Loading...
HomeMy WebLinkAboutMiscellaneous - 48 ROYAL CREST DRIVE 4/30/2018 48 Royal Crest Drive, Apt. 3 i I i i I I v Date... ..... ............... OF AORT#1 r; 009 TOWN OF NORTH ANDOVER .- 0 i PERMIT FOR WIRING � ,� + cMu�stg Thiscertifies that ..:... ................................................................................................................ has permission to perform "' .... SQ CDU / q x� S' wiring in the building of........ ..'M.C.Q.................................................................... .4 at ... .................... North Andover,Mass. Fee).D l ...............Lic.No.. ...... L�� ......... ...... ........... .................................. ELECTRICALINSPECTOR Check# rQ to 1; ( o»smonwea i o�I//aeeachieedl J 0 Twial Use 0r ly l Permit.No. •} ..CJdp�xrfnu�►at O�.}i+ur Jervicae Occupancy and f ee Checked BOARD OF FIDE PREVENTION REGULATIONS (Rev, 1/07] (pcaveblank.) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance:with the Masscrchuseti i I"slectricaI('odo(MEC),527 CMR 12.00 (PLEASE, PRINT IN.INK OR TYPE ALL INTORMA.TIO.N) Date: �—C7—/.5 City or mown o-f: POMfkw, rr To 1he Inspectol'of mires: By this application the undersigned gives notice of his or liar intention to perform the electr•icalljwork described bolo . Location(Street&Number) 91ptyc \, Cf�tS[ OyIsmy,03. n AN �©wultj �r• Owner or Tenant jyyN, b - 'Telephone No. 0_6'3q-605^A Owner's Address 60 _f�a !al, Bret vrwe...-h pip-kogy- - Is this permit in conjunction with a building permit? Vey F1 No (Check Appropriate Box) Purpose of Building_ 9Wt.S ts, ut tl1- Utility Authorization No. Existing Service Amps / Volts Overhead El I..Judgrd❑ No.of Meters New Service Amps / Volts Overhead D Undgr(10 No.of Meters Number of Feeders and Arnpacity Loention and Nature of Proposed Electrical Woric: �►.u� tRl���`rVM �utt�_TO at��l-b.UL (3��. 0►a� D�`��....��y�i FMy�'C' Z'1n� lira rxL�Ar?CS C'om letfarr n'tire oflowin table nrcry be waived by the Inspect,)?,or wires.LisTCO No.of Recessed Luminaires No.of Ccil.-Susp (Paddle) ons pr o Total _ _ TrAnsformcrs SVA, No.of Luminairc Outlets Y No.of Hot Tubs Ge crnt:ors KVA No.of Luminaires 'Swint ming Pool Above ❑tri- ❑ 0.oT .tnergency ig mg rnd- rnd. Battery Uniiw No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners � o.o electron an r lnitiatin DeYiCe9 No.of Ranges No.of Air Cond. 'Tons No.of Alerting Devicea No.of Waste Disposers I-lent Pump ..um er 'Paas l(w o.o Self-C:ontnme p Totals: .... Detection/Alerting Devices al No.of Dishwashers Space/Aren Keating KW Local(] -nn actio 0 Outer _ C.onnect':on No.of Dryers pl Heating A )liance.s Kir Security S $teml, No.of evicCs or 6 quivallent No,of Water KW No.of No.017 Data Wiring: i'ieater4 Si ns Ballasts No.of Devices or Equivalent No.H dromnssage Bathtubs No.of Motors "Total F1P a etommttn cations ariag: y No.of Devices or E uivalent OTHER: Attach additional(lr:/oil f/cje.hvd,or ars required by the Inspector of R/fres, Estimated Value of Electrical Work: I C�OCX (When required by municipal policy,) Work to Start: 1; Inspections to be requested in accordance with NIIEC Rule 10,and upon completion. INSURANCE COVERAGU: Unless waived by the owner,no perinit for the performance of electrical work may issue unless the licensee provides proofof liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited pmoi'of same to the permit issuing office. CI-1L'CK ONE: INSURANCE ox BOND [l OTHER ❑ (Specify:) I certify,miler the pains and penalties of perjruy,that the igfi)t'matiov on this application is true attd complete FIRM NAME: Newport Eloctric LiC.NO.: A20803 Licensee: David McMullen Signature