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HomeMy WebLinkAboutMiscellaneous - 28 ROYAL CREST DRIVE 4/30/2018Y� �l r Date ... .......... TOWN, OFINORTH ANDOVER PERMIT FOR WIRING .......... This certifies P.0,0 ............................ .. / .... ( . .. ... ........... ... has permis sion to perform wiring in the building of ....... ....................................................................... at ........................ ....... �orth Andover Mass. Fee .............. . ........ Lic. No 11 Check # T!� 7 r- 0 , Commonwealth Of Massachusetts BOARD OF FIRE PREVENTION REGULATION$ DePartment of Fire Services Official Use only Permit No, -Q46-� Occupancy and Fee Checked (ev, 11/991 I kleave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance th the MOSSachusetts Eloclrical Code (MEC). 527 CMR 1 .00 (PLEASE PRINTIN INK OR TYPEAL4 JN1,,0 Wi 2 City or Town of: NOT RA�4 TION) Date: A By this application the u T -k kickolvo-y- e_34fqiL�.�� nders' TO lh� Inspector of 'res: 1glied gives notice of F1s­o`rT_er­1_"n_tention to perform the electrical work described below. Location (Street & Number) IZ-0 Owner or Tenant _A-Y'Aco moy-T�_ 18��Mc� 0 1 Owner's Address Is this permit in conjunction with 0 building permit? Yes No PUrPOseof Building_ Dviens (Check Appropriate 13�0x!) Existing set -vice Amps i_bl� Utility Authorization No ------------------- Amps --Volts Overhead R UndgrdE] No. of Meters —Volts Overhead R Undgrd No. Of Meters Number of Feeders and Ampicity— Location and Nature of Proposed E lectrical Work: tKI at I ^C' , - wIn fatile ma be waived b the Ins 'eclor o Wires, 0.0 0 a Transformers KVA Generators KVA 0 0.0 miel 1, ;�I:!1;12�i� g ng — atte Units — FIRE ALARMS No. of Zones .0 Otec on' an — Ini 18tin Deyie s — No. of Alerting Devices Municipal - Connectinn 0 Other s or I Data Wirt Sl ----------- Uallasts nX: No. Hydr No f ices or, gguivalent e ecofflin' T'N Omassage Bathtubs I)ev No. of Motors muiiir Total HP C. No. of Devices 6 un c "T OTHER: 7eeNcjoo:� f Dley or Equivalent L___.� 01 G�t� �& \,�X 9 -\- INSURANCE COVERAGE: Attach additional detail tl"d or aj requ ;rea OY file Impeclor ql`Wires, Urlle,ss waived by the owner, no pormit for the Performance work may issue unless the licensee provides proof of liability insurance including't�ompleted 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 F' BOND [3 OTHER F] (Specify: Estimated Value of Electrical Wor TI-7x—PlIftlion �Date) Work to Start: lkllio_u_�n_ (When required by municipal policy,) Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, t4 n de 7�,-,-, r the pains andpenalties, ofperjury, thal the Information on this application is true and complete, FIRM NAME: N \10 r Licensee: Signatur L I C. N 0. (Yapplicable enter "&6n1pl­ 1h Address: '�b in e licepe number line.) LIC, NO.: 0 URUN '81 ,S IN�S OWNER IS iNsU 2oit-YT LN Pr dt) Bus. Tel. NO, - WAIVER: I'L_ required by law. By my Sig am awAare that �lt. Tel, No. - he Licensee does not have the, liability 1 3 Owner/Agent nature below, I hereby waive this requirement. I am the (check one Lnsurance coverage normally Signature owner owner's a rit. Telephone No.------ PERMIT FEE,.-$ a0c _v 0 OL C Loa t,"e afe yml�il C', S e letion o 'the letio" 0 the No, of Recessed Fixtures No. Of Cell.-Silspr. (Paddle) Fans No. of Lighting outlets f r No. Of Hot Tubs No. of Lighting Fixtures Swimming Pool X �Ove No. of Receptacle Outlets rnd. L -J rn No, Of Oil Burners No. of 81vitches No. of Gas Burners No. of Ranges No. of Air Con otal FN Tons No. Of Waste Disposers ea u1nP I lilt, urn er on$ & . Totals. ��= No, of Dishwashers 7 SPace/Area Headng KW No. of Dryers Heating Appliances 0.0 ater XW Heaters KW .010 n wIn fatile ma be waived b the Ins 'eclor o Wires, 0.0 0 a Transformers KVA Generators KVA 0 0.0 miel 1, ;�I:!1;12�i� g ng — atte Units — FIRE ALARMS No. of Zones .0 Otec on' an — Ini 18tin Deyie s — No. of Alerting Devices Municipal - Connectinn 0 Other s or I Data Wirt Sl ----------- Uallasts nX: No. Hydr No f ices or, gguivalent e ecofflin' T'N Omassage Bathtubs I)ev No. of Motors muiiir Total HP C. No. of Devices 6 un c "T OTHER: 7eeNcjoo:� f Dley or Equivalent L___.� 01 G�t� �& \,�X 9 -\- INSURANCE COVERAGE: Attach additional detail tl"d or aj requ ;rea OY file Impeclor ql`Wires, Urlle,ss waived by the owner, no pormit for the Performance work may issue unless the licensee provides proof of liability insurance including't�ompleted 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 F' BOND [3 OTHER F] (Specify: Estimated Value of Electrical Wor TI-7x—PlIftlion �Date) Work to Start: lkllio_u_�n_ (When required by municipal policy,) Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, t4 n de 7�,-,-, r the pains andpenalties, ofperjury, thal the Information on this application is true and complete, FIRM NAME: N \10 r Licensee: Signatur L I C. N 0. (Yapplicable enter "&6n1pl­ 1h Address: '�b in e licepe number line.) LIC, NO.: 0 URUN '81 ,S IN�S OWNER IS iNsU 2oit-YT LN Pr dt) Bus. Tel. NO, - WAIVER: I'L_ required by law. By my Sig am awAare that �lt. Tel, No. - he Licensee does not have the, liability 1 3 Owner/Agent nature below, I hereby waive this requirement. I am the (check one Lnsurance coverage normally Signature owner owner's a rit. Telephone No.------ PERMIT FEE,.-$ a0c 42 C'Molonweaffl; of Alaisachlorseta ))Varfln en f Of III d"strial A ecidents Offlee of Investigations I Congress Street, suite I go Boston�, MA 02114-2017 W"I"10MUSSIgouldia Workers' Compensation Insurance Affidavit Bui.lders/Cointra�ctors/Electricians/Plumbers )nlirnnf Tnfd%V-W"ft"-- Name (Bilginess/Organi7,ation/iiidividual): WCkMprf I'� ............... 10 _n Co Address: An�) J� A k ?A Wt 4- -A AC - :Ariy ippliollit thpt Chdrks boy, it) rni4stalso Fill 1, Out thc scctiOTI below showing Ilicir workers' compensation policy information, Ronle0wilers w1losubillit thi9 affildavit indicating thcy are doing all work and thon hirc oulSide c01ltl`act0fS MlIql. subrnit a new affidavit indicating such, tContractors that ch"Ic tllis box Must attachod in tidditional sheet Showing the name ofthe sub-Mhtractot,� nold gta�; whethgr Or not tlloqe ontitiel ]live cmPloYQvs, lfthesLLb-conirputor,-havt,,ernployee �q, tl'QY Inust Provide thc;ir WOrkers' comp, policy number, ain an employer thar ispro-Viding Workers' compensation jn$11ranCefor 17ry ajjjoplo in rntatiopl. _Vees. BeloW is 00 the Policy andjob site InsuranceCOMpany Narne:6wa& ;�t� POlicY # Or Self -ins. Lic, AM Expiration Date:! J I ell') Job Site AddressZO -;�Qdqt Attach a copy of t1l Cit.Y/3 tate1Zip:.Nh_n4ve9-,M A e workers, cOMPMAHOM policy declaration Page 01101ving the policy number and expiration date), Failure to secure coverage as required. under Section 25A of M.GL C, 152 can lead to the imposition of crimin,,;tl penalties of a fine up to $1,500.00 atid/or One-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and afine of up to $250.00 a diy aga�iDst the violator. Be advised that a cOPY Of this statement may be forwarded to the Office of l"VestigatiOns of the DIA for insurance coverage verification, I do at fhe #�&iriadon Novided a6ove i,5 trije an —I' -A I-" d correct, Q/r1ci171 U.Te only. Do riot ",ritg in fhiy areq, to be CQn1,P1e10d by city or fowl; of City or Town., Pertnit/License # INSUing Authority (circle one): 1, Board of Health 2. Building Department 3 6. Other - Cit'VTOW11 Clerk 4, Electrical Inspector 5. Plumbing Inspector Contact Person - Phone Phone P, 2— Ar ,rou an employer? Check the approp 'A I am a empi,oyer with 4. E] I am a. genel,11 contractor and I or a nd IT T Type of project (required): MnPloyees (full and/or part -ti me).