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450 HIGHLAND AVE - BUILDING INSPECTION (5) Commonwealth of Massachusetts Sheet N[etal Permit Date: 20 /4'-' Permit # Estimated Job Cost: .O o Permit i E mit Pee: $ .9 Plans Submitted: YES NO Plans Reviewed: YES NO J-" ,. Business License # Applicant License # L3'/ O Business Inforinatim . Property Owner/Job Location Information: Name: n /{rare P / -Tf�4 4- �y I G Name: C' Iq 99 Street: .2 �q r� p, J Street: �_(� #"' b� City/Town: h)e,-s 'Peo-VL Ala Oz-7?p City/Town: a C� K-1 —c-- Telephone: S09 to y4, 12 /?j!�, Telephone: Cr!( so i? 4 9.3 -1 z 2-S hoto LID. required/Copy of Photo I.D. attached: YES 'V NO Staff Initial J-1Virestricted license J-2 / NI-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 i,/ Industrial_ Educational Institutional_ Other Square Footage: under 10,000 sq. ft. _ over 10,000 sq. ft. Number of Stories: Shect metal work to be completed: New Work: _ Renovation: &--� H VAC ✓ Nlelal Watershed Rooting _ Kitchen Exhaust System Ntetal Chimney / Vents Air Balancing Provide detailed description of work to be done: R Im C-9V t a A? 42��� A,*-/ b -0 b n"t m ti nr*fIRP r—� -C3- C'7 O f+t ti c:r�r t� �Yj l rn o tM 2 l o J• P s --- INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes 9"o❑ 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 waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this boxl],I hereby certify that all of the details and information 1 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 Proflress Inspections Date Comments Final Inspection Date Conunents Type of License: By L✓� Master 4 Title ❑ Master-Restricted 464 L4 CltyiTo6111 in ❑Journeyperson Signature of Licensee j'�/ Permit i I e;- -- ❑ JJourneyperson-Restricted License Number: GY Fee S',-� ❑ Check at vdmw.mass.gov/dpl •t-. Inspector Signature of Permit Approval � OMWk-:f m..n FM H SETTSEA TH BOARD 0 .. " SHEETMTALWORKERS ° `;"Pq }t; e ISSUES THE FOLLOWING LICENSE AS A, UNRESTRICTED '`��IEFFREYA NDRAD 248 SANFORD " ',WESTPORT,'MA 02790 3741 � "'�+ / A �w , ,��'��5109 , 4ww12/28/2017 s s�`�'y'7998��.� •�--�� I* ?AWWMC USETTS DRIVER'S f xis• �, v: J eF k,x , LICENSE • .K ya 1¢a Y � 9 ENp 4C NIIM9Efl r �v *10.10.2014 NDNE,. S58071933 ' awooe g 1968� � nss�E3£ an— ,s sEx M, � r'Q:p03 � Tilt {} WESTPORT MA 027901sRJ37)41 limla R 'o> oa ,1 „jt A��a CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/VYVO sn 7/201 s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS Ir 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: N 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 endorsements . PRODUCER NAMEACT Rick Rosenfeld _ Kaplansky- Fairhaven FHONE . 508-984-1616 FAIC No,AX 508-984-1919 208 Washington Street EtdAIL Fairhaven MA 02719 ADDRESS.rosenfeld@kaplansky.com INSURER B AFFORDING COVERAGE NAIC p INSURERA:National Grange Mutual INSURED ANDRPL2 INSURERB:The Hartford Andrade Plumbjng&Heating, In INSURER C: Jeffrey Andrade INSURERD: 248 Sanford Rd.#t 1 Westport MA 02790 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2065054975 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MWDD MWDD A X COMMERCIAL GENERAL LIABILITY Y Y MPT4098R 3/18/2015 3/18/2016 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMSMADEOCCUR PREMISES Ea occunence $500,000 MED EXP(Any one person) $10,000 PERSONAL B AOV INJURY $1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY jEOT F7 LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ CO INGL AUTOMOBILE LABILITY Ea accident $. ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOSHRED AUTOB AUTOS AUUTOSWNED Parr. identDAMAGE $ � $ UMBRELLA LIAR' OCCUR EACH OCCURRENCE $ EXCESS LWB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION OBWECCRI920 8/29/2015 8/29/2016 X I STATUTEI IERµ AND EMPLOYERS'LIABILITY YIN - ANY PROPRIETOR/PARTNEWEXECUTME E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? ❑N NIA If (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $100,000 (Dyes describe under DESCRIPTION OF OPERATONS below E.L.DISEASE-POLICY LIMIT $500,000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may 1,e atla,hed if more space Is required) The Certificate holder is an additional insured on a primary, non-contributory basis with a waiver of subrogation for general liability of the insured, if required by written agreement with the insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTAME ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD