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HomeMy WebLinkAboutMiscellaneous - 44 ROYAL CREST DRIVE 4/30/2018 l �5 (�7n1 Cud fie. BUILDING FILE � i Date .. ................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING j This certifies that `�'��'P�".'�................r........................................................................... has permission to perform *�-�, wiring in the building of.... ...... .........✓ ......................................................................... .......... ..............................................I............................ at ........+5......... .............................................North Andover,Mass. Fee..P.�...........Lic. No-CW:S ........A1, t 'L*'E'C** 1, �p ECTOR Check 33n ' ommonarsa i o�///ueeeee c�,zf of tial 1Jse Only ,, �dlitErWYlRl7l.P�.JirR arvicnb - Occ.� ane and ree Chocked 1P Y BOARD OF FIDE PREVENTION REGULATIONS Rev. 1/07) (leaveblank) APPLICATION FOR PERMIT TO PERFORIN ELECTRICAL WORK All work to be performed in accordance with the Massichvwt1$uloctrical Codo(MGC),527 CMR 12.00 (PLE,ASL,PRINT 1N INK OR TYPE-ALL INFORIidAT1ON) T>!a.#e: J✓ _ City or Town of- l,uQM Ac2A"P_Y _ To lite Inspeclor of'Wires: By this application the undersigned gives notice of his or liar intention to perform the electrica�ll workdescribedbel w. Location(Street&Number) 9,m cpA. C'm.5'T,�ylw— `M_.AWOMC Owner or Tenant k'MCb Yelepbone Nn. � _(_B 1_x+45 A Owner's Address 57.._� I,gl, Is this permit in conjunction with a building permit? Ves No (Check Appropriate Box) Purpose of Building_DWe ]!N�S �ltvl'� _ Utility Authorizatian No. Existing Service Amps / _Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead D Undgrd D No.of Meters _ Number of feeders and Ampacity Location and Nature of Proposed Electrical Work: � ��s5ralt Alew � rrMt, STw-, Ta_�t'� ru �. r�l`C t c.►: -.._t'�,�g t►�n „C r tri uV�AF'"iS C:;onElotion o'the bllawin sable mov be waived by the Ins ecior of Wires.L1sTvv M No.of Recessed Luminaires No.of Ceil.-Sus .(Paddle)if ans o.o Total wi ( Transformers 'KVA No.of Luminaire Outlet.~; No.of Hot Tubs __. Generators KVA No.of luminaires Swimming Pool Apovc fin- El h.oT ,mergrncy i .�n tnd. rncl. Batte Unitas No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Glttikias Burners T o.o ion Devices No. eviCOs No.of Ranges No.of Air Cond. Totts No.of Alerting Devices Hent um 9.mber `funs1CR� o.o seiTContnine No.of Wnste Disposers Totals DetectionJAlerting,Devices ` No.of Dishwashers Space/Area Heating ICWT Local[ unicipAt Connection Other No.of Dryers Heating Appliahces KW security Systems: No.of Devices or E uivolent 4 0.o Water KW No.of o.of Data Wiring: Heaters Signs f3allael:s No.of Devices or U Divalent dromassage Bathtubs No.of Motors 'Tntnl HP c No of Devices Detl cations No.H um : y No.of evices or E ttiva�ettt OTHER: Alluch uddiilonal dr.-7;i]f/de.sired,or ars required by the Inspector of Wins, Estimated Value of Electrical Work: 16-)OK)O (When required by municipal policy.) Work to Start: I; I Inspections to be requested in accordance with N,117-,C 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 forco,and has exhibited prop>f of same to the permit isst.-ling office. CHECK ONE: INSURANCE O BOND [l OTHER [] (Specify;) ! I certify,under the pains arld penalties gf perf rn?,that file information on this application is trice and complete: � FIRM NAME: Newport Ploctric LiC.NO., A70803 Licensee: David McMuileo Signature JAC.NO.: 116086 (If❑pplicahle,enter "exempt"in the license number line.) taus.Tel.No.:40t.-293_0527.. Address: 200.Hig point Ave. Portsmouth,,81.02871......... ....__ . _. Alt.'i'el.No.- 617-908-4193, , *Per M,G.L_c. 147,s.57-61,security work requires Department of public Safety"S"License: laic.No. OWNER'S INSURANCE WAIVER: i am aware that the Licensee does fznl have the liability insurance coverage normally required by law. By n1 si naturc below,I hereby waive this requirement, t ant the(check fine x owner 0 owner's agent, _ Owner/Agent Signature Telephone No. ',LFI iT E.E. $ S,-T i r l i I i Date..62 q- `14 .......................................... NONTH 1 TOWN OF NORTH ANDOVER n PERMIT FOR WIRING ss�CHU Thiscertifies that ,,..11.Q.U! .....................................................l.... .................................... P has permission to perform ((....... .. � C� A-1..tX. . -�... ./t..QM..o� wiring in the building of... .t ..... .......... !YN P ..............^ ....�........................................ at .,. ,...,es-, JuA'A Andover,Mass. Fee... . .. ......Lic. No. (�1 ��!��. .,.:.. r... y,� ELECTRICAL IN PECTOR r I Check# V 9ICommonwealth of Massachusetts offio Only Department of Fire Services permit No, �� BOARD OF FIRF pFtEVENTION 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 Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE AL INFO TION City or Town of: ttiOf Date: By this application the undersi n AN1J) ©ver To the In ector Of res g ed gives notice of his or tier intention to perform the e Location(Street& Number) lectrical k described below. Owner or Tenant �� MST C)rt�. ivr ^' I -�{' M0, p j Owner's Address C`fC� Telephone No, g lis 6FSJ\ a0c Is this permit in conjunction with a building ? Nd6v 01�S4 ► LCi • Purpose of Building_ permit. yes _�V�e.1,1 �� ❑ No [gl"_ (Check Appropriate Box) Existing Service ---- Utility Authorization No. mps / volts Overhead ❑ Und rd Am / g ❑ No ps . of Meters _Volts Overhead❑ Und rd No,of Meters Number of Feeders and Ampacity 8 ❑ Location and Nature of Proposed Electrical Work, lel, TS 1 N �.ii,► i .� � — C ,ms s aN�,tt,re VM1V aLs �r letlon a 'the ollowin table ma be waived b the In ector o Wires. No,of Recessed Fixtures No.of Cell.-Susp. 0.0 p (Paddle)Fans No.of Lighting Outlets No.of Hot'Pubs Transformers KVA No.of Lighting F Generators KVA g g fixtures Swimming Pool ove n- o.o mergency g ng t Nn,of Receptacle Outlets rnd. ❑ rnd' Batte Units No.of Oil Burners FIRE ALARMS No,of Zones No.of Switches No.of Gas Burners o,o etec on,an No.of Ranges otal InItiatin Devices No.of Air Cond, ns No,of Alerting Devices ca um No.of Waste Disposers p , um er ons SIC,Totals: bet ction/Alertln nDevices No. of Dishwashers Space/Area Heating KW unle a No,of Dryers Heating Appliances Local onnecttion ❑ Other o.o ea KW No of Devices or E ulvalent Heaters KW . 010 o.o Signs Ballasts DataWiring: No,Hydromassage Bathtubs No. f Devices or E ulvalent No. of Motors a ecomrnun cat ons r ng: Total HP ARMTM¢ra7' OTHER: 6 I:U.07Y1 C o.of Devices or NE ulvalent ��rd kuTv,i % wall U i �e�rnto 11. INSURANCE COVERAGE: Unless waived by the owner, no permit for the perfoarmancet of electrre icalredby workthe ImPecloro/'Wires. 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 IF' BOND ❑ OTHER [] (Specify: Estimated Value of Electrical Wor (Expiration Date) Work to Start: (When required by municipal policy,) owith MEC Rule 10,and upon completion. J`lcf Inspections to�e requested in accordance I certify,under the pains and penalties of py, er ur that the Information on this application is true and complete, : ,,,I,) �. FIRM NAME NO. Licensee: LIC. ,•A_jk0' m (If app �applicable ente• "' Signatur c'aa1"i Address: Q p n the licevse number line,) LIC.NO.: 0 Por m�I d `i3`1 Bus.Tel.No. OWNER'S INSURAN E V1,AIVERc I am aware that the Licensee does not have the liability Alt.Tel.No., - required by law. By my signature below,I hereby waive this requirement. I am the(check one 3 Owner/Agent ty insurance coverage normally Signature owner owner's a ent. Telephone No. PERMIT FEE; $ () rJl 'fit