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HomeMy WebLinkAboutMiscellaneous - 34 ROYAL CREST DRIVE 4/30/2018E I v -) Datek(l...J.1,-� ............... TOWN OF NORTH ANDOVER PERMIT FOR WIRING �...........`.e AJ�-41�This certifies that .................................. has permission to perform .........r ...................... 4 ...... .................. wiringin the building of ......................................................................................................... at n 1 0,g-sA- .......... I ............ i***"**",***'*'***'**'*****""***'*"**"**"*"*"'**"*', NoAh Andover, Mass. Fee Lic. No. D3 %. 6--5 jvL- .. ....... ............. ........... a& .... tv ELECTRIC A T- 2 Check # L r o►amonwars[#h a� /I%uneae�uca Officikllll 1Jse Only - a ..LJ.s�rnrfinenf o�.}irts �arvcwe - -_ -- Occupancy and fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev, 1/07 (Icnve Ulank.) APPLICATION FOR PERMIT TO PERFORMELECTRICAL WORK All work to be pertbrmed in accordance: wii.h the Massachtrsuti.9 I Iccl.rical C'odc (MEC), 527 CMR 12.00 (PLL, ASE, PRINT WINK OR TYPE ALL INFORMA.T10N) City or Town of:`Il7.e lmy7eelor ofWires:iAT By this application the undersigned gives notice of his or her intention to perform the electrical work described below, Location (Street & Number) 9opkA, \. CmsN 0,6\ - .- A1V , I�'1"—S�A10,\ '#F lilt or Tenant k v\, t V Telephone No. { 605 Owner's Address Is this permit in conjunction with a building permit? Ves F1 No (Check Appropriate Dox) Purpose of Building , e'Qt-i p-.. Ut'Al- Utility Authorizatinn No. Existing Service Amps ! Volts Overhead El Untlgrd ❑ No. of Meters New Service. Amps / Volts Overhead f —� Undgrd No. of Meters Number of l;'ecdem and Ampacity Loention and Nature of Proposed Electrical Work: Cx�u�_�'r•RUt"C1�.rrM �at"�__Ta_4��.�pca.. �� c�,.`t' Q�� ��►�'"Oi�'--Z'4+lS t►.n1\..�CC,Uac t�,uth A�'�i5 (7mmnlaNnn n0lin (nllu,uma 01)10. may ho waived by the InsDectrlr orwi es, UsTO1 No. of Recessed Luminaires No. of Ccil.-Susp. (Paddle) Pons rr• o Total TrAttslorttlerS NOVA, No. of Luminstire Outlets No. of Hot Tubs _.. (ielncrntors NOVA No. of Luminaires Above "Tn�-- Switlr:tting Pool rnd. me#. 0. oT ' mcrgency ig 'mg Battery UniLq No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners � o. o Nttiiti t ng D ant atin Devices No. of Ranges No. of Air Cond. 'Totts No. of Alerting Devices No. of Waste Disposers eat um Totols: um .er 'farts 1{4V o. o l -C: Selontatne Detection/Alerting Devices No. of Wshwnshers Space/Area Heating KW Local(� _ tttticipal 0 Other_ Ortgeciibn No. of Dryers Heating Appliahces KW T Security S stemis: No. of Devices or E uivolent o. o Watcr IOW No. of o. of Data Wiriog: Heaters Signs Ballasts No. of Devices or i>, uivalent Hydromassage Bathtubs No. N y No. of Motors 'Total HP a No of De saunas trtn No. of Devices or E ttiva�ettt OTHER: Attach additlonal (. roil it,,A.vired, or as required hip the inspector of N"b•cs, Ui►nated Value of Electrical Work: 1 -)000 (When required by municipal policy,) Work to Start: i ; inspections to be requested in accorda.ncc with MEC; Rule 10, n.nd upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of Clcctrical 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, C REC K ONE: INSURANC:L' Q BONE) E] OTHER [] (Specify:) I certify, under the pains and penalties of perfnn7, that the infortnatiov on this applicaden is true and Complete - FIRM NAME: Newport Eloctrlc LiC. NO.: A20803 Licensee: David McMullen Sig_Inature — IANC. NO.: mom (lfapplicable, enter "exempt" in the license number line.) Bus. Tel, No.: X01.-293-052%. Address: 700_Hig int Ave. Portsmouth,. Rf_02871 .................... . ... .. .. ______ A i Tel. No.: 617-908-4193 *Per.M,G•L_ c. 147, s. 57-G1, security work requires Department of public Safety "S" License: Lic, No. OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee dnes not have the liability insurance coverage normally required. by law. By my signature below, I hereby waive this requireincnt., f a,0. the (check once x owner EJ owner's agent, Owner/.Agent Signature _ Telephone Na,___��-� �. >l'MIT I+EE: $/b,)5- �p - �>- - /",f - "j, �o v IfS //- Ste' 9 V Date ........`7`.. 2 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.......... L...�.f ..�... (�%Z�...................................... has permission to perform .. .,:04Z4 �:-............ ....�.�....... wiring in the building of.,,,,,, atS....a./5......................................... North Andover, Mass. 4 Fee( Z. 5 ®o ��.... Lic. No... .? ... . . ..............R.. ...........................,..., :............ ELEcrRicAL INsPECf.OR' Check # 12315 Cotnmonweabli, o f /i'/aysac4u9ettj Official Usc Only 2eparinwnt ol3h-e Serilicei Permit No. 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 INFORMAT.ION) Date: April 24, 2014 City or Town of: 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 # 34 Apartment 1 Owner or Tenant 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 ❑ (Check Appropriate Box) Purpose of Building Utility. Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: _Change breaker in panel damaged by water from apartment above. Comnletion ofthe f6l1rnvinv tnhlp)llnl,be ivah,ed h„ the 1--tnr of ,Fir- No. of Recessed Luminaires No. of Ceil: Susp: (Paddle) Fans -r r o Total Trof T KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool ove ❑ n- ❑ rnd. rnd. o. o mergency �g mg 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 and Initiating Devices No. of Ranges ,No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: umber ons "'""" "' """"' "' o. ofSelf-Contained Detection/Alerting Devices No_ of Dishwashers Space/Area Reating KW Local ❑ Municipal❑ Other Connection No. of Dryers Heating Appliances KW SecuritySystems:* No. of Devices or Equivalent No. of KW Heaters No. o o. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications irmg: No. of Devices or E uivalent OTHER: Attach additional detail {f desired, or as required by the Inspector of !fires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 04/19/2014 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, under the pains and penalties of perjury, that the information: on this application is tree and complete. FIRM NAME: LIC. NO.: A10737 Licensee: Michael J. Parziale Signature Auv 4 oIC. NO.: E20269 (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 781-322-9344 Address: 60 Branch Street Malden, MA 02148 Alt. Tel. No.: 781-322-3100 *Per M.G.L. c. 147, s. 57-61, security work rrquires Department of Public Safety "S" License. Lic. Nu. 55 GO 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 —7 Signature Telephone No. PERIUIIT FEE. $ The Conintonwealth of Massachusetts Department of Industrial Accidents Office of Im,estigations ' 600 Washington Street r. Boston, MA 02111 www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lei?ibly Name (.usiness/organization/individual): The Electricians & Co.. Inc Address: 50 Branch Street uttyi3tate/LIP: Malden. MA 02148 Phone #:_ (781) Are ,you an employer? Check the appropriate box: 322-9344 _— 1. Q I am a employer with_ 15— 4. ❑ I am a general contractor and I Type of project (required): employees (full and/or part-time).* have hired the sub -contractors 6. ❑ New construction 2. ❑ 1 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• ❑ Building addition [No workers' comp. insurance comp. insurances required.] 5. ❑ We arc a corporation and its 10.❑X Electrical repairs or additions 3. ❑ .1 am a homeowner doing all work g officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp, right of exemption per MGL 12.