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41 LINDEN ST - BUILDING INSPECTION / Commonwealth of Massachusetts Sheet Metal Permit Date: Permit# Estimated Job Cost: $ 1�7 040 . Permit Fee: $ .Plans Submitted: YES_ NO_ Plans Reviewed: YES_ NO Business License # 5(7_ Applicant License# yro Business Informattiion: Property Owner/Job Location In Name:�g.Se�4COtn� sm_e_►_Ty-jC Name /b/Sa b//el egy-- Street: Cs+ Street: y z i+n * City/Town: � Ma _.. (5AC ty/Town: SJ�P—��J City/Town: m a jl9V Telephone: 9]$-7y5-Sb28" Telephone: Photo I.D. required /Copy of Photo I.D. attached: YES_ NO stall Initial J-1 / M 1 nrestricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family Multi-family_ Condo /Townhouses_ Other Commercial: Office_ Retail Industrial_ Educational Institutional Other Square Footage: under 10,000 sq. ft. ✓ over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: _ Renovation: HVAC t/ Metal Watershed Roofing_ , Kitchen Exhaust System Metal Chimney/Vents_ Air Balancing Provide detailed description of work to'be done: . r INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes ❑ No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware thatthe licensee.does not have the.insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only i Owner Agent ❑ Signature of Owner or Owner's Agent By checking this box[],I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO !/ Progress Inspections Date Comments Final Inspection Date Comments Type of License: By V6aster Title ❑ Master-Restricted Cityrrown ❑J - ourneyperson Signature of Licensee Permit# - ❑Journeyperson-Restricted License Number. 3y(o Fee$ Check at www.mass.gov/dpl Inspector SigWPe=lt Foltl,Then Detach Along All Pe-iO-V,ne SCOMMON WEALTH OF MASSACHUSETTS S AS A BUSINESSRKERS i ISSUES THE ABOVE LICENSE TO;' I RAYMOND B NOYES III g. . ESSEX COUNTY CRAFTSMAN INC : w2 60 .WARD ST SA'LEM MA 01970 '0.000 $01 02/23/14 139631 Fold.Then Detach Along All Pedoretio :a � 9T 21/9Z/10 7tamer �' � III ;S'�ON -,fl d�►� _ + !€€--; �13sN30n37tpEl�/�wls3nssL_ fi3i l2l1S321Id0 Rm W I MA11 Vf9 rii� �R_ iIMMMM' 5 - S1f3SEiF[ bSSMW CIOMl'IV3 ------------- - --- ESSEX3 OP ID:SM CERTIFICATE OF LIABILITY INSURANCE DAT 12120DIYYYY) 1 y20j12 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 pollcy(les) 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 endoreemen s. PRODUCER 781-914-1000 CONTACT NAME: TGA Cross Insurance,Inc. PHONE FAX 401 Edgewater Place,Suite 220 rnai E (A/C No), Wakefield,MA 01880 ADDRESE- S: - John Scanlon INSURE S AFFORDING COVERAGE NAICd INSURER A:Aoedla Insurance Company INSURED Essex County Craftsmen,Inc. INSURER B: Charlotte Noyes 60 Wald St. INSURER C Salem,MA 01970 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. 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. WSR TYPEOFINSURANCE POLICY NUMBER MMLICYE POD P LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY BOAS02639411 12131112 12131/13 PREMISES Ea oaumnce S 300,00 CLAIMS-MADE F 7xOCCUR MED EXP(Any we person) $ 10,000 PERSONAL B ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 17 POLICY F7 PRO- LOC I $ AUTOMOBILE LIABILITYEe a.d INGLE LIMIT $ 1,000,00 A ANY AUTO MAA50Z MII 12/31112 12131/13 BODILY INJURY(Per parson) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS X AUTOS ROPER MA X HIREDA(TTOS X AUTOS Par accident $ S X UMBRELLA LIAR -Xi OCCUR EACH OCCURRENCE E 3,000,000 A UCESSUAB culMs-MADE CUAS025211 12131112 12131113 AGGREGATE $ 3,000,000 DELI I X I RETENTIONS 10,000 $ WORKERS COMPENSATION WC STATU• OTH- M ANY ROPRIEERsuAelurr cAEozedssll 1,000,00 A ANYPROIMEMBR/PARTNERrD(ECUTIVE YIN NIA 12I31N2 12/31113 E.L.EACH ACGDENi $ OFFICERIM In NH)EXCLUDED? (Mantlatory In NH) E.L.DISEASE-EA EMPLOYE S 1,000,000 U yas,dasulba under DESCRIPTI E.L.DISEASE-POLICY LIMIT S 11000,00 ON OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,H mme apace Is required) CERTIFICATE HOLDER CANCELLATION PROOF-2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PROOF OF INSURANCE ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORDED REPRESENTATIVE 4 v©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD