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Home My WebLink AboutMiscellaneous - 26 Stonington Streetr1l) ON W �j 0 0 t4 En tTl 9 This certifies that Date................... A .......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING has pennission to perform ............... . ............................................................................................ wirin in the building of ............... 9 ................................................................................................ at ......................................................................................................... . North Andover, Mass. ;e ............. ............... Lic. No . ........... ...... ................... ..................................... .. ELECTRICAL INSPECTOR Check # N C.Ijetieueahl, ol Namaclit., ipm BOARD OF FIRE PREVENTION REGULATIONS �to' oiii�ial use (inly Print Form Permit No. 0ectillancy aful . Checked 'Rev. 11071 (Ieac APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK %11 wotk to he licifornied in accoidance with floe Mn%sachtswas 1-1cchical Code (W -C). 527 CMR 11410 mum mun, iN iNK ol? rrpr.- Am, xronm nojv) Date: 1,17 9/ City or Town of: ovw Ah Jovet/ ro the fnspector qf1fire.v: By (Ins applicalion the toidemirmic-d gives notice of hisor her intention to perlonn the electrical work- described below. Location (Sirees & Number) Vo )w, J0 V1 Owner or 1'enant &LO C3 Telephone No. Owner's Addre%s Is this permit in conjunction with a building permit? Yes E01 Nip LJ (Check Appropriate Box) Purpow of Building wl Solar - PV Utility Autherivalion Nit. nfa Fifisting %ervice Amps Jolts Overhead Ll tindgrdE] No. of Meters New Service Amps Volts Overhead Ll Undgrd F] No. of Meters Number of Feeders and Ainpacily Location and Nature of Proposed Electrical Work: Install Solar Electric - Pholovollaic (PV) system panels) rated kWAX @ S.T.C. Grid Tied. In conjunction with a Building Perfffit. I'- J'ah... Ao..6.11 ... h., it... No. of Recessed Luminaires - - - No. of Ceil.,Nusp. (Puddle) Fans -- -- - - - - --- - - - � I _ _.1iFi -- -1 . .. _- No. of a I;i Transformers KVA No. ofLuminalre Outlets No. of Hot Tubs G encratan KVA No. of Luminaires Swinuiling Pool Above [I In- Prod. Prnd. 0 No. of RmeFg`F5fy-TTXTfi`ng— Baum Uidis PIRF Mw lit ficti-dioll And 111ii-ialing Dul ice% 'Noto. (of AlvrlinV 11mirt., m Inli.-Ipal "oe'd other Necurity S I Ms. No ai 11evices fir Equlval!rp� Dats Wiring: No. of Ilit-vi"s or E(juivalcut No. of Receptacle Outlets No. of Oil Burners No. of Switches No. of Gas Burners No. of Ranges No. or Air Cond. Tons No. of Waste Disposers I eat Pump Totals: I r6mber kiv— No. of Dishvirashers SpacelAres Heating KW Ilealing Appliances KW No. of Dryers a. of Water Heateors; KW . 0. it No. (of Slaus Hallam% f No. Ilydromassage Bathtubs No. of Motors 'fatal I IP "Felei'an-unu-nTe'ations wiring: No. of Devices orEquivalent 10THEI46 A ftelt-haddifiesnahleffid olldrsiorst. ow oros jr(pohrethol- the, lowliet-hir oil 111ism R1.0rY-),Q!2 (Wltcnrcquiredhyinuiiicip.illwtilicy.) Work Ito Start: A.S.A.P. lospe lintis to be re(Iticsfed in accordance with MEC Role I O.and 11111111 complellim — PC INSURANCEC4WERACE: I hiless u awed by the owner, no permit for the locrhirinaticc of electrical work inq i %slic 11111cm the licensee provides prow til liabilliV iiIS111alk-C ilit-11116118 **o,;UJnplo:t;;d eupcia6ean" coverage fir its sulistaimal etloi%alcni. 'I lic ondersignctl ccililics that such coverage is in force, and has exhibited protiful'sairic let the liennit ifsiiing office. CIIECKONF: INSURANCE* a 110ND [I OTJIFR I reoloy', under floe pains andpenattlers ofperjury, that the infin-matioss an Ilik applif-ation is trur and camplete. FIRM NAME: SOLARCITY CORPORATION 1.11C. No.: 1136 MR Licensee: Matthew T. Markhain Signature UC. No.: 11 i6 �R Mehl' "I'AMN/J1 he Me- fif-MIS41 IUM111111' h1w) Bus. 1'el. No.: 774-258-8180 Address: ' 24 St - Martin Drive (Buildinq 2 1 Unit 11). Marlborough, MA. 01762 All. Tel. No.: 774-258-8505 "Per M.(o.l .. e. 147, s. 57-61, security work requires Department or i,obiic Safety "S"' License: Lie. No. OWNER'S INSURANCE WAIVER: I am aware that (fie Hucissee thees ##()I have (lie li, iffily institance coverage oormally required by law. By iny signature below, I hereby waivc this nNoirenient. I am the (chcc onc) U owner LJ owner's agent. Owner/Agent Pr., 4 1 T r, A. r. Signature Telephone No. i.13E&Mvf of Consumer Affnin& HuxintaRtgulation E IMPROVEXENT CONTRACTOR R"isl(AtUM 168572 Type CYPIMUO'n 302015 Supplement SOLARCITY CORPORATION MATTHEW MARKHAM 24 ST MARTIN STREET BLD2UN1 [ALBOROUGH, MA 01752 tiodeweretary ROMM2 VEALTH gig -Isz SaAm cw FLECTR 11C I ANS ISSUES THE FOLLOWING LICENSf AS V REGISTERED MASTER ELECTRICIAN SOLARCITY CORPORATION MATTHEW T AARXHAM 24 SA I NT 14ART I IN OR BLDG 2 UNIT 11 MARLBOROUGH MA 01752-3060 q'4- Mal- 43 The Commonwealth of Massacionseus Department ofIndusitialAccidents 0ifice Of In Vestigadons 1 Congress Stred, Smile 100 Boston, MA 02114-2017 wwwmaiLgovIdia Workers' Compensation Insurance Affidavit: Builden/Contractors/Electricians/Plumbers Allglicant Information Please Print Legibly Name (Business/orguni7ationnndivid SOLARCITY CORP Address: 3055 CLEARVIEW WAY : 0MI M1% I Cu, %4A r,none v: 000- t vu--t—F Are you an employer? Check the appropriate box: Type of project (required): 1. N I am a employer with 5000 4. [] I am a general contractor and 1 6. El New construction employees (fulland/or part-tiwe). 2.[] 1 am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. 7. n Remodeling ship and have no employees These sub-contrwAors have & El Dcmolifion working for me in any capacity. employees and have workers' 9. [] Building addition (No workers' comp. insurance required.] comp. insurance.1 5. We are a corporation and its I O.E) Electrical repairs or additions 3. 0 1 am a horneowner doing all work officers have exercised their I I.0 Plumbing repairs or additions myselL [No workers' comp. right of exemption per MG1. 12.E] Roof repairs insurance required.] c. 152, § 1(4), and we have no 13.X Other SOLAR / PV employees. [No workers' comp. insurance required.) sAnyapplicanilhatchecksbox#1 mustalsofill out thcscCtim below showing their workerq'corripcimation policy intotmation. 't llorricownews who submit !his affidavit indicating they are doing all work, and then him outside contractots must submit a nc%v afridavit indicating such. tContfactors. that eftek this box must attached an additional sheet shouing the name of the sub -contractors and state whether or not those entities have employ=. ir the sub-contraclors; have employees, they must provide (heir workas'comp. policy number. Inman employer that isprostiding workers' compensation insaranceformyensployees. Below isthepolicyandjobsife Information - Insurance Company Namc:_LIBERTY MUTUAL INSURANCE COMPANY Policy N or Self -ins. Lic. 0: WA7-66D-066265-024 Expiration Datc: 09/0112015 JobSitcAddress: 2�0 S±Qamckn �(�----Cily/statefzip:_X OL+ �_Anjwq�L tww 0 1 e. q Attach a copy of (he workers' compensiLn 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 finc u,p to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the rorm of a STOP WORK ORDFR 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 Officcof Investigations of the DIA for insurance coverage verification. I do hereby cer-16& ander the pir aidesofperj y of e beformallonproWdedahope Is true and correct . - I A I hilt, Phone#: - - -- - Offlcial use opslj% Do not write In this area, to be completed by dly or town offtelal. City or Town: Permit/License 0 Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Elec(rical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 10 ACCORD CERTIFICATE OF LIABILITY