❑ Roof repairs insurance required.] t 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. t 1-lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub -contactors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I ani an emplolyer that is providing workers' compensation insuraiice for my employees. Below is the policy and job site information. Insurance Company Name: Hanover Insurance Companv Policy # or Self -ins. Lic. #: WHN 6055762 Expiration Date: 09/01/2014 Job Site Address: 50RWa1QresLDr*ye B tildino # 34 Apartment 1 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 25.A of MGL r. 152 can lead to the imposition of criminal penalties of a fine up to S 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�encdtiekof perjure that the information provicted above is true and correct. 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 6. Other Contact Person: 4. Electrical Inspector 5. Plumbing Inspector Phone #: The Electricians & Co., Inc. 50 Branch Street Malden, MA 02148 Tel# 781 322-9344 Fax# 781 322-3100 Email: theelectricians@comcast.net Web: www.theelectricians.org Invoice Royal Crest Property # 042391 Invoice#: 13035 C/O Aimco Accounts Payable Invoice Date: 4/19/2014 P.O. Box 981725 Due Date: 4/19/2014 EI Paso, TX 79998-1725 POM Verb: Tom Customer ID: 20733 350.00 Contact: Tony Russo Job: RCNABIdg34Apt1:ReplaceBreakers Phone#: (978) 681-1822 Job#:04191401 1.00 Page 1 of 1 Work Ordered: Work Ordered Date: 4/19/14 W.O.# 017190 Customer Request: ***Emergency Saturday Service Call*** Replace Circuit Breakers in Panel subjected to water damage from Apartment above. Check all Circuits associated and make repairs as needed. Work Performed: Work Performed Date: 4/19/14 50 Royal Crest Drive, Bldg# 34 - Apt# 1, North Andover, Ma. Replaced Circuit Breakers, (Customer Supplied), in Electrical Panel that was subjected to water damage from Apartment above. Also, checked all associated Circuits to make sure that all is working properly. NOTE: Electrical Inspector requests that we pull an Electrical Permit to change the Circuit Breakers as the Fire Department was also involved. Job Site: Royal Crest Apt's: Bldg# 19 - Apt# 1 Contact(s): Tony Russo 50 Royal Crest Drive Tony Russo's Cnt# 978-284-3261 North Andover, MA Telephone: (978) 376-9427 Ext.: Item Description Qty Total L159 Journeyman Overtime 2.00 L100 Journeyman Hours 2.00 Labor : 350.00 M177 Fuel, Tolls, Parking 1.00 M194 Electrical Permit 1.00 Misc Charges: 137.00 Total Due $487.00 Terms: Payment due upon receipt! Customer Copy 1142 Date.. w?/ °1 /15...... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .................................................. 1.................. has permission to perform ...... .................................................. plumbing in the dui dings ofA.'''..�'.............................. at ..�`-�....�.��... .........t....0�-.......................................; North Andover, Mass. Fee . 30..........Lic. Nol .�3..... . ................................................................................ �-1 PLUMBING INSPECTOR Check # M�- E M�3— P TYPE OR PRTN'T CLEARLY TED MASSACHUSETTS UNIFORM APPLICATION. FOR A PERMIT TO PERFORM PLUMBING WORK CITY 9A. DATE �� � PERMIT # JOBSITE ADDRESSO'WNER'S NAME t � pp OWNER ADDRESS: TEL: -17 (ObO 165 AX; OCCUPANCY TYPE: COMMERCIAL . EDUCATIONAL ❑ RESIDENTIAL ❑ NEW: ❑ RENOVATION: ❑ 1 REPLACEMENT: [�, PLANS SUBMITTED: YES ❑ NO` -4 1 .5 1 6 7 6 9 tMURANCE COVERAGE ave a current liabilityinsurance policy or its substantial equivalent which meets the requirements. of MGL. Ch. 142 Ic;; OU have checked YES, please indicate, the type of coverage by checking the appropriate box below - LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY ❑ BOND ❑ 2 _1 13 14 YES -C3 NO Lj 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. OF OWNER OR CHECK ONE ONLY: OWNER ❑ 'AGENT ❑ 1 hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to be .of my Knowledge and that all plumbing work and installations performed under the permit issued for this application be omplance ith all . ertinent provision of the Massachusetts State Plumbir;g.Code and Chapter 142 of the General.Laws. PLUMBER NAME: I LICENSE 9 t SIGNATURE COMPANY NAME: - f ADDRESS; Z 1' LA CITY ; STATE: ZIP:�;� . Ew FAX: TEL: - /S CELL EMAIL: �— MASTER JOURNEYMAN ❑ CORPORATION #aPAR; NERSH►P ❑ # o LLC OVER 44 Vto In Date ........1.0.1 1 el.I1....5.................. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION Thiscertifies that................................................................................................... has permission for gas i stallation ... ....... . inthe b ildin s of.... 10 ............................................................................... at ................. .......... I.AA.............-...... ' ..................... , North Andover, Mass. Fee . oQ 0.......... Lic. No..q.�..4...�-�........ GASINSPECTOR Check # 10229 VM r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK RK OVPf —1111DATEID, _ PERMIT# D ZIlT JOBSITE ADDRESS:. r OWNER ADDRESS: ' CHER S NAME: TYPE T OCCUPANCY TYPE; FAX9 t'ItIlVT COMMERCIAL EDUCATIONAL iCLEAI211 NEW: ❑ RENOVATION: RESIDENTIAL E] ❑ REPLACEMENT:` PPLIANCESZ FLOOR—PLANS SUBMITTED: YES No �j 3ILER Bsrnt 2 3. 4 $ 6 i 7 u n .._.,..:.....j ...:..... _....I............T. . I ......,, a... __....., ....t... . I have p a cx"ent liaM insurance policy or Its substantial equivalINSUent v E C VERAGE i if you have checked YES: lease indicate the meetsthe requirements of MGL Ch. 142 of Coverage bychecking the appropriate box below: YES El NO ❑ LIABILITY INSURANCE POLICY Q OTHER TYPE INDEMNITY � BONN . OWNER'S INSURANCE WAIVER: I am acuate that the lice ❑ Massachusetts General tauus;.the insurance and that my signature. on this pe` app ow this req gement y Cha uired b pier 142 of the -------- wv vv.rlYCK UK AGENT CHECK ONE ONLY: OWNER ❑ 1#GEI+tT ❑ hereby certify that: all of the, details and Ufa matron !have submitted (or entered] regarding this a q Knowledge and that all plumbing work and Installations performed under the perrrtit issued for this s a� atlon are true and accurate to the best Provision of the Massachusetts State Plumbing Code and Chapter 142 of the Genera[ Laws. PP will be in compliance with all nt PLUMBERIGASFITTER NAME:�p LICENSE #t Pi . COMPANY NAME -M GtC �,r�f. p/12 -- SIGNA : f" . CITY ; `: � .� , ADDRESS c .,. �-`�-------_ _ STATE: P" --t Zip: Cn 1<1;;t. TEL: t26— (L. CELL: EMAIL: MASTER JOURNEYMAN ❑ LP INSTALLER[] CORPORATION I P PARTNERSHIP [] # �_ LLC 0 # The Comwnwe m ofm4ssackusetis DVartment offndusWa(Ac cidettfs free a, f Invesfigations 600 Washington street -Hostorz,, MA 021.11 Workers= °COMPensation, Insurance A# day t: B de ContractorsMe-eitid=& Timbers Applicant Information Phase Prim t� Marne 93vsineW0Tmtzdfon/lrut1vidua1):. MacComAck Fttia, nts Ynn Address: 17 Bicicte Sheet Are you an employer? Check the aper i.94 I am a employer with „ __. employees (hill and/or paw -time),# 2. M am a sale proprietor or partner. ship and have no employees worldog for me in any capacity: [No workers' comp; iansumce required,] 3 Q I aunt a holnevwiter doing alI wore... i4No workers' comp: insurance required<J t. 4. Q I arts a`general contractor and I Have hired the sub -contractors listed on the attached sheet. These sub -contractors lave employees and have workeW comp. insurance.: 5. We are a corporation and its affirm have mrcised their iighi of emptio per l►lf{�i , e.152, §1(4), and we hate no employees. [No workere comp.. insurance reguired.'I Type of projoci (required) 6. New construction 7. Remode.lirig S. Demolition 9. ElBuilding addition 1 O.©Elec:trical repairs or addition 1 LCI Pitttnbing r rs oraddifi ons 12.0 Roof tapaas 18.E] dither MW appiirant ""heft box *1 manalso 0 out the seWon below A=fag their wodme iampem8tion poticlr _.• ••,••---•...................