HomeMy WebLinkAboutMiscellaneous - 1600 OSGOOD STREET 4/30/2018 (13) 1� ym-Atell a f �i I I E Location 1460 No. /U 7 oZd�� Date • - TOWN OF NORTH ANDOVER • . 644 • -x° Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check 30207 Building Inspector I NORTH Town of : x ndover No. b — - h , ver, Mass, .w- -r: C OC NK NlWK 411. �ds R�TEO U BOARD OF HEALTH Food/Kitchen PER LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR has permission to erect g Foundation .......................... buil in son ..... 41Z.0:116 .......... ... ....... . ............ . Rough to be occupied as .CAANNA..... .... . .. .......... ..... . j ..I. ........................ Chimney provided that the person accepting this permit shall in every respect conform to the to ms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STA T Rough ,- Service .................................. .....................�,(,�('�'�. . .. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Date... 611 y.................. NORT�y °� "`" '•,� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �ss�cHus�t< 4 This certifies that ....................... .....'-'`''.......ul......................................................... has permission to perform .... .........;:... .... wiring in the building of.....1�* �..... I � - ............................... at .... .. ...... ........................North Andover,Mass. Fee...N.. ..........Lic.No.24..o..5. ........................ I'^ ELECTRICAL..INSPECTOR Ij Check# 13249 PSP Ia4c.P-2L0((, NL ��I�� L.ommonwealtk o f V466achu6ef Official Use Only aLJ cc��rr��ePartment ol.}cc�� Permit No. �ervice� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [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: JP/�j L_7 d 6FI 6 City or Town of: YV()11-C�1 Kir/n�jp� 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) /(,P GU(} 0 S D�GL 5 Owner or Tenant / Telephone No. Owner's AddresstL Ti 4 X71 fd7 Is this permit in conjunction with a building permit? Yes ❑ No ®. (Check Appropriate Sox) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ rd Und g ❑ No.of Meters New Service Amps / Volts Overhead❑ Und rd g ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: d1ld J— � ^� Com letion Of the ollowin table m be waived b the Ins ector o bf'ires. 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 No.of Luminaires Swimming Pool Above ❑ In ❑ o.o mergency �g Ing rnd. rnd. BaftenLUnits No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices No.of Waste Disposers eat Pump Number..Tons_....... ._. No.of Seif-Contained Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security vim s.: No.of Water No.of No.of Devices or Equivalent Heaters Kit Bal as Data Wiring: Si ns Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail if desired,or as required by the Inspector of Gl�ires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 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 sins and pe alties of perjury,that the information on this application is true and complete. FIRM NAME: Py LIC.NO.: �:,2 /105 (IfLicensee: � Signature jam/ LIC.NO.: A ab/e, enter "a.empt"in the li tse number line.) Address: G S p Bus.Tel.No.Tel •Ir6�°'9le S•y3d'� of P Per M.G.L.c. 147,s.57-61,secur ty work requires Department Public Safety« »S License: Alt.Lic.� ' No. p OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature elow,I hereby waive this requirement. I am the(check one ❑owner ❑owne 's agent. Owner/Age Signature -).No Telephone 6S�' 94� p � PERMIT FEE: $ • - . ._ 1 SSUE5 E FOLLOWII I LENSE :" y > _ :.A � JOURNK [�1 LECTR I C-1 Am' F 't-2 o :BERGER0k 105 NART'OFT ARD 10 t 111 S ;">`"l 03049 fill .STATE.OF NEIN HAM ELECTRIC .NAME: CPIRES' _ = t;r �yoRry OF�t�eo �6•k0 tip,ry` 0� Town of North Andover 0 � Machine Shop Village Neighborhood Conservation District Commission �4S A,r„ 1600 Osgood Street North Andover, MA 01.845 SACHUSE A Application For EXCLUSION From Certificate to Alter Certain alterations are excluded from review by the Machine Shop Village Neighborhood Conservation District Commission in accordance with the Bylaw. Applicants for-exempt projects must fill out the form bellow and submit to the Commission Chairperson(contact info below). Date: ;?, ! l Contact Name&Address: a ` 500 P Project Address: /<g V, 2-0 /5(X�6 Project Description (attach additional pages,if needed): e-PAnn,tN-c.�r ' 1 u u- (0 /1 ���,n � w 4oww-s Exclusion From Review Requested For: ❑ 1.Interior Alterations existing conditions including materials, design and dimensions. ❑ 2. Storm windows and doors,screen windows and doors. ❑ 9.Replacement of existing substitute doors,substitute siding or substitute ❑ 3.Removal,replacement or installation of windows with new materials that are gutters and downspouts. substantially similar to the existing condition. ❑ 4.Removal,replacement or installation of window and door shutters. 10.Replacement of original fabric windows or doors with substitute © 5.Accessory buildings of less than 100 windows or doors that maintain the square feet of floor area. architectural integrity with respect to form, fit and function of the original ❑ 6.Removal of substitute siding. windows or doors. ❑ 7.Alterations not visible from a public ❑ 11. Reconstruction,substantially similar in way exterior design,of a building,damaged or destroyed by fire,storm or other disaster, ❑ 8. Ordinary maintenance and repair of provided such reconstruction is begun architectural features that match the within one year thereafter. MSV NCDC Page 1 Current Chair:Liz Fennessy,77 Elm Street,lizettafennessv@vahoo com,978-688-2915 i %toRTIJ 2 '= °2 Town of North Andover -,; Machine Shop Village Neighborhood Conservation District Commission 1600 Osgood Street North Andover, MA 01845 SACHUS� Application For EXCLUSION From Certificate to Alter For Items 9,10 or 11,provide the following documentation: 4-Photos/drawings of existing doors, windows or siding, as applicable X.-Description/Catalog Cuts of proposed materials to be used for doors, windows or siding Plan and elevation of reconstruction for Item 11 Determination: k roject is determined to be mpt ®not exempt from review by the Machine Shop Village Neighborhood Conservation District Commission. Projects that are not exempt must.complete the Application for Certificate to Alter,available from the Building Department and be reviewed by the Commission. Determination made by. Signature Neighborhood Conservation District Commission Date MSV NCDC Page 2 Current Chair.Liz Fennessy,77 Elm Street,lizettafennessyC yahoo.com,978-688-2915 1 1 o U 5 i Date.......y./...................... NORTH "°oma TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUSE•� This certifies thatEK/�J �/ LL_�1f2� ................................................ ........... ..................... ..... has permission to perform ... Ivh7a/ZS wiring in the building of �4©v �/Z-7/ S/,� ��GvS at....lkfY-9..../127.�,eQ—.......`............................. ..:North Andover,Mass. ©O Fee....�5' Lic.No.�. L-7&..........._..P!4RICAL-INS hLECTRICAL INSPECTOR{ r Check # J b 3 F v/ Commonweal&of Mamac4a6ettj Official Use Only c� Permit No. Apartment of3 ire Service.4 �z�r Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [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 INFO TION) Date: %� / A2 City or Town of: /yQf� /'Quailye � To the Insp ctor of Wires. By this application the undersigned gives notice of his or her intention to perform the electrical work described bel403)Location(Street&Number) G V Q © pp h /�� Owner or Tenant �$�&. s O C Telephone No. y Owner's Address go, p 6 0 .SQQ /D b , Is this permit in conjunction with a building permit? ' �Y;es No E] (Check Appropriate Box) Purpose of Building o'-mp k✓i r. n S For t,Og 1� 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 a 4th era-- o f,s Location and Nature of Proposed Electric ork: /�/ ;i7 Cz!4t'vetQ I Goo o « j Fir Completion o the following table may be waived by the Inspector of Wirer. 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. ❑ Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones 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 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❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of WaterK`l, No.of No.of Data Wiring: Heaters Si ns Ballasts No.of Devices or E uivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: S Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical rWork: 1000— (When required by municipal policy.) Work to Start: / /t t :J Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VERAGE: 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. Tile undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 1< BOND ❑ OTHER ❑ (Specify:) certify,under the pains mid penalties perjury,that Vie inanon on this application is true and complete. c FIRM NAME: .Se4.A /1t 2gge' AICC_T1 C' t LIC.NO.: /21? Licensee: _5'v7 147, -eiC Signature �i••�-- LIC.NO.: 2M 7 F_ (Ifapplicabl rater ,exemp i t( license numb line.) Bus.Tel.No.: Address: O"Rok T X /?AjeS & I k, Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires'Dtpartment 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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE: S 5�� APPLICATION FOR ELECTRIC WORK ` PERMIT (DO NOT FILL OUT THIS FOLD) No. Serial No. Street&No. Owner Electrician ' Permit Issued ,19 REPORT OF INSPECTOR OF WIRES N i t A ALLIED SPECIALTY INSURANCE, INC. 30431 PULF BOULEVARD, TREASURE ISLAND, FL. 3370£ . Toll Free 1-BOD-237 3333 Natjonal .1._B.DD-.252-�?7� .F3or�da Certificate Number: 10 C3VZFICATE CJS' .INSUHBNCE . This certificate neither affirmatively nor negatively amends, extends or alters the covera e afforded b the policy(ies) described hereon and is issued as a matter of information andconfersno right upon the holder. The polic (ies) identified below by a olic number is in force on the date of certificate issuance. Insurance is affordedYonly with respect to those coverages for which a specific limit of liability has been entered and is sub 'ec to all terms ofpthe policy, having reference thereto. Nothing herein contained shall modify any provision of said policy. In the event of cancellation of the policy, the comppany issuing said policy will make all reasonable effort to send Notice of cancellation to the certificate holder at the address shown herein, but the Com any assumes no responsibilities for any mistake or failure to give such notice. Any insurance made a part of the policy includes as a person insured with respect to an occurrence taking place at a Carnivals site, (1) the Fair or exhibition association, sponsorin organization or committee (2) the owner or lessee there of (3) a municipality granting the Named Insured py ermission to operate a (n) Carnivals, but only as respects bodil i njuror property damage caused by or contributed to by the negligence of the Named - while acting in the course and scope of their employment. NAME & ADDRESS OF INSURED: ADDITIONAL INSURED: Dean & Flynn Inc. DBA Fiesta Shows Sear. M. Kenney P. O. Box 460 Seabrook NH 03874 NAME & ADDRESS OF CERTIFICATE HOLDER: Sears M. Ke-nney Electrical P.O. Boy_ 423 Amesbury, MLS. 01913 DATES: 2/15/2010 - 2/15/2011 PRIMARY COVERAGE EXCESS COVERAGE Company: T.H. E. Insurance T.H.E. Insurance Company Company PolicyNumber: CPP0100071-00 ELP0010022-00 LIABIITY LIMITS BI/PD AGG: $0 $4, 000, 000 $0 OCC: $1, 000, 000 $4, 000, 000 $0 Excess of Excess of Food Products: $1, 000, 000 $1, 000, 000$1, $0 Policy period: From: 02/15/10 02/15/10 00/00/00 To: 02/15/11 02/15/11 00/00/00 * - COMBINED SINGLE LIMIT Coverage shown herein applies only to those items scheduled on or endorsed to the policy. This certificate is not valid unless an original signature appears below. (Copies Not Valid) January 18 2010 DATH OF RTI �'IF ZATETSSUANM- A I RE r ------------------------------- - -- COMMONWEALTH OF MASSACHUSE��S ELECTRICIANS REGISTERED MASTER ELECTRICIAN ISSUES THE ABOVE LICENSE TO: SEAN M KENNEY ELECTRICAL SEAN M KENNEY PO BOX 423 AMESBURY MA 01913-0009 12198 A 07/31/13 873875 COMMONWEALTH OF MASSACHUSETTS -- c1 ea �''e c :e ELECTRICIANS AS A REG JOURNEYMAN ELECTRICIAN ISSUES THE ABOVE LICENSE TO: SEAN M KENNEY 1 PO BOX 423 AMESBURY MA 01913-0009 28247 E 07/31/13 873876 e The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 f� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information // Please Print'Legibly Name (Business/Organization/Individual): ���3 �� 5 40 w S Address: P- 0, D City/State/Zip: f od K, 41A, 0W Phone#: / n� 0 lf--! ,35`0 Are you an employer?Check the appropriate box: Type of project(required): l.i�S4am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El 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. ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.F] Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 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' 13.q•Other CQ/7�yt�,/ comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors add 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. C Insurance Company Name: 411; � S/o e C• 7 5 r Co. Policy#or Self-ins. Lic.#: W C, / 03 30 3 Expiration Date: a Job Site Address: / Coo 0,50001 44-07do-19! City/State/Zip: IV40 144U)VC4 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 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 co of this statement may be forwarded to the Office of PY Y Investigations of the DIA for insurance'coverage verification. I do hereby certify Ander the pains and penalties of perjury that the information provided above is true and correct.' Si nature: h Date: Phone#: /G/ 3.-0 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three aparhnents and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or-on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if ` necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cavy workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confinnation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the pen-nit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pen-nit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future pen-nits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street. Boston,MA 02111 Tel. #>:617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax 9 617-727-7749 www.mass.gov/dia , / Locationsy� No. Date Nom*M TOWN OF NORTH ANDOV R Certificate of Occupancy $v_ Building/Frame Permit Fee $ Foundation Permit Fee $ r� JL, — Other Permit Fee $ TOTAL C$ Check # 2 4 L 06 Building Inspector ORT#q F TONM of o over No. - - Zo tL- �AKE 'o dower, Mass., COCMICME W ICK 0*"?ATED PPS` �5 SS BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D . h BUILDING INSPECTOR THIS CERTIFIES THAT f GC s ,Q ... 0 �� ............. .... ... . .................................. Foundation has permission to erect........................................ buildings on .. ... :.........:................... Rough to be occupied as...... .... 1�-�✓1 1. .'... .....e�� . I.I....S?� .!��.�..... . ..157. 7..Q.00.......................... Chimney provided that the person accepting this permit shall in res ect conform to the tbrms of theapplication on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration aConstruction of Final Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations'Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ,ELECTRICAL INSPECTOR X� UNLESS CONSTRUCTIOVE TS Rough ................ .............................................................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner, Street No. SEE REVERSE SIDE Smoke Det. Date.�..:.:-..................... gORTN 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING 3S�CHUSEt t _ This certifies certifies that .......:..................................................................................... has permission to perform, '.:: 2-� °i -'� --� ................................................................ wiring in the building of. .................................. at .rr�.... �� � ................................. ,North Andover,Mass. Fee. .......... Lic.No.�,'/ C?.......... .. ELECTRICAL IN E Check # i 93u `� 1 Commonwealfh of Mamacku6etb Official Use Only a.Uecc�� Permitf 0 / Parfm.enf 0/-71,.. No.ervice� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(IvIEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Bate: 3/A (116 City or Town of: 1116 Jh V4do✓e/ To theInIpead of Wires: By this application the undersigned 'ves notice of his or her i to tion to perform the electric work.described below. Location(Street&Number) O 0.5 0� Owner'orTenant Fiesta Shows V Telephone No.