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Home My WebLink AboutBLDG-23-9431 S0 N.. MA5S,4CHUSEI TS UNIFORM APPLICATION E iON FORAPERMIT TO PERFORM GAS FITl 19 I,=�.ram,..,, � �(,� I(...1 �T�( �G WORK w MA DATE c2O L� PERMIT f G' JOESITE ADDRESS - 3� 3 G �� f--� OWNER'S NAME��A�„f��v OWNER ADDRESS is` 9 id TYPE OR TEL 5 UPi 87d'� �Y FAX PIN OCCUPANCY TYPE COMMERCIAL II---------)CL)✓ EDUCATIONAL ❑ RESIDENTIAL❑ NEW:❑ RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES -2 NO❑ APPLIANCES T FLOORS—+ SEN 1 BOILER 3 1 BOOSTER ® II 12 13 14 CONVERSION BURNER _________i____ COOK STOVE ---- — DIRECT VENT HEATER DRYER, -- FIREPLACE _L.__ .11FRYOLATOR - FURNACE 04 e 7 GENERATOR .1 -- , GRILLE ; --+ INFRARED HEATER -- 411] . LABORATORY COCKS �-- � � —_____ MAKEUP AIR UNIT __ ---- ..I� V^ »i MPOO L HEAT ER s' G 'EPA THE T O -- la •� ROOF TOP UNIT + _ UNIT HEATER Ilill 111.111 -NM OTHER -----_ imminimommon...,......____—...m....m...............11MILIZIMIMMIM INSURANCE GE VE I have a current liabli insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 11-------- OTHER TYPE INDEMNITY ❑ BOND IOWNER'S INSURANCE WAIVER: I am aware that the licensee does not the insurance coverage required by Chapter142 Massachusetts General Laws,and that my signature on this permit application waives this requirement. . of the ,—r '• SIGNATURE OF OWNER OR AGENT ► NE ONLY: OWNER ❑ AGENT ❑ ' ;; I hereby certify that all of the details and information I have submitted or entered regarding this application are true and arc .n= and that all plumbing work and installations performed under the permit issued for this application will be in com lian Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ur �t of my knowledgeP /Li j t all 'ertinent of the PLUMBER-GASFITTER NAME LICENSE# SIGNATURE MP ! GF❑ JP ❑ JGF❑ LPGI ❑ CORPORATION _------- ❑4PARTNERSHIPEl# LLC❑ COMPANY NAME cot ., f , ADDRESS CITY SqK STATE/1/7" ZIP G90%5:3? TEL.50 'v11 "—Y•?6'G� FAX CELL fG�';,7t✓i • 1 —� 43�c EMAIL A •C CO ^�—..„,% FARNPLU-01 DBRIGGS01 A �RO° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 6/30/2023 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 have ADDITIONAL INSURED provisions or 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 NAppMEACT Diane Briggs Almeida&Carlson Insurance Agency,Inc PNE FA/cX PO Box 719 (AHO/C,No,E:t):(508)888-0207 122 (A ,No):(508)888-0550 Sandwich,MA 02563 ADDRESS:M dbriggs@almeidacarlson.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:NORFOLK&DEDHAM GRP 23965 INSURED INSURERB:ARBELLA PROTECTION INS CO 41360 Farnham Plumbing and Heating Inc. INSURERC: 4 Juniper Hill Road INSURER D: East Sandwich,MA 02537 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTRINSD END POLICY NUMBER IMM/DD/YYYY) IMM/DD/YYYYt LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR R2112451A 9/21/2022 9/21/2023 DAMAGE O N AEA PREMISES occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- POLICY ELOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ ANY AUTO 1020071204 OWNED SCHEDULED 2/7/2023 2/7/2024 BODILY INJURY(Per person) $ AUTODS ONLY X AUTO{{S�� BODILY INJURY(Per accident) $ X HHIRED ONLY X NON-OWNED PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY PER OTH- Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Mashpee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 16 Great Neck Rd ACCORDANCE WITH THE POLICY PROVISIONS. Mashpee,MA 02649 AUTHORIZED REPRESENTATIVE /71--)4"-- ACORD 25(2016/03) The ACORD name and logo are registered marrks9ofACORDCORD CORPORATION. All rights reserved. DIVISION OF OCCUPATIONAL LICENSURE I • BOARD OIr PLUMBERS AND GASFITTERS ISSUES THE FOLLOWING LICENSE • MASTER PLUMBER KEJTH J FARNHAM . • 4 JUNIPER HILL RD EAST S IUDWIGH,MA 02537-1036 V • • 11601 05/01/2024 206281 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER t ' • • • • • • • • • • • ppG • t ' k