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Home My WebLink AboutMiscellaneous - 21 ROYAL CREST DRIVE 4/30/2018ti I Date ...... e ... >\. .............. TOWNkOF'NORTH ANDOVER, PERMIT FOR WIRING This certifies that ..... .. haspermission to perform ........... ................................................... r ......................................... C wiring in the building of ...................... '(Y.. N r- .... .. U .........a..... O.. . ........................................... 1 P-0,1 rsj CAP� PIA orth d at...:01 ......................... t ..... ................................................................ IN Andover, ee.. .......... Lic. No. 15111 " r,�- ...... ........... ................. ............................ .. ........ ................ I J. ....... ..... ELECTRICAL INSPECTOR 0 &��?� 3 IS 43b Check # 5 P, .1 Commonwealth of Massachusetts Official Use Only V- Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev..l/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 INMK OR TYPE ALL INFORMATION) Date: A Oc, u S -L (, P I L4 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) SQ Q O U 0 -1 C.Ce- S+ 2 Owner or Tenant /4-M I C 0 Owner's Address bu i 1 i r1 N Is this permit in conjunction with a building permit? Telephone No. Yes ❑ No LvJ (Check Appropriate Sox) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: C;6 e CK Cong nc-4-furl `S i l,4 e-te-drLi c, 1-i- o-+ I Li n e- vo Ie- 4 {P r -t o S J, -JS an & Ca r( -g L -� b e tc,-k e r S Pe- e- o i n C% �'h--e-S e- 'L_s n 14-- ' '-S Completion ofthe following 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 No. of Luminaires Swimming Pool Above ❑ In- ❑ No. of Emergency Lighting rnd. grnd. Battery 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 Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number - Tons ......................-1-* KW * *.......... No. of Self -Contained 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 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: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: wo : ® 6 (When required by municipal policy.) Work to Start: 8 (ol 1p 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:) Icertify, under thepains,�and alt' !f erjury, that the information on this application is true and complete. FIRM NAME: �� 1 e- P= V t �I e- LIC. NO.: A 15"79 O/ Licensee:"DW 1 e I , P=, V 1 A,g„ 1 e- Signature o ,,,� P McAe- LIC. NO.: 16 50 C (If applicabey-,enter "exempt" in the license number line.) Address: t () DR I e S-�- wa-1 M 14 C5 D, Lt 15 Bus. Tel. No.: 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: .$ (Z'� Signature Telephone No. The Commonwealth of Massachusetts Department of lndustrial Accidents Office of Investigations kvi 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leaibiy Name (Business/Orgmi'zation/Individual): � � � �� 1' � 1 � Q e' t : ec Address: IN Ci /State/Zi ('�1 Wl �111� i�a� Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with - 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. t ship and'have no employees These sub -contractors have working forme in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F1 Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roofrepairs 13.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors 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: Policy # or Self -ins. Lic. #: �. �JGC� (Q`� 3 G'LCC`l Expiration Date: l Job Site Address: 5 6 CZ �t i�Cc 1 C r<s I-- T) rL City/State/Zip: N, �qJ 0 OLS K M A (318 Q. S Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requireclunder 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 copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb cert under the pains an'dpenalties ofperjury that the information provided above is true and correct. Sienature• s-,..��,.—� � -\) Date: a Lata l l c ' Phone#: 508-'- 50atN dr\9C 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 CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - Contact Person: Phone 14,ec o5cecoO =Q 1 ® A� o CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DI YYYYY) 8/26/14 THIS CEknFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CRTIFICATE 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 to the certificate holder in lieu of such endorsement(s). PRODUCER James O'Connell Insurance AgenPHONE 572 Boston Rd Unit 7 Billerica, MA 01821 CONACT NAME: LESLIE HANNON (978) 667-6150 AIX No: (978) 667-0587 ADDRESS: JIMINS@OCONNELLINS.COM INSURE S AFFORDING COVERAGE NAIC # INSURER A: Merchants INSURED DANIEL P VITALE ELECTRIC 190 DALE ST WALTHAM, MA 02451 I NSU RER B : A . I . M . Insurance INSURERC: INSURER D: INSURER E: INSURER F : rnv=onr•C:c RI=1?TII:ICATF NIIMRFR KtVI51UN NUMOLK: 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 LTR TYPE OF INSURANCE ADDL I SUBR WVD POUCY NUMBER POLICY EFF MM/MN POUCY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR Q BOP9098053 9/12/14 9/12/15 EACH OCCURRENCE 1,000,000 _$ DAMAGE To aENTED $ 500,000 MED EXP (Anyone person) $ 15,000 PERSONAL&ADVINJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER X POLICY PRO- LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED _ AUTOS EOaBc�EDtSINGLELIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ide) AGE $ PROPERTYHIREDAUTOS Peram $ UMBRELLALIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y� OFFICE RIMEMBER EXCLUDED? (Mandatory in NH) If yyes describe under DESIRIPTIONOFOPERATIONS below N/A WCC5006538012009 10/11/13 10/11/14 X WCSTATU- I OTH- E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE -EA EMPLOYEE $ 100,000 E.L. DISEASE-POLICYLIM IT 1 $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is regli red) ELECTRICAL WORK 1%=M'r1 .