INSURANCE DATE (NINUDDIVYYY)o 09790114 I ka� CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED 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 pollcy(ies) must be endorsed. It SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endomemeft A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER MARSH RISK & INSURANCE SERVICES CONTACT KANE: MORE fAx 345 CALIFORNIA STREET, SUITE I NO rak,"Lol!"i (ArC. NO); CALIFORNIA UCENSE NO. 043?153 SAN FRANCISCO, CA 94104 ADDRE33: 5 100,000 fN1S!!RER(SJ AFFORDING COVERAGE NAIC 8 "8301-STND-GAWUE-%i5 INSURER A: Liberty Mutual Fire Insurance Company 16586 INSURED INSURER 8: UtiedyinsuranceCarpoiation '42404 Ph (6M) 963,5100 Solmoty Corporation INSURER C: NIA NIA 3055 Clearyiew Way INSURERC: San Mew. CA 94402 GENERAL AGGREGATE $ 2=.0w INSURER E: GERL AGGREGATE I [MIT APPLIES PER INSURER F., COVERAGES CERTIFICATE NUMBER: SEA -002440269,02 REVISION NUMBER: 4 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 REOUIREMENT, 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. E XCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS, INSR ADDL SUSR: POLIC . YEFF Poucyao- ;INSR LTR TYPEOFINSURANCE WVQ POLICY NUMWA IMMIDDIYYM I IMMODfYYYYI LIMITS A GENEM LIABILITY T87-661-066265-014 09.'0112014 EACH OCCURRENCE S 11.000M 10010015 x ;COMMERCIAL GENERAL ILIABILITY DAMAGE TO �RE NTED PREMISES JEa otpInew I I 5 100,000 CLAIM64MOE X I OCCUR MED EXP (Any.qno person) S 10.000 PERSONAL A ADV INJURY IM.00D GENERAL AGGREGATE $ 2=.0w GERL AGGREGATE I [MIT APPLIES PER PRODUCT COMPIOP AGG $ 2,000,000 X I POLICY,'_ X � PRO LOC Deductible S 25�0 _"i A AUTOMOBILE UASILITY AS2-66i-M265-0" owomm IM911015 COMBINED SINGLE L WIT (EsPockle"l) $ 1.00.000 x ANY AUTO BODILY INJURY (Per person) ALL OININED SCIILI3ULEI.) BODILY INJURY (Poramddr") $ AUTOS AUTOS I NON WMED PROPERTY DAMAGE x x HtREDAUTOS AUTOS (Per accKlory X iPhys. Damap COMPICOLL OE11. $ $110001$1.0001 UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS UAD CLAIMS MADE $ 1 DEC RETENI;ON; - 6 W ORKERS COMPENSATION WA7MO-OW265-024 1%1011014 10910112015 —INIA� X W. STATU- OTH-1 AND EMPLOYERS' LIABILITY N Y I WCI-661-W265-034 (WI) !09JOI/2014 0910112015 ; TORY LIMITS, ER i Aw PROPRtETORIPARINPAIEX tCUTIVI: E L EAC#1 ACCIDENT OFFICERN.EM EREXCLUDED7 WC DEDUCTIBLE-. S350.0W B (Mandwtofy in NHI E L 1) SE ASE - EA EMPLOYEE, S 0 descnba under 61OSSCRIPTION Of OPERAVIONS V L D:SFASF POLICY LIMIT 1 $ 1.00010w DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES lArtach ACORD i0l, Additional Remarks SeNdWe. IT more space Is required) Firdeimolinsuranoe SdarCdy CorporaW 3055 Cleatview Way San Mateo. CA 94407 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh Risk & Insuronce Services Charles Mofmolejo -=:7� -oz". 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D m t r z > < E -1 -22 0. 4! �!j z 2 E 0 z c 0 0 Su c 0. -,o lo x x -�i + 0 -o 1 u u E 0 < z .5 0 > z 020 t5 o 3: or- 0 O-rwouv)(i 0 x r� u % uz :tf to :2 :!� - W, 0 M, c 0 E = 2 2 u 0 a w. -@ c u *Z a OD C; M > 0 o t -- w W U u z m Z4 5 E 0 E tj u o o z > cm w > + C 0 v z E E N NN z o 'E x m x m wl -a E E x m 4) 08 x ,A ol 'A a, 0 ul t E Ln. D m r z > < E -1 -22 0. 4! z 2 E i c 0 0 Su c 0. -,o lo Lu CL c x 0 0 0 1 u u E 0 < z .5 0 > z to 0 11 I Q) u m wl -a E E z 4) 08 LU ,A 'A a, 0 CA D m r z > 2 z 2 a i c 0 Lu CL -C Ln z > z 020 t5 o 3: or- 0 O-rwouv)(i 0 , r� u % uz :tf to :2 :!� - W, 0 M, c 0 E = 2 2 u 0 a w. -@ c u *Z a OD M > 0 o t -- w W U 0 i: -f -T 6 - u -00 > < - .!= .0 01 -C 'Ei -0 E .S > -or & 2 2 0 z 4.0 0 0 v m E BO* m L4E-600wli 2 > a cc '7 CL r - 0 0 w (D cu E CO -C 0 L< a - 0 Ln I I t 11 I 9458' Date.. 4.:,;. /zz % .*.. 4a ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... OL�-,l ....... A�11.6.p .......................................... has permission to perform ........... ......................................... wiring in the building of .... z e, x �/ ...... /-,9f k, -4 Z, z �ie K, t I x. E, ........ 