I.iC.NO.: 116088 (Irapplieahle,enter "exenrpr"in the license number line.) Bus.Tel.No.:401-263_0527 Address, 7.00Hig�oint Ave. Portsmouth,,RI-02871._ _-_-_ - Alt. rei.No.: 617-908-6193 *Per.M.G.L.c. 147,s.57-61,security work requires Department of public Safety"S"License: Lic,No. OWNER'S INSURANCE WAIVER: i am aware that the Licensee does not have die liability insurance coverage normally required.by law. By my signature below,I hereby waive this requirement., I oni the:(check one x owner owner's agent, Owner/.Agent Signature Telephone No, "_��_—„��� powa 1'EEr $ c 6— Date.......... ........ 14............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING SQtCHU This certifies thatk .....W.. ........... 7 ....... ..................... has permission to perform (Ae4 -1...Ik.0 .. ......... ...... .. .... wiring in the building of.... ...... .. .......................................................... ..........4....at. ......1r, Andover,Mass. Feo . ..............Lac.c. Noohk M�......... ..... ...............4 -�'ii�a4nNSPECTOR V Check# Commonwealth of Massachusetts Official Use O/nj'�'• Department df Fire Services permit No..__ BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Chocked (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 (PLE'4SE PRINT 11V INK OR TYPr, 9L INr, TION . 'City or. Town of: '1 No �, ) •� Date: ..v� By this application the undersigned' iv To the Ih eetor g g es notice o is4or . ipt�nttion to e r �f rtes: Location(Street&Number) �O P :farm the e7ectf'ioal work described below, ,• �2 �( Ctt,�i t U�ner or Tenttnt.• , nr� Nom` ltNt� +�Y' Mull, /4t Hca. N��M nc�V . •Ll, C- Owner's Address —O CYr?.5 ` ,`Telephone No, 9787 6ga 7a O( l., Ndoy O�Fs� S •��` . Is this permit in conjunction with a building permit? Purpose of Buildin Yes 140 g �w�l✓1, (Chock Appropriate Box) Existing Service Utility Authorization No. Am s N v p Volts Overhead 11 . � Undgrd ❑ No, of Meters -�� Amps / Volts Number of Feeders and Ampacity_�- Overhead❑ CTndgrd [� No, of Meters Location and Nature of Proposed Electrical Work: 1N ��-fie t�S IN �t�t I NA \T\V2 _ C ymily 0-S �r Ietlon o 'the ollnwin Table ma be waived b the Ins ector o Wires. No,of Recessed Fixtures No,of Cell.-Susp, 0.0(Paddle)Fans Transformers KVq No.of Lighting Outlets } No.of HotTubs $ KVA Generator No,of Lighting Fixtures ON Swimming Pool n- o.o Emergency g ng No,of Receptacle Outlets rnd, rnd. Batte Units No.of Oil Burtiers No.of Switches FIRE ALARMS No.of Zones No.of Gas Burners No. Of etec on an No,of Ranges otal Initlatin Devices No, of Air Coud' No.of Alerting Devices No,of Waste Disposers P , um er ous ea um Tons Totals: bet ction/Alertin pevices No.of Dishwashers Space/Area Heating KW unic a No,of Dryers Heating Appliances Lo Onnecpin ❑ Other o-U ater ecur yyss Heaters KW o.o KW No.of Devices or E uivalent o,o Data Wiring Si ns Ballasts No. f Devices or E uivalent _�•. No,Hydromassage Bathtubs No. of Motors a ecommun cat ons r ng; Total HP ARvr, NT OTHER: 6 Glktr T r\CCCf\ No,of Devices or E uivalent jrS INSURANCE COVERAGE; Unless waived by the owner, no permit for the performance of electrical o3 �'1evM�STAY ttoch addltlonpl detaJl iJ'deslred,or pr rega,ired by the/nspector of Wires, the licensee provides proof of liability insurance including`�ompleted operation"coverage or its substantial equivalent. The undersigned cc;t•tifies that such coverage is in force,and has exhibited proof of same to the permit issuinoffik may issue unless CHECK ONE: INSURANCE [FI BOND (] OTHER E3 office. ❑ (Specify; Estimated Value of Electrical Wor Work to Start: (When required by municipal policy,) (�Xptrat�on Date) `' Inspections to be requested in accordance with MEC Rule 10,and upon completion. 