* 2, am a'sole have Ured the, sub-conjra,ctors �'ractors listed the 6, Ll New construction 6' proprietor or partner� ship ati'd have no employees on attachrd sheet, These SUb-contractors. have 7. Remodeling worldro'g, for mc in atly capacity. M1310yees and have woricers D Demolition E [No workens, comp. insurance GOMP, insurance.1 9 9, D.Puilding addition 101 required.] 3. 1 am a hom'cowner 5, We are a corporation and its, I OXE, lectrical repairs or additions doing all worl� mr9olf [Noworkers, ool-np, Offirers have exercised their right of exemption Per MQL I I - 0 Plumbing repairs or additions insurance required.] f c. 152, § 1(4), and we have no 12.0 Roof repairs cmPlOYees. [No workers' MCI Other Comn. M.Turnne-r-, re 111'rArl I :Ariy ippliollit thpt Chdrks boy, it) rni4stalso Fill 1, Out thc scctiOTI below showing Ilicir workers' compensation policy information, Ronle0wilers w1losubillit thi9 affildavit indicating thcy are doing all work and thon hirc oulSide c01ltl`act0fS MlIql. subrnit a new affidavit indicating such, tContractors that ch"Ic tllis box Must attachod in tidditional sheet Showing the name ofthe sub-Mhtractot,� nold gta�; whethgr Or not tlloqe ontitiel ]live cmPloYQvs, lfthesLLb-conirputor,-havt,,ernployee �q, tl'QY Inust Provide thc;ir WOrkers' comp, policy number, ain an employer thar ispro-Viding Workers' compensation jn$11ranCefor 17ry ajjjoplo in rntatiopl. _Vees. BeloW is 00 the Policy andjob site InsuranceCOMpany Narne:6wa& ;�t� POlicY # Or Self -ins. Lic, AM Expiration Date:! J I ell') Job Site AddressZO -;�Qdqt Attach a copy of t1l Cit.Y/3 tate1Zip:.Nh_n4ve9-,M A e workers, cOMPMAHOM policy declaration Page 01101ving the policy number and expiration date), Failure to secure coverage as required. under Section 25A of M.GL C, 152 can lead to the imposition of crimin,,;tl penalties of a fine up to $1,500.00 atid/or One-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and afine of up to $250.00 a diy aga�iDst the violator. Be advised that a cOPY Of this statement may be forwarded to the Office of l"VestigatiOns of the DIA for insurance coverage verification, I do at fhe #�&iriadon Novided a6ove i,5 trije an —I' -A I-" d correct, Q/r1ci171 U.Te only. Do riot ",ritg in fhiy areq, to be CQn1,P1e10d by city or fowl; of City or Town., Pertnit/License # INSUing Authority (circle one): 1, Board of Health 2. Building Department 3 6. Other - Cit'VTOW11 Clerk 4, Electrical Inspector 5. Plumbing Inspector Contact Person - Phone 0 'kf"' ,:E,UECTRI m 'EN?SUHL--M I 6 NEW.,P013 OP ID: LS CERTIFICATE OF LIA131LITY INSURANCE DATE (MWDI MYY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CT --ffO17/00/2014 ONFERS NO RIGHTS UPON THE CERTIFIC TE WO—LD"ETTHIS ''I','"',,,!'' CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY),THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($ RE P I R 11 ES 11 E 11 N 11 TATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. AUTHORIZED 11, the certificate h Ider Is an ADDITIONAI the policy(les) M e endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement uZ 0 -Certificate holder In 11su of such endo statement on this certificate does not confer rights to the PROIDWER )F Dw .