(603 - 24 Owner's Address P.O. Box 460 Seabrook, N.H. 03874 Is this permit in conjunction with a building permit? Yes fnNo ❑ (Check Appropriate Box) Purpose of Building Temp. Wiring for carnival 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 er1 PI Jo/S Locatio and Nature of Proposed Electrical Work: 7-own Ca l ht Vee, e-T 1600 0.;%o dI,/ 1& 1 a a 0 0, 1-1 11 Completion o the ollowintable maybe waived b 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 No.of Luminaires Swimming Pool AboveElIn- Elo.o mergency rg ng rnd. rnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No,of Zones No.of Switches No.of Gas Burners o.of etection and Initiatin Devices No.of Ranges No.of Air Cond. To Tons No.of Alerting Devices " No.of Waste Disposers Heat ump Number Tons KW No.of Self-Contaid ............._.................___- ne Totals: ......... Detection/Alerting Devices l No.of Dishwashers Space/Area HeatingW Municipal KLOBI❑ Connection ❑ Other No. of Dryers Heating Appliances KW Security Systems:* No. of Water No.of No.of No.of Devices or Equivalent Heaters KW Data Wiring: Si g 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. 0 I (When required by municipal policy.) Work to Start: /i Z(, `,� 0 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE OVERA E: 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: Sean M. Kenney Electrical LIC.NO.: 12198 A Licensee: Sean M. Kenney2824/ E Signature IC.NO. — (Ifapplicable,enter "exempt"in the license number line.) Address: Bus.Tel.No.:(979)Sl 5-1�50 p n R„v �� Omn�}»lY (11 91 Alt.Tel.No.: i603-14-4 24 *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'sa ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ I F t r Fold,Then Detach Along All Perforations -4 COMMONWEALTH OF MASSACHUSETTS DIVISIONOF •. BOARD OF ELECTRICIANS EL REGISTERED.MASTER ELECTRICIAN ISSUES THIS LICENSE TO TYPE SEAN M KENNEY ELECTRICAL SEAN M KENNEY -A N t PO BOX 423 AMESBURY MA 01913-0009 336049 1.2198 A 07/31/10 �33.}1600449�� Fold,Then Detach Along All Perforations Fold,Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS " BOARD OF ELECTRICIANS E L AS A REG JOURNEYMAN ELECTRICIAN ISSUES THIS LICENSE TO TYPE. SEAN M KENNEY -E C PO BOX 423 AMESBURY MA 01913-0009 336050 28247 E 07/31/10 336050 Fold,Then Detach Along All Perforations I I ALLIED SPECIALTY INSURANCE, INC. 10431 GULF BOULEVARD, TREASURE ISLAND, FL. 33706 Toll Free 1-800-237-3355 National 1..�8OD-282-577k Florida Certificate Number: 10 CERTIFICATE OF INSURANCE This -certificate neither affirmatively nor negatively amends, extends or alters the covera e afforded b the policy(ies) described hereon and is issued as a matter' of information and- confers no right upon the holder. The policy(ies) identified below by a olicy number is in force on the date of certificate issuance. Insurance is afforded onl with respect to those coverages for which a s ecific limit of liabiliy has been entered and is sub 'ect to all terms ofpthe policy, having reference thereto. Nothing herein contained shall modify any provision of said policy. In the event of cancellation of the policy, the company issuing said policy will make all reasonable effort to send Notice of Cancellation to the certificate holder at the address shown herein, but the Com any assumes no responsibilities for any mistake or failure to give such notice. Any insurance made a part of the policy includes as a person insured with respect to an occurrence taking place at a Carnivals site, (1) the Fair or exhibition association, sponsorinorganization or committee (2) the owner or lessee there of (3) a municipaligy granting the Named Insured permission to operate a (n) Carnivals, but only as respects bodily injuryor pro ertyy damage caused by or contributed to by the negligence of the Named lnsureTwhile acting in the course and scope of their employment. NAME & ADDRESS OF INSURED: ADDITIONAL INSURED: Dean & Flynn Inc. DBA Fiesta Shows Sean M. Kenney P. O. Box 460 Seabrook NH 03874 NAME & ADDRESS OF CERTIFICATE HOLDER: Sean M. Kenney Electrical P.O. Box 423 Amesbury, MA. 01913 DATES: 2/15/2010 - 2/15/2011 PRIMARY COVERAGE EXCESS COVERAGE Company: T.H.E. Insurance T.H.E. Insurance Company Company Alicyy Number: CPP0100071-00 ELP0010022-00 LIABILITY LIMITS BI/PD AGG: $0 $4, 000, 000 $0 OCC: $1, 000, 000 $4, 000, 000 $0 Excess of Excess of Food Products: $1, 000, 000 $1, 000, 000 $0 p Policy period: From: 02/15/10 02/15/10 00/00/00 To: 02/15/11 02/15/11 00/00/00 * - COMBINED SINGLE LIMIT CC-overage shown herein applies only to those items scheduled on or endorsed to the policy. This certificate is not valid unless an original signature appears below. (Copies Not Valid) e�2 6' January 18 2010 D-- (.A �3'3�1�Z A R R 03/12/2010 PRI 15- 52 FAX � �j001/Q02 1??'