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HomeMy WebLinkAboutMiscellaneous - 112 FOXHILL ROAD 4/30/2018 (2) 112 FOX HILL ROAD 210/037.C-0010-0000.0 I I m� R� '10155 Date........ . - `` 3:°•�;�`"-: "�O� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING a This certifies that v p. Rt>xl........................... has permission to perform .... J711'Di wiring in the building of / ,1 A o. .... ............................. .North Andover,Mass. a , Fee..! ..:.:... Lic.No...l. 5Q...4............................................ 8 a ELECTRICAL INSPECTOR Check # Commonwealth Of llassachusetts Official Use only Department of Fire Services No. BOARD OF FIRE PREVENTION REGULATIONS ncy and Fee Checked _ ] (leave blank :. .� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL ETgoo All work to be performed in accordance with the Massachusetts Electrical Code(ME 527 CI,R 12.00 ® K (PLEASE PRIN1'.ININK OR ME ALL INF0R1V11gT10A9 City or'Town of NORTH ANDOVER To Date: By this application the undersigned gives notice of his or her intention to perforin theje trical wk dpector of escribed below. Location(Street&Number) I Owner or Tenant �� B Owner's Address Telephone No. Z Is this permit in conjunction with a buildin e ? ' g p rnrut. Purpose of Building Yes ® No ❑ (Check Appropriate Box) Utility Authorization No. NeServiceExisting Service�_ Amps Z� /� Volts Overhead ❑ Undgrd No.of Meters _ _eAmps _Volts Number of Feeders and.Ampacity Overhead Unclgrd No,of Meters Location and Nature of Proposed Electrical Work: G Com letion of the followin table may be waived by the Ins ector of Wires. No.of Recessed LuminairesNo.of Ceil.-Sus No.of p.(Paddle)Fans Total No.of Luminaire OutletsgVA No.of Hot Tubs Transformers Generators KVA. No.of Luminaires S Above In_ . wimming pool d• o.o mergency lg No.of Receptacle Outlets nd. Ba Units g ` No.of Oil Burners ,�ALAR , c No.of Switches " N°•of Zones No. of Gas Burners No.of Detection and No.of Ranges Total Inrtiatiu Devices . No.of Air Cond. No.of Waste Disposers .Heat Pum Tons No.of Alerting Devices p Number Tons Totals: ...... No.of Dishwashers Detection/Alertin Devices Space/Area Heating KW Local❑ Municipal No.of Dryers Heating Appliances Connection Other KW KW Security Systems:* No.of Water ' No.of No.of Devices or E tdvaIenf HeatersNo.of - Data Si s BallWiring: asts. No.Hydromassage Bathtubs No.of Devices or,Equivalent No.of Motors Tele T comm Total uric HP atcons Wiring; OTHER: No.of Devices or E uivalent �. Estimated Value of Electrical Work: <4ttach additional detail tf desired,or as required by the Inspector of Work to Start (When required by municipal policy.) p W es' INSURANCE COVERAGE: Unlesss waived by the Owner,no pspections to be requested in ermit fo theieer forma Rule el and upon completion. the licensee proof of liability insurance performance of electrical work tY a me °� l ui including issue coin Y unless undersigned certifies that such coverage is ' g pleted operation coverage or its substantial g m force an ial equivalent . d has exhibited q ent. The CHECK ONE proof of same to . INSURANCE �] BOND ❑ OTHER the permit issuing office. I certify,under the pains and p aloes o er u that the information on this application is true and complete FIRM NAME: P > ry' P e Licensee: O LIC.NO.. OJ Signature ---�-�--�'30`a (If applicable, enter" emp "in the license number line.) LIC.NO.: LLg Address: Bus.Tel.No.:G/ 1 q Ub 01 *Per M.G.L c. 147,s.57-61,security w�k requires L / — OWNER'S INS ep�nent of Public Safety"S"License: fit'Tel.No.: INSURANCE WAIVER; I am aware that the Licensee does not have the liability Lic.No. required bylaw. By my signature below,I hereby waive this requirement. I am the(check one)[]owner coverage normally Owner/Agent Signature El owner's agent. Telephone No. PF�MIT ELECTRICAL PERMIT NO. INSPECTION REPORT: .. ELECTRICALINSPECTOR-DOUG SMALL "ROUGH INSPECTION: Passed—[ ] Failed—[ ] Re-inspection requirecf($50.00)-[ ] Inspectors' comments: 1. (Inspectors'Signature-no initials) ' Date Z.FINAL INSPECTION. Passed—[ Failed—[ ] Re-inspection required($50.00) Inspectors'comments: (Inspectors'Signature- o ini s) �L Date 3.UNDER GROUND INSPECTION: Passed—[ ] Failed—[ ] Re-inspection required($50.00) Inspectors' comments: (Inspectors'Signature-no initials) Date .'.INSPECTION—SERVICE: - DATE CA.LT ED NATIONAL GRID: NAME:. Passed—[ ] Failed—[ ] Re-inspection required($50.00) Inspectors' comments: (Inspectors'Signature-no initials) Date INSPECTION-OTHER: Passed—[ ] Failed—[ ] Re-inspection required($50.00) �Tnspectors' comments: (Inspectors'Signature-no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF$50.00 IS TO BE CHARGED. y AC R® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/m") 712/20/10 THIS CERTIFICA t 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 t0 the certificate holder in lieu of such endorsements). PRODUCER NAME:CONTACT kevin w flynn W.T. Flynn Insurance Agcy, Inc PHONE FAx 40 Fanwood St 508 877-0078 I N : (508) 877-1413 ADDRESS: Framingham, MA 01701 PRODUCER 3266 -- _ INSURERS A) FFORDINGCOVERAGE NAIC# INSURED INSURER A:COMMERCE Norberto D Rosa INSURER IS:Commerce Insurance Com an 47 Reed Ave INSURERC: Everett, MA 02149 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 ANDCONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADID SUBR POLICY EFF POUCY EXP LTR TYPE OF INSURANCE POLICY NUMBER MIDDY MM/DDIYYYY UMTS GENERALLIA9IUTY EACH OCCURRENCE $ 1,000,000 B X COMMERCIAL GENERAL LIABILITY BBYGRT 12/4/10 12/4/11 DAMAGE ES I RENTED $ 100 000 CLAIMSNADE a OCCUR MED EXP(Arryone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000.000 X POLICY PRO-JECT LOC $ AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT $ ANYAUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY(Per person) $ 1, SCHEDULED AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS PROPERTY DAMAGE $ (Per accident) NON-OWNED AUTOS $ $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIASIUTY Y/N ANY PROPRIETORIPARTNER/EXECUTIVE OFFICE RIMEMBER EXCLUDED? N/A E.L.EACH ACG DENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ K es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more apace Is required) ELECTRICIAN- RESIDENTIAL & COMMERCIAL CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE NORBERTO D ROSA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE KEVIN W FLYNN ©1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD