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Miscellaneous - 50 ROYAL CREST DRIVE 4/30/2018
A r, ik Jw' n Commonwealth Of Massachusetts Official Useonl Department of Fire services permit No, BOARD OF FIRE PREVENTION REGULATIONS (ROccupancy and Fee Chocked ev, 11/99J leavo 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 PRINTININK OR TYPE AL4 INFO TION) Date: City or Town of: �1d`1NOV e,�- By this application the ulydersi ned To the Inspector of fres: g gives notice o Is or er intention to Location(Street 3c Number) 2 perform the electrical work described below, Owner or Tenant A.l-tvt,Cb Owncr'sAddress 0 N i Cr)ti ICC1'� Telephone No, 97& 61Sa, ZaOC --- _ L YC j ' POCN, Aobyey- O I S Is this permit in conjunction with a building permit? yes No + Purpose of Building Dwen (Check Appropriate Box) Utility Authorization No. Existing Service Amps p .____/_Volts Overhead❑ Undgrd❑ No, of Meters Amps ._...__/ Volts Overhead❑ Und rd Number of Feeders and Ampacity g No,of Meters Location and.Nature of Proposed Electrical Work: 1 N fl-�...n'�"`�Co, t�, �� i N I�in,► i � � _ ��1r.1 U ta11�..1��`1\v2.. i ilNr�, +.�_ _„g., ,a ._,_.�, _ � fo!lnwin table ma be waived b the Ins ector o Wires, ° oa nsformvrs KVA erators KVA Date.1 .�.J`4.................... o nrergency g ng e Units OF r10RTh TOWN OF NORTH ANDOVER o Aotpn an o.of Zones ii 0sInItiatilgg Devices %!?* ,, PERMIT FOR WIRING » of Alerting Devices CHUS� etion/Alertin Y Devices l � unu pa This certifies that ... ..,. ,, C'_ He-HLA F, onnection d Other U ?f1� ... .4'�!....../b"...................................................... r ty ystoma: 1 No.ofD � evices or E uivalent has permission to perform . .. ,t... �,.c..,�,G .� ► ..P:u { � t� Wiring: // o. f Devices or E luivalent wiring in the building of....r_...........(`11.C...o........................................................................ common cat ons r ng: '' cc o,of Devices or E uivalent at ............. ....... .... . ... .... .....K....... North h Andover,Mass. -- to cul rred,or as required by he Inspe 1o�rO'Wr'res, e...1 ..........Lic.No7c)W ..,.100............. ..)♦�/,I/�'-f....� of electrical work may issue unless ' ELECTRICAL INS0T-O#"` or its substantial equivalent. The i heck# P5Permit issuing office. (Expiration Date) licy,) nspecttons to e requested in accordance with MEC Rule 10,and upon completion. I certify, under the pains and penalties ofpedury,that the Information on this application is true and complete, FIRM NAME: NP,1W G Licensee: LTC.NO,:A C&O3 (If applicable enter "exempt"in the lice{',renumber line,) Signatur ` �_ LIC.NO,: 0 Address: O Bus.Tel,No., o ~� OWNER'S INSURAN E WAIVE Por m�� - a `i37 required by law. By my signature below T hereby waiveat tthis requirhe ement,went, I amoes not ahe the liabili AIt,Tel, No.- -0 3 ty insurance coverage normally Owner/Agent ( hectPE one owner owner's a ant. Signature Telephone No. RMXTFEE: $ '}j U t Date C . .. f. � .................... Q O? NonrM,�O m o TOWN OF NORTH ANDOVER s PERMIT FOR WIRING CHU t[ M This certifies that .,.....::( C?1't.., .Gt�-. ............................................................ has permission to perform'. .. .. c�,c !Q 1�•P Mn4 .'� wiring in the building of......, C p........................................................................ at ............. ,,North Andover,Mass. • Fee... ..r`)...-..........Lic. No7 C% 00 / Imo, �j, EL CTRICALINSPE�TOR� --*Check it ' Commonwealth of Massachusetts Offcia Use U►oni Department of Fire Services Permit No. ` BOARD OF FIRE PREVENTION REGULATIONS [ROccupancy and pee 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 (PLEASE PRINT IN INK OR TYPE A L4 INF /O TION City or Town of: {�1dY_ A NCAD\/ y Date; I3y this application the undersigned gives notice o ,s or er,ntent,on to perform he electrical tricalctor k described below. Ins �04fl'r Location(Street& Number) n Owner or Tenant Al-t�Cd N� .� �{' Mcg 01 y Owner's Address i_� Telephone Na 978- a a OC �O L CY�.'S Is this permit in conjunction with a buildin 400 0)1ST S Z Purpose of Building_ g permit. Yes ❑ No � (Check Appropriate Box) Existing Service AmUtility Authorization No, N Amps i_Volts Overhead❑ Undgrd ❑ ew-- SU Amps / No. of MetersVolts Number of Feeders and Ampacit may_ Overhead[] Undgrd ❑ No, of Meters Location and Nature of Proposed Electrical Work: vls�1 J K:J i `r letion a 'the ollnwln table ma be waived 6 the Ins ector o Wires, No.of Recessed Fixtures No.of Cell.-Sus o.o p.(Paddle)Fans KVA No,of Lighting Outlets Transformers No.of Hot'Pubs Generators KVA No,of Lighting Fixtures ove Swimming Pool n- ❑ o.o mergency g ng . Bette U No,of Receptacle Outlets rnd, ❑ rndnits No.of Switches No.of 031 Burners FIRE ALARMS No,of Zones No.of Gas Burners 0- 0 otec on an No.of Ranges otal Initiatin Devices No.of Air Coud' No.of Alerting Devices ea No,of Waste Disposers p um er ons ns um No, of Dishwashers Totals. bet ction/Alertin nDevices Space/Area Heating KW Loco ❑ ante a No,of Dryers Heating Appliances l onnecttion r] Other o.o ater KW ecur ty stems: Heaters KW 0.0 No.of Devices or E ulvalent $1 ns Ballasts Data Wiring: No,Hydromassage Bathtubs No. f Devices or E ulvalent No.of Motors a ecomrnun cat ons r ng: Total HP ARWTMeN"T OTHER: Ej C-Ak ri t No.of Devices or l: ulvalent PSS mrd 1}t?aT\'W t>`N 1 S 3 W c,,,tl. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of eros} �'12M•M�STdj, A11ach r the pe dotal!!ancered,oras required w r the may issue ou 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 issuinl substantial e may issue unless CHECK ONE; INSURANCE g office. (x' BOND ❑ OTHER ❑ (Specify;) Estimated Value of Electrical Work to Start; � LSl� (When required by municipal policy,) (hxp,rahon Date) d ai, Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,ander the pns and penalties o er ur Ilia,the Information on lltls application is true and complete, FIRM NAME: NC'.uJ r IP i y, Licensee: G LIC. N0,:�0� (Ifopplicahle enter "exempt"in the lice .re number line,) Signator Address: D LIC. NO.: (,n OWNER SU1tAN E WAIVER: Paf mW� Bus.Tel.No. re air at the Licensee does not have the liabilityAlt.Tel.No.• 3 Ow r/Agelnt 13y my signature below, I hereby waI requirement, I am the(check one Insurance coverage normally S3 ature owner owners a ent, ,_ { Telephone PERMIT FEE; $ 3 So . � IllC' 4,4fassachifseta E�MI Department of Industrial Accidents �. Offrce of Investigations I congress Street,Suite.100 Boston, MA 02114-2017 �y wn,m i sass govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers licant Infoxmatxnn iease vu r;int Ile M Name(Business/organization/individual): Wfwpprf fC'�Yleln � on crhlk aa AC1dICSpP rrn 1 til rte' City/State/dip: l'1'arG! .• "! phone#: .„ F[] l n employer? Checl�the appropriate box: an'a employer with--�� 4• d I am a general con iXa.ctor and I Type of project(required): oyees(full and/or part-tirrte), have hired t'he sub-contractors 6. Ll New eonstauctioti a-sole proprietor or partner listed on the attached sheet, 7. ( Remodeling ship and have no employees These sub-contractors have worldng, for Inc in any capacity, employees and have workers' 8, Demolition ns [No worket:s' comp, insurrtnce comp. insurance.t 9• [� wilding addition 1r�p4 3.[:] regttired.] 5. EJ We are a.corporation and its IQ Electrical repairs or additions 1 am a homeowner doing all woric officers have exercised their myself [No workers' comp. right of exemption per MG>~ I I.Q Plumbing repairs or additions . insurance required.]t c. 152, §1(4),and we have no 12-El Roof repairs employees. (No workers' 13•C] Other comp, insurance required,] Any�Pplicant that checks box#1 must also X11 out tho section below showing their workers'compensation policy information, I'Homeowners who submit this affidavit indienting they are doing all work and then hire outside contractors must submit a new affidavit indicating such, 'fContraotors that ch"k this box must attachoci an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contactors have employees,thcy must provide their workers'comp,policy number, 1 am an employer that is providing N�orkers,corrpensai0tt Miyaapcefor y emploinfOyees. Below is flie policy andfob site )insurance Company Name:�&ewol042� Co 0� /"1 Policy#or Self--ins.Lic.#: � � Expiration Dale: (,y/ Job Site Address:Za�/e /� y "7`� City/State/Zip:-A OVr&,- MA Attach n copy of the%Yorit;ers' compensation)policy declaration page(showing the policy number and elpirntion date). Failure to secure coverage as required under Section 25A of MGI',c• 152 can lead to the imposition of criminal penalties of n fine up to$1,,500.00 attd/ar one-year imprisonment,as well as civil penalties info form of a STOP WORK ORDER an of tai to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of d a foe lnvestigatiorts of.the IIIA for insurance coverage verific a.tion. I do herb cerci V under flr ar.rt nil enalties o 'Ter itr flrat fie in nrnr.adOn provider,!above is trite and correct. St nature: Of�cial use only. Do not"mite in rids area,to be completed by city or town official, City or Town: IMing Authority(circle one): Permit/License# 1, Board of Health 2.Building)department 3.Clty/Town Clerk 4.Electrical Inspector 5Plumbing Inspector 6. Other . p Contact Person: Phone#• <.�i<#OMMONWFJ�LTH'OF:�MIYS�A�HUS < Lei I Lei • • • `. ,BOARFl:QV ELEL`�`#�IrEI#IN,ST(4 f,SSUES'THE FOLLOWINGl Tt 1NSE ,. . R'1rG4xST�R�D�MASTER 1�LEC -Rl C�I%1f��s '' '` NEWA(tRTF ELECTR I CORPORAT I1 -BUR OM — �3�iVl�l :<1.r0WELt r{ r , t o 01852 4021"i' fri 20803:::>A» 071:3::t::1.:a<6a a t:to39 OMMO NWECLTH`'OF'M1H1 5F ELCTFCIANS 55UES (THE FOLLOW11+tG/ LICENSE 4 p t rlJOURNEYMAN ELE.CTR.I-C,1A ¢ pAYi '`A MCMULLEN � , a 76 K I Ii tL l P STRf �,��tTsl�►ouT►,1 .�, �t o287t 5802 , ;,, `�.<: NEWP013 OP ID: LS HIS C - CERTIFICATE OF LIABILITY INSURANCE DATE(MWD�'rrl 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO 01/00/2014 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES RIGHTS UPON THE CERTIFICATE HOLDER. THIS BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED I REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy fes) 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 Ileu of such endorsement s. PRODUCER Dwyer Agency T 30 D,F. Dwyer Insurance Agency 3@ Bellevue Avenue P �•-- Newport,RI 02840 .401-846-9629 FAX— Da F.Dwyer Ill 401-846.9629 dfdfd A d er,com _ INSURE 8 AFFORDING COVERAGE _ INSURED Newport Electrlc COnstrUCtf;n INSURER A:Foremost NAICM Corp INSURER 8:Scottsdale Insurance Com an 200 High Point Ave,Suite B5 INSURER C:Beacon Mutual Insurance ...... -- 41297 Portsmouth, RI 02871 — __._..... .. INSURER 0: ........