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Miscellaneous - 32 ROYAL CREST DRIVE 4/30/2018
14 \\�_ �V v.Y k -_ � 1 { Date 0F.01A................. OF NonrM,� TOWN OF NORTH ANDOVER o ° !PERMIT FOR WIRING SSACHUS� This certifies that .n�t_t ii1 .. ! .<'�Ya .1.� ..4�'..!..!.0�U� �... .. ............. ...........J........ has permission to perform..k.. r '.Ewiring in the building of........: .. ..�....................................................................... ti orth Andover Mass. .Fee....... .�� .....Lic. No.r26. .�5. ...!...I .......... .......... :. h*CTRICAL INSPECTQR ~ ~ '' / ` Check# _!�)�� i � 7a t Awl Commonwealth of Massachusetts Official Use Only a Department of Fire Services Permit No, BOA�tD OF SIRE PREVENTION REGULATIONS Occupancy and Fee Chocked [Rev, 11/99] (save blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordancewith the Mnasachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE AL4 INFp City or Town of: {UOY I'►,` TION) Date: A N ©V�r By this application the undersigned gives notice o is or er Intention to perform the electrical work described below, To the Inspector of fres: Location(Street&Number) �� Owner or Tenant �t �d —�'�', � (Ohp,, p 1 +�_ Owner's Address N Y'� �'� Tele hone No, _o cre5 p 978- GUa 7a OC Is this permit in conjunction with a buildiitg permit. Yes 0)FS'A S C i F 3Z� ❑ No � J Purpose of Building Dw eL, (Check Appropriate Box) Existing Service Utility Authorization No, Amps / Volts ElN, v -------______. Overhead Uudgrd❑ No, of Meters —� Amps / Volts Number of Feeders and Ampacit �� Overhead F-1Undgrd [DNo,of Meters Location and Nature of Proposed Electrical Work: kk ITS IN 1 � c°lU oLS letion a 'the oldowin table ma be waived b the Ins ector a Wires. No,of Recessed Fixtures No.of Cell.-Sus . o.o p (Paddle)Fans Transformers Ko0 a No.of Lighting Outlets No.of Hot'Pubs No,of LightinGenerators KVA J g Fixtures Swimming Poo( ove o. g enc ng rnd. � $eftsUeBNo,of Receptacle Outlets nits No.of Switches Nu. of Oil Burners FIRE ALARMS No.of Zones No.of Gas Burners 010 otee on an No.of Ranges Initlatin Devices otal No.of Air Cond, Tons No,of Alerting Devices ea No,of Waste Disposers umP um er ous Totals: o• o e - onto ne No,of Dishwashers Detection/Alertin Devices Space/Area Heating KW ❑ un c a No,of Dryers Heating Appliances Focal onnecttion ❑ Other NOT o ater RW ecur ty ystems: Heaters KW . 010 010 No.of evices or Equivalent Si ns Ballasts Data W1r1ngg: No.hydromassage Bathtubs N No. f Devices or uivaient No. or Motors Total H e ecommun ca A P tons r n : 7' OTHER, B • 6 �� r No,of Devices or E uivaient L L • d It_0-� .l INSURANCE COVERAGE. Unless waived by the owner, no permit for the performance of electrical}ai lltach addltlonaJ detalJ J'deslred,oras required by the Inspector oJ'Wires. the licensee provides proof of liability insurance includin ` work may issue unl "• undersigned c'•' g Dom leted operation', , rage Y ess g certifies that such overage is to force,and has exhibited pr of of same to he permit issits substantial ing toffice. ivalent. The CHECK ONE: INSURANCE [F` BOND ❑ OTHER ❑ (Specify: Estimated Value of Electrical Wor, 'AID-9 ?�_� (When required by municipal policy,) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under thepains and penalties of P erJ' yur , FIRM NAME: N that the Information on this application is true and complete, f'�S,1J ,. Licensee: G LIC.NO,:�Q�Q (Ifapplicable enter "exempt"in the dicet'se number line,) Signator r LIC.NO.: (�0 Address: D Bus.To).No.- VER:OWNER INSURAN WAIVER: I am aware that the Licensee does noha�e�t�j � required by law. B m Alt,Tel,No.- does .- 3 Y y signature below,I hereby waive this requirement. I am the the one insurance coverage nozmally required q Signature owner owners a ent. Telephone No, 30 PERMIT FEE; $ th ` lIle (.071synon")0adttr of 1assachtfsetts I De,Part1ft,ent of IIIdrastrial Accidents Office o fInvestigations 1 Congress,Street, Suite 100 BostonMA 02114-2017 Www"Inass gov/dia Workers' Compensation Jusu>r'ance,affidavit: Builders/Contra.ctors/Electricilans/PXumbers Anpligant Tinfolrinnatxaia lease Pit�>Tnt Legibly Natne(Buriness/organization/I»dividual): ( r4- {cm C_ ��#% a Address:-AMrn �1 G►n ' City/!tate/�ip: Yadtl Ar du an employer?Check the appropriate box: 1, 1.ani a employer with 4. �] I a,w p.general contractor and I TYPE of project(required): emloyees(Hl and/or part-ti trte).'� have hired the sub-contractors b. L1 New consuaction 2,11 1 am, a'sole proprietor or partner- listed on the attached sheat. 7. 0 Remodeling ship at)d have no employees 'these sub-contractors have g, D Demolitionworrr3 t in any [No'workers,comp. i.gurattcey comp,yesur�nes ce have workers' 91 wilding addition irSPs required.] 5, �] We are a.corporation and its l0 Electrical repairs or additions 3. 1 am a homeowner doing all worl,C officers have exercised their myself [No workers' comp. right of exemption Per MGr:I, I l.❑Plumbing repairs or additions insurance required.)t c. 152, §1(4),and we have no 12-El Roof repairs employees. (No workers' 13.0 Other ' comp, insurance required.] '"Any applicant that chicks box if] trust also fill out the section below showing their workers'compensation policy information. Hm oeowners who submit this affidavit indicating they tore doing all work and then hire outside contractors must submit a new affidavit indicating such, tcontractors that chcok this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those cntitiev have cmployces. If the sub-contractors have employees,ti uy must provide their workers'comp,policy number, am an eniployer that is providing workers'coriipensatioii insurance for my employees. Below is the policy anal job site in farmati'on. Insurance Company Name: { o y" Policy#or Self-ins.Lie.#:_�p Expiration Dale: t3I Job Site Addre5s:1150 a 1 /117 �7``� City/State/7iP_ Vt 4/ '�I ' Attach a copy of the worker's' compensation policy declaration date). p%ratia Page(showing the policy number and eil 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 Is civil penalties in the form of a STOP WORD ORDER and a fine of tubi to$250.00 a day' the violator, Be advised that a copy of this st3temcnt may be forwarded to the Office of. Investigations of the IIIA for insurance coverage verification. .l do hereb cerci 1,under ih ai.n nd�,, ,Ies 'ler irr,that t{re lot ornr.ativn provided above as trice and correct. Si nature: _ — — .— _— —Da.te Q Q Of�cial use only, Do not write in this area,to be completed by city or towri official. City or ToVYn: permit/License# Issuing Authority(circle one): 1, Board of 1Eleakth 2.Building)department 3.City/Town Clerk 4,Electrical Inspector 5.Plumbing Inspector C (ether Contact Person: Phone�- �a OOMMONWEALTH OF:MkAHUS . .:: • • • • • • BOARD ,ISSUES THE .FOLLOWINGI1ftdSE RE �,-STE RE D MASTER ELEGTR1 G 1"Aid s NEWPORT ttCTR I C CORPORAT!ON �' ji 19 BURLS q , 1Ok1ELL ¢lA 01852 4o2Es io8o3.:a 07311. 6 1-11039 - �P tyOMMONWEI�LTH �HIJ ETI'S ;_AANS 1=5SUES Tk1E fOLLOWII�lG CICENS.f � , E x.IOURNEYMAI� EL CTRI.C,I A � DAVM A MCMULLEN' k i �..--- CERTIFICATE OF LIABILITY IN " P013 OP ID: LS ANCE�.,j �►s(MlwDcvYYYY, THIS CERTIFICA7t3 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS�NO RIGHTS UPOW TME CERTIFICA.IE HO/0"2014CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTHE COVERAGE AFFORDED BY THE 8ELO1N. THIS CERTIFICATE OF INSURANCE DOES,N07 CONSTITUTE A CONTRACT BETWEEN THE ISSUING IN8URER(S), AUTHORIZED I REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, POLICIES IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED,the pollcy(les) must be endorsed. if SUBROGATION IS WAIVED,sub act 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 CertifiFNewpoM tolder In Ileu of such endorsements. PRODUCER , war _ D,F, Dw r�er Insurance Agency F enue P E ---• r , 840 ��,o.Exit 401-846-9629r III AKS:dfd(cDdfd lac Noe 401-8469629 wyer Com -�-- _ INSU S AFFORDING COV r RAGE i INSURER A:FOC@most NAI.0 p INsur�o Newport EI@ctric Construction ..__- -� _ Corp INSURER B:Scottsdale Insurance Company _ 287 200 High Point Ave,Suite 96 INSURER C:Beacon Mutual Insurance _1 Portsmouth, RI 02871 41 — —.--.--. ..>._....._._....._....... INSURER 0: ---• INSURER C: _ COVERAGES CERTIFICATE NUMBER: P THIS IS 70 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE.t3EEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY REVISION NUMBER: INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIPERIOD CH THIS CERTIFICATE MAYO 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. TYPE OF INSURANCE ASB ............. ...__.....___..._._�__.._.._._PWGENERAL LIAINUTY POUC NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY SCP00904644$ EACH OCCURRENCE 3 1,000,00 CLAIMS MADEL-aj 12/30/2013 12!30!2014 ! �C a S—___300,00 OCCUR MED EXP An one arson $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE' $ 2,000,00 POLICY PRO AUTOMOaILE LIABILITY LOC PRODUCTS•COMPIOP A S 2,000,00 S A ANYAUTO OMB NED SINGLE LI I7 ALL SCP005046448 E acct en AUTOS NED X SCHEDULED 12/30/2013 12/30/2014 BODILY INJURY(Per AUTOS person) S HIRED AUTOS )( NON-OWNED BODILY INJURY(Per accident) 3 AUTOS PR PER TY D GE —-'--- — CCIQgtqTl UMBRELLA LIAR E X OCCUR $ ._..^ B X EXOE88 LAB CLAIMS-MADE BS001969$ EACH OCCURRENCE $ 1213012013 12/30/2014 gGGREGATE D ETE N $ _ 6,000,00 WORK M COMPENSATION _. . AND EMPLOYERS,LIABILITY WC STATU- 0TH• 3 C ANYPROPRIMBER/PARTNER/EXECUTIVE Yf N 68861 sltYltY1I&_._-_.-.ER___-_`_•_ (Mandatory In H) LUDED? N/A 01/18/2014 01/18/2016 E.L.EACH ACCIDENT(Mandatory In and S 600,00 If yea IPTIONescribe under E.L.DISEASE-EA EMPLOYEE 3 600,00 DE GtR PTI NOF PERATtONS below A Empl Prac Liab SC 12/30/20 12/30/2014 E.L.DISEASE-POLICY LIMIT S 600,00 13 60,00 DESCRIPTION OF OPERAT1pHg/LOCATIONS I VEHICLES (Atlaoh ACORD 101,Addltlonal Renurks Schedule,If mon apace Is required) CERTIFICATE OLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE InsUred'e Copy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE Daniel F. Dwyer III ACORD 26(2010/06) The ACORD name and logo are registered marks of CORD D CORPORATION.. All rights reserved. 3 � S b y`v Date......!.j 12L o.1.. .......... r10RTly TOWN OF NORTH ANDOVER p PERMIT FOR WIRING 88,CIIlJS� This certifies that .........................................................:............ ....... ............................................. �. has permission to perform .Aw" V- &. T-...................................... -........................... wiring in the building of...... 'te.. ............................................................................. 