-yer A ncy 10 89119vuerlyonue, 4ewport, RI 02840 )anlel F. Dwyer III INSURED Newport Electric Constr­u'c­tlI Corp 200 High Point Ave, Suite 85 Portsmouth, RI 02871 D.F. Dwyer Insurance ,11401-84�6-Aa2a .Corn A: Foremost a: Scottsdale Insurance Cor on Mutual Insurance 297 THIS 18 To cE 11 11:1,1,-I-H;�T- THE POLICIES OF U —RA N C 31: REVISION NUMBER: I I J :� !,: 1: l�'I I ':: I:: I 11: 1 - INDICATED. NOTWITHSTANDING AN ........... I ...... ...... :-- -- i THE IN !,L; t THE P IN OF ANY CONT ILICY PERIOD WITH RESPECT TO WHICH THIS CERTIFICATE MAY 13E ISSUED OR MAY PERTAIN, TH'E INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, *D I Y REQUIREMENT TERM OR CONDITIO IiACT OR OTH'A EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS. TYPO OF INSURANCE GENERAL LIABILITY POLICY NU 13ER A X COMMERCIAL GENERAL LIA131LITY SCP006046448 EACH OCCURRENCE UMITS $ F—W-1 CLAIMS -MADE I A I OCCUR 12/30/2013 12/3012014 owVGM921— $ 31 --------------- MED EXP An one arson 10.01 I I I DESCRIPTION OF OPERAnoNS I LOCATIONS I VEHICLES (Attaph AUVIRD 101, Acidtflortal Rwmft Schedule, If fmr* $15904 Is requir*d) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPI IRATION DATE THEREOF, N0710E WILL BE DELIVEREO Insured's Copy ACCORDANCE WITH THE POLICY PROVISIONS, IN AUTHORIZED REPRI I A v ive ::i___ Daniel F. Dwyer III ACORD 26 (2010/06) 0 1988-201 The ACORD name and logo are registered marks of ACORD PER AL & ADV INJURY $ 1 EWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 POLICY I LOC PRODUCTS - COMPICip AGG 2 A UTOMOSILELIABil A ANYAUTO SCP005046448 0 aB NED SINGLE LI IT CCI gnil I OWNED ALL X SCHEDULED AUTO ALIT S 12/3012013 12/30/2014 — BODILY INJURY (Per Person) $ M C NON?OWNED IRED AUTOS X AUTOS BODILY INJURY (Per accident) $ PR R C GE $ 911215N T) UMBRELLA UAS X OCCUR .. I B X EXOFSs UAS CLAJMS-MADE B80019698 EACH OCCURRENCE ETE 11 WOWJM 1213012013 12130/20114 AGGREGATE COMPENSATION C AND EMPLOYERS, LIAINUTy $ ANY PROPRIETOR/PAR YIN OFFICE TNERIEXECUTIVE R/MEMBER EXCLUDED? El 68861 WC STATu. OTH. ndatOrY In NH) N/A et describe under R PTI N OF 01118/20 14 01/18/2016 E.L. EACH ACCIDENT )PERATIONS below -E.L. DISEASE - EA EMPLOYEE I A EMPI Prac Liab SCP005046448 — 12/30/20 —E—L--21—SE—ASE - POLICY LIMIT $ IMIT+ ; 12130/2014 I I I DESCRIPTION OF OPERAnoNS I LOCATIONS I VEHICLES (Attaph AUVIRD 101, Acidtflortal Rwmft Schedule, If fmr* $15904 Is requir*d) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPI IRATION DATE THEREOF, N0710E WILL BE DELIVEREO Insured's Copy ACCORDANCE WITH THE POLICY PROVISIONS, IN AUTHORIZED REPRI I A v ive ::i___ Daniel F. Dwyer III ACORD 26 (2010/06) 0 1988-201 The ACORD name and logo are registered marks of ACORD 9266 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ........... a ........... ...... ...... A 0 has permission to perform .. . ...... ...... plumbing in the b gs of W6 .............. at Z 6, ... ............................... North Andover, Mass. Fee Lic. No. J1407 16,4 ..... .. ........................... PLUMBING INSPECTOR Check # INSURANCF r.0V1=PA1-_C I have a cu _Ijfa� nsurance policy or its substantial equivalent which meets the' requirements o*f MGL. Ch. 142 Yes,& No El rrent . I ri i"i If You have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy. 12, Other type of indemnitYE] Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the MassaGhusetts General Laws, and that my signature on this pe�rmlt application MLaLives this requirement. Check One Only 1.) 1 Pal�reot Uwner or Ownees Agent Owner E] Agent I hereby certify thafa-11 of the details and Int—HIdLion I nave submitted (or ent Knowledge and that all plumbjnq 11&1� ri�qljar'1111�1 11111! 111!j l:! 