_._............. INSURER l : — ---- COVERAGES CERTIFICATE NUMBER: P T THIS 13 ED CERTIFY THAT TWE POLICIES OF INSURANCE LISTED BELOW HAVE.BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD REVISION N MBER: 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. .._.—. TYPE OF INSURANCE 1_1......----- .--GENERAL LIABILITY POLICY NUMBER — -- LIMITS A X COMMERCIAL GENERAL LIABSCP006046448 ILITY EACH OCCURRENCE a 1,000,00 14 —— CLAIMS-MADE a OCCUR 2/30/2013 12/30/201PS&&[L2Bee1__, $ - 300,00 MED EXP Any one arson $ 10,00 PERSONAL 8 ADV INJURY $ 1,000,00 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY PRO- LOC PRODUCTS-Coll AGG S 2,000,00 AUTOMOBILE LIABILITY a A 7 ANY AUTO OMB NED SINGLE LI 17 5CP005046448 E asci enl ___ 1,000,00 AUTOS NED X SCHEDULED 12/30/2013 12/30/2014 BODILY INJURY(Per person 3 AUTOS ) HIRED AUTOS X NON-OWNED AUTOS BODILY INJURY(Per accident) $ PR PERTYD GE '------ a u61bReLLA LIAR PR OCCUR $ .— B X EXCESS LU9 CLAJM84AADE BS0019598EACH OCCURRENCE $ D D ETENTI N 12/3012013 12/30/2014 'AGGREGATE WORKERS COMPENSATION $ 6,000,00 AND EMPLOYERS,LIABILITY — 3 _ C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N WC STATU- OTH- OFFICER/MEMBER EXCLVDED9 68861 $__ (Mandatory In NW) N/A 01/18/2014 01/18/2016 E.L.EACH ACCIDENT If ee deecrThe under $ 600,00 DE G�RIPTI NOF OPERATIONS below E.L.DISEASE-EA EMPLOYEE 3 600,00 A Empl Prac Llab SCP00&04644812/30/2013 12!30!2014 E.L.DISEASE-POLICY LIMIT S 600,00 '- 60,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Aeaoh ACORD 101,Addltlorurl Remarks 8ehedule,Ii mon all Is requlnd) CERTIFICATE HOLDER CANCELLAT ON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Insured's 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 masks2of ACORD D CORPORATION. All rights reserved. Date...I., �g). .............. of NORTN,h TOWN OF NORTH ANDOVER p PERMIT FOR WIRING s`rACHU5� Thiscertifies that V. .................................................................................................. has permission to perform ........... e.!a.............1. .�- .......................... ....................... s wiring inthe building of....................., C ... .. ...................................................... at .....2-1 -���! .............. orth Andover,Mass. ......................................... ................................ 1 ' Fee ).7C5...................Lic.NoA` IqI h/f r—N--' EL ICAL INSPECTOR Check# 13 Commonwealth of Massachusetts Official Use Only pern o. 7j Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (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 (PLEASE PRINT IN NK OR TYPE ALL)NFORMATION) Date: De-C a q , 1 q City or Town of: NORTH ANDOVER To the Inspector of Fires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Q nUC t� L r s A, d 2 b ��"ti -02-1 - Owner or Tenant e No. Owner's Address 8ukllm 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❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number.of Feeders and Ampacity _ Location and Nature of Proposed Electrical Work: �`K ,�'c��.�tC�( ern o�ckt 0� 'S it-1 'k�)c-Sg-bcxzrt z✓lec�+tic e.-k, Line Vb&ge- 446err-.os #aAfS ct-nQC. C ,rLv%+ bf-d6r5 kekmq 11n Qs Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans TransTotal Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting 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. Tons TotNo.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons J.KW No.of Self-Contained P Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal El Other P g Connection No..of Dryers Heating Appliances KW Security Systems:* Y No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs - Ballasts No.of Devices or Equivalent Bathtubs No.of Motors Total HP Telecommunications Wiring: No.Hydromassage No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value ofiiElectrical Work: ✓ ,Ga (When required by municipal policy.) Work to Start: Q-1 mA 14 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,itnder the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: . 4 tu 1,e l P V • I- , C, LIC.NO.: J 1 Licensee: -/k(vO (> Vt(aa e Signature (a V i.ta-Ck LIC.NO.: I �0 G (If applicable enter "exempt"in the license number line) Bus.Tel.No.: Address 6 C S 1- � )[3.IF I) �a 5 I Alt.Tel.No.:�i G *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. — Signature Telephone No. l <:>� COMMONWEALTH OF MASSACHUSETTS..- BOARD"OF R It I AN S S U E S THE..: FOLLOWING >I IGENSE`.:>AS:: R:EG'ISTT`ERED MAST.ER.::ELECTRICIAt.:. " z BAN,LEL P VITALS`"> t�. � r< 190 D 024 1 WALTH�AM :MA 5 -37'7`3 A>::«>`> 07/3:>>. 6:_ 3500 t 1579. ... ... »:4^COMMONWEALTH OF MASSACHUSETTS:;><:> ' . • - • • N.BOARD'O E.L ECT�t'I C'1 AN ISSUES T. FOLLOWING=>::LTi GEMSE UP, AS >.A<';R. :G :JOURNEYMAN,..ELECTRiCIRN:.' Q Q PV I T A L E 90 D A <':.;W:A`(`rH`AM <MA 02451-3773` 35002. .....:A t 3 t 85 ; -.-... _ . t . 