0 O�I at ..................... . ..L���^. ort-Andover,Mass. .... ............................................. ................. . Fee...12 .......Lic.No R ELECTRICAL INSPECTOR Check# 2Vi-z i 112370 p � �c� —ty ti G' �)/ / Official Use Only amnwtawea th o ad6ac wells Z�� g Aparhw.nt ol5ire Services Permit No. Occupancy and Fee Checked Z vz,-�4BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1'07] HCl\'C bizuik APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cade(NEC),527 CMR 12.00 (PLEASE PRhVT hV hVK OR TYPE ALL L'VFOR;WATION) Date: May 20, 2014 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' Building # 32 Common Areas Owner or Tenant Royal Crest Apartments Telephone No. 978-681-1822 owner'sAdaress 50 Royal Crest Drive North Andover, MA 01845 Is this permit in conjunction with a building permit? Yes ❑ No Q (Check Appropriate Box) Purpose of Building Commercial -Apartment BUildincis 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: Rewire Common Hallways and Laundry to code due to Fire Damage lona pletion o'the iillrnvin table tnav be wahi ed by the Inspector of ff'ires. No.of Recessed Luminaires No.ofCeil.-Susp.(Paddle) Fans No.o Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Uenerators KVA Above In- o.o Emergency Lighting No.of Luminaires 3 Swimming Pool rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets 3 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 2 No.of Gas Burners No.of Detection an Initiating Devices TotaF— No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers eat um Numbe ons No.o Self-Contained Totals _..._.._ ........... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ municipal ❑ Other 3 Connection No.of Dryers 2 Heating Appliances KW security systems: No.of Devices or Equivalent No.of Water KW No.o No.o 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: Refeed 1 Water Heater 'l- Attach additional detail ifdesired, or as required bY the Inspecto•QflFires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 05/15/2014 Inspections to be requested in accordance with NEC 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 iiisurance 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 ❑ (Specifi,:) I certify,under the pains and penalties of perjury,that the information on this application is true and conydeta FIRM NAME: The Electricians & Co. Inc. LIC. NO.: A10737 Licensee: Michael J. Parziale Signature I LIC. NO.: E20269 (1/'applicable,canter "exempt"in the license ntunber line.) Bus.Tel.No.: 781-322-9344 Address: 50 Branch Street Malden, MA 02148 Alt.Tel.No.: 781-322.3100 *Per M.C.L.c. 147,s.57-61,security work requires Depwtnicnt of Public Safcty"S"License: Lic.No. Xss eo 001021 OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insu", ice coverage normally required by law. By my signature below,l hereby waive this requirement. I am the(check one)❑owner ❑owner's at gen Owner/Agent Signature 1� Telephone No. PERMIT FEE. $ 125.00 y POW- 61 �w f The Commonwealth of Massachusetts Department of Industrial Accidents , et Office of Investigations 600 Washington Street Boston, MA 02111 www.muss.gov/diu Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Busiticss'Orgaluzatioiilindividual): 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): .❑Q 1 am a employer with 15 4, ❑ I am a general contractor and 1 6 ❑New construction employees(full and/or part-thee).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees I hese sub-contractors have g. R Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.hisurauce.y 9. EJ Building addition required.] S. EJWe arc a corporation mid its 10.❑X Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.E]Plumbing repairs or additions s myself. [No workers' com . right of exemption per MGL p 12.[] Roof repairs insurance required.] c. 152. C](4),and we have no employees. [No workers' �•❑Other comp.insurance required.] "Any applicant that checks box#I must also fill out the section below showing their workers'compensation pol icy information. Homeowners who submit this affidavit indicting they are doing a]I work and then hire outside.contractor`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 state whether ornot those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,polio-number. I am tin empluver that fs providing workers'compensation insurance for my employees. Below u the policy mud job site information. Insurance Company Name: Hanover Insurance Company Policy#or Self-ins. Lic.#: WHN 6055762 Expiration Date: 09/01/2014 Job Site Address: 50 Royal Crest Dr. Building 32 Common Areas 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. /do hereby certify undeZtliahts and pevas of perjury that the infornrador:provided above is true and correct. Signature: Date: May 20 2014 Phone#: (781) 322-9344 Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermitlLicense# 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##: 61 Main St. g CORNERSTONE 1794 Bridge St. P.O.Box 657Unit 17B Pepperell,MA 01463 o Land Consultants, Inc. Dracut,MA 01826 Phone: (978)433-8100 Civil Engineering•Land Surveying•Land Planning Phone: (978)455-7960 Fax: (978)433-8125 Fax:(978)433-8125 www.cornerstoneland.net May 23,2014 Gerald Brown,Inspector of Buildings Town of North Andover 1600 Osgood Street North Andover,MA 01845 Dan Milinazzo, Construction Services AIMCO—Regional Operating Center 50 Dinsmore Avenue Framingham, MA 01702 RE: Construction Completion Affidavit Fire Damage Structural Repair—Building 32 Royal Crest Estates 50 Royal Crest Drive North Andover,MA 01845 Mr. Brown, Accompanying this Construction Completion Affidavit,please find photographs of the repaired structural damage within Units 4 and 8 of Building 32 completed at the Royal Crest Estates North Andover property. The photographs included show the different.stages of repair,including pre-construction,during construction and post-construction. Cornerstone Land Consultants completed plans entitled"Unit 4&Unit 8 Repair Plan",Dwg No.9303 dated April 10,2014 detailing the repair. Based on field inspections conducted during and after the repair,the work completed is in substantial compliance with the plans referenced in this letter and on file with your office. Should you have any questions or require additional information on this matter,please don't hesitate to contact us in our Pepperell,MA office. k�i�,1`�itttutrt!lU�"/ PHILI Sincerely, R ` �r rHlsr ULT No,2335 000Kenneth .Lania,E.I.T. Phil' �Ar kt kenCa-)cornerstoneland.net ph' erstoneland.net 1� 1f X � r 1 e � f k-, •� r ({�}j z n., IIIA a � i t It 7t I 'f (p�`'x 1��s�4, ��h��h r ,� ��'., -• - G)f V` P cr _ 9 my . ::A:- � a � mow...,+..n.