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HomeMy WebLinkAboutMiscellaneous - 22 ROYAL CREST DRIVE 4/30/2018 �k(� N �h �, . F Date...�..�..�r.. . . F SRT~1 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING Hut This certifies that . .V `T\.©0'�- .......... ...................................................................................... ..................... has permission to perform .PP!.... -.-- wiring in the building of................................................n ....... .....................................:................ a5 �� J _ at ..................................y` 1...............`�� . ................................... Andover,Mass. . . Fee, 5...."'.....Lic.No. ...............f .........1... '".........:............... :. .......... ..: -. ELECTRICAL INSPECTOR Check �- �► Commonwealth of Massachusetts Official Use only o Department of Fire Services Permit No. /0�-2 3 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 27 CMR 12.00 (PLEASE PRINTW)NK OR TYPEALL INFORMATIOA9 Date: /V 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) (25-D 22 y c Owner or Tenant N tel-c) �A� l00A30,)11Z LLC— Telephone No.ll 1 (031-L052— Owner's Oj—Owner's Address N. Af- -'YV\8-SS Is this permit in conjunction with as building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building"OLT l- NVV\\ `�f Utility Authorization No. - Existing Service ( Amps 110 / 2y0Volts Overhead❑ Undgrd 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: Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans TransTotal Trsformers KVA 3 No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. 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 No.of Alerting Devices Tons No.of Waste Dis osers Heat Pump Ngmber Tons KW No.of Self-Contained p 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 i 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: e Attach additional detail if desired,oras regztired by the Inspector of Wires. Estimated Value of Electrical Work: 4 0 (When required by municipal policy.) Work to Start: J'l- ( 4 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 ❑ (S ecify:) I certify,under tl�a�e..{�sins and penalties gfperjury,that the ' ornza lzi application is true and complete. FIRM NAME: "fie \C�►L l yl LIC.NO.: �2.�1 Licensee: Signature LTC.NO.- kZ1 166 (If applicable ter "exempt"in the.license z be`r limon'. Bus.Tel.No.-cl�^(,'49-l2°t Address: bl SCANW -� AA C>Itzl Alt.Tel.No.: S-13-%W- C'W11 *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. f OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally I 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:$ Signature Telephone No, i .❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed r on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: on Z© -/ Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: f Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass I Failed Re-Inspection Required($.) Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass IN Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass 0 Failed (] Re-Inspection Required($.) ❑ Inspectors Co ents: i Inspectors Signature: Date: 1 B WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com L�j\8 The Commonwealth of Massachusetts Department oflndustrlalAccidents Office of Investigations 600 Washington Street Boston,MA 02111 UV www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: 5-k City/State/Zip: = Phone5l y-(4:>'4' �Z'l l ok-f-t Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with l 4. ❑ I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling ship and'have no employees These sub-contractors have S. ❑Demolition P insurance.'coin working forme in any capacity. workers9. E]Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10)4Electrical repairs or additions required.] officers have exercised their 3.❑ 1 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' 13.[i Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i'Homeowners who submit this affidavit indicating they tie doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached anadditional 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.Lie.#: Expiration Date: Job Site Address: City/State/Zip: 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 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 Inv esti ' ns o e DIA for insurance coverage verification. Ido here i r Iz p in ndpenalties ofperjury that the information provided above is true and correct. r r Signa Date: Phone#: a 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#: i wa N Informati®n and Instructi®ns 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 apartments 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 carry 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 r Accidents for confirmation 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 permit 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit e multi l p permit/license apphcations m 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 permits 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 bum 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 Counponwealth of Massachusetts Department of Industrial Accidents Office ofInvcstigations 600 Washington Street Boston,MA.02111 TO.#617-727-4900 at 406 or 1-877:MASSAFE Revised 5-26-05 Fax##61.7-727-7749 wwwauass,gov/dia 3, I � 1 .COMMON.WEALTWOE MigSS�CH,lfS�l'TS IAC ;; 'ISSUE'S'STk1E FOL�40WTN'G`���t;LfNSE' A5�11 t ��� `..a: REG irS1ERED MASTER £LECTR'I �`�pN�'°.` t� ; STpT.fWYDE ELECTRIC I NG' ROB,E;RT 4d Hdhk 'z KINSTABLE %4ilivA IPA g-JAIDI'- . MA 0;1827 0174 /I i Date......... ........................ TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that ........... has permission to perform ........................P........ ....................... go wiring in the builf... .............................................. t 7 a ...................................... North Andover,Mass. Y- w ...eA4.:-.5r. Fee..IZ5.................Lic.NoA.1-037..........IA"�. 7, 0z.wwaav! .................. ELECTRICAL INsPEc 41 . V To� Check g 21-77 1. 21 -82 ( omrnonweaA4 of/V/adjactt:t4jelli Official Use Only Apartment of Jire Serviced Permit No. Occupancy and-Fee Checked. BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1.'071 IC fYG'l)lilllh� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE.PRIYT LYTVK OR TYPE ALL TYFORMATI(.)N) Date: February 21, 2014 City or Town of: North Andover To the Inspector of fres: By this application the undersigned gives notice of his or her intention to perform the electrical work described below-. Location(Street&Number) 22 Royal Crest Drive Owner or Tenant Royal Crest Apartments Telephone No:978-681-1822 Owner's Address 50 Royal Crest Drive North Am-dower, MA 01845 Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Boa) Purpose of Building Commercial -Apartment Buildings Utility.Authorization No: Existing.Service Amps / Volts Overhead ❑ Undgrd ❑ 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: Ware Temp Generator and run new UNDERGROUND FEEDER TO REPLACE DAMAGED FEEDER AND RESTORE POht R TOB I DIN 1 Completion o thefiX,mIng table in.av he ii.,aiiyed by the Inspector o 'TT'ires. No.of Recessed Luminaires Nig.ofCeil.-Susp.(Paddle) Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ I n- ❑ o.o mergency. ig ting 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 an Initiating Devices No.of Rangcs No.of Air Cond. Total No.of Alerting Dcvices Tons g No.of Waste Disposers eat um um ons KW Self-Containe TotalP ........ .._. er o.o Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ other Connection, No.of Dryers Heating Appliances KW euritySystems:* No.of Devices or Equivalent No.of WaterNo.o No o KW Data Wiring: 1?eaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP a ecommumcationsWiring: No.of Devices or Eq uivalent OTHER: .Attach additional detail,ifdesired rir as,required Fit the,Inspector`nf f-Yires. Estimated Value of Electrical Work: (When required by municipal,policy) Work to Start: 02/21/2014 Tnspections to be requested in accordance with M-EC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue utiless 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 e dmibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑X 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. n T ALIC.NO.: A10737 Licensee: Michael J. Parziale Signature., LiC.NO.: E20269 (%f aj�plicable,enter "exeml)t"in the license nionber linea Bus.Tel.No.• 781-322-9344 Address: 50 Branch Street Malden, MA 02148 alt.Tel.No.: 7R1-122-31na *1'cr M.C.L.c. 147,s.57-61,sccurivy work rcquires Depart►ncnt of Public Safcty"S"Liccnsc: Lic.No:. s3 GO 001021 OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee.does not have the liability insurance.coverage normally required.by law. By my signature below,l hereby waive this requirement. i am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PEJU11T FEE. $ tf;Lr,6)d ` The Commonwealth of Massachusetts Department of Industrial Accidents �� T" - ..••�ra Office of Investigations 600 Washington Street y Boston,MA 02111 www.muss.guv/dirt Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please PrintLegibly Name(Busincsslorgani7,ltiot�Ilndividual): The Electricians & Co., Inc Address: 50 Branch Street City/State/Zip: Malden, MA 02148 Phone#: (781) 322-9344 Are you.an employer?Check the appropriate box: Type of project(required): 1,EK i am a employer with 15 4, ❑ 1 am a general contractor and 1 employees(full and-'or paittiine).x have hired the sub-contractors 6. ❑ New construction 2.❑ I am a.sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling. ship and have:no employees These sub-contractors have g, ❑ Demolition. working for me in_any capacity, employees and have workers' 9. 'E]Building addition [No workers'comp.insurance comp.uisurance.` required.] S. ❑ We arc a corporation turd.its 10.❑X Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 1.1.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required]+ c. 1.52. §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] '=Amy applicant that checks box#I must also fill out the section below showing the ir'workers'compensation policy.information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors`must submit<t new attidavit indicating such. *Contractors that check(tis box must attached an additional sheet showing the name of the sub-contractors and state whether or not those 6whics have employees. if die sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policV'andjob site information. Insurance Company Nance; Hanover Insurance Company Policy#or Self-ins. Lic. 0: WHN 6055762 Expiration Date: 09/01/2014 Job site Address: 50 Royal Crest Dr. Building 22 City/State/Zip: North Andover MA 01845 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 copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. 1 d6 hereby certify under the pains n►id per hies of perjury that the infortnation provided above is true and correct. Si nature: Date: Febrary 21 2014 Phone#: (781) ;12-9344 U 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#: ACORD CERTIFICATE OF LIABILOTY INSURANCEDATE(MMIDDIYYYY) 08/21/2013 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 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 CONTACT NAME: Appleby & Wyman Insurance Agency Inc. PHONEo A AcNEll: 978.922.2288 AiNe;978.922.2731 152 Conant St. E-MAIL Beverly, MA 01915 PRODUCER CUSTOMER ID#: 00003385 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Citizens Insurance Co.of Amer. 31534 The Electricians & Co. , Inc. INSURER B: State Auto Ins. Companies 25135 50 Branch Street INSURER C: Hanover Insurance Company 22292 Malden, MA 02148 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 13-14 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 LTR INSR WVD POLICY NUMBER MM/DD/YYYY MMIDDIYYYY LIMITS GENERAL LIABILITY ZDN60559470 09/01/2013 09/01/2014 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE PREM SESO RENTE a occurrence) $ 300,000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ 10,000 A PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 21000,000 POLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY BAP2360955 09/01/2013 09/01/2014 COMBINED SINGLE LIMIT $ (Ea accident) 11000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ B X SCHEDULED AUTOS PROPERTY DAMAGE X HIREDAUTOS (Per accident) $ X NON-OWNEDAUTOS $ $ X UMBRELLA LIABX OCCUR UHN628048 09/01/2013 09/01/2014 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE C AGGREGATE $ 5,000,000 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLO ERS'LIABILIITY YIN WHN605576209/01/2013 09/01/2014 X I ORY IMITS OETHANY R C OFFICER MEIMBER/EXCLUDED?ECUTIVE❑ N/A E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 11000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $ 1,000,000 i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover Attn: Wire Inspector AUTHORIZED REPRESENTATIVEnncttul� 1600 Osgood Street Nonth Andover MA 01845 Lisa Marciano/LFRENC ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD f 9972 Date...3.— ... ......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING ass^CH This certifies that .................................... 4�7.................. ........... .. ........... .......... has permission to perform . wiring in the building .. 0 ... ........ ........ ....................... ................................... !4f ..T. ....... ......... ........... at.$.P..�h North Andover,Mass. 2 fir-- 0-7 3 7,61 --0;;— Fee...i................. Lic.No.............. .................. ELEcnticAL IN ncroR// Check # Inommonwea&of W amac4ajettj Official Use Use On ly -LJepartment o�.}ire�ervice� Permit No. %�J Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (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 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) 5O Royal CreSt DrIVe Building,#,2a 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 X❑ (Check Appropriate Box) Purpose of Building Commercial -Apartment 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: Install 6 Gell Packs! Completion of the following table may be waned by the Inspector of bPires. 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 [1n- ❑ o.o Emergency Lighting rnd. rnd. Battery Units 6 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 I{W Security Systems:* No.of Devices or Equivalent No.o Kit No.o No.of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wirin : No.of Devices or E uiva ent OTHER: Attach additional detail if desired, or as required by the Inspector of I gyres. 