6 ' t 4 . �® CERTIFICATE OF LIABILITY INSURANCE RIGHTS UPON THE CERTIFICATE HOLDER THIS 4 •. R OF EXTEND CONORACT BETWEENOTHERICIES IBSUINGGE F INSURER(S)ORDED BY TAUTHOHE LRIZED li1FICATE I NOTAFFIRMATIVELYEDAS EOR NEGATIVELY AMEND �D CONFERS NO ,GATE DOES DOES NOT CONSTITUTE N. THIS CERTIFICATE OF INSURANCE RESENTA7IVE OR PRODUCER,AND THE CERTIFlCATE HOLDER. n endorsement. A statement on this certificate does not confer rights to the If the certificate holder is an ADDITIONAL INSURED,a a policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subjeo o ,PORTANT require ,he terms and conditions of the policy,certain policies may q certificate holder in lieu of such endorsement(s). CONTACT LESLIE HANNON NAME: (978) 667-0587 PRODUCER PHONE 978) 667-6150 Alx No: James O'Connell Insurance Agen EMAILJIMINS@OCONNELLINS.COM ADDRESS: NAIC# 572 Boston Rd INSURE S AFFORDING COVERAGE Unit 7 INSURER A:Merchants Billerica, MA 01821 INsuRER B:A.I.M. Insurance INSUREDI NSU RER C: DANIEL P VITALE ELECTRIC 190 DALE ST INSURER D: Wp,LTHAM, MA 02451 INSURER E: INSURER F REVISION NUMBER: OD COVERAGES CERTIFICATE NUMBER: M OR CONDITION OF ANY CONTRACT OR OTHEBR DOl-CUMENERE N IS SUBJECT TWITHRESPTO ALL O THE TERMS, THIS IS TLICIES O CERTIFY THAT THE POLICIES OF INSURANCERISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI INDICATED. NOTWITHCHTHIS STANDING ANY REQUIREMENT,T CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY T Ou OD By CL EXP LIMITS EXCLUS000 000 IONS AND CONDITIONS OF SUCH OLICADD L SUe LIMITS SHOWN MAY HAVE BEEN REDUCED CY F PAID IJCIA�' ILTR POUCY NUMBER TYPEOFINSUR{WCE IN R WD BOP9098053 9/12/14 9/12/15 EACH GETORENTED 00 $ 1 5O0 QQO A GENERAL LIABILITY occl 15 000 X COMMERCIAL GENERAL LIABILITY MED EXP(Anyone Person) $ CLAIMS-MADE ❑X OCCUR PERSONAL&ADV INJURY $ 1 000 OOC GENERAL AGGREGATE $ 2 O0O O0C PRODUCTS-COMP/OPAGG $ 2 000 00( GEN'L AGGREGATE LIMIT APPLIES PER COMBINED SINGLE LIMIT y POLICY T PRO- LOC Ea accident $ X BODILY INJURY AUTOMOBILE LIABILITY (Per person) $ BODILY INJURY(Per accident) $ ANYAUTO PROPERTY DAMAGE $ ALLOWNED SCHEDULED Peraccident AUTOS AUTOS $ NON-OWNED j HIRED AUTOS _AUTOS $ EACH OCCURRENCE I UMBRELLALIAB OCCUR AGGREGATE $-- EXCESSLIAB CLAIMS-MADE $ WC STATU- OTH- _ t DED RETENTION$ 10/11/13 10/11/14 }{ $ 100'0 ( WORKERS COMPENSATION WCC5006538012009 E.L.EACH ACCIDENT B AND EMPLOYERS'LIABILITY Y/N 1001011 ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.DISEASE-EA EMPLOYEE $ 50001 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-POLICY LIMIT $ (Mandatory in NH) If yes,describe under DESCRIPTION OF OPERATIONS below dditional Re n a,ks Schedule,if more space is required) E DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, ELECTRICAL WORK CAN CELLATIO N CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 8EF THE EXPIRATION DATE PROV S ONSEE WILL BE DELIVERED ACCORDANCE WITH THE POLICY TOWN OF NORTH ANDOVER MA 120 MAIN ST AUTHORIZED REPRESENTATIVE NORTH ANDOVER, MA 01845 n LESLIE HANNON ©1988-2010 A ORD CORPORATION. All rights res 1y The AC ORD name and logo Ire registered marks of ACO RD ACORD 25(2010105) \� Fax: Phone: AW Date...v.. ............. RF NORTH� i ° ~ TOWN OF NORTH ANDOVER * i PERMIT FOR WIRING 'gsACHU5�t �y 1 This certifies that!. TL �{C1"�,c* has permission to performl �' U ttf?�5 .............................................................. wiring in the building of.:. .............V`Y1 ....C)........................................................................ a_,A :�...... nz\�...4- .` ....u.!`.`.�...'. '..> orth Andover, as/Fe` ..` 5..'.*".......Lic.No. (� Q?? , . ....:. ELE TRICAL INSPECTOR/J Check# V , Commonwealth of Massachusetts Official Use Only Department of Fire Services permit No, 91 BOAR© 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 Mnssachuaetta Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPEAL4 INr,ORAV TION City or Town of: Cdr Date: By this application the undersigned gives notice o is or er-intention to perform the electrical work 'rTo 1he Inspector of�balow, Location(Street& Number) �O R� t a $y 5 Owner or Tenant - '•- ANr•��'�(' M c�i Owner"3 Address �� C5 NCP( U Telephone o, 9 6Ua 7a 0C Is this permit in conjunction with a building Ndav O)FS4 S Purpose of Buildingg permit. Yes ❑ No (Check Appropriate Box) DW el,i Utility Authorization No. Existing Service Amps NM Sem Amps Volts Overhead❑ Uudgrd❑ No. of Meters Volts Overhead❑ Und rd $ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: iN�r '� -fie � TS IN �U•► } G` �d rel �, \S\VQ., Qu ,Z? .es CILN� ci YMW c-5 �r teflon o '!he ol(cwin !able -E be waived b the Ins ector o Wires, No.of Recessed Fixtures No.of Cell-St's p.