+,+•+ra ..'.a.'a�'T.`..n`+r. . t ... r;._,.[ .. i5 'r e m b Y ICU y� P r n 1IL t � r 179 c ' f MIN I' i by ., i ,M � "^�=P' -•rhe.—. *• �`�i i 41 jo� 99T low jj i. t. '� t �1 3 a �• r ' ' � `t �, � gyp. •i .. ,i � ...,...,.,.;�� .�...—,.:` � � .. , i r a. v. v by .' '• - � .. ... - vs{w^^.fiM - y ..v { y' 7 61 Main St. 4 CORNERSTONE 1794 Bridge St. P.O.Box 657 /�Consultants, 178 Pepperell,MA 01463 Land Consultants, Inc. Dracut,MA 01826 Phone:(978)433-8100 ivil Engineering•Land Surveying•Land Planning Phone: (978)455-7960 Fax: (978)433-8125 Fax: (978)433-8125 www.comerstoneland.net May 23,2014 Gerald Brown, Inspector of Buildings Town of North Andover 1600 Osgood Street North Andover,MA 01845 Dan Milinazzo,Construction Services AIMCO—Regional Operating Center 50 Dinsmore Avenue Framingham,MA 01702 RE: Construction Completion Affidavit Fire Damage Structural Repair—Building 32 Royal Crest Estates 50 Royal Crest Drive North Andover, MA 01845 Mr.Brown, Accompanying this Construction Completion Affidavit,please find photographs of the repaired structural damage within Units 4 and 8 of Building 32 completed at the Royal Crest Estates North Andover property. The photographs included show the different stages of.repair, including pre-construction,during construction and post-construction. Cornerstone Land Consultants completed plans entitled"Unit 4&knit 8 Repair Plan",Dwg No.9303 dated April 10,2014 detailing the repair. Based on field inspections conducted during and after the repair,the work completed is in substantial compliance with the plans referenced in this letter and on file with your office. Should you have any questions or require additional information on this matter,please don't hesitate to contact us in our Pepperell,MA office. �1t1tIIH41i/� `w PHILIPPE '� �• Sincerely, R, = THISAULT t Kenneth . Lania, E.I.T. Ph Ii �Ar ct ken@cornerstoneland.net ph' erstoneland.net �t 'Imp .1It p if#• �F� r� lE !!! .F it i i 1 l t x p a :w F n c • sr. r 7 i �E J 1 4' I n JCP` c 7 y . F.� � f5 �.R a W r`+—. .r � * 111 ' � P •Y '•. r .... £4t g, ,n ! I y 4 �} z IS a Fl 1-7 "LL, ter._� �y._• ���� � ", ti.,"�' sem.. , , �� '_ �� I Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-082747 THOMAS H KIN1!�kL - 286 BROADWAY.; s Haverhill MA 01$32 Expiration Commissioner 06120/2016 I A l Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor ^i -License: CS-082747 THOMAS H IL 286 BROADWAY, Haverhill MA 01$32 t � F Expiration Commissioner 06/20/2016 12 I�Z, eA,,-5r j 2, eo Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor R. License: CS-0827.47 THOMAS H IGN tkL 286 BROADWAti °~� Haverhill MA 01$32 ,/ Expiration Commissioner 06/20/2016 Date...`1�... .!........... t NonTN TOWN OF NORTH ANDOVER O 9 PERMIT FOR WIRING 88'�CNUSE •- lei ? '. D. This certifies that ........ Z a"� has permission to perform ... P!^ ........ l�ll ° , �. �. .. wiring in the building of. /..)..�..!K........ �- `'PI....... n . .. -at ........... .......�d.?..1- ...... ...............lUWwl N,rth Andover,Mass. .....Lic.No. <<�73� ...M.�'.............� X ..... . . ELECTRICAL INSPECTOR Check# �� 12 2 4c 0 Comrfwnwea&o f/V a.macltrjetfl Official Use Only Permit No 122gb Apartment ol 7ire Servicee . Occupancy and Fee Checked. w BOARD OF FIRE PREVENTION REGULATIONS lRev. 111071 (leave blank) 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 PRhVT hV hVK OR TYPE ALL IIVFOR,VIAT[O?V) Date: March 19, 2014 City or Town of: North Andover To the Inspector of'Wihes: By this application the undersigned gives notice of his or her intention to perform the electrical work described elow. Location(Street&Number) 50 Royal Crest Drive Building # 3 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 BUlldincls 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: Reinstate Power to building areas not effected by fire so that building can be reoccupied Completion o1'the fbllowin table mat-he waiver/by the Inspector of Tf'ires. No.of Recessed Luminaires No.ofCcil.-Susp.(Paddle) Fans No.of Total Transformers KVA No.of Luminaire Uutlets No.of Hot Tubs generators KVA No.of Luminaires SwimmingAbove In- o.o Emergency Lighting Pool 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 InitiatingDevices Tonnss No.of Ranges No.of Air Cond. TotalNo.of AlertingDevices Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KIV Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.o No.o Data Wiring: treaters Si ns Ballasts No.of Devices or Equivalent �\ No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Airing: No.of Devices or Equivalent P OTHER: .Attach additional detail;f desired, at-as required by the Inspector of ITire,v. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 03/19/2014 inspections to be requested in accordance with MEC Rule 110,and upon completion. INSURANCE COVERAGE: Unless waived awed by the owner,no permit for the performance of electrical work may�issue unless . p P 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 ❑ (Specifi-:) I certify,under the pains andpenaltiev of per,jury,that the information on this application is true and complete. r FIRM NAME: The Electricians & Co. Inc' LIC.NO.: A10737 Licensee: Michael J. Parziale Signature i� Yom; ; LIC.NO.: E20269 (/f aplrlicahle,enter "exemCrt"in the license member line.) Bus.Tel.No.: 781-322-9344 SC Address: 50 Branch Street Malden, MA 02148 Alt.Tel.No.: 781-322-2100 "Per M.C.L.c. 147,s. 57-61,security wort:rcquires Department of Public Safety"S"License: Lic.No. 55 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,/hereby waive this requirement. 1 am the(check one)❑owner ❑owner's agent. � Owner/Agent PERMIT FEE. $ 12 Signature . Telephone No. — N In 4 L � �`y � - ZY- ,y � _ �. �Gli y�•S� �� r'i,rte/) �� �� � 3 �sy—�� �� r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ;- 600 Washington Street Boston, MA 02111 www.muSS.guv/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(BusineSS!OrQaniaitior>llndividual): 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): I.0 1 am a employer with 15 4. ❑ I am a general contractor and 1 G ❑New construction employees(full and/or part-time)." have hued the sub-contractors 2.❑ I alp 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- [No addition [No workers'comp.insurance comp.insurance.4 9.5. We arc a corporation and.its 10.NX Electrical repairs or additions required.] ❑ P 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself o workers' comp. . right of exemption per MGL insurance required.]'' c. 1.52, �1(4),and we have no 12.[]Roof repairs employees. [No workers' I').F-I Other comp.insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers`compensatim pnl icy information. � Homeowners who submit this affidavit indicating they are doma all work and thea hire outside contractors ttmst submit a uevti affidavit indicating such. �C'ontractors that check this box must attached alt additional sheet showing the name of the sub-contractors and state whether or not those entities have employccs. !f flu sub-contractors have employees,they must provide their workers'comp.policy number. 1 am tin employer that is providing workers'compensation insurance fur my employees. Below is the polio anal job site information. Insurance company Name: Hanover Insurance Company Policy 4 or Self-ins. Lic.A: WHN 6055762 Expiration Date: 09/01/2014 .lob site Address: 50 Royal Crest Dr. Building 30 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 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded.to the Office of investigations of the DiA for insurance coverage verification. 1 do hereby certifi'under file/trims and penalties of'perjury that the information provided above is true and correct. Si mature: Date: March 19 2014 Phone#: (781) 322-9344 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical inspector 5.Plumbing inspector 6. Other Contact Person: Phone#: 'COMMONW ALTH OF M WHUS ::. S .. . BOARD OF F ' Ir:LE:CTR I C I ANIS .SSUES ;T;HEFOLLOWING t;.LCENSE AS:;:A EiEG15Tf2D MASTIiI ' €LECTR:I.CtANtcI TILE *tECTR I C I ANS AND COMPANY INC MICHAEL .!'PARttALE 50 BRANCH '$T. 48- —JULDEN: 02 073 : <:16 < " ` 65846 7'.. 0 7/3...1. 3COMMONWEALTH OF MASSACHUSETTS.. BOARD OF, . 'ISSU:E:S:::.THE FOL LOW I`N `'`"L.I`C A :< ..`'CG'>JOURNEY:M:AI; `EiECTR I C I A MICHAEL J PARZI.ALE ; 107 LOCUST STREET - W , � NVERS 'MA 01923 2205 2026 : .: o / 11<)b . : 64865 3, , Date................... ....................... t NORr#t "q�oo TOWN OF NORTH ANDOVER p PERMIT FOR WIRING .�tt gsACMUs'6 This certifies that .1�... C'�1Ce.1....�!4.�.�.... °`.............. ................................. has permission to perform .......V ........................... wiring in the building of..V'olA (�rw 1 t M P 0 ...............................�.......................................................... at ..................�............. .................................. .............. ^,,, ,o)rth Andover,- ass. Lic.No. �U3� ....Fee�. ..� ......................... ......... ELINSPE "Check.. + (ffilz oI O'ficial Use Only omuwrtcvea a.9Aac acc;4ett3 Permit No. Apartment of Jire Servlceo 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(NEC),527 CMR 12.00 (PLEASE PRhVT hV LVK OR TYPE ALL DVFOR,VATIOIV) Date: April 8, 2014 City or Town of: North Andover To the Inspector offires By this application the undersignned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 50 Royal Crest Drive BuildingI# 32 Apartment 4 h Owner or Tenant Royal Crest Apartments Telephone No. 978-681-1822y Owner's Address 50 RoyalCrest Drive North Andover, A 01845 Is this permit in conjunction with a building permit? Yes ❑ No ❑X (Check Appropriate Box) �-7/� Purpose of Building Commercial -Apartment Buildings Utility Authorization No.17 7 4 0 612— Y Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Rewire Apartment to code due to Fire Damage Completion qfthefi)llolving able mat°he waived by the Inspector of bFires. No.of Recessed Luminaires No.ofCeil.-Susp.