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HomeMy WebLinkAboutMiscellaneous - 15 ROYAL CREST DRIVE 4/30/2018 1 BUILDING FILE P t f Date....*.w4.......... to c4 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING r �`S3gCH This certifies that..........`...........! A1�,��!�.�,L... .��N&....... .......... ..... ...... has permission to perform .... ..1... ...C�:�.. Pa ri wiring in the building of..............V C. ... ..0............................................................ �. ...:.. U."1` ..i..... ............................................... North Andover,Mass. 14--�= e.............................Lic.No. ................. ............................. .... :...................i;........ ELECTRICAL INSPECTOR V Check# � ..96 59 - Commonwealth of Massachusetts Official Use Only Permit No. N Department of Fire Services " Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ROM 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEA SE PRINTMHKORTYPE ALL INFORMATIOA9 Date: AuGU. t 5(6 . ( L4 City or Town oh NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 'S® Q p U 0-1 ` CL S 0.2 Owner or Tenant 4m t C o t t6 r L 44- A ry Dtiv-t+r L'. Telephone No. Owner's Address budcbriq is Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: C�e cK �� `r ( '(�v�n C�-ie c,`S N-4 84SOM—OL entedriic, eco ' 1 1inryoIir,,ge. A-kerm®staj-S ar►cL0-Ar(.gLk brec,-ke-r5 Fre-Oirlq —fi'M--e-S e— v n y 4 e !S Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones c✓ " No.of Switches No.of Gas Burners No,of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No.of Waste Disposers HeatPump Number Tons KW No.of Self-Contained p Totals: ........... Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other p g Connection No.of Dryers Heating Appliances KW SecuritNo.o Systems:* or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: 0 C) Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 3Q(7 r (When required by municipal policy.) t Work to Start:a(a 1,2 1 1 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURA-NCE ❑ BOND ❑ OTHER ❑ (Specify:) I•certify,under the pains and penaltiers'oIf erjury,that the information on tills application is true and complete. FIRM NAME: D A i e.I P, eVsq, I e— U e-c-kL i C LIC.NO.: A 15'79 9 Licensee'Dw e"1 P=, yi A,, .l e— Signature P tt-< LTC.NO.:31650 E (If applicab e enter�exe�mpi din the llicensee)m�bei line) - (5 Bus.Tel.No.: Address: '� f"e s Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: . Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE. .$ Q SignatureturaTelephone No. . 1 i The Commonwealth of Massachusetts - - Department ofIndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information 1 ( Please Print Legibly (� Name(Business/Organization/Individual): 1 1' Address: Leo 01PJ r-_- City/State/Zip:t Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with L' 4• El am a general contractor and 1 6. E]Now construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. �• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. El Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.F1 Electrical repairs or additions required.] officers have exercised their 3111 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' q l 13.0 Other comp.insurance required.] *Any applicant that checks box#i must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A ,L M V-J--_::)U (-0,VV't), C Policy#or Self-ins.Lic.#: C-C SGC �4`�3 � � Expiration Date: ( � Job Site Address: Jc 6 ��t-QCc:' C c<s 'D rL r City/State/Zip: 14,A. 06�CK M A G Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP-WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do liereb certlo under the pains and penalties of perjury that the information provided above is true and correct. Signature `y Date: La � 1 Phone#• X508_sc)`k_ a9cc Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: x COMMONWEALTKOF M6SSACHl1SETjTS • • e � ® s ` LE£1 R"I C I ANS i %SSUES THE ,FOLLOWING :LICENSE AS;;,A s REG I;STERED MASTER ELjTRI C I AN< �: DANIEL P VITALE # , �Z 1.90 DAL E'ST , Z. J WALTHAM MA 02451-3 15799 07/3116 35001 -� WCOMMONWEQLTH:OF."