�...;>aav�...,,wg�.aunvaaaanstuwiutccYU6siucwl![CiioWi.isAtlSi:$�p1f1tE$7ieW.YiESIIg1C'dUa$:$QCii. led ntraetarstharehecdc9�is:haxamstattag4�edasaddi>iQkaetshov&Stheaameo£the aCioisandstatewhodwvract9meemienhaft employees. ttdmau6-cxu *itsha1. ve cnspioYces, *ey muapmvide their -WID ts' oomp- poHq. =Mbw. -ram an Mvkyer that isprd),ming workers" coiVenuffon irtsirnwee for my employe. irfrrmativrt.. =InsrYrairce QSmpany Name:= ,AmGuard Insurance Ccm pan rs the pa&7' Md jvb site Policy # or:Seif-inns. Lae. # _„_MAWC578693 Expiration DOD: -1011112015 14b Site Address: Attach a ropy of the workers' c }pensat one policy declaration page (showing the policy number and enAfadonAzie). Failure to secure coverage as requited ander Section 25A of Mtn c„ 152 cru: leant to the itac posidon of minimal penaMa of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in +e form of STOP WORK ORDER and a fine of up to V&.00 a day against the violator. Be advised that a copy Of1his scatema ti may be forwarded to tate Office of Investigations of tine DIA for insurance.coverage vex f cation. Ido Eby cmVy under thepa ns an4penaXes ofperjurytisat Me InformadonpmvMed above is free and wrma Sianatttret 33at� Offiiclafrrse only.. Do not write in this area, to be con Tided by ay or town tt„ffi d City or Tawny Permit/License ff .. Isstilog Authority (circle one): 1. Berard o health 2., Balding Department I City/Town Clerk 4, Electrical Impector S: Flumbiag ImpCdor 6. met Phone ff. OP ID; 0 CERTIFICATE OF LIABILITY INSURANCE U-Momm"rr I 1,0114114 THIS CERTIFICATE ISSUED S A '"%OF INF "ON ONLY -AND CONFERS No RIGHTS UPON THE CERTIFICATE HOLDER CA 'I ERTIFICATE D NOT AFF ME A=Y A EXTEND OR ALTER THE COVERAGE AFFORDED BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CON . BY THE POLICIES , CONSTITUTE ACONTRACT BETWEEN THE ISSUING.INSURER(IS), AUTHORIZED REPRESENTATIVE -OR PRODUCER, AND THE CERTIFICATE HOLDER. —TM—PORTANT-. If the certificate .holder Is an ADDITIONAL INSURED,. the POlicY(ies) must be endorsed. If SUBROGATION IS the terms and conditions of the policy ceftin Wicies maY re AWED to quirs an endorsement A statement on this certificate does not co certificate holder ln.116u of such jDndorsemerd(s). confer rights to Ow PRODUCER Phone: 111'II,I-Ii241 1,411111) INTACT �CT DeSanctis Insurance Agcy, Ina phoNAME 100 UnicoPa* Drive Fax Woburn.; MA 61901 17 Bridge Street Suite -203 1311143,468i MA 01021 THIS it To CERTIFY THAT THE FOLIC REVISION.NU IES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYPERIOD INDICATED, NOTWT1qSTANDTKi3ANY,REQUIR I EMENT, TERM OR CONDITION OF ANY C CERTIFICATE NAY BE ISSUED , CONTRACTOR OTHER DOCUMENT WRH-RESPECT To MICH THIS THE INSURANCE AFFORDED By THE POLICIES EXCLU-SIONSANDOONDMONSOOFRSMUAcYHPERTA'h' DESCRIBED HEREIN IS SUBJECT To ALL THE TERMS; PoLicim tIMrTS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. LTR iYPE OP INSURANCE X=WN POUCYNUMBER Q IX -F AM GV�UABI�Lrr( C Mbt*4tAL 98A2130601W7 4011i/14 10/111#5 FACH.00CLmmee S 11000.000 s :1 cwms-wm FRE Mw EXP (Am ori Pawn) ocow X alkt oontiacival. PERSON . &&AMOMMY a 1,000,00 X XCU Hazards G84EPALAGC-REC-ATE t 2,MA111C GvftAGCPEPATE�aAPPLIES PER POLICY FRI M � PRODUCTS4 A 17 AUTOMOsLErUASUTY AWAUTO COMBNEO SNUE U.Mrr -S 00,00C SWILYM(P-pam" S ALL MWED ALqM B0DU.Y RUM (Per acddw* $ B X scHEDuLbAuTos PRC00001003156 10111114 16111115 PROPEIM DA04E $ lC ARMAUTOS X NON-OWWD AIMS S $ X UMBRELLA UAa X _jCLAIMSMAM OCCUR EACH OCCURRENCE S is ON,= D EXCESSLIAB I cupo(lol OD1373 IOMII14 0t11114 1.0KIMS POGMGATE, 5 U00.000 DEDttcnate . X REMN11ION 10, 000 WORKMCOMP AND EMPLOYERS LMILrry x I VVC STATU- TORYLNMI * ANY, PROME=1PARTN3UMCur4E YINn OFFJCMMSM6MEk=EO? :NIA PAWC578693 1()111114 1OWMIMS F -L WHACCMW S 1;000,0 (NwWatogy In NH) rA� PJ, NN) F -L DISEASE - EA B4FLO EL DISFASE- POLICY LWT S 1,000,00( Limits Mm Occu * pom—ip"ONS below Pollution Liab OPL201082M OiTj�ls w/ Mold Coverage $2M ft DMkgGkibNOFOPERrAMONSILOCATIONS! VEHICLES tA#achACMIOI,Ad=*.,gReMMiMSChgfttglfmac Wa"iSiDOWMd) Evidmea of Coverage SHOULD ANY OF THE ABOVE DESCRIBED. POLICIES SE CMCMA ED BEFORE EVIDENCE OF INSURANCE THE Evimnom DATE THmtEoF, NOTICE WILL BE DmAwm m ACCORDANCE- WITH THE POU.CY PRoMoNs. AU7NOW2W,kPRWWA R D CORPORATION..AHrialft rasarvAd- ACORD 26 (2009109Y The ACORD name and logo are registered marks. of ACCIRD 4 Date .. .