(Paddle)Fans o.o �,A No.of Lighting Outlets No.of Hot'Pubs Transformers Generators KVA No,of Lighting Fixtures eve Swimming Pool n- ❑ o.o rnergency g ng No,of Receptacle outlets rnd, rnd, Batte Units No.of Oil Burners FIRE ALARMS No,of Zones No.of Switches No.of Gas Burners 0.0 etee oni an No.of Ranges otal Initiatin Devices No,of Air Cond' ns No,of Alerting Devices Nu-of Waste Disposers cu p , um or tins o,of Dishwashers Detection/Aler Tum tin Devices Local Dotals: - onto ne N Space/Area Heating KW ❑ un c a No,of Dryers Heating Appliances onne pion 13 Other r�oKW ecur D� .o ater o,o No,ofeces or E ulvatontHeaters KW010 Data Wiring: Sl ns Ballasts No. f Devices or E uivalent No,Hydromassage Bathtubs No. of Motors a ecommun cat ons r ng; > Total HP It�vr iT OTHER: 6 Mkz�`r(e- � r No.of Devices or l✓ uivalent d �ieuT�l l ttiN fi r s 3 w INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance ed electrical�dbythe Attach additional decal!!J'derlred,oras required 6y the Inspector oJ'fyires. the licensee provides proof of liability insurance including`t;ompleted 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. may issue unless CHECK ONE: INSURANCE F" BOND ❑ OTHER g ce. ❑ (Specify; Estimated Value of Electrical Wor xprrahon Dace) Work to Start: (When(When required by municipal policy,) (I a' d Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the pains and penalties of pert ury,that the information on this application is true and complete. FIRM NAME: t-J Licensee: L LIC.NO,: (if applicable enter "' O LIC.NO,:exempt"in the lice se number line,) Signator Address: 0 6 OWNER'S INSURAN Por m� - d `I Bus.Tel.No., E WAIVER: I am aware that the Licensee does not have the la Ii Alt.Tel,No., 3 required by law. By my signature below,I hereby waive this requirement. I am the(check one r Owner/Agent ty insurance coverage normally Signature owner owner's a ant. Telephone No. PERMIT FEE; $ d �(} lite c.n„ir„n a�trerxltl: nf'� a�ssaclr,csett�s t AIM Department Of,lizdacstrial Accidents Q Office o•f bivestigation4c `' 1 Congress street,store 100 Boston, MA 02114-2017 �y www,inass l;ovIdia Workers' Compensation Insurance Affidavit: Builders/Contlra.ctolrs/EIectricialns/P)lumbers A licant�iaforlrnat>io>a ._, ,_,- Fiease dame � —. P�r>Znt_Le>�ibXv (Business/organization/Individual): ( r� ►t.j -� � D — Addresi 11 o In City/State/dip: [� irYbGl r .. ”( PhoTsh7.� ►�. -�fAr ou an employer? Cheep the appropriate box: to I am a employer with-1(9 4. [D I am a.general coI Type of project(required): employees(full and/or part-time).* have hired the sus 6, Ll New construction 2. 1a.m a*sole proprietor or partner, listed on the attaac7. �]Remodeling ship and have no employees These sub-contraworking, for mt in any capacity, Mployees and ha �' ❑Demolition ns [.No workers' comp, insurance comp. insurance.t9. []Building addition love required.] 5• [] We are a.corporation and its ! Electrical repairs or addition 0 Xs 3.❑ 1 am a homeowner doing all wor1G officers have exercised their myself. [No workers' camp, right of exemption per MCJ.L I l•I Roo-frPlumbepa repairs or additions insurance required]t c. 152, §1(4),and we have no 12.[� 1ZOo'f repairs etnpleyees. (No workers' 13.© Other ' comp, insttrancc required.) '^Any applicant that shacks box fi must davi also Fill out tl�c sectipn below showing their workers•compensation policy information. r Homeowners who submit this affidavit indianting they are doing all work and then hire outside cghtractnrc must Submit a new affidavit indicating such, tCont+�ctors that check this box must attac:hod an additional sheetm showing the nae of the sub-contractors and state whether or not those cntitie9 have employees. lithe sub-contrpctors bavc employees,thcy must provide their Workers'comp,policy number, art ertiplayer that isprovidirig workers info 'Compensation iinsilrtince for lily enrpluces. Below is the policy and job site information. insurance Company Name: 4,r- j 11 Policy#or Self-ins.Lic.#:�p -^ Expiration Date: t�I Job Site Address: Xg�/e /7`- City/State/Zip: vee `�p1,9,ys- Attach a copy of the workers' cOmPensatiON policy declaration page(showing the policy number and eXPIratlon date). Failure to secure coverage as required.under Section 25A of MGL c, 152 can lead to the imposition of criminal penalties of a tiffs up to$1.,50p.U0 and/or one imprisonment,as well as civil penalties in the form of a SCOP WORK ORDER and a fine of up to$250.00 a day against 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 verifica.tiot,. I do hereb cerci y under-tar ar.n .nd Venatipv p tet''tl1q,titer the in ornration provided above is trice and correct. Si nature. — — — D.ate:L2V.� p .Phone : " Ci/ q, -- — 0Qfrcial rise only, .Do not write in chis area,to be completed by city or town official. City or Town: Issuing Author'lt (circle one): 1'ermlt/License# L6. O rd Of lFlea)tth x,Building)department 3.Cliy/Town Clerk 4,Electrical Inspector 5.Plumbing Ins ectorer pct Person, phone#r`: a,:t.>�fOMMONWEALTH'OF MASSAjC�iUS DIVISION OF • • @OARS i`'>f S S U E S THE;:F01 OWI NG. 4u.< t SE^;AS.,, R't 't ERt D MAST.ER.:IsLEC illC1'AI�Ts'i" E 1P,( tT..ELECTR I C"CORPORATCOW.f .' ;...; ,.i - ; , bf 19 ..BURS''` ' } W t-1 » :>�l�i1 01852 40� o 1 i l o . .:.... 3.... 7/3:..1.. 