_MASSQCWUSETTS ` BOAR aR UECTR I C i'ANS ISSUES THE FOLLOWING LICENSE ASA'REE; JOURNEYMAN ;.ELECTRICIAN ` f I DAN1Et P VITALE 190 DALE ST Z O 4,►A'LTHAM MA 02451-3773 31850 `E 07/3.1./16 35002 ,C 4. ACOS® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD26/ 8/26/14 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 CERTIFlCATE 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 to the certificate holder in lieu of such endorsement(s). PROWLER CONTACT NAME: LESLIE HANNON James O'Connell Insurance Agen PHONE (978) 667-6150 FAX No (978) 667-0587 572 Boston Rd ADDRESS: JIMINS@OCONNELLINS.COM Unit 7 INSURE S AFFORDING COVERAGE NAIC# Billerica, MA 01821 INSURER A:Merchants INSURED INSURER B:A.I.M. Insurance DANIEL P VITALE ELECTRIC INSURERC: 190 DALE ST INSURER D: WALTHAM, MA 02451 INSURER E: I NSURER 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. ILTR TYPEOFINSURANCE ADDLSUBR POLICY EFF POUCYEXP INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY BOP9098053 9/12/14 9/12/15 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENE RAL LIABILITY PREMDAMAIS TORENTED ES Ea occu e $ 500,000 CLAIMS-MADE FX]OCCUR MED EXP(Anyone person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY PRoi LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB Ea accident $ ANY A UTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY erarEatl Y DAMAGE $ HIREDAUTOS _AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WCC5006538012009 10/11/13 10/11/14 X WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/ExECUTIVE YN/A E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yyes,describe under DESCRIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICYLIMff $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Re marks Schedule,if more space is requi red) ELECTRICAL WORK CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER MA ACCORDANCE WITH THE POLICY PROVISIONS. 120 MAIN ST NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE e� L.1 a L LESLIE HANNON �� ����� ©1988-2010 ATO-RD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: 9948 Date... .......)-Jz..... TOWN OF NORTH ANDOVER 41 PERMIT FOR WIRING SS U us This certifies that .... ................................................. .................... has permission to perform .......... wiring in the building of...... ........................... ....../:,�. Morth Andover,Mass. Fee... Lic.No... . .... ............... . ............ .. .......... ........ ICAL INSPECTOR 'k Check it 0 ELE (fomnwnwea&o f Maedac4uaetb Official Use Only cc�� Permit No. 2epartmznt of3 ire Service] < r BOARD OF FIRE PREVENTION REGULATIOccupancy and Fee Checked ONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: March 4, 2011 City or Town of: North Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 50 Royal Crest DrIVe Building # IS Owner or Tenant Royal Crest Apartments Telephone No. 978-681-1$22 Owner's Address 50 Royal Crest Drive North Andover, MA 01845 Is this permit in conjunction with a building permit? Yes ❑ No X❑ (Check Appropriate Box) Purpose of Building Commercial -Apartment BuildingsUtility Authorization No. Existing Service Amps / Volts Overhead ❑ Und&d❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install 6 Gell Packs! G►,' Completion of the follovving table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans o.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- 1-1o.o Emergency Lighting rnd. rnd. Battery Units 6 No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners o.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Dcviccs Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained ......................................................... Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local E] Cico nnnenctioatio n F] Other Co No.of Dryers Heating Appliances Kms, Security ystems:* No.of Devices or Equivalent No.of Water Kms, No.of No.of Data Wiring: Heaters Si ns Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent � OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: $ 600,00 (When required by municipal policy.) Work to Start: 03/04/2011 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: The Electricians & Co.. Inc. LIC.NO.: A10737 Licensee: Michael J. Parziale Signature LIC.NO.: E20269 (If applicable, enter "exempt"in the license number line) Bus.Tel.No.: 781-322-9344 Address: 50 Branch Street Malden, MA 02148 Alt.Tel.No.: 781-322-3100 *Per M.G.L.c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. SS CO 001021 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ 125.00 Signature Telephone No.