/w1.U')LI.U�lX�I� Department of Public Safety License to Operate .A.nuusement Devices Eugene J. Venn,Jr. Licence it: MA.-001 -10 (003)474-5424 Issued Date: 3/12/2010 Dean&Flynn Inc., Expiration Date: 2/15/2011 Fiesta Shows Certified Maintenance Mechanic 15 Pine St.,PO Box 460 Wallace Wagemaker Seabrook NH 03874 U.S,i,.l). N Device U.S.1.A. 0 Device U.S.1.D. fl Device 05266 Pharoolt's Fury 10394 1•litur►led Murtsiun Dar;; 10452 Alpine Funhouse(NM) Ride 09974 Slide(1) 10453 Lark hide.Castla of Evil 10400 Cobra 09975 Scooter 10454 Ariie 13Sast 10439 Zipper 09978 Tilt A Whirl 1045,5 Sea I;hltRpp 10440 Twister 09979 Nittany Ferris Wheel 10458 1•I:111ntcd Nouse(NM) 30441 Surfer(Tip Top) 09980 Turllw 10460 Flying St)b, 10%142 Zi>wr 11 1001(1 $winµcr 10461 Dra+on Wu rott b b i(1441 C'yclonc hound Up 10017 'Tornado 10462 Berry it Round( 11'I•irnEcr 141 67 hresrkc)ul 10463 Mini el P t i 445 S. J to c a 1U .sir1.)rn;on 10204 13urobungu 10469 Mini ht IIcPltant 10446 Tilt-A-whirl 0224 Wacky Worm 10465 Boomer's Chew(NM) 10447 Thunderbolt 10,111 Music Fest 10448 Scooter 104(1( Merry Go Pound 10390 Nitimty Perls Wheel 10467 Slide(NM) 10449 (iundolu C/ _ hridtty,March 12,x010 C:a»ntlssinnerof'PuiS u-Snfc�y Page I oft 03/12/2010 FRI 15: 52 FAX w` X002/002 �.h...., Department of Pubic Safety .License to Operate Amusement Devices Eugene 1,Dean,Jr. 1'..iccnse M MA-001 ..10 (603)474-5424 Issued Date; 3/12/2010 Dean&rlynn Inc., Expiration Date: 2/15/2011 Fiesta Shows 15 Pine St.,PO Box 4(10 Ccrtifled Mnint.enancc Mccllnnic Wallace Wagemakel Seabrook NN 03874 i U.S, I.D. # Device U,S.1.D. # Device U.S.1.D. It Device 10468 Tootctville 10488 Dizzy Dragon 1001973 Dabnation A i'rante 10469 Earthgaako 10489 Cray Bus 1301111m 1001974 bunny Vann A Framc 10470 Oricut Express 10490 Umbrella Combo III Botmecr 10471 Rounec(Winniu-NM) 10655 Lucky l,izry Funhouse 1001975 Fad;Lone Obstacle Course 10473 C.ouvoy Cinema 2000 106% Grund(:aro1mcl Q1111cc 1001976 3 in I Kid Combo 10474 Rockin Tug 10817 Remix 1001977 Wacky WOrld 10477 Merry Go Round 10819 Traffic Jam 1002406 Atianlis 10478 Raiders(NM) 13347 Mardi Gras 10479 Crury Bus 1000121 Bomirx-CA 10480 Convoy 1001900 Candy tractor), 10482 Slide(NM) 1001901 hingle Island 10486 Umbrella Dune(Umbrella 1001971 hurgle.Islam)A Franc Combo 1l2) Bouncer 10487 Gravittnn Friday,March 12,2010 Commissioner of NrrGlic.Sr firty Yagc 2 ol'2 Date...... ................. i. .. NOR71{ °f�"`°;•�"0 TOWN OF NORTH ANDOVER 3? °c PERMIT FOR WIRING s � •�a ACMU This certifies that �.... (/.......... ......, ............. ... has permission to perform ........ wiring in the building of lC�S�DO� 5.'............... .North Andover,Mass. Fee....A&..... Lic.No..L Z 1`l� ._. ........... q / ELECTRICAL INSPECTOR Check # `y 876J (fommonwealg o/Maaaachuwetb Official Use Only 2epartment of-7ire Service.4 Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrica41specto(MEC ,527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFO MATION.4 J ) Urate:City or Town of. /'P 6j 7401,/e Tother o Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number)__ /G66 ps aot� ,,/. Owner'orTenant Fiesta Shows IJ TelephoneNo.(603 - 24 Owner's Address P.O. Box 460 Seabrook, N.H. 03874 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Temp. Wiring for carnival 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 ,Z el& of S Location and Nature of Proposed Electric Work: cp /CSA w"�,"pg f,7/ Owry C ��v�t &_T // Corn letion o the ollowin table may be waived b *the Inspector o Wires. No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans No.of Total Transformers KVA No,of Luminaire Outlets No.of Hot Tubs Generators KVA No,of Luminaires Swimming Pool Above ❑ n- El o mergency ig ng rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS 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 Devices ns No.of Waste Disposers Heat Pump Number Tons KW o.of elf-Contained Totals: ......._..