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HomeMy WebLinkAboutMiscellaneous - 5 ROYAL CREST DRIVE 4/30/2018 �c�Y�1 LC��cc5� . T '1;.�/� 4� �.� 4 bai. t r 4 ROYAL CREST DRIVE Complaint Detail RepoYt Printed On:Wed Nov 13,2013 Complaint#: ` CT 2014-000016 .Status Closed . - r. �° GTS"#: .�Violator: Roya]'Crest Esfates. amu, Address': 4 ROYA>✓;CREST.DRIVE Map: Address: SO Royal Crest'Drive Date Recvd.: Sep-03-2013 Time;Recvd:: 04.36 PM :Block: NORTH'ANDOVER,MA 018' Category Mold Lot: Type: Commercial GeoTMS Module: .Board of Health District. Trade: food .0=�- Recorded By, Lisa Blackburn Zoning: 1, Structure: ATFD Description-.:n ,y , ,; Complaint. Alexandra Finney;tenant at 4�Royal Crest Drive apt.43 called to place a complaint regarding mold throughout the apartment:There`is mold sprouts on wood apartment 2 months clothes thes and`fumiture throughout the apartment.Her roomy and asked if if have notified Royal Crest manproblems since moving into the been experiencing respiratory go.The Health Department assistant spoke to A gement,regarding the complaint.She had not contacted management and was advised to place the complaint to Royal Crest.Her complaint will be logged and forwarded to Michele Grant.w. ..._. Comments: Inspector Assigned to Complaint:Michele Grant Contacts Contact Type Date Time Name Phone Best Time To Reach Recorded By Response Tenant Sep-03-2013 4:36 PM Alexandra Finney (508)776-4270 Q Lisa Blackburn Forwarded to Health Inspector Actions Taken GeoTMS Module Status Date Time Response Type Action Taken Comments Board of Health REFERRAL Nov-13-2013 8:44 AM Follow-Up by Health Follow up by Michele Grant. Inspector Spoke with renter and Royal Crest.Problem has been taken care of Case closed. GeoTMS®2013 Des Lauriers Municipal Solutions, Inc. Page 1 of 1 I .. Date...........e�� .. ............ .. .... '40PTh 0 "'. TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING S$ACHU This certifies th has permission ion to perform I(Z. J �Y C5 ........ ...*"**...........CA. wiring.in the building of ....................................................... )C—L"-VAN...k�.... ....H2 �'Xorth Andover,Mass. ................................... Fee...)Q 5........Lic.No.15191. ?....!.0......... Check# Commonwealth of Massachusetts Official Use 'Only Department of Fire Services Permit No. � p`c® ' Occupancy and Fee Checked �M BOARD OF FIRE PREVENTION REGULATIONS [Rev.iw] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASEPRWTINNKORTYPEALL)NFORMATION) Date: AyGU.5t. ;� 6 , I LI 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 Q O U Q_1 CC-S+ -0.2_ Owner or Tenant Am i C© lqO tZ 44� A N pdv.<v- e... Telephone No. Owner's Address u i cb rl 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 Und rd ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �;�i C� G`'�eC +2 tC ( '(.ESr�n�C-I-tt�sl S ► �S@('�c3r� e_1 e e,frL i c. ).ko-+ i�n C vo I �6L�e- A-h-e-r n.e o s ba-A-S p-n c1. Ca r(_g L ect-k e-r S Re- i r,q e t ' Completion of thefollowing table m be waived b the Inspector o Wires. S n 'l3 � � P f g a1' Y p .f No.of Recessed Luminaires No.of Cell: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- ❑ o.o mergency Lighting 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 No.of Alerting Devices Tons 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 Heating Appliances KW Security 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: O C) Attach additional detail if desired,or as required by the Inspector of 97res. Estimated Value of Electrical Work: 300 r (When required by municipal policy.) Work to Start:8(a le I I'-f 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: 1NSURAsICE ❑ BOND ❑ OTHER ❑ (Specify:) X certify,under the painsyand enald`,of erjury,that the information ore this application is true and complete. FIRM NAME: \e. p, Y i�I e— LIC.NO.: Licensee: ie— Nit 1,,x l e— Signature P ec - LIC.NO.:3 I6`6 eapp---- te�enOter�exe�mp'"lin thhee llicense��bel li'ne) � A- C5 a Li Bus.Tel.No.