocking this box ,'thereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and
ons perfor
ed
In compliancee
ewbest of my knowlede and that ith all pertinent prow sion of the all
Building Code and Chapter 112 of Ider the he Generalnit Lawsued for this application will be
Duct inspection required prior to Insulation Installation: YES NO--
Proum It1S000tIn BB li
Comments
Date
Fival lusllectlon
C0111111tnts
Date
Type of License:
By _. CO] Master
nue _ ❑ Master-Restricted � it
i
❑Journeyperson Signature of Licensee !!
i
Farina
3---- ❑Journeyperson-Restricted License Number:
row 5 .----- -_..--- !
❑ --------------- Check at�:r.v_.v.ui t�;s.,1ov'�t��l I
1Z 1J ly �I I
Inspector Sipnaturo of Permit Approval