39 L SSAHt ETTS MONWrALTH OF MA UES THE F-OLLOWiNG<` I.SS .t `10ENSE;;;< A ..Ar ''JOURNEY,MAJ! LECTRa�C,I 1 >.E r. 1 ;pA'j'b, A' MCA Ul LE`N' ` a: pi `T SA10UTH <; ., 112293 NEW,,P013 OP ID: LS �•--- CERTIFICATE OF LIABILITY INSURANCE DATB(MMNDD,YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLpER, THIS CERTIFICATE DOES N07 AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER 01/0 /2014 THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED I REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. th ter a In If the certificate holder is an ADDITIONAL IN8URED,the poiicy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and condttlons of.the policy, certain pvllcies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Ileu of such endorsements. J PRODUCER 30 Dwyer A viin _ DIF. Dwyer Insurance A one 36 Bellevue venue P �_--_. y Newport,RI 02840 .401-846-9629 ?Ar01. Daniel F.Dwyer III c No Mess.dfd(4Ddf_ dvyyer tom ' 846.9628 INSURENS)AFFORDING COVERAGE —� INSURED Newport Electric COI1StfUCtlOn INSURERA:Foremost NAIC N Corp iNsuRERB:Scottsdale Insurance Compa.ny 200 High Point Ave,Suite 85 INSURER C:Beacon Mutual Insurance _._._.._-_41287 Portsmouth, RI 02871 — INSURER 0: ---- INSURER E COVERA ES CERTIFICATE NUMBER: P THIS IS 70 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 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 COND.ITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. — TYPE OF INSURANCE _..---._..._._ ___.._,_._15WGENERAL LIABILITY POIJCY NUMBER — LIMITS A X COMMERCIAL GENERAL LIABILITY SCP006046448 EACH OCCURRENCE s 1,000,00 CLAIMS MADE 12/30/2013 12/30/2014 F_%1_1 OCCURCC§89e]_., S _300,00 MED EXP An one arson $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,00 POLICY PRO- PRODUCTS- AGG S 2,000,00 LOC AUTOMOBILE LIABILITY a A ANY AUTO OMB NED SINGL LI I SCP005046448 E acol an _ 1,000,00 C. AUTOS NED X SCHEDULED 12/30/2013 12/30/2014 BODILY INJURY(Per _ "' AUTOS Parton) S HIRED AUTOS X NON-OWNED BODILY INJURY(Per accident) $ AUTOS PR PERTY D GE --.—._.-- E 11MBRLLLA LL4B X OCCUR B X EXCk88 LAB o D EACH OCCURRENCE $CLAIMS-MADE BS0019598 ETE I 12/3012013 12/30/2014 AGGREGATE $ _ 5,000,00 WoRKHRB COMPENSATION AND EMPLOYERS,LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC STATU- 0TH• OFFICER/MEMBER EXCLUDED? 68861 S__ ER IlNoodstory in NH) N/A 01/18/2014 01/18/2015 E.L.EACH ACCIDENT If yet dea«Ibe under S 600,00 DE CR PTI N OF PERATIONS below E.L.DISEASE-EA EMPLOYEE S 500,00 A Empl Prac Liab SCP00504644812!30/212/30/2014 E.L.DISEASE•POLICY LIMIT S 500100 013 50,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attnoh ACORD 101,Addhloru l Remarks 8ahedule,If mon apace Is requirW) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Insureds Copy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOtPoZED REPRESENTATIVE Daniel F,Dwyer III ACORb 26(2010/06) The ACORD name and logo are registered marks2of CORP 0 CORPORATION.. All rights reserved. C Gam, 1- ,13 -15 J .64- V V � f �a ✓ fl 7 I Date. ;/6,)3*/t..... .. ,,ORTN , of �` 6 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION SSACMUSE�h This certifies that . 40AIM,"eld. . . .3911.141. -S -5 has permission for gas installation . . . t1,.o. . . . ° ^. . . . . . :. ` in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f at . �, . �rQ S d' ,f�.o� ?., North . nd ver, Ffe 'at`'. . . Lic. No.. 3�6 07 . . . _ GAS INSPECTOR Check# o�S `�`f�' 6 C�il MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING k1City/Town: Al —, MA. Date: Permit# ri Building Location: lee)M-L ���, SCG Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes❑ Nodi] FIXTURES U LUCd rn IU = W Ir Q m 2 O W W U N H O = W v Z F- Z J W Z W W O F- yw N w m 0 Z W � � Q a H o � w X L > co U W Lu t9 w O W o = LL VZLU W Z O J F— F— O Z —j U' LL U) W W W W U o o LL 0 = 2 O ao IW— > > > O SUB BSMT. BASEMENT ,e -i'FLOOR 2 FLOOR 3 RL)FLOOR 4 THFLOOR 5 FLOOR 6 IH FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate# Installing Company Name: [:1 Corporation Address: /.5-Z e6W11,W S'% City/Town: State:lG/.4 ❑ Partnership Business Tel: 7d�-/e9V' 1/5/,i�7 Fax: ❑Firm/Company Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes❑ No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Y- Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 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 Signature of Owner or Owner's Agent Owner ❑ Agent ❑ By checking this box❑;1 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By ❑ Plumber Title ❑Gas Fitter Signature of Licensed Plu ber/Gas Fitter ❑Master City/Town 14Journeyman License Number: -Ir/Go7 APPROVED OFFICE USE ONLY ❑LP Installer I COMMONWEAL rH OF MASSACHUSETTS PLUMBERS AND GASFITTERS LICENSED AS A JOURNEYMAN P. UMBER ISSUES THE ABOVE LICENSE TO: TIMOTHY R FOLEY 310 POWELL ST : . STOUGHTON MA 02072-393' Lj 31607 . 05/01/12 800768 , LICENSE NO. EXPIRATION DATE SERIAL NO. r i R�® CERTIFICATE OF LIABILITY INSURANCE OP ID BL DATE(MM/DDmmr) COMMS 3 05/17/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Smith Buckley & Hunt Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency, Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 500 Forest Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Brockton MA 02301-5749 Phone: 508-586-5432 Fax:508-587-4935 INSURERS AFFORDING COVERAGE NAIC# j INSURED INSURER A: The Charter Oak Fire Ina Co 25615 INSURER B: The Phoenix Insurance Co 25623 Commercial Boiler Systems, Inc INSURER C: Twin City Fire Ins Co 29459 152 :Oldham St INSURER D: Travelers Indent Co of Amer 25666 Pembroke MA 02359-2522 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YYYY DATE MM/DDS LIMITS GENERAL LIABILITY EACH OCCURRENCE $1000000 A X