1 certify,under the pains aid penalties o er ur that the Information on this application is true and complete. FIRM NAME: Ne,,),> `r. f P Y, Licensee: LIC,NO,:�Q�(� (Ifapplicable enter "exampl"in the licese number line,) Signatur Address: LIC.NO,: 1110 OWNER"'"' D H t Pc,�of +'<� g, !ti Par Bus.Tel.No., -� 'r L".'SURr'N4cE WAIVE.,. I am aware that the Licensee ee does O have al 1labili required by law. B m -•- Alt.Tel,No., - 3 Owner/Agent y y signature below,I hereby waive this requirement. I am the(check one insurance coverage normally Signature owner owners a ent• Telephone No. PERMIT FEE: $ 3d 5U �1 --_ --- a r • j.! ./1 �6 N�� . ��. � � � o� � �;� , ����- � ���� �y r�- C., 'J,� �. , l fte ("Ontm oil wealth 0j,Alassacliff eta IMEMM , ;M ,�tf�i. .0epar1111ent of Industrial Accidents y a .�r �JJ`Oe OfxllveSti'gfltld/IS I Cottgpess Street,Suite 100 Boston, MA 02114-2017 WI M-MassgovIdia Workers' Compensation Insurance,Affidavit; IIui.iders/Contractoirs/Electricians/Pllumbers Avylicant intfozimation ].ease"'Dint Le ibi Name(Business/organi7,ation/Individual): � Address: AM i h two m city/stat c/7-ip: ak�o_Loliql i'hane Ar ou aln employer?Che appropiriatt box: 1, 1,ant a employer. ith---j� 4. C] I am a.general contractor and I Type of project(required): employees(full and/or part-time).* have hired.the sub-contractors C L1 New construction ng 2.❑ i a.m a'sole proprietor or partner- listed on the attached sheet. 7. ship and have no employees These sub-contractors have �demolition working, for me in any capacity, employees and have workers' S. Q Demolition r►3 [No workers' comp, insurance comp. insurance.t 9• [� uilding addition iriP4 required.] 5. ] We are a.corporation and its Ip IJ1ectrieal repairs or additions 41 3.❑ I am a homeowner doing all work officers have exercised their Myself [No workers' cotnp, right of exemption per MC,L I l.❑ Plumbing repairs or additions insurance required.]t c. 152, §1(4),and we have no 12.[l Roofrepairs crnployees. [No workers' 13.D Other ' comp, insurance required,] *Any applivant that ehavks box Vit rnust also fill out thv section below showing their wprkers'compensation policy informtlkion. t Homeowners who submit this affidavit indicsating they are doing 1111 work and then hire outside cohtractors must submit a new affidavit indicating such, tCvntracbrs that che�lc this box must atta:hed an additional sheer showing the name of the sub-contractors and state whether or not those cntitie have employees. !t the sub-contravtors have employees,they must provide their workers'comp,policy number, I aham an employer that isimoviding workers'compensation insurance for MY chipinyees. Below is the policy and job site information. Insurance Company Name: / Policy#or Self-ins.Lic,#: �/r � Ex11,07 piration Date: of Job Site Address:���'7`�' City/State/Zip: Vfl� OIti► Attach at copy of clic rworl�eYs' co>�npensatiorr Policy declar>;ttion page(sho�vi>ag 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 ttp to$1,500,00 and/or one-year imprisontnen1,as well as civil penalties in the form of a STOP WORK ORDER and a fine Of un to$250.00 a day aga.utst the viola.tor.• Be advised that a copy of this statement may be forwarded to the Office of. Investigations of,the DIA for insurance coverage verification. �Si o laereb cerci 1,under th aan tad enalties o 'ter irr,that the in ornaarion provider]aGove is true and correct. nature: — .Pl�orte#: —Date: .