1 accurate to the best of my .work and installations performed under the!! rm issued for this application will be in compliance with all' Pertinent provision of the Massachusetts State Plumbing Code and Chapter 14p2e ofithe General Laws. By Type of License: Title -it, El Plumber Signature of Ll con ber '31tyffown El Master 7 %PPRO �FICE USE �ONLY�) I RJOurneyman I License Number: Je',144 a MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town. City/Town: MA. Date: /,;7 Permit# - Lo Building Location: 7A Owners Name: Type of Occupancy: CommercialEl EducationalEj IndustrialEj InstitutionalEl Residentialj& w: e . N F] El Alteration:E] Renovation:Ej Replacement:0 PlansSubmitted: YesEl NojR FIXTURES DEDICATED Uj SYSTEMS > LU z 0 V) _j U V) LU In < _25 En 2 W Ln C) W R < - �2 Uj D In (D LO 0 Ce 9 < < LU Ln F - . �: :he= 0 U I— U :) § 0 0 < 9n .3 _j 0 Ln LU -SUB BSMT. L6 0 CC Ln En X F- V) Ln BASEMENT 11T FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6e' FLOOR 7' FLOOR 8' FLOOR Installing Company Narne. C h e r- k n 9 0 n ly Certificate 1A Address: d6��e—f City/Town: State: A14 Corporation Business Tel:� &/',' "'91 /' 11�-1'7 Fax: El Partnership El Firm/Company Name of Licensed Plumber: INSURANCF r.0V1=PA1-_C I have a cu _Ijfa� nsurance policy or its substantial equivalent which meets the' requirements o*f MGL. Ch. 142 Yes,& No El rrent . I ri i"i If You have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy. 12, Other type of indemnitYE] Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the MassaGhusetts General Laws, and that my signature on this pe�rmlt application MLaLives this requirement. Check One Only 1.) 1 Pal�reot Uwner or Ownees Agent Owner E] Agent I hereby certify thafa-11 of the details and Int—HIdLion I nave submitted (or ent Knowledge and that all plumbjnq 11&1� ri�qljar'1111�1 11111! 111!j l:! 1 accurate to the best of my .work and installations performed under the!! rm issued for this application will be in compliance with all' Pertinent provision of the Massachusetts State Plumbing Code and Chapter 14p2e ofithe General Laws. By Type of License: Title -it, El Plumber Signature of Ll con ber '31tyffown El Master 7 %PPRO �FICE USE �ONLY�) I RJOurneyman I License Number: Je',144 a W 9967 Date....,��7Z ..... 'ORT� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............. r .) ... ................ has permission to perform ..... wiring in the building of ......... 411-lvlg�elzel ........................ at 40... North Andovei, M114ass. ... .... .... 'Ulutjv"' Feel� Lic. No..JP73.74 ........... . . . ...... EL PCr'RICA�L INSPECTOR Check # FA .C11N (fommonwea& ol Maija4wetti Official Usc Only Permit No. 702 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 Ofi 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) SoRoyal CreSt prmVe 13U*Idang # Q Owner or Tenant Royal Crest Apartments Telephone No. 978-681 -1 0`"� Owner's Address 50 Royal Crest Drive North Andover, MA 01845 Is this permit in conjunction with a building permit? Yes El No Z (Check Appropriate Box) Purpose of Building Commercial - Apartment BuildingsUtility Authorization No. Existing Service Amps Volts Overhead UndgrdE] 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 Completion of the following table mav be ii�aived 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- E] grnd. grnd. No. oTE—mergency Lighting Battery Units 6 No. of Receptacle Outlets - No. of Oil Burners FIRE ALARMS fNo. 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 HeaF--u YPiFmT--p7y,%4eFJ otalls: I . . . . . . . . . . . . Tons -1-1�7o.ofSelf-Contained ............. ........... -C ............... ­ Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local El Municipal El Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wirin : No. of Devices or Eg uivalent 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 [J BOND EJ OTHER El (Specify:) I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: The Electricians & Co., Inc. LIC. NO.: Al 0737 Licensee: Michael J. Parziale Signature LIC. NO.: E20269 (tf applicable, enter "exempt " in the license number line) 4o.: 781-322-9344 Address: 50 Branch Street Maiden, MA 02148 io.: 7R1-.'122-A1nn *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) El owner El owner's agent. Owner/Agent Signature Telephone No._ FE"ITFEE.. $ 125 nn