COMMERCIAL GENERAL LIABILITY I6808466B288COF09 05/24/10 05/24/11 PREMISES Eaoccurence $300000 CLAIMS MADE X❑OCCUR MED EXP(Any one person) $50'00 PERSONAL&ADV INJURY $1000000 GENERAL AGGREGATE s2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2000000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $l OOOOOO B ANY AUTO' 6243CI0009 05/21/10 05/21/11 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ X. SCHEDULED AUTOS (Per person) X HIREDAUTOS BODILY INJURY $ X NON-OWNEDAUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) . GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $10000000 DNX OCCUR D.CLAIMSMADE ISFCUP4275YB89-IND- 005/24/10 05/24/11 AGGREGATE $10000000 $ DEDUCTIBLE { $ RETENTION $5000 $ WORKERS COMPENSATION _ AND EMPLOYERS'LIABILITY y/N TORY LIMITS I I ER C ANY PROPRIETOR/PARTNER/EXECUTIVED 08WECIW8489 05/21/10 05/21/11 E.L.EACH ACCIDENT $500000 OFFICER/MEMBER EXCLUDED? l-1 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $,500000 It yyes,describe under SPECIAL PROVISIONS below. E.L.DISEASE-POLICY LIMIT $500000 . OTHER ESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUT ORIZEDR�PRE¢ENTATIVE :ORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 8 9 I ► Date., � /�l. . H°RTM TOWN OF NORTH ANDOVER O� ,h p PERMIT FOR PLUMBING SSACMUS� This certifies that . . . &AP14A . . . . . has permission to perform . . . k. .L vq-�. . . . � plumbing in the buildings of . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . at . ./Q . . R1 V4. .C_�w.— .�r. . .�.dt, Nort AWdeass. Fed`. 30,V.0.Lic. No.31(P.a7. . . . .��. . . . . PLUMBING INSPECTOR Check # s y MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/To i!/ .4,uyDv MA. Date: 9 -// a Permit# Building Location:_ 10,Q�y,¢L C,e a df Owners Name: Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential New:❑ Alteration:❑ Renovation: ❑ Replacement:® Plans Submitted: Yes❑ No 0 FIXTURES DEDICATED z SYSTEMS z z > Y D LU Zi z Ln 4A v� z a w z ~ Y a "' U w C7 Z a z H z a a z a 0 m Ln cNC cQC in } W Q tn Y O a = N &n w H -2 Q w O Q z o: Ln (7 U L6 1•- h 0_ W p 13 W z W z U �' LL "•� 'Q u 2 S O 0 x z R LL 3 h _I Q 2 W w a' 06 O W S' a m m o o LL x Y g 3 N 3 3 3 0 a -SUB BSMT. BASEMENT I'FLOOR 2ND FLOOR 3"FLOOR 4r"FLOOR 5r"FLOOR IST"FLOOR 7'FLOOR 8r"FLOOR Installing Company Name: Check One Only Certificate# _ � syr Address: ff d�L7hf4/r'1 y� ����� ❑Corporation Cit Town: State• �'LlG4- ❑Partnership Business Telr_7�-/ 05el yy.?� Fax: ❑Firm/Company Name of Licensed Plumber: j 1!�-)7e INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes❑ No❑ If you have checked Yes,please indicate the.type of coverage by checking the appropriate box below. A liability insurance policy. 1- Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee d Massachusetts General L oes not have the insurance coverage reuired b aws,and that my signature on this permit application waives this requirement. Y Chater 142 of the Check One Only Si nature of Owner or Owner's A ent Owner ❑ Agent ❑ 1 hereby certify that all of tfie details and information I have submitted(or entered)regarding this application are true 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: 1 Title ❑Plumber Signature of Licensed Plumber Citylrown ❑Master APPROVED OFFICE US ®Journeyman License Number: �I&C} E ONLY) 7 5 o Ro o-Q (°fit BUSLD61SG FILE f q Date.... .1...... C t NOR7M, TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ACNUS� \(! Thiscertifies that .............. ......:.�..... ...............................................��;;....... has permission to perform ........ 9—.1.1/ ? wiring in the building of ................................................................................... at j`� .... .. .7.. -4, 1...e-,North Andover Mass. / 1 e�e�....�G'"...... Lic.No.....�'��©D9.,?........ &R&ALN�SP�EC ETOle Check # /3 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with thepzovisions of M.G.L.c.143,§,3L,the Permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed- " On the prescribed form.After a permit application has been accepted by an Inspector of Wiresappointed pursuant to M.G.L c. 166,§32,an }f� electrical permit shall be issued to the person,firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. " Permits shall_be limited as to the time Ofongoingconstraction.activity,and maybe.deemed_by-thelnspector_of_Wires{abandoned-and.invalid-Xhe_. or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-mouth period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. n The Permit Extension Act was created by Section 173 of Chapter 240 ofthe Acts of 2010 and extended by Sections-74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job,growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certahrpermits-arid licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its othce" erwise applicable expirafion date,any permit or approval that was "in effect or existenduring the qualifying period beginning on August 15,2008.and extendingthrough August 15,2012. -\ e —Permit/Date Closed: Vote:Reapply for new permit, ❑Permit Extension Act—Permit/Date Closed: DateO..l`. . >>................. NOwTN TOWN OF NORTH ANDOVER c PERMIT FOR WIRING ;Tw r... g 's3'�►CMt1 U9� i This certifies that . -t` ✓!.CX...... — ,k� `. ' ............................................................... has permission to perform .. N.