-ATC Ur%! nco CANCFI_LATION V 7955-LU'lU AGUKU 1-UKr UKA 1 IUIV. All rlgnts reserve U. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E -Mail: 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 AUTHORIZED REPRESENTATIVE NORTH ANDOVER, MA 01845 Q LESLIE HANNON V 7955-LU'lU AGUKU 1-UKr UKA 1 IUIV. All rlgnts reserve U. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E -Mail: 9973 Date ..... !�.. TOWN OF NORTH ANDOVER PERMIT FOR WIRING —Z This certifies that ................................................ has permission to perform ........ . ...... Z 7 -J .......................... wiring in the building of ......... ................. 7 ............................ at ............................... b ... q. ... North Andover , Mass. 'C' Fee.. ................. Lic.NoJ0-7S7,31 A�lCAL IN P! R7 Check # I'D l,ommonwea& of WaiiacLietti Official Use Only c� Permit No."� 2epartmeni oIcc77 ire Servicea Occupancy and Fee Checked J BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) ,APPLICAT-ION 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 14, 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 BUmldiing # s2l Owner or Tenant Royal Crest Apartments Telephone No. 978-681-1822 Owner's Address 50 Royal Crest Drive North Andover, MA 01845 Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) Purpose of Building Commercial - Apartment BUildinclsUtility Authorization No. .J Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install 6 Gell Packs! No. of Meters No. of Meters Com lotion of the fn1lowina table may be waived biv the Ins ector of 11 Tres 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- E] rnd. rnd. No. of Emergency Lighting 6 Battery 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 Tons No. of Alerting Devices g No. of Waste Disposers Heat Pum Totals Number Tons KW ................... Nlf-Contained o.of SeDetection/Alerting Devices No. of Dishwashers Space/Area Heating KWLocal ❑ Municipal El Other Connection No. of Dryers Heating Appliances KW Security Svstems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: 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: 03/14/2011 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. A 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. MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) .17/_ C NORTH ANDOVER Mass. Date_ �S kuilding Location Permit Owners Name _zV/ v' • New Renovation D Replacement Plans Submitted D FIXTURES l� (Print or Type) Check%ne: Certificate Installing Company Nam e%%y l�'i/L/f1�//j�i/ .�i1 i'Ti�C. /C 1� Corp. Address Fj%j� &J e Partner. jW`� . ell'JV3 Firm/Co. Business Telephone: Xp-!!�--- x.v,-� Name of Licensed Plumber or Gas Fitter d'6�'"z /t'(G�- Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy EO ---'Other type of indemnity 0 Bond Ej Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property . Owner 17 Agent M I hereby certify that aU of the deuits and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and titat all plumbing worst and installations performed under'Permit hawed [oz this application will -be lrs eomplianoa with ad V=Unent provisions of tho Massachusetts Slate Cas Code and Ouptes 142 of the General Laws. B PE LICENSE: p y Plumber Title sfitter- Sig ature of Licensed City/Town: Master Plumber or Gasfitter Journeyman Z3 APPROVED (OFFICE USE ONLY) License Number rn ou = o z a s f- tri tz W o to . v = to f' x a► c: zx Z tu t-< 0:O r x O :. o O t - w tL tt1 N W h' 4 W W_ W_ }. of a W y !— 4 N W W Of w Z (7 < W S a of 0: W 4 CC oC W t- O> W x C! 6 O 2 t- d W W .1 •J t' G cc tr W r USC2 Y- N m ? O "' r1 W O N Ug x d, to > C W O 2 d 3: tL d < O O W O W i,- 01 O U. =1 a O -1 0 cl:> a c. t- O SUA-6SWIT. BASEMENT I ST FLOOR 2MD FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR TTH FLOOR 8TH FLOOR (Print or Type) Check%ne: Certificate Installing Company Nam e%%y l�'i/L/f1�//j�i/ .�i1 i'Ti�C. /C 1� Corp. Address Fj%j� &J e Partner. jW`� . ell'JV3 Firm/Co. Business Telephone: Xp-!!�--- x.v,-� Name of Licensed Plumber or Gas Fitter d'6�'"z /t'(G�- Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy EO ---'Other type of indemnity 0 Bond Ej Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property . Owner 17 Agent M I hereby certify that aU of the deuits and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and titat all plumbing worst and installations performed under'Permit hawed [oz this application will -be lrs eomplianoa with ad V=Unent provisions of tho Massachusetts Slate Cas Code and Ouptes 142 of the General Laws. B PE LICENSE: p y Plumber Title sfitter- Sig ature of Licensed City/Town: Master Plumber or Gasfitter Journeyman Z3 APPROVED (OFFICE USE ONLY) License Number s Date. ..........' .. . i J „pR,►, TOWN OF NORTH ANDOVER tip 0 `p PERMIT FOR GAS INSTALLATION. o a � 9S3ACHUSEt .. T+ ..a 1-. O This certifies that .. :............ ..... ................. .. . has permission for gas installation ............................... in the buildings of....................................... at .:.:....:.. ! .............. ! ........ North Andover, Mass. Fee.:`....... Lic. No......;.... .......................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: 'Flle