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68 VALLEY ST - BUILDING INSPECTION 09/29/2011 13:05 9787409846 CITYOF SALEM PAGE 01/02 Commonwealth of 'Massachusetl PECR CEIVONAL SD RVICES Sheet Metal Permit 2814 NOV 20 P Z. 10 Date: ._��G — Permit #-- — Estimated Job Cost: f /— Permit Fee: $ — m Phuis Submitted; YES — NO ✓ Plans Reviewed: YES_ NO VD U/ Business License # Applicant License # Bosinoss Information: "" Property Owner/Jab Location Information: lNan, -t- . -U-\Namc: �tI•S.Q3'� -� ey ^^ City/Town: ,Y\ City/'town: l L Telephone: Sim Telephoric: Q0,5 S2)b Photo 1Attired /Copy or Photo LD.attached: YES NO_ surf ruunai estricted license J-2/ NI-2-restricted to dwcllings 3-stories or less and commercial up to 10,000 ,sq, r q, Ft. / 2-stoies or less Rvsidentlal: 1-2 Family ! in Multi-Family_ Condo/Townhouses Other C'ommercinl: Office— Retail— Industrial— Educational Institutional_ Other Square Footage: under 10,000 sq. R. ]over 10,000 sq. 11. _ Number of Storics: Shect metal work to be completed: New Work: Renovation: _ I IVt1C/V Metal Watershed Rooting_ Kitchen F.xhuust Systcn,— iNlctal Chimney/ Vents_ Air Balhncing Provide detailed dcscriptinn or work to be done: C(i,( -L- w rt E5-1-J D(DN e- , �i I z uI Cat -L D 1-,o W .L) . /zv wos�i /� S j i BRAN `E COVt=RAGE: i have a currentRALIft Insurance policy or 6ts equivalent which meets the requlrem�'nts Of M.G.L-Ch. 772 ea QC No[] If you have checked YYaj, indicate the type of coverage by checking the appropriate l ox below: A liability insurance policy ® Other type of indemnity ❑ � good OWNER'S INSURANCE WAIVER: I am aware that the licensee dges not havg the inau nce,coverage require by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application wale this requirement. Check One Only Ojner ❑ Age ❑ Signature of Owner or Owner's Agent accurate checkto the beat of my ing this bex❑,r hereby cart fy that all of thtr detalig and Information I have submitted or entered)regarding this In oomp)tan a with all pertinent provisiond that of the all Massachusetts Building Installationa and ChaptePerformed 112 of under he General Laws. od fo SAie application will he pplicatlon am true and Duct inspection required prior to Insulation installation: YES „_, NO Pro rasa Ins actions � Date Comments I It'inalIns action j Date i Comments Type of License: Ey [�Master Tille / ❑ Master-Restricted y/ ; city/Town yy ❑JDurneyperson fpermlt s I Signature of Licen ee EJournayperson-Restricted Foe 5 License Nurriber. / Check at .mass, o, d I Inspector Signature of Permit Approval L 09/29/2011 13:05 9787409846 CITYOF SALEM PAGE 02/02 r. INSURANCE COVERAGE: �� _ I have a current liabili insurance policy or Its equivalent which meets the requirements of M.G.L.Ch. 112 Yes ly'No❑ If you have checked Yes, 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 112 of the Massachusetts General Laws,and that my Signature on this permit application w_ aives this requirement. Check One Only Owner [] Agent ❑ Signature of Owner or Owner's Agent By chocking this box❑.I hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and accurate to the boatlof my knowledge and that all shoot metal work and Installations performed under the permit Issued for this application will bo In compliance with all pertinent provision or the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation Installation: YES NO Proeress Inspections Date Comments Final Instmetion Date Comments Type of License: By ❑Master