(Paddle) Fans No.of Total j Transformers KVA No.of Luminaire Outtets No.of Hot Tubs Uenerators KVA No.of Luminaires $ Swimming Pool Above Ei In- 1:1 o.o mergency Lighting rnd. rnd. Battery Units 1 No.of Receptacle Outlets 30 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection an 6 Initiating Devices 3 Total No.of Ranges 1 No.of Air Cond. Tons No.of Alerting Devices � Heat Pump um er ons o.o -e o n t a me No.of Waste Disposers 1 Totals: .............'......_. Detection/Alerting Devices r No.of Dishwashers 1 Space/Area Heating KW Local❑ municipal ❑ Other Connection No.of Dryers1 o.oo.o evices or Equivalent Heating Appliances 7 KW 2.8 Security Systems:* D No.of Water KW No. NDatNo.of a Wiring: /eaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Te ecommunications In No.of Devices or E uivalent OTHER: 1 sub panel-100 Am p5 Attach additional detail if desired; or as required hr the Inspector of lVires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 04/8/2014 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 X❑ BOND ❑ OTHER ❑ (Specify:) I certify,ander Ilse pains alit/penalfles of perjuq,that the information on this application is true and complete. FIRM NAME: The Electricians & Co. Inc. LIC.NO.: A10737 r Licensee: Michael J. Parziale Signature LIC.NO.: E20269 .14 ///'applicable,enter "exempt"in the license munber line.) Bus.Tel.No.: 781-322-9344 Address: 60 Branch Street Malden, MA 02148 Alt.Tel.No.:_781-322-31 nn *Pcr M.G.L.c. 147,s.57-61,security work requires Depwtmcnt of Public Safcty"S"Liccn5c: Lic.No. SS 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,I hereby waive this requirement. 1 am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE. $ 1 Z� Signature Telephone No. zo � ,�. � e�`3— int ��' " ��� m� �i z-��j�� N., The Commonwealth of Massachusetts Department of Itldustrial Accidents Office of Investigations ;.; ' 600 Washington Street Boston, MA 02111 ^ + =]] www.muss.guv/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business..!organizatiori'lndividual): 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): 1.0 I am a employer with 1 `t• ❑ I am a general contractor and 1 6 ❑ New construction employees(full and/or part-time).' have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. 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.insurance.¢ ❑ We arc a corporation required.] 5. oration and its I 01 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. o work ' right of exemption per MGL � workers' com p. 12.❑ Roof repairs insurance required.]+ c. 152. §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required] *;any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 7 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submits new affidavit indicating such. �Comractors that check(Itis box must attached ail additional sheet show ine the name of the sub-contractors and state whether or not those cwhics have employees, if the sub-contractors have,employees,they must provide their workers'comp.policy number. i am an emplover that isproviding workers'compensation insurance for my employees. Below is thepolicY anti job site information. Insurance s c.eNa,,,e: Hanover Insurance Company Policy 4 or Self-ins. Lic.4: WHN 6055762 Expiration Date: 09/01/2014 i Job Site Address: 50 Royal Crest Drive Building#32 Apartment 4 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 do hereby certif1;under the pains and penalties of perjury that the inforntatioa provided above is true and correct. Si,_nature: Date: Aril 8 2014 Phone#: Official use only. Do not write in this area,to he 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#{: COMMONWEALTH OF MASSACHUS S ' 90ARD OF ISSUES THE ;F0LLOWI NG `Lt CENSE AS :A� 6" REGISTERED MASTER f1ECTRl ANS W 47 L THIS EtECTR I C I AN AND COMPANY IVC MN MICHAEL..] PARIALE 50 BRANCH` ST l� 4 14801+ 1073 :.A o7 /�6; ; 65846 l 0664. Date....�f./.-4 ............ TOWN OF NORTH ANDOVER jo * PERMIT FOR PLUMBING This certifies that 5A.I ,,..........................Yt t. r �44box`) rv� ............................. .................... ... has permission to perform....c...e- �- �A (.�........r Ate.... .... ................................ ✓L2. . plumbing in the buildings of... Y:Y".Q................ ................................................... Cat.......5....w.��'. ............. .5� ...:k.......Z......` orthAndover, Mass. Fee -".......Lic. No. .�.�.!.& I... ..�: ............................................................. PLUMBING INSPECTOR Check# r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK lop CITY \a I MA DATE�. ( PERMIT# t JOBSITE ADDRESSr( - WNER'S NAME r C POWNER ADDRESS -6 I `I- TEL ^ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL © EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: � RENOVATION:® REPLACEMENT:Q PLANS SUBMITTED: YES© NO Fj FIXTURES-1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I -{ ___ { r CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM T! DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM ! DEDICATED WATER RECYCLE SYSTEM I DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) E ! E _ S ! ! _....__i ...... 1 KITCHEN SINK lL-_1 LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET { __. _I ____� __-_! __ I _. ..! __._{ ._._ _� ._- t _-- •.1 _-._-- --___I __, { -___-.- ____ ' URINAL -j _.__ { -____l -._. _-- _____! ._.___._f WASHING MACHINE CONNECTION ( _( _. _ _,.;I .__._._3 _ , 4 -_. 77== ... E _.___1 _...:..._I WATER HEATER ALL TYPES WATER PIPING ! i E ___._..1 ! ! _. .