� .......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that..N.P............!Z-.....4-.4�".�.�Z'.........U!"1 l�tl�rJ has permission to perform....,,z�!.!!.!`� wiring in the building of......!!h..n........................................................................... at ..... 71 Z— North Andover, Mass. Feet.2°Lic. NoA��.. H.�� ........ ETRICAL NSPECTOR Check # 1 '� V i Commonwealth of Massachusetts Offioial useonly Department of Fire Services Permit No,'� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev, 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the MnssachuseM Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE AL INFO City or Town of: �lO�f'� n� TION) Date: a By this application the undersi neo A ���(' TO the Inspector 1� glues notice omlsor!)W�er tntentton to perform the e e trical w k described below. Location (Street &Number) � � _ Owner or Tenant ol,' d �y Owner%Address _�Q � C�� Telephone No, 978' 6�� ZaOC Is this permit in conjunction with a building ? N�6v p l �S c, ' Purpose of Building_g permit. Yes �] No []� k�1Ju�.L1 (Check Appropriate Box) lOA Existing Service Utility Authorization No. ---- Amps / Volts N vOverhead Undgrd ❑ No. of Meters Amps / Volts Number of Feeders and Ampacit _� Overhead ❑ Undgrd No, of Meters Location and Mature of Proposed Electrical Work: 1N Q T� I N �.i i'+ G`-- ` �j �y�1��1 G��tt�V� 1�1'1�VC� I�nt`t��►� 1� SinA�A t. n Al 4 C`—o'P ft._ ,i. t� No, of Recessed Fixtures No. of Lighting Outlets No, of Lighting Fixtures No, of Receptacle Outlets iNo. of Switches No, of Ranges No, of Waste Disposers No. of Dishwashers No, of Dryers .IV 45 letiort o 'the No. of Cell: Susp, (paddle) Fans No. of Hot 'Pubs Swimming pool Above rnd, No. of Oil Burners No, of Gas Burners No. of Air Cond, mp Tt ea— u iirl'1�incc Space/Area Heating KW Heating Appliances KW be waived b the Ins p ctor ojWires O _ Generators KVA o, o +,ruetgency TgTi1}ng` i3nfta.K, rrwi... FIRE ALARMS 1N0, of Zones o, o otoc�Tt on an o. of Alerting Devices I ❑ Municipal Connection ❑ Other Heaters KW no, of Si ns Ballasts tvo, of Devices or E uivalent °' ° Data Wiring: No, Hydromassage Bathtubs No. f Devices or E uivalent � No. of Motors Total HP a ecommun cat ons r ng: FT!,��" OTHER: �j CSC; �; LSC r No, of Devices or E uivalent � INSURANCE CO Attach addltlona! dela!/ t 'd � Nl ��'YM° S�dl� VERAGE: Unless waived by the owner, no permit for the performance of electrical work may or oissue unless J estred, oras required by the Inspectf Wires, the licensee provides proof of liability insurance including `bompleted 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 [�r BOND ❑ OTHER ❑ (Specify:�W Estimated Value of Electrical Wor V0� b�___e-0___ (When required by municipal policy,) ��xptrahon llate) Work to Start: �' Inspections to be requested in accordance with MIC Rule 10, and upon completion. I certify, under the pains and penalties of perfury, that the Information on this applleatlon is tlete, rue and complete. FIRM NAM};: Ne,� `,.. p Licensee: L LTC, NO,. -,8_j9 (,� (lf applicable enter"exempt ' in the lisecenuntC�er line,) Signatur c Address: LIC. NO,; b d OWNERS INSU Bus. Tel, No., ISN i WAIVER: I am aware that the Licensee does nol haO liability required by law, B Alt. Tel. No,; Owner/Agent y my signature below, I hereby waive this re uirement. I am the check one Insurance coverage normally Signature q ( owner owner's a ent. Telephone No, PERMXT FEE; $ U -4 1z5 ' ! f't. y ("OnlynorrM)eaffl; 001amacltifsettS Department vf.Indristrial Accidents O cQ Of blvestigations } 1 congress Street, Sri ile 100 Boston, MA 02114-2017 WjvmY,mass g0v1Iiia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers MIicant Informnfinn Maine (Bt►siness/Organi�,ation/Individual):Afvwor—+Qnc�,.