• �-��-, Address: ``1l f��t / Alt.Tel.No.•ma-569- *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 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: �$ 2—'7 Signature Telephone No. i /f ` _ �, �� s �' I c { � i ; I The Commonwealth of Massachusetts07 - Department ofIndustr'igl Accidents Office of Investigations 600 Washington Street Boston,MA.02111 Ulf www mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information (� Please Print Legibly Name(Business/Organizationdlndividual): L ` � 1' j � e-tV L) (L Address: Le© o vn�� Ia- City/State/Zip: .a-k-L('�'LC,,-w) f lA- 09US) Phone#: S0g"S ^CQ, Z Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with r f 4. El am a general contractor and I ` * have hired the sub-contractors 6. ❑New construction employees(full and/oxpait-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12,❑Roof repairs insurance required.]t employees.[No workers' 13.FJ Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I"Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box mast attached an additional sheet showing the name of the sub contractors and their workers'comp.policy information. .1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and joh site information. r� Insurance Company Name:. . ,L , A� c-3 r^�y-i C e Policy#or Self-ins.Lie..#: U_CJG(2)(Q`a 3 aExpiration Date: l Job Site Address: Jr 6 �g40" ' cy,<S:�_- 1:)rL rCity/State/Zip: I�,ok13 O 6bi�r IN[-A N64! � 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 ofup 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 DIA for insurance coverage verification. I do hereb cert under flee pains and penalties of perjury that the information provided above is true and correct. - Signature: .� `U Date: Fj t at a )q Phone 4: S08--"50A' a9C 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##: s s> COMMONWEALTH<OF MASSACHUSET=TS e ga e EL�C11R1CIA:NS i ISSUES THE .FOLLOWING LICENSE AS ;A ; REGfSTERED MASTER IL'E-TRICIAN �¢'o R DANIEL P..VITALE r . � .. fz 190 DALE ST .x z wALTHAM MA 02451 3773 1579:4!!:!.A.-.-::::: 0'.7/3.1/16: 35001 -� fi COMMONWEALTH.0F MASSACHUSETTS I+ ® o ® a ELECTRIC': ANS } ISSUES THE FOLLOWING LICENSE ;.I AS A REG JOURNEYMAN E LECTR ICIAyN ¢' DANtEl P VITALE C�m<. 1 0 y ; D 9 ALE ST ,Z WALTHAM MA 02451 3773 31850 E 2 07/3:;1/16. 3500 ® DATE(MM/DO/YYYY) A�o CERTIFICATE OF LIABILITY INSURANCE 8/26/14 THIS CEF111FICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject 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 certificate holder in lieu of.such endorsement(s). PRODUCER CONTANAME: LESLIE HANNON James O'Connell Insurance Agen PHONE (g78) 667-6150 AX No: (978) 667-0587 572 Boston Rd E-MAIL Unit 7 ADDRESS: JIMINS@OCONNELLINS.COM INSURERS)AFFORDING COVERAGE NAIC# Billerica, MA 01821 INSURER A:Merchants INSURED I NSURER B:A.I.M. Insurance DANIEL P VITALE ELECTRIC INSURERC: 190 DALE ST INSURER D: WALTHAM, MA 02451 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF 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 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. INSR ADDL SUBR POLICY EFF POUCY EXP LTR TYPE OF INSURANCE N WVD POUCYNUMBER MM/DD/Y MM/DD/YYYY LIMITS A GENERAL LIABILITY BOP9098053 9/12/14 9/12/15 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED }{ COMMERCIAL GENERAL LIABILITY