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1 BARR ST - BUILDING INSPECTION O b Commonwealth of Massachusetts, ' / Sheet Metal Permit INSPECTIONAL Date : /I- 2C�- / `I Map Lot Permit# 1014 NOV 20 P 2 09 - Estimated Job Cost: —1 '5 OL Permit Fee: $ ?� Plans Submitted: YES_ NO X Plans Reviewed: YES_ NO x Business License# 141 Applicant License # 2912 Business Information: Property Owner/Job Location Information: I Name:Swampscott Refrigeration Inc Name: Tracey Giarla 1 I Street: 163 Essex St Street: 1 Barr St City/Town: Lynn, Ma 01902 City/Town: Salem, Ma 01970 Telephone: 781-592-1519 Telephone: 781-858-3224 Photo I.D. required/Copy of Photo I.D. attached: YES x NO Building Type: Residential: 1-2 family X Multi-family_ Condo /Townhouses Commercial: Office_ Retail Industrial_ Educational_ Institutional_ Building Cubic Footage: under 35,000 cu. ft. X over 35,000 cu. ft. Sheet metal work to be completed: New Work:_ Renovation: HVAC x _ Metal Roofing_ Kitchen Exhaust System— Chimney/Vents Provide brief description of work to be done: Installation of one Central air conditioning system and modification of duct work to acce tp thenew system. _ Inspector Signature ll I2� Cf��,l tEDD POf- U . i . RA�)66-= COVERAGE: r have a current)!abilhy Insurance policy or its equivalent which meets the requlremante of M.G.L. Ch. 112 ee[',aC No If you have checked , indicate the type of coverage by checking the appropriate d�ox below: j A liability insurance policy ® Other type of indemfiity ❑ Bond OWNER'S.INSURANCE WAIVER: 1 am aware that the licensee yes not have the in 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 O, ner ❑ Age ❑ Signature of Owner or Owner's Agent I By chocking this box0,I hereby cortify that all of the detallh and Information I have submitted or eneared) regarcling this pplicadon are true and accurate to the paha of my knoPertinent provision and that all sheet metal work and Installations performed under the permit Issued to thie application will bo In compliance with all pertinent provision of the and Building Code and Chapter 112 of the General Lawa. Duct inspection required prior to Insulation installation: YES NO Pro less Ins ecttons � Date Comments I Final Ins ection j Date Comments Type of License: By ❑Master 1'iue i ❑ Master-Restricted City(Town ❑Journeyperson Fermil u I Signatures of Licen ee ❑Journeyperson-Restricted Foc$ License Nu ler: ❑ I Check at .mass. ov/d I InsPeotorSignature of Permit Approval INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes ff No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy [n 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 itn Owner ❑ Agent c Signature of Owner or Owner's Agent h this b I re certify that all of the details and information I have submitted or entered regarding this application are true and By checking t s ox❑, hereby fy ( ) 9 9 P 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. Progress Inspections Date Comments Final Inspection Date Comments -- Type of License: By ❑ Master Title. ❑ Master-Restricted CityrTown ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number Fee$: I ❑ Check at www.mass.gov/di)l Inspector Signature of Permit Approval j LLICIENSE �{ :apt 0�2s 9�NONE as, ER FlaV-rfA _ ==%��a 2Qt7 , 560992575 is sex M4 5952 ttIAMESV - 54 WINDS 9WAMPSC077,Mq 07907-fOgq�;.yry9u + S W 11gs}%r Rev O].15p09 =016,Then DQtacI Along Ail?=^crallonc ^ r COt;?11rs0NWEAL,H OF FOASSACHUSETTS p) 9 S BOARD SHEET METAL WORKERS SM AS A BUSINESS ISSUES THE ABOVE LICENSE TYPE JAMES V CARONE SWAMPSCOTT REFRIGERATION INC —B 163 ESSEX ST LYNN MA 01902-0000 289245 141 12/06/14 289245 .. .— -dl'^.TT r,Jg12CF is Ong A Etc r, Fold,Then Detach Along All Pertorations COMMONWEALTWO "N71VIOSgCWUSETT i D ® ® 9 i :� 8# BOAFiD9Fp xr v SHEET"M TAS WORWER`S �B � � �ISSUtESy"*TrH�E,..#vF`0'L�L'OWING�LfCEN��'��i�(p.'� •' T i r#i$�YF �`x:^'�°,y+.$ �3�'4rsrye�ep...5ry E�� r;r AS A MASx1UER�uUNRES�T�RIC'TED°� t '� w JAMESVCAR(OjJIEry , SWAMRSC0ITT REF I,GERAttON �� 163 ESSEff§ J 90"-,'.r7-96' � 00%26/2014 00:31 FAX 978 532 2217 CROSS INSURANCE 001 CERTIFICATE OF LIABILITY INSURANCE DATE(MMDO 9/26/201a14 THIS;ERTIFICATE 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: It the Certificate holder i5 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 CAME:O A T Lauren Goldman Cross Insurance-Peabody PHONE (970)532-5445 P^X - (BTB)532-2217 139 Lynnfield Street EMAIL .Igoldman@ crossagency.com INSURERS AFFORDING COVERAGE NAICF Peabody MA 01960 INSURER A Pmeri-Can StatOS Ins CO 19704 INSURED INSURER B:Ci Cation Ins CO IIA only) 0274 SWAMPSCOTT REFRIGERATION INC INWRERC:Oh10 Security Ins Co 24082 163 ESSEX ST INSURERD: INSURER E .LYNN MA 01902 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1472515166 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 AORL %mm POLICY EFF POLICY EXP LTR TYPE OF INSURANCE lmgp I Mna POLICY NUMBER M MMIOOrc LIMITS GENERAL LABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES 44G11lence S 200,000 A CLAIMS-MADE O OCCUR O1CG62734300 /15/2014 /15/2015 MED EYP(Ary one Dement 3 10,000 PERSONAL&AOV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMO APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC S AUTOMOBILE LIABILITY Ea a,,,c ISINGLE LIMIT B ANT AUTO BODILY INJURY(Per person) $ Boo 000 ALL OWNED % SCHEDULED 4MMCKHZt4 4/12/2014 4/12/2015 BODILY INJURY(For em'�denq $ 1-1-00-0-10-010- X HIRED AUTOS X AUTOS�EO CpQr PROPERerJ AMAGE g 100.000, MedicAl Dols 3 5,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE 3 EXCESS LIAO CLAIMS-MAGE AGGREGATE $ OED RETENTIONS S C WORKERS COMPENSATION WCSTATUIM T- OTH- AND EMPLOYERS'LIABILITY JE ANY PROPRIETORIPARTNEREISECUTIVE YIN EL.EACH ACCIDENT $ S001000 OFFICERJMEMBER EXCLUDED? ❑ NIA 655654132 /2812014 /2e/2015 (Mandatory in NB) EL DISEASE-EA EMPLOYEE $ 500,000 Ifyy dowibV untler OESCIRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AHncH ACORD IDI,Aodleenal RemaMs SPAeduM,If mom sPare Is rown,o) Refer to policy for oxciveionary esldorseTRQnts and special proTisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES RE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of SalemACCORDANCE WITH THE POLICY PROVISIONS. 120 Washington St Salem, MA 01970 AUTHORIZED REPRESENTATIVE Timothy Tramonte/MDI `~�'c�• � ACORD 25(2010106) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(zotoosym The ACORD name and logo are registered marks of ACORD