-...................I.................. Detection/Alerting Devices No.of Dishwashers Space/Area HeatingMunicipal KW Local.❑ Connection El Other No.of Dryers Heating Appliances KW Security Systems:* Si No.of Devices or Equivalent No.of WHeaters KW No. aof Data Wiring: Signs Ballast. No.of Devices or E uivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications firing: No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work:'K=L (When required by municipal policy.) Work to Start: !j/, 7,Z4pinspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE VERA E: tJnless 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 X BOND ElOTHER F] (Specify:) I certify, under the pains and penalties of perjury, that the information.on this application is true and complete. FIRM NAME: Sean M. Kenney Electrical LIC.NO.: 12198 A Licensee: Sean M. Kenney Signature �— IC.NO.: (If applicable,enter "exempt"in the license number line.) Bus.Tel.N.o.:(97R)81 5-1 X50 Address: � n R„v [,�� �mOQ}�71Y �� Ma 611 913 Alt.Tel.No.: (603-1 r.-7L 24 *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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 1 fry �Qr� C 1 Fold,Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS DIVISION OF PROFESSIONAL BOARD OF E1.-tCAAST�ETRICIANS EL REGISTERED IWit ELECTRICIAN ISSUESTHIS LICENSE TO TYPE SEAN M KENNEY ELECTRICAL SEAN M KENNEY m -A PO BOX 423 AMESBURY MA 01913-0009 336049 1.2198 A 07/31110 336049 Fold,Then Detach Along All Perforations 5 Fold,Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS -a BOARD OF ELECTRICIANS EL AS A REG JOURNEYMAN ELECTRICIAN ISSUES THIS LICENSE TO TYPE. SEAN M KENNEY ti -E PO BOX 423 AMESBURY MA 01913-0009 336050 28247 E 07/31/10 336050 •kill 0 � Fold,Then Detach Along All Perforations r ALLIED SPECIALTY INSURANCE, INC. 10451 GULF BOULEVARD, TREASURE ISLAND, FL. 33706 G Toll Free , 1.-800-237-33:55: National 1-800=282-6776 Florida Certificate Number: 12 CERTIFICATE OF INSURANCE This certificate neither affirmatively nor negatively amends, extends or alters the Covera e afforded b the policy(ies) described hereon and is issued as a matter of inTormation andyconfers no right upon the holder. Theolic (ies) identified below b a olic number is in force on the date of certifica e yy issuance. Insurance isaffordedonl with respect to those covera es for which a s ecific limit of liabili�y has been entered and is sub 'ect to all terms ofpthe policy, having reference thereto. Nothing herein contained shall modify any provision of said policy. In the event of cancellation of the polic the company issuing said policy will make all reasonable effort to send Notice of Cancellation to the certificate holder at the address shown herein, but the Company assumes no responsibilities for any mistake or failure to give such notice. Any insurance made a part of the policy includes as a person insured with respect to an occurrence taking place at a Carnivals site; (1) the Fair or exhibition association, sponsorin organization or committee (2) the owner or lessee there of (3) a municipality granting the Named Insured permission to operate a (n) Carnivals, but only as respects bodily j'n_7ury or proertyy damage caused by or contributed to by the negligence of the Named- Insuredpwhile acting in the course and scope of their employment. r NAME & ADDRESS OF INSURED: ADDITIONAL INSURED: Dean & Flynn Inc. DBA Fiesta Shows Sean M. Kenney P. O. Box 460 Seabrook NH 03874 NAME & ADDRESS OF CERTIFICATE HOLDER: Sean M. Kenney Electrical P.O. Box 423 Amesbury, Ma. 01913-0009 DATES: 2/15/09-- 2/15/10 PRIMARY COVERAGE EXCESS COVERAGE EXCESS COVERAGE Company: T.H.E. Insurance T.H.E. Insurance T.H.E. Insurance Company Company Company Policy Number: M9MF9703 M9XF9704 M9XF9705 LIABILITY LIMITS BI/PD AGG: $0 $1, 00, 000 $3, 000, 000 OCC: $1, 000, 000 $1, 000, 000 $3, 000, 000 _ Excess of Excess of g1, 000, 000 $2, 000, 000 Food Products: $1, 000, 000 �;3, — 1uuuluuu Policy period: From: 02/15/09 02/15/09 02/15/09 To: 02/15/10 02/15/10 02/15/10 COMBINED SINGLE LIMIT Coverage shown herein applies only to those items scheduled on or endorsed to the policy. This certificate is not valid unless an original signature appears below. (Copies Not Valid) January 20 2009