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. LIC.NO.: A10737 Licensee: Michael J. Parziale Signature C.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 re uirement. I am the check one owner owner's amt. q ( ❑ ❑ Owner/Agent Signature Telephone No. PERMIT FEE: $ 125.00 d VilL Vw UIUL111tW1,U111' lit "tULlJJUL4;u:IL'1" rciriiii i.�. c/ < >< _ BtVarWtrlit of public Lattt� Occupancy b Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3190 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORE All work to be performed in accordance wilh the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date July 11 , 1997 Q(j){ or Town of_, —No. Andover To the Inspector of Wires: The udersigned applies for a permit.to perform the electrical work described below. Location (Street & Number) 22 Royal Crest Drive Owner or Tenant Royal Crest Estates Owner's Address Same Is this permit in conjunction with a building permit: Yes ❑ No ® (Check Appropriate Box) Purpose of Building Residential Multi—Family Utility Authorization No. Existing Service Amps _I Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Hol Tubs o. of Tiansformers Total N No, of Lighting Outlets I KVA Above In- No. of Lighting Fixtures I Swimming Pool grnd. ❑ grnd. ❑ I Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners I Battery Units No. of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection end No. of Ranges I No. of Air Cond. tons Initiating Devices No.of Heat Total Total No. of Disposals I Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers I Space/Area Healing KW Detection/Sounding Devices 7— KW Municipal. .�—;Other No. of Dryers Heating Devices Local CI Connectioh C •_ No, of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: Remove and replace (49) existing 120V T)f~ red build-i h� - (existin beacons do not ijork) INSURANCE COVERAGE: Pursuant to the requirements of I.iassachusens general Laws _ I have a current Liability Insurance Policy including Completed Overalicins Coveraoe or its substantial equivalent. YES NO L_ i _ have submitted valid proof of same to the Office. YES = NO = If you have checked YES. plesse.inoicate the type of coverage by checking the appropriate box. INSURANCE X BOND = OTHER = (Please Soecily) (Expiration Dater: Eslimated Value of Electrical Work 5 3 200•00 ��D Work to Start 7/15/97 Inspection Date Requests : Ro Final Signed under the Penalties of perjury: 14302A FIRM NAME Ando I No. Robert J Branca Signatu LIC. NO. Licensee 8 475-4995 Bus. Tel. No. —1 1 2--- k Duo 21 1 Address 206 Andov C S Art. Tel. No. _ OWNER'S INSURANCE WAIVER: 1 am aware that the Lice ee des not have the insurance coverage or its substantial epuiva!ent as re- quired by Massachusetts General laws. and that my signature re this cermrl application %valves this requirement. Owner Agent (Please check onel Please fj Teleohone No. 7 EfiI 3 iI (Signature or Owner cr Agent( ILyS s 5°3i M Jul 1 8 Imi BUILDING DEI°'iW"1-_nJTI � . � 1 Date.......�... .. .... .J . 1065 NORTI{ TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACOUSEt This certifies that ......kJ.0... ....R.......)r.. _ n has permission to perform ..... ...... .(.U.f2.4?�.. .. .. >!.� �.: wiring in the building of.....vt .(1 .Cc.�....C.� . ....... S ....... at.....7..�......ko..,1. . ��5 ... North Andover s. Fee...f .. tLic.No.M) .,Z!` ./i . .......... + ELECT RICAL'INSPECTOR - - 1 08/14/97 12:01 154.04 PAjjnn WHITE: Applicant CANARY: Building dept. PINK PreaSurer if1AbbAUHU5tt Ts UNIFORM APPLICATION FOR PERMIT TO DO PLUMUINU (Print or Typal NORTH ANDOVER, , Mass. Date .t0� Building Permit # Loca//t��ion A2) Name'a New ❑ Renovation ❑ Replacement Pians Submitted: Yes❑ No.❑ FIXTURES ..._•...- w s 1 � « Xw i < v ~ sr M a R M M s at ae O M a o » M M h s M 16a s 1- V s O O s r ~ `_• a► i ;O F ; �e Y s al >s a " s a IL K w > H O 2a at 0 $ M r rF O 0 7C 0 s H M 9 0 0 s s 10 i 0- sua—�sMT. eAe�M•NT ISTFLOOR Ivi !NO FLOOR . IIAD FLOOR 4TH FLOOR ITH FLOOR aTH FLOOR, rTH FLOOR •THFLOOR - Check one: Certificate Installing Company Name /U d/6ec��6151� Address (3 Partnership ' ❑Firm/Co. Business Telephone C>-D Name of licensed Plumber ��� INSURANCE COVERAGE: Chack 0-- 1 have a current liability Insurance policy or No substantial equivalent. Yes IT No ❑ It you have checked y", please /IrWicate the type coverage by checking the appropriate box A liability Insurance policy Other type of Indemntly ❑ Bond O OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Maas. General laws, and that my signature on No permit application waives this requirement. Check one: SIgnOwner ❑ Agent ❑ a Ura o Owner a Gema s en I heraby certity that al o1 the details and Information 1 have submitted for enlaced)In above application are true and&=urate to the best of my knowledge and that all plumbing work and Installations performed under theparmlt lamad for We application will be In compliance with an pertinent provisions of the Massachusetts Slate Plumbing Code snd Chapter 142 of Mss r laws. By Ute TNN of Ucensed Plumber city/Town ;' I 90996 Ucense Numbec % Af'f'RCJVED(OFFICE USE 0WYI,,._.