� p [Bloard e only, Do not write in dais area,to be completed by city or town official, v►vn: Fermat/Lkecnse# thority(cir'cle one): f Health 2,Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector rson: Phone#• i a • • OMNI'. • ISSUES THE FOLLOWINGftSE "-REFRIE D 14AST.E:R;<E'LEC �R7CfAf� > _ l >:NE:�P:.,. :RTJ�:E-L:'ECTR i.t;",CORP I; 'PORAT ON, - >u:.DAVIYI :A` EN r INONWECLTH OFFMYSSACNS buf '=LOIiJ t�tG`< S AN<:ELE.CTR .SsdJC,;;RE :.JOURNE AMA.6 A MCMULLEf3 � �. , 1� t7SIMOUTN i 0287,`115802 VT V ` � �40RTN O`,-jolo .14,0 U 3= ' BOARD OF HEALTH 1O i D t ' 120 MAIN STREET -- :.n---, -- °,,,l°."4y 9SS^cHusE` NORTH ANDOVER, MASS. 01845 text. 32 or'33 COMPLAINT FORM DATE: `i "! ( CASE COMPLAINANT: ADDRESS: .^ C1,0173 PllONE COMPLAINT W OWNER• ADDRESS: PHONE# ACTIONS• f / /V C �! c . - - t} 24 441r; - (ij Ic 4da 11111"T - � 9 o DATE OF INSPECTION: ~ NEW1_P013 OP ID: L$ �--- CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDYYYYY) FRTIFICATE IS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER$ NO RIGHTS UPON THE CERTIFICATE NOLpER. THIS 01/0$12014 DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. PORTANT: If the certificate holder is an ADDITIONAL INSURED,the poiicy(les) must be endorsed. If 3WBROGATION IS WAIVED,sub ect to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certlflcate holder In Ileu of such endorsement s. PRODUCER Dwyer A encu r 38 Bellevu@Avenue D.F. Dwyer Insurance A enc 38 P D.F. Newport,RI 02840 �,.E,dl•401-846-9629 R_ Daniel F.Dwyer IIIA/0 L14 4401.846.9629 �erREss.dfd dfdwy@r com --- INSURENS)AFFORDING COVQRAOE INSURED— Newport ElectricConskructfon INSURER A:Foremost iNA1QM Corp LNSURER0:Scottsdale Insurance Com an 200 High Point Ave,Suite 66 INsuRtsRc:Beacon Mutual Insurance 41297 Portsmouth, RI 02871 — — INSURER 0: _._........._. ..._�—. COVERAGES CERTIFICATE NUMBER: INSURER R — THIS 13 TO CERTIFY THAT THE POLICIES U INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER OCUM REVISON NU RESPECT TO WHICH T CERTIFICATE MAYO ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIENTN IS SITH UBJECT TO All THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. HIS TYPE OF INBURANCe ----_._-.,__.._.__Ii GENERAL LIABILITY POLICY NUMBER LIMITS a SCP006046448 12/30/2013 12/30/ 1,000,00 2014 CLAIMS MADE a OCCUR 4( e QAC L�gpge� S ___300,00 MED EXP An one eaon S 10,00 PERSONAL$ADV INJURY S 1,000,00 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AOGREOATE $ 2,000,00 POLICY PRO AUTOMOBILE LIABILITYLOC PRODUCTS-COMP/OP AGG S 2,000,00 a A ANY AUTO 0 B NED SINGLE LI IT ALL SCP005046448 E ace en 1,000,00 AUTOS OWNED X SCHEDULED 12/30/2013 12/30!2014 BODILY INJURY(Per person $ AUTOS ) HIRED AUTOS X NON-OWNED AUTOS BODILY INJURY(Per accident) S PR PERTY D GE $ ------ UMtSIlELIq LIRE X OCCUR " S B X O UAB CLAIMS-MADE BSOO19598EACH OCCURRENCE S D D TENTI 12/30/2013 12/30/2014 AGGREGATE WOR,"iCOMPENSATION S 6,000,00 AND EMPLOYERS,LIABILITY 5 C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/" WC STATU- 0TH- OFFICER/MEMBER EXCLUDED? 68861 S-___i - (Mand+tory In Ni "/A 01!18/2014 01/18/2016 E.L.EACH ACCIDENT If yes describe under S 600,00 OE GIR PTI NO PERATIONS below E.L.DISEASE•EA EMPLOYEES 600,00 A Empl Prac Liab SCP 12/30/20 DISEASE-POLICY LIMIT S 500,00 12/30/2013 12/30/2014 50,00 DESCRIPTION OF OPERATION /LOCATIONS I VEHICLES (llttaoh ACORD 101,AddlUo,u l Remarks Schedule,IT more spas Is nquirW) CERTIFICATE HOLDER CANCELLA N SHO LD ANY THE UEXPIRATIIONHDATE ABOVE THEREOF, NOTICE POLICIES WILLL CBE ANCDELIVERED RE InaUr@d'e Copy ACCORDANCE WITH THE POLICY PROVISIONS. AUHOPoZED REPRESENTATIVE Daniel F. Dwyer III ACORD 26(2010/06) The ACORD name and logo are registered marks 2of ACORD ACORD CORPORATION.. All rights reserved. y s � �U