5�7 ............... . N&rth Andovei, Mass. Fee..._? ........... Lic. No. 7,4 ............. e .......... �&crRICAL INSP�49-RV Check # 3 77 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 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 orcorporation 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 oforigoing 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 entitNstated on the permit application. n 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 th ' e 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. 8 — Permit/Date Closed: 0 Permit Extension Act — Permit/Date Closed: *** Note: Reapply for new permi,5,,—, .C-\ Commonwealth of Massachusetts Depattment of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 9 Occupancy and Fee Checked ,[Rev- 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfonned in accordance with the Massachusetts Electrical Code (MEQ, 527 CMR 12.00 (PLEASE PRflVT 17VUVK OR TYPE ALL MFORMA TION) Date: ),.Ar*\p _ ) Z , 2t)jip City or Town of.- NORTH ANDOVER To the 7nspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) I � — 24 411211 Ln� OwnerorTenant V"&4m C,Lae- ^o Telephone No. Owner's Address -,5 )A)2 kf:!� Is this permit in conjunction with a building pennit? Yes No 2' (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead Undgrd No. of Meters New Service Amps Volts Overhead UndgrdEJ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: c�Lk\ C,\,r< Completion of the followine table mav be waived bv the InsDector of Wires. No. of Recessed Luminaires No. of Cefl.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above Ei In- Swimming Pool Md. RrIld. No. of Emergency Lighting BatteEX Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS INo. of Zones No. of Switches No. of Gas Burners Detection and Initiating Devices No. of Ranges No. of Air Con Total d. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: I Number I Tons , JKW No. -o? Self -Contained DetectiowAlerting Devices I I I No. of Dishwashers Space/Area Beating KW Local El municipal El Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water Heater. KW s No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total UP Telecommunigtions Wir�,Mg: No. of Devices or Eguivalent OTHER: Attach additional detail tf�destre4 or as reqwred by the Inspector of Wires Estimated Value of Electrical Work: (When required by municipal policy.) lllur� U., Siart: inspmdons !u bc requesied in accurdance with IVIEC Rule 10, and upon completion. (a aid INSUIL&NCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless He, Z :--".A:-jE 4;CC - - - I- cnsc-c providcs in-u-i-Han"o- snCiuutsi 1--r'C, -- -.- --.L-' — vaicnit. T �Cl ky, .. . ....... . ..... .. ...... uol,ui Zial= 1U L11= JJC11111t 1��Ulllj� V"11%.C. 1Z, III rJl�,Z, =!U !I= C. ULLCU F� T-, TCT TT', A T�- i --o, �- 77 r7 i- 13% it V I J 1 4 t.1 C t it A\ L -j I,% rc.-s'.7 C.—!� un dt-T alid U - --------- : ---- ---- - J P, -'J"i e i Pffiallies . I 11JUL Lf9t: &11JU1"UUSU11 U11 1111a 11,UPILLULIU11 13 411ZE: U:ZU LV.. =U. FIRIMNA WI: CTO'(11011", I P U-fiv ltl Address: LIC. NO.; Fe— —1M ;W T'e-l* N—o.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" Lice I ,, \11� OWNER'S INSURANCE WAiVER: i am aware ihai ihe Licenstt db_p_s -_- Immig ihp_ liAhiiii.- in�ssr�nt_-� r-�LVtrw, C,e nu- ny required by law. By my signature below. I hereby waive this requirement. I am the (check one) [] owner 0 owner's aae—V-1 Owner/Agent i Signature Telephone No. PERMIT FEE. S J BOARD OF HEALTH C 'hgirman NORTH ANDOVEH Z-, FAASSACIIUSIETTS George &ron .,d\,%.;Ird J. SC;InIon (',OIAPI.ATIFP REPORT TIL CS�1-6400 Date Mide By— Tcl Address Nature of Go-nplad-nt - 7 -11f - U r I f ocmipant —Location Address Owner or AEcnt '11 ITS LTNE DO N(Yr MlITE Date I IvCstigat d— , d Ref erre Result Of Inves"iE;ation