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100 WASHINGTON ST - BUILDING INSPECTION Commonwealth of INIassachusNIMEiVE0 INSPECTIONAL SERVICES Sheet ttMetal Permit 2014 NAY -b A 11= 5b Date: ._ 3�//1�-- Permit It ----- Estin,atc�d Jot) Cost: S, Z 00.` Permit Fee: Y Plan, Submitted: YES _ NO_ flans Reviewed: YES /_ NO _ Business License N Applicant License # — 1 /2 l Business fntiirmution: p Property Owner/Job Location fntormation: Name: QLA d Name: Street: It w. Goa Street: 1Ob C�d4ipp,,,, Citylrown: ktlCljc, II►a Cityrrown: Telephone: �97Fh29V Vlaql�z Telephone: Photo I.D. required/Copy of Photo LD. attached: YES VL NO_ J-1 / INI-I-unrestricted license 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 htdustrial Educational Institutional Institutional_ Other / Square Footage: under 10,000 sq. tt. _ over 10,000 sq. d. �Numher of Stories: Sheet metal work to be completed: New work: _ Renovation: 1IVAC✓ Metal watershed Rooting_ Kitchen Exhaust System_ Metal Chimney/ Vents_ Air balancing Provide detailed description of work to be done: t e o\ar a t4na v4 to to rt ra Fs e leer r y ooC n Cz� (� ------ --------- r INSURANCE COVERAGE: . i I have a current Iiabilityin9urance.policy,o.r ts"e'quivalent which meets the requirements of M.G.L.Ch. 112 Yes No❑ If you have checked Yes, indicate t 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-Ge rat Law an 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 boxes,1 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 k Prot-tress Inspections Date Comments Final Inspection Date Comments Type of License: r By _ '/ Master nne ❑ klaster-Restricted civjJawn ❑Jcurneyperson Signature of Licensee Penns x ❑Journeyperson-Restricted License Number: �� Ins?3S7 FoaS Check at viw•.v.in.l:;,.gov!�Ilrl G i Inspector Sig ature of permit Approval � ✓UO/F7b/2014 F7b:3bAM y/88548144 DANCO MANAGEMENT INC PAGE 01/02 l I Danco Management,Inc. 67 Foster Street,Suite 1 Peabody,MA 01960 978-532-2612 1 9784354-51441 dancocolleen@gmail.com fax uoy L0 01 TO: City of Salem 3 pt uF.ir, Jauorssµuw03 FAX: 978.740.9846 PHONE: N `IIt 'L nT.2rn9ua7a 9167vfeS RE: Bulldln8 Permit * ' r,� "r i.�� Wan"*, 90 b tssz>�- q r veufv 1L.asuaor� 9 ❑Urgent ❑For Review s}f sp1eS 3ff9nd jo iva� oo4e.re2 ijan ;Recycle o W o eSS wue da4 e I .,.,� 4�leaMuowwo Please see attached workers comp for Danco Manage Ent D i_ 0£06LZ;: ? bi/8Z/.0i i 0000 IIL££ld ' 9bn8S21713di1S { t H1nOS 5 gild v, Vn9 N N.Hor ..= tj e013SN3011�3AOSb'3H1 S3r1SSl Q31�Rl1S3iINf1-a31SdW t/ Sy r S'Mlaom *IV13W 13Hamm 3HS . . l S113Sf1H3t SSt'' d0'u. FronI:DaT1 Hurley FaxID:9787779394 Date:5/6/2014 11 : 51 AM Page: 2 of 2 ./� GUARD-1 OF ID: DH a►�o�zc� CERTIFICATE OF LIABILITY INSURANCE D0510612014Yl " 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). PRODUCER Phone:978-777-9394 NAME: Dan Hurley Dan Hurley Insurance Agency PHONE FA% Chestnut Green,Suite 24 Fax:978-777-3306 AIC No E :978-777-9394 Alc No): 976-777-3306 Seven Federal Street n-,I dan hurleylnsurance.com Danvers,MA 01923-3620 Daniel Hurley INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arbella Protection 41360 INSURED Guard Mechanical Inc INSURERS:Preferred Mutual - 15024 Richard Modini PO Box 5866 INSURER C: Salisbury, MA 01952 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. NOTVV ITH STANDING 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE POLICY E%P WyD POLICY NUMBER MMNDIYYYY MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 B X COMMERCIAL GENERAL LIABILITY BOP 0100711288 11119/2013 11/1912014 PREMISESOEaoccurDnce $ 100,000 CLAIMS MADE 7X OCCUR MEDEXP(Anyoneperson) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER _ PRODUCTS-COMPIOP AGO $ 2,000,000 POLICY F7 J CT LOD $ AUTOMOBILE LIABILITY EagutleD SINGLE LIMIT $ A ANY AUTO 1020013523 11/1912013 11/19/2014 BODILY INJURY(Per parson) $ 100,00 ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ 300,000 AUTOS AUTOS I HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ 100,000 AUTOS Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE •$ EXCESS LIAB CLAIMS MADEAGGREGATE $ LED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN Y LIMITS ER ANY PROPRIETORIPARTNERIEXECULVE NOT HANDLED BY THIS AGY EL.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N I A (Mandatory In NHl EL.DISEASE EAEMPLOYEE $ It yes,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACO RD 101,Additional Remarks Schedule,if more space Is required) As per policy terms & conditions: CERTIFICATE HOLDER CANCELLATION III CITYSAL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Salem ACCORDANCE WITH THE POLICY PROVISIONS. Inspectional Services Attn: Harry Wagg AUTHORIZED REPREtS�ENTA��`TAAANE ,,�,, ��... 120 Washington St.,3 rd FI l " Salem MA 01970 J ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD ��yvr CITY OF SAL.EI,f, .tiL.1SSACHUSETTS BUILDLNG DEPARTNZNT NGTON STREET, } FLOOR .z., `'h TEI. (978) 745-9595 KIN 1BERr Y DRISCOLL FUC(978) 740.9845 �1L►Yo;4 Tt-tows Sr.PtFxng 0IRECCOR OF Pt;BLIC PRO PERTY/aL:MDLN(;COJOnSSIONEX Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Coda, 730 CDjfR section 111.5 Debris, mid the provisions of tNIGL c 40, S 54; Building permit y this is issued with the condition that the debris resulting tirom l 1, S I SOA.1 work shall be disposed of in a properly licensed waste disposal facility as defined by ,NIGL c The debris will be transported by: y (name ufhauler) The debris will be disposed of in I, (name of facility) of(taility) , stg W lure of permit appliedfu J.uc --- From:Dan Hurley FaxID:9787779394 Date:5/6/2014 11 : 51 AM Page: 1 of 2 • DAN HURLEY INSURANCE AGENCY,INC.,7 Federal Street-Suite 24,Danvers,MA 01923 Phone: (978) 777-9394 Fax: (978)777-3306 Fax From: Dan Hurley To: Attn: Harry Wagg Pages: 2 Fax: (978) 740-9846 Date: 5/6/201 4 1 1:51:44 AM Phone: Subject: coi. Guard Mechanical Confidential Note: Information in this facsimile is confidential and intended for use by the individual or entity named If you received this telecopy in error, please immediately telephone us and return the original via U.S. Postal Message: Attached please find requested certificate.