} II� 1 ty A ou an employer? Check the appropriate box: 191.1 ), am a employer with -- pw 4. D I a.m. a. general contractor and I employees (full and/or pal t -time. 2. ❑ l• am a*sole Proprietor have hired the sub -contractors listed the or partner, ship wid have no employees on attached sheet. These sub -contractors have worlcin' for me in any capacity. employees and have workers' [No workers' comp. insurance comp, insurance) required,] 3. ❑ I am a homeowner doing all work 5. D We are a. corporation and its officers have exercised their m s(f [No workers' cotnp, right of exemption per MC, L insurance required.] t c. 152, §1(4), and we have 110 cmployees. (No workers' Type of project (required): 6. New construction 7. Remodeling 8. [ Demolition 9• D uilding addition 00110 IO X l✓lectrical repairs or additions I l.© Plumbing repairs or additions 12 -El Roof repairs 13.D Other comp, Insurance required.) *Any applicant that chtrks box 41 m submit this a,4st also till out the sectipn below showing their workers' compensation policy information. l' Homeowners who submifl�idtvit indicating they are doing all work and then hire outside c4htractvrs must submit a new affidavit indicating such, #Contractors thAt chcuk this box mast attac:hod an additional sheet showing the name of the sub -can 0tMc rt and stare; whether w not davit cnti ati have employees. (t tae sub-contrpctves have employees, they must provide their workers' camp, policy number, information. am an oyer xti at iP s'Ovidi"9 worker'•s' corixpensatioit irr!sttrrrttce far my er)tpdOy¢es. Below is the policy and job site Insurance Company Name: 0 Policy # or Self -ins. Lic. M, " � Expiration Date: pt Job Site AddressZOd�/ /� 1 ie City/State/Zip . vc� —A 9 -Ys Attach a copy of the Vvorlcers' co>ntpensntio>ra 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 f+ne up to $1.,500.00 and/or one -yeas imprisonment, as well as civil penalties in the form of STOP WORD ORDER and a fine of up to $250.00 a day against the Wola.tor. Be advisod that a copy of this statement may be forwarders to the Office of Investi,gatiorts of tide .DIA ,for insurance coverage verif cation. I do h.erel floe itt orneatfvn prorided above is true and correct. t7fcial use only, Do not write in trtis area, to be completed by city or town of rciar City or Town: Permit/LNccnse # Issuling Authority (circle one): 1, Board of Health 2. Building )Department 3. City/Town Clerk 4, Electrical Inspector 5Plumbiector 6. Other. ng Ins p Contact Person. - Phone #' SSUES w a NEWP013 OP ID. LS CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDYYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE �HO p 01/0$!2014 CERTIFICATE b0E3 N07 AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POR. THIS LICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN'THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. tM terms an If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. if SUBROGATION IS WAIVED, Subject the terms end conditions of the policy, certain policies may require an endorsement A statemenGon-this certificate does not confer rights e t certificate holder In Ileu of such endorsements , 1 to PROL1uc6R g he )F Dwyer Aency 10 Bellevue avenue : D.F. D er Insurance A enc Jewport, RI 02840 • 401-8469629 )anlel F. Dwyer III ADOREgS d1d00dwy®r.com c NoaL401-846.9628 - ----H INSURED Newport Electric Construction Corp 200 Hlgh Point Ave, Suite B6 Portsmouth, RI 02871 A: Foremost B: Scottsdale Insurance Con c: Beacon Mutual Insurance 1 r THIS IS TO CERTIFY THAT TWE POLICIES OF'INSURANCE LISHTED BELOW HAVE BEEN ISSUED -C THE INSURED NAMED A60VE FOR THE POLICY PERIOb INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMECNN WUM RESPECT TO ICY CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CH THIS TYPE OF INSURANCE __._._.....