aocc $ 500,000 CLAIMS-MADEI—XI OCCUR MED EXP(Anyone person) $ 15,000 P ERSO NA L&ADV I NJU RY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS-COMP/OPAGG $ 2,000,000 }{ POLICY PROT LOC $ AUTOMOBILE LIABILITY (CE OMBINED SINGLELIMT Ea accident) ccident $ ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS $ NON-OWNED PROPPEiRdTY DANIAGE HIREDAUTOS _ AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WCC5006538012009 10/11/13 10/11/14 X I WC STATU- OTR- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE YIN E.L.EAC HACCIDENT $ 100,000 OFFICE PJMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yyes,describe under DESCRIPTIONOFOPE RATIONS below E.L.DISEASE-POLICYLIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is regri red) ELECTRICAL WORK CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER MA. ACCORDANCE WITH THE POLICY PROVISIONS. 120 MAIN ST NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE s/ , LESLIE HANNON ©1988-2010 A ORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: t i ° 2446 ��� Date.{ .' ... ..... G� ko oTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMusf� This certifies that ..... ': .... --'.-' "' �`� : .Xrr ..... ..l ..,��.......................: has permission to perform wiring in the building of: :. t- :- ........................................................... at..uj.....11. .7:2' r: ..........................:........ .North Andover,Mass. D �C . / j Lic.No:'� ..�`. ..... ...:..............-r .............................. Fee ��������........... ....•..••.• �"--ELECCRICAL(INSPECTOR Check # ._. WHITE: Applicant CANARY: Building Dept. PINK:Treasurer TIM COMMOAW LYIOF+AMSVAMU,S`L+� Office Use only j 1��sR9lrffiVTOFPl1B1.IC ' Y Permit No. r/y 13OAROOFIMEPREVEMONREGM770AS527Q ]Z-00 Occupancy&Fees Checked M '�APPLICA TTONFOR PERAIRTTO PERFORMELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 �* 1 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perforin the electrical work described below. AP PARCEL „ Location(Street&Number) Owner or Tenant Owner's Address ,� f/V Is this permit in conjunction with a building permit: Yes�/No (Check Appropriate Bo Purpose of Building -:5 /Q 0z04�/� 6:)WV Existing Service Amps / Volts Overhead Underground No.of Meters New Service lee Ampst / olts Overhead Underground M71 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground and No.of Receptacle Outlets No.of Oil Burners No.of Ep6gency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS of Zones Tons No.of Disposals No.of Heat Total 1 No.of Detection and Pum Tons KW Initiating Devices No.of Dishwashere Space Area Heating KW No.of Sounding Devices No.of Self Containe Detection/Soun g Devices No.of Dryers Heating Devices KW Local Municipal Other Corrections No.o2Vt Heaters KW No.of No.of Signs Bailasis No ydro Massage Tubs No.of Motors Total HP } OTHER- hlst==CmaaW PI>r<a�rtmtheragtmana�sofIvlaS�da Ga�aallaws llnwaam=LmbdtyhEL==PbhLymduchrgCaipideOpwabcnsCowmWcrisatswriWegivalat YES L.,ff NO a IhawsiJhndtadvaWproofofsmr1othe0ffi=YES NO F-1 Yyiuhalwdul®dYFS Plea micatotbetFcfooraaWbydtadmlgthe Wpubox �T l�1SURANCE BOND OIFIFR a OnseSpefy) __ Esbrn&dValu dEkchiralWank$ WdktoStut !C�- ?— rr�actianDatRapEsled Ratgh Final Sigrvdtrrtd TiiePtx a sofpegu y FRCVINAN JE LioaseNo. Licasee �/ ,� ApF� s..— ry�Btsir=RlNo. 9 ,?2"0 �'a � UPJ `Gk1 P(7-ST .(. /Ta� 7� Alt.TdNa OWNERSRJSURANCEWAIVE ,IamawarethattheL=mdoesmthmetheinstmmocn�eritsskswnbalecLwAutasracamedbyNlassadase>t CxnjalL3ws andfitmysigtnhuecrifispatrmappt l waiusthisrer}marlart (Please check one) Owner Agent F--J A)") dv Telephone No. PERMIT FEE$ rgna e of Uwner or Agent