-, �_. __._ Type of Plumbing License: Master Journeyman ❑ _ -.r rG. --1.a.r•'Y.R'M�.�^'�Y�. 4. .a � iar'a^i4'#dYG__"i'�.� ..r4.i:..,- ....., �vy.�.w,.. ,.....-o.-..,.` �. Date.q 12 2881 NOR7h �', ��° •1�0 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING CMUS� This certifies that A h-.&.Y. t �`. . . . � �. . r . . . . . . has permission to perform !fir. . . . . . . ;. . ' plumbing in the buildings of . 6?. . . . . . . North.Andover, Mass. rFee; �.r.'. . .Lic. No.: } . . �- �LUIVIBING INSP TOR 04/16/% 13:27 25:00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File .,`�v ."...1. .a ..yC .y •A,,,.^ ._.....��- �.. ra+...:.n:; "' ..:^..�;:.• 4=7t ETTS UNIFORM APPLICATION FOR PERMIT TO DO^QASFITTINQ (Print or Type) NORTH ANDOVER , Maas. Date t g _ � Building Locatlon � T Owner's Name 2 s° New O Renovation 0 Replacement 03" Plana SubmRted:. Yea E) No El n h s a ri a at 1- o rn w C Q a 0 tt w at a 11-- o d0 0 16 0 a u° C s a o .RUQ—t3oMT. .ti ®ASIRMENT , 110TFLOOR 12NO.FLOOR Tf I - 3RDFLOOR 4TH FLOOR OTH FLOOR I OTH FLOOR s 71rH FLOOR I , OTH FLOOR Check one: Certificate Installing Company Name > •e Address y - v Q Corp. L' t` d Partnership UFirm/Co. Business Telephone f - f WO O.- Name of Licensed Plumber or Gas Fftter ,_jti INSURANCE COVERAGE: Check one I have a current Ilablifty Insurance policy or Its substantial equlvalent. Yes O No 11 If you have checked,yea, please Indicate the type coverage by checking the appropriate box. A Ilabli ty Insurance policy O Other type of indemnity O Bond O OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signatute of Owner or Owner's hent Owner 11 Agent O I hereby certify that all of the details and Information I have submitted(or entered)In above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all ' pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the all Laws. TI of License:TRle Raster umber gna urs nae Plumber or as er aslltter City/Town License NumberG S C�Joumeyman /1 T00 O(OFFICE USE ONLY) C BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO, APPLICATION FOR PERMIT TO DO GASFITTING- NAME d TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFTTTER -•.. UC: NO. PERMIT GRANTED DATE GAS INSPECTOR I '.�. Date. . : &O T qti TOVIi1Q/ NORT PERT FOR H ANDOVER o�o�tt a.e oa� �Op A * ALLATION No, SA US" _ . or This certifies that . . . '61-elf4 . . . . . . . has permission for gas installation,. K4-'', .�' in the buildings o /. . .�. ::. ' . . . . . . . . . . . : . . . r at .� :# -. .j North Andover, Mass. F ,S . Fee. .�5. . . . ic. No, . . . . . . . . . . . . . . . . . . . . . .. . . > , � GAS INSPECTOR etc � WHITE:Applicant CANARY:'Building Dept. PINK:Treasurer GOLD: File THE COMMONWEALTH OF MASSACHUSETTS 1 k 0D TOWN OFNORTHANDOVER BOARD OFHEALTH Date: DECEMBER 30,1996 Permit#: 0019-7 This is to certify that: ROYAL CREST ESTATES, 22 ROYAL CREST DRIVE,NORTH ANDOVER,MA 01845 IS HEREBY GRANTED A DUMPSTER PERMIT This permit is granted in conformity with the statues and ordinances relating thereto, and expires DECEMBER 31,1997 unless sooner suspended or revoked. Gia t r goo ;;Caarma, Francis'"1 'acN ,� ' 15dih n' Rizza D MeD. 'lYlem er, r "- u `7 { TOWN OF NORTH ANDOVER BOARD OF HEALTH TOWN HALL ANNEX 146 MAIN STREET NORTH ANDOVER, MASSACHUSETTS \ TELEPHONE# (508) 688-9540 APPLICATION FOR DUMPSTER PERMIT ` JJ PURSUANT TO SECTION 31A AND 31B OF CHAPTER III OF THE GENERAL LAWS, AND RULES AND (P REGULATIONS OF THE V NORTH ANDOVER BOARD OF HEALTH DATE Application is hereby made for a permit to maintain a dumpster (s) on property located at Royal /V,A& J6,te- in accordance with the rules and regulations of the Board of Health. / Number of Dumpsters: Check use: ( ) Residential use ( ) Commercial use ( ) 30 day temporary '�� ( ) Annual Name of applicant: 0 [ Owner of property: J= /� Telephone#: Dumpster Company: (3 rOLAjv :n Telephone#: Pick-Up Schedule: Sc,- vs-cla-yj Trash Contractor: Frequency of Pick-Up: c3ne_-Q ex S On the bottom half of this form, please sketch an 6utline of property, showing the proposed location of the dumpster (s) . Give distance from dumpster to other buildings and lot lines or boundaries . Use back side if additional space is needed. Please . return this application with a fee of $25.00 per establishment ($10.00 for temporary permit) to Town of North Andover, Board of Health Office, Town Hall Annex, 146 Main Street, North Andover, M A 01845.