__� i _...._.E _ ! __...._{ I J= t ` OTHER INSURANCE COVERAGE: �► have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO D IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW ©II LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Q BOND 0 N OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER Q AGENT 10 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are tr 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 co m I nc ith a rtine vision of the (Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME _ (LICENSE# �- SI URE (VIP© JP DI CORPORATION R-I# PARTNERSHIP P# _ LLC _€ COMPANY NAME _ aJ {� ; ADDRESS �( CITY rI STATE �(1� _� ZIP ] l� T�� TEL c FAX CELL EMAIL - - -EACP Z- f ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION N S Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES �S The Commonwealth of Massachusetts - Department oflndustriglAccidents Office of Investigations 600 Washington Street Boston,MA.02111 www.mass govIdla Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: - City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction ployees(full and/or part-time).* have hired the sub-contractors 7• E]Remodeling 2`. I am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g• ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 1011 Electrical repairs or additions required.) officers have exercised their right of exemption per MGL 11.❑Plumbing repairs or additions C 3.❑ 1 am a homeowner,doing all work g p P myself.[No workers'comp. c. 152,§1(4),and we have no l2.❑Roof repairs insurance required.]i employees.[No workers' 13.❑Other comp,insurance required.] 'Any applicant that checks box#1 must also fill out the section below showingtheir workers'compensation policy information. Homeowners who submit this affidavit indicatingthey ace doing all work and then hire outside contractors must submit anew affidavit indicating such. #Contractors that checkthis 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'compensafion insurance for my employees. Below is fhe policy andjob site information. Insurance Company Name.A t e\ 1 L Policy#or Self-ins.Lic.#: ` Z5Z2 Expiration Date: a=� o•nn V GCZE-V -) C41 -1 Job Site Address: - 14 CSP (4 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 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 maybe forwarded to the Office of Investigations of the AIA.for insurance coverage verification. X do hereby cer and theoVinsand enalties of perjury that the information provided above is true and correct. - Signature: � Date: .,— � L Phone#: 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.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: t Information and Instruction's 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 ofhire,• express s or implied,oral or written. An employeils 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 re uired" q Additionally,MGL chapter 152,§25C(7)states `Neither the commonwealth norany ofits 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-contractor(s)name(s),address(es)and phone number(s)along with their certificates of ins certificate(s) 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 LL C or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial 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 multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: Tho Coinmoawoal&ofmassachusPtts Department ofladustdal.Accidents OfMe oflnvestigations 600 Wasbington Sixeat BostwMA02111 TQJ,#61.7-727-4900 0A 406 or 1-877,MASSA.F.F Revised 5-26-05 Fax#617-727;7749 Fold,Then Detach Along All Perforations :: ht,'OMMONWEAM OFSaACHIJSETTS - f • • gOAf�Dl~' x `AN�1�`GASE a Tfi = , V ' p'�,uMBERP. 51: # �1I: ^ AS AJpUNEYMANUMER "SRLV'A'��6i�E J °LIMINA � � � gg W f i s t4 r'n 37 GtEAST EXE. f rra b1752�3�64� h ;. i 1 sf*. +�A d �x tr� ,f l ' { b a. I err X f 1 1� 5 f; I Date. . 2.0.1.�.` .. ... ............. OF NonrN,�'O o?; o� TOWN OF NORTH ANDOVER PERMIT FOR WIRING 88'�CNUg� �n ( PA This certifies that ... .!G'!`Gel .................................................... has permission to perform ..... �'.(��,, wiring in the building of...eo`i A i,,,,,,,. / A (��,, ......................�:^... .. ..........................,.... at .3? f Q ' S+ :; orth Andover,Mass. f Fee.... G Lic.No.1.Y�3� MSD .... ... E CTRICAL INSPECTOR Check# 12371 I ��1 �rn��' � ficial Usc Only COiTLIrtOltlflP,RLGl7.O�'r(R�O6RCiIdIQP.tf.� � s Permit No. l ryry,, 2 2eptartinent of Sire Services Occupancy and Fee Checked. BOARD OF FIRE PREVENTION REGULATIONSRev. 1/07 [ ] lCilYe b12111k APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be periornied in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL I.-VFORMATIOM) Date: April 8, 2014 City or Town of: North Andover To the Inspector Uf'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 'Building # 32 Apartment 8 Owner or Tenant Royal Crest Apartments Telephone No. 978-681-1822 Owner's Address 50 Royal Crest Drive North01845 Is this permit in conjunction with a building permit? Yes ❑ No 0 (CheckAppropriate oa}'` h Purpose of Building Commercial -Apartment BUildil7gS Utility Authorization No. � 7t/© f 7 T 7 4 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: -Rewire Apartment t0 Code due t0 Fire Damage Cana pletion of the i)llowing table rnav he waived by the Inspector of I1='ires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle) Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot'l ubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- E] o.o Emergency,Lighting 1 g rnd. rnd. Battery Units No.of Receptacle Outlets 15 No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches 3 No.of Gas Burners o.o etectton an Total Initiating Devices No.of Ranges 1 No.of Air Cond. Tons No.of Alerting Devices 3 No.of Waste Disposers eat Pump umber ons -K o.ofSelf-Contained Totals: ' - "......... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ MunicipalE] Other Connection No.of Dryers Heating Appliances KW ecurity stems: 3 1.5 No.of Devices or Equivalent No.of Water KW No.o No.of Data Wiring /eaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsWiring: No.of Devices or E uivalent OTHER: 1 sub panel-100 Amps Attach additional detail if desired, at-as required ht the Inspector of(Fires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 04/8/2014 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 uriless the licensee provides proof of liability uisurance including"completed.operation''coverage or its substantial equivalent. The undersigned certifies that such coverage is in force and has exhibited proof b b p f 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 IC.NO.: E20269 (Ifapplicable,enter "exempl"in the license ntcntber line.) Bus.Tel.No.: 781-322-9344 Address: 50 Branch Street Malden, MA 02148 Alt.Tel.No.: 781-322-3100 *Pcr M.G.L.c. 147,s. 57-61,security worl:rcquires Department of Public Safcty"S"Liccnsc: 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,l hereby waive this requirement. 1 am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERA[IT FEE. $, 5 du 8- /2 - ��l �-r.� i The Commonwealth of Massachusetts Department of Industrial Accidents "s.. ��'� Office of Investigations -g 600 Washington Street Boston, MA 02111 www.muss.guv/dirt Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Busincss'Organizatiott::'Individual): 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): 1.0 1 am a employer with 1— 4• ❑ I arm a general contractor and I ❑New construction employees(full and.-or part-time). have hired the sub-contractors 6. 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.4 required.] S. EJ We arc a corporation and.its .1 0.[E Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' .comp right of exemption per MGL insurance required.]t c. 152,§ 12. Roof reairs1(4),and we have no p employees. [No workers' 13.❑Other comp.insurance required] *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 it uew affidavit indicating such. %Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I am ern employer that is providing workers'compensation insurance for my employees. Below is the policy anti job site information. Insurance Company Name: Hanover Insurance Company Policy#or Self-ins. Lic. * WHN 6055762 Expiration Date: 09/01/2014 Job Site Address: 50 Royal Crest Dr. Building 32 Apartment 8 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. I do hereby certify under the pains and penalties•q/'perjury that the information provided above is true and correct. Si_,nature: Date: Aril 8 2014 Phone#: (71�1 322-9344C/ 6- 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#: OMMONWEALTH OF MASSACHUS LlBOARD OF ..:. ...::. L E<CTR I C I At S :ISSUES THE .FOLLOWING LICENSE AS `A� REGISTERED MASTER ELECTIR,ICIAN :" THa �ECTR It I ANS AND COMPANY h,NG �z 1'ICHAEL ,J PARZIALE �� Z,;- 50 BRAN'G'H....ST MALDEN' MA 02148-4304 10737;.>;A 07/3:1;:/: 6::>;; 65846 f pf NORT:,� 5365 365 . O o w 9 Town of North Andover HEALTH DEPARTMENT CNO`,tt CHECK#: �" DATE: / W LOCATION: H/O NAME: CONTRACTOR NAME: Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type. $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTICSystems : ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ e' Other:(Indicate) $ (/ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer v. Date.... TOWN OF NORTH ANDOVER iL PERMIT FOR WIRING Thiscertifies that ................................................................ . ........ ............. has permission to perform ...... Z7 wiring in the building of...... ..R-0 C7— . .. ......................................................... at Y.,lit I IKC ee....7..........3.4 .......... . .North Andover,Mass. Lic.No./.I).73..7.//......... . ZE Check # (nommonwea&of MaieacLeif� Official Use Only c� Permit No. ,pad.nl ofcc77 im Services v Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07) s 2 ) (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) 50 RoVaI Crest Drove Building # ?�;L 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 Q (Check Appropriate Box) Purpose of Building Commercial -Apartment BUildingsUtility 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! i II Completion ofthefollowing table ma 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- of 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 lqo—.-of Detection an Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers eat Pumpumer "'ons .. " o.oSelf-Contained Totals: .. . ........ Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipa ❑ Other Connection No.of Dryers Heating Appliances KW ecurityystems: No.of Devices or Equivalent - o.o Water KW o.o o.o Data Wiring: Heaters Si ns Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wirmg: 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 thepains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: The Electricians $ Co. Inc. LIC.NO.: A10737 Licensee: Michael J. Parziale Signature LTC.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. k q y + 32- Yr '• �„n.s;. - �'� fix• ° �,t .'d„ tl� V Win'• t & {tyy 9 .a '+� ) Tj " t+ fi u z7 0 �ine: t �� g y NT•O � ��? 1 !! 4 a !� ,