Title L]Master.Restricted Cityl7own ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted Fee S License Number: ❑ Check at_rjww.mass.clov/dpl Inspector Signature of Permit Approval i E COMMONWEALTH OF MASSkCHUSETTS t- • • s e o � �� ,,k>SHEEuT�METAL�WORt(fR�rKK � i {��, ISSUES THE �FOLLOWINGLICENSf ��w ,,ASS, BUSJRESS . r JA fS V1 CARONE,% a . „ SWAMPSGOTT RfTI21GERATIAN IN� *J`�s� ""r�'n"-Aef" � 'n4st kg;o +•a.'Ss ��$y�i•�+"�y 09.M'2014 09:31 FAX 978 532 2217 CROSS INSURANCE _ 001. ® OF LIABILITY NS i1� q N ATEI/201 YY) CERTIFICATE 1J 1(- �IY.7Vf\Hltl�� /26/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE_ A CONTRACT BETWEEN THE ISSUING INSURERS , AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. _ IMPORTANT: if the certificate holder is an ADDITIONAL INSVREO, the policy(ies) must be endorsed- If SUBROGATION IS WAIVED.Subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not co fer rights to the certificate holder in lieu of such endursemengs). _ PRODUCER CA A T Lauren Gol3man AME: Cross Insurance-Peabody P"ONE E.IL (976)532-5445 rass . 1 70)532-2217 139 Lynnfield Street EMAIL ,lgoldman@crow-agency.Com INSURER 5 AFF(IRDING COVERAGE NAIC 8 Peabody MA 01960 INSURER Apmeri Can States Ins Co 19704. INSURED INSURER B:Ci Cati On Ins CO (MA only) 0274 SWAhIL>SCOTT IiEF'RIGERATION INC IN3URERC-O$ip Security Ins Cv _ 24002 .LC3 E5SE:C ST INSURER INSURER E: W_ LYNN MA 01902 _ INSURER F: _ I COVERAGE$ CERTIFICATE NUMBEfipL14'72`75166 REVISION NUINBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TH POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CCNDI ION 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 t AVE BEEN REDUCED BY PAID CLAIMS. wool UBR PODGY Err POLICY EYP �— INTR TYPE OFIN$DRANCE POLICY NUMBER 61. LIMITS GENERAL LIABNTY EACH OCCURRENCE $ 1 r OOO,OOO ft NIED 200,000 8 COMMERCIAL GENERAL LIABILITY PRF,MISFS f gave.P'P A CL41MSWAoE OCCUR I)1CGe2734300 7/15/2014 /15/2015 MEDEXPAnyonn0erenn) 10,000 PERSONAL S AUV INJURY S 1,0001000 �— GENERAL AGGREGATE 2,000,000 GFN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPIOP AGG 2,000,000 X POLICY PRG LOC d-_ _ COMBINED SINGLE-UN117� AUTOMOBILE LABILITY IEa scidcnl _ BODILY INJURY(Per Perean) 500 000 B ArvrnurD -----I SCHEDULED X SCHEDULED 1gMMEC8EZ7P 4/12/2014 4/12/2015 $ODILT INJURY(Parswident) IS l 000 000 AUTOS AUTOS PROPERTY AMAGE X HIRED ALfi'O5 X WON OWNEDent �$ 100.000 WONAUT O MedltPl nn onl' B 5 000 UMBRELLA UAB OOCOP. EACH OCCURRENCE I* — AN LIAE CIAIMS-MADE AGGREGATE S I$ pEp RETENTIONS �"— (] WORKERS COMPENSATION -�_ YVCSTATu-1�QFIL 714- AND EMPLOYERS'LABILITY YIN E,L EACHACCIOENT S SOO 000 ANt PROPRIETORIPARTNERIEBECUTIIc OFHCERIMEMBER EXCLUDED? D NIA c S556 S4132 /29/2014 /2B/201."s IfA"dee'T mNH) EL.OIBEA$E-E4 EMPLO'IE S 500 GOG 11p - doyprlbe under E.L.DISEASE-POLICY LIMIT S S00 000 DESC(1 10N OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AMeaH ACORD im,Aomnonxl R mama SG,edule,IF mom spso I:rOgV Iraq) Rafe, to policy for oxclvsienary endorsements and special provisions. I CERTIFICATE HOLDER a CANCELLATION _— SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE C(,NCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL ED DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Salem 120 Washington St. AUTHORIZED REPRESENTATIVE Salem, MA 01970 Timothy Tra Qr to/MDI 74'r"�•1rbol-d' ACORD 25(20101o6) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005)ol The ACORD name and li go are registered marks of ACORD