y�'1 19v- f w � 6 P V ✓ 3 c..01nmol:weaIth 0014,5sdchusett s' DCPai M',ent of I llilustrial Aecidents Office ofxtavestil;atioi'ls I Congress.Street,Suite 100 Bostorx, MA 02114-2017 wl'4+1-mass govltlia Workers' Compensation Insurance Affidavit: Builders/Contiro.etoirs/Electricians/Plumbers A licant Tinfnrmatioia lease Print Iae ibl Name(Business/organization/Individual): ( r•+01" iA O � A ddreSs; . a►r7 City/State/&p: d 1"1'adU � Phone# : •. Ar ou an, employer? Check the appropriate box: 1, 1,am a employer with�� 4. D I am a.general contracto7atidI TT oject(required): employees(full and/or part-time).' have ktixed the sub-confiK6, construction2,© 1,am a sole pxbprietor or partner, listed on the attached sh7. odeiin� ship and have no employees These sub-contractors have working, for me in any capacity. Cnrtployees and have workers, $' Demolition nt [.No workers' comp, insurance comp, insurance.t 9. wilding addition required.] 5. EJ We are a.corporation and its M � Clectrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MCrL 11.❑Plumbing repairs or additions insurance required.]t c. 152, §1(4),and we have no 12.El hoof repairs employees. (No workers' 13.0 Other ' comp. insurance required.) Any applicant that ehacks box 4 1 must also fill out the section below showing thcir workers'compensation policy information, 'i'Nomeowners who submit this affidavit indicsting they are doing all work and then hire outside c tContrac:Pors thstt the ghtractnrs mus cic this box must attac,hcd an additional sheet showing the name of the sub•contractnrs find state whether or not tl osc'cnt't ets indicating employees. If the sub-contrpctors have employees,they must provide,their workors'comp,policy number, 1 am an erraployer that is providing workers'corirpensar'ion insarance for rqy errrplr7y¢es. Below is the Policy pn.d job site information. Insurance Company Name: 0 � Policy##or Self--ins.Lic.#: Expiration Date: t3I � Job Site 1lddress:;���/,e !4t� y, '�`—" City/State/Zip:- Vt� j Q/�''�i►�" 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 M("rlr o, 152 can lead to the imposition of criminal penalties of a fine up to$1,50U,U0 atYd/or one-year imprisonment,as well zs civil penalties in the form of a STOP WORD ORDER and a fine o£up to$2SU.pU a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of InvestigatiOns of the.DIA,for insurance coverage verification. I it?IWO certi y under tla am .rad enaltzes o let r)that frac it, orrnatidn Provided d aGove is tare and correct. Si nature: — — —— —Date: .� Q Of�cial arse only. Do not write in this area,to be comp by city or toturr official. City or Town: 1"Crmit/LkCense# Issuing Authority(circle one 1. Board of l=fealth 2.Building)Department 3.City/Town Clerk 4,Electrical Inspector 6, Other p 5. Plumbing Inspector contact Person! Phone#; Y "aOOMMONWEALTH OF;NIShIHUS EI»E�1`RICIANS - iSSUES THE .IO.LLOW.ING k fNSE Il'EG t TER 1 D MASfi i EL tTR7 NEIwlPt1RT ELECTRIC' CORPQRAT'i�(11`C� r ib I1C[ UL1rEN ra g :19 BURS LOt,€ELL 1�tA 01852 4026 20803 A .€ 07�311k.r 11 1039 . ; 0 M�DNWEALTH p NILtS ACHI�$ ! ELTR1 C+I ANS ISSUES THE 'FOLLOWING {CENSE JOURI�EYMA ELECTRa C,t %pAy1f1''A MGMULLEN , ` - ''` 76 K Iµf pH I tl I P STRt r ,' 1 'TMOUTH RI NEWP013 OP ID: LS �..---� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HO foe/2014 E/ROTHI CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLI BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS AUT S REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. CIES thePOF an If the certificate holder Is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION- O AUTHORIZED the terms end conditions O suchf the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certiticate holder in/leu of such endorspolicy, merit s. IS WAIVED,rights tosubject to PRODUCER 30 Dwyer a Aven D,F, D er Insurance A enc 38 Bellevue Avenue P E------•--_ Newport,RI 02840 E F.MI;401-846-9629 Daniel F.Dwyer III AIss:dfd dfdwyer Com c No1L401.846.9629 IN8URE S AFFORDING COVERAGE _ NAIC N INSURED Newport Electric Construction - -- INSURER A:Forem ost Corp INSURER B:Scottsdale Insurance Company _ 200 High Point Ave,Suite B6 INSURERC:Beacon Mutual Insuranc41297 Portsmouth, RI 02871 _ .