__.._..._._ ___ _._ _� CX� 7AX ERAL UA10 POUC NUMBER LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _ 1,000,0 SCP006046448 12/30/2013 12!3012014 CLAIMS MADE OCCUR REMISFS m. GEML AGGREGATE LIMIT APPLIES PER: --i — AUTOMOeILe LIABIUTY - A 7 ANY AUTO AUALLTOS NED X HIRED AUTOS X UMNI LIAe B X EXCESS LIA9 / D ETE WORKERS COMPLNSATtON AND EMPLOYERS, LIABILITY C ANY PPM101 m—.,�.. A JElnpl Prac Liab MED s - • wmrrUr AGG S S SCP005046448 OMB NE D SIN L LII I Il E acct on SCHEDULED AUTOS 12/30/2013 12/30/2014 BODILY INJURY (Per person) s NEO AUTOS AUTOS BODILY INJURY (Par accident) $ PR PER , p GE $ OCCUR $ CLAIMS -MADE 88001969$EACH OCCURRENCE $ It 12/3012013 12/30/2014 Af:f]bcnex YIN 11 168861 01118/2014 01/18/2016 12/30/2013 12/30/2014 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Renuft echeduls, If mors $Pace Is roqulred) ...... —r M A1W IULNT $ E.L. DISEASE - EA EMPLOYEE 3 E.L. DISEASE •POLICY LIMIT s 10 1,000, 2,000, 2,000' ---------- 600,( 500,( 600,( 60,0 LD ANY THEUEXP1RA IONHDAABOVE E VTHEREOF, NOTICE POLICIES ISE CANCELLED BEFORE RIN Insured's Copy ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Daniel F. Dwyer III ACORD 26 (2010/06) The ACORD name and logo are registered marksr2of CORD ACORD CORPORATION.. All rights reserved. 3 r✓ l6' ✓ 0 ACHUS Date.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... , --/z 1!57��� .:�7 - / 4At-1 ..... .................................................. has permission to perform............................ we�tt/ .......Z�.:l ................. AG" wiring in the building of ..... ..... K ........................................................... ru"ove M, at .................................................. ......... ... ... North Ando, Mass. I�eel� Lic. No. N6?'W ........ �. MICAL-i K.- - I E.. �S Check# '02-6(1:7 PE*L��&L INSPEC70;JR ' Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 10 :� 2 a� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked kv [Rev. 11/991 (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: 10-13-2011 City or Town of. North Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 50 Royal Crest Drive Building # 3 L� Owner or Tenant Royal Crest Estates Telephone No. Owner's Address 50 Royal Crest Drive Is this permit in conjunction with a building permit? Yes No X (Check Appropriate Box) Purpose of Building Apartment Buildings 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: Upgrade Emergency Lighting Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- 11o. of Emergency Lighting 6 rnd. grnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons INo. of Alerting Devices No. of Waste Disposers Heat Pump Number ......................................................... Tons KW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Healing Appliances KW stems: Systems: No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP 'telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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:) 3-21-12 (Expiration Date) Estimated Value of Electrical Work: Work to Start: 10-17-11 Inspections to be requested in accordance with MEC Rule 10, and upon completion. certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Stilian Electric, Inc 108 Tenney St. Georgetown, MA 01 Licensee: Karl Gonsiorowski Signature LIC. NO.: A11067 LIC. NO.: E31598 (If applicable, enter "exempt" in the license number line.) Bus. Tel. N0.' 978-352-9994 Address: 108 Tenney Street Georgetown, MA 01833 Alt. Tel. No OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $125.00 r_-- ll� -/-/- /I-/- / 17/-1// /4('