- INSURER 0: INSURER C: COVIl ES CERTIFICATE NUMBER: P THIS 19 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE.BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD REVISION NUMBER: INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM A CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE GENERAL LIABILITY FOLIC NUMBER LJMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 SCP006046448 12/30/2013 12/30/2014 �'� —'— CLAIMS MADE XI OCCUR Q r y ��.e g _300,00 MED EXP An one arson $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY PRO" PRODUCTS•Coll AGG S 2,000,00 LOC AUTOMOBILE LIABILITY S A ANY AUTO OMB NED SINGLE LI I SCP005046448 E acs en __ 1,000,00 AUTOS NED X SCHEDULED 12/30/2013 12/30!2014 BODILY INJURY(Per person S AUTOS ) HIRALLED AUTOS X NON•OWNED BODILY INJURY(Per accident) g '-- AUTOS PR PER TY D GE — --- -- UMBRaLIA LU1B E X OCCUR .�.� S B X EXCEss LU►B CMM8 M OE BSOOI9598EACH OCCURRENCE g D D ETENT 12/30/2013 12/3012014 AGGREGATE WOAMRS COMPENSATION $ _ _6,000,00 AND EMPLOYERS,LIABILITY $ C ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A 68861 01/18/2014 01/18/2016 ry In NW) E.L.EACH ACCIDENT (Mandatog 600,00 If edea uME.L.DISEASE•EA EMPLOYEE S 600,00 DE GtR PTITII N Nor OF PERATIONS below A Emil Prac Lb SCPO0604$44$ E•L DISEASE•POLICY LIMIT S 600,00 12/30/2013 12/30/2014 60,00 DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (Attooh ACORD 101,AddMonal Remarks Schedule,If more spaos Is squired) CERTIFICATE H LDER CANCELLA ON SHO LD ANY 'IF-FORE]OTHE ABOVE COETH �EPOLICIES E EXPIRATIONDATE THEREOF, WILL BE DELVER Insured's Copy ACCORDANCE WITH THE POLICY PROVISIONS, AU1TtOPoZED RLPRESENTATIVE Daniel F. Dwyer III ACORD 26(2010/06) The ACORD name and logo are registered marks 2of CORD ACORD CORPORATION.. All rights reserved. T 0 3 b 6 Date....P.................... R f NORTH TOWN OF NORTH ANDOVER 3? �°A ......• OL p PERMIT FOR WIRING ,SSACMUS� This certifies that s n �G .................�- ................1 T!? ...................... has permission to perform ter..........rl �...... l. X wiring in the building of.... ' atb... P�� r� Tr ' ` �` ..... orth Andover,Mass. . ......... .......... . Fee.t..�-:.. ©'"G'.�Lic.No..Y O67,4 .. .. .......... .i.. .. .. E ECPRICAL. iNSPECTOR Check # d Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 6 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked u,p [Rev. 11/99] (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# l f 5 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 oll wing table may be waived by the Inspector of Wires. • No.of Recessed Fixtures No.of Cei!: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- ❑ o.of Emergency Lighting 6 rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tonal !No.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 HeatingAppliances KW PP Security Systems:No.of Devices or Equivalent No.of Water Kms, 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. I certify,under the pains acid penalties of perjury,that the informative on this application is true an omplete. FIRM NAME: Stilian Electric,Inc 108 Tenney St.Georgetown,MA 018 xLIC.NO.: A11067 Licensee: Karl Gonsiorowski Signature LIC.NO.: E31598 (If applicable,enter"exempt"in the license number line) Bus.Tel.No.: 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 PERMIT FEE: $125.00 SignatureturaTelephone No. L- l