�^�... ..0^. .... ................ r wiring in the building of... ................... . . ........................................................................... at ..... ......... .'t�. ..1.......`"....".S' Noq Andover,Mass. '. Fee.....1 ........Lic.No.^� 2 ....��...K�...:. r ELECTRICAL INSPECTOR Check# T339- 8 (v1�' l a»►manur�r�f#Ji o�7/(iieeac�rue fl 0 T1i0kil Ilse Only c•� ee�� Pier nit:No. 1-�S'-_2>W ..La�rarn#,o�.}irn�avrricae -- Occupancy and bee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev, 1/07] (lanvetilank) L---- APPLICATION —APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perlbrmecl in acaordancn witlt the Mussochusc tly lilcetrical C:odo(MEC),527 CMR 12.00 (PLEASE PRINT 1N.INK OR TYPE ALL XFORMATION) tla.te: City or Town of: PQM 7"01he ll?,Peclor of[Vel-es: By this application the undersigned gives notice of his or her intention to perform the electrical work described below, Location(Street&Number) 90- c x, Cm '[ y� 1` AfV �lawUloa-st. O Owner or Tennnt k'�KGb _ Telepbone No.X12-619-60 Owner's Address , o N_qAt, �'ce:,T N)TN$ MgjEn IkP+„�►4.`c Is this permit in conjunction with a building permit? Yes No (Check Appropriate]Rost) Purpose of Building I jN ts..ut'Al- _ Utility Authori7,atian No. Existing Service Amps / Volts Overhead 0 I)ndgrd❑ No.of Meters New Service -- Amps _ ! Vnits Overhead f Undgrd❑ No.of Meters Number of>rceders and Ampncity Location and Nature of Proposed) Iylectr•icni Work: �►„�� .R1,�11�,Q.'rrM � __To_R�. .t,R.�� ck�'t' {�`C'��,�c3u�F4,�c�s'c_-l'13�, tta v`W Ar�'S C:'nnr rletlnn r7'Jlrc frllourin fable ntnv be waived bE the Ins ector•ri Wires.1.15T� No.of Recessed Luminaires No.of Ccil.-Sus Paddle flans a n Total � p•( ) Transformers ICVA No.of Luminaire Outlets _No.of Hot Tubs r� Generntors KVA No.of Luminaires Swimming Pool Above El n- � h.oT :mergrncy �� mg rnd. rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners F IRE ALARMS No.of 7olnes n and No.of Switches No.ofGas BurnersIniti R o.o t ng Devices eviCe9 No.of Ranges No.of Air Cond. Tuns No.of Alerting Devices eat. um urn ,er 'R'oas I<W o.o'Self-C:outnine No.of Wnste Disposers Total DetectionIAlerting Devices No.of Dishwashers Space/Area Heating IOW Local( C OrAcln'n"'ipal ❑ ection 011ie _ No.of Dryer's Heating Appliafnce.9 Kiri Security systems: No of Devices or Couivallent o,o Water KW No.of o.o' Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.H dromnssage BAt:htubs No,of Motors Total IIP c etbmmcin rations Wiring. Y No.of 1)cvice5 or E uiivalent QTFiTR: Attach additional t1r:Jc,il iI r4uh-rd,or as required by the I pector of 011res, Estimated Value of Electrical Work: i 6-,000 (When required by municipal policy,) Work to Start: i; inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGI?: Unless waived by the owner,no poinit 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 forec,and ha.s exhibited proof ol'same to the permit issuing office, Cl-IL'CK ONIv: INSURANCE [] BOND ❑ OTHER ❑ (Specify:) I certify,under the paints and penalties of perjruy,that they igformation oil this opplieatien is true and complete. FiRM NAME: Newpon Eloctric LiC.NO.: A20803 Licensee: David McMullen Signature.� LIC.NO.: 116088 (If applicable,enter "exempt.,in the license number line) Bus.Tel.No.:409-293-052'1 . Address: 200Hi9int Awe. Portsmouth,RI 02871 A i Tel.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: l am aware that the Licensee does nol have the liability insurance coverage normally required.by law. By my signature below,I hereby waive this requiremcni., !nm the(check one x owner owner's agent, Owner/Agent Signature Telephone No. �_� __� PL,R.YtT TEE. S Id S \ (.,omrnonweaR of Maeeachuiett9 Official Use Only \ �] Permit No. 2eparlinen1 011— -le Se11ice9 4 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATION'S [Rev. 1/071 (leav, blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance -ith the iMassachuszas Electrical Code(N-(EC). 527 CMD, 12.00 (PL EASE PRGVTININK OR T)_PE ALL 1./JEo0tAL.(,T'IO) Date: 9�0�df City or Town of: A)Oo .�- the Inspector- of ffrires: By this application c`�lication the undersgned gies notice of his551er intzntion�experfshe e tical work described belo�{. Location Street Number) P � Owner or Tenant /�,�' Telephone No. Owner's Address - Is this permit iri-conjunction >yith a building permit? Yes ❑ No (Check.appropriate Box) Purpose of Building Utility .authorization No. Existing Service .amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undcrrd ❑ No. of Meter., Number of Feeders and Ampacity q Location and Nature of Proposed Electrical Work: Completion of the following(able may be waived by the Insoecror or 44'ires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No.Traof Total nsformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KN A e In- No. of Luminaires Swimming Pool end. ❑ arnd. t o. o mer�encvto ttna vAbov ❑ 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. Tota! No. of Alertin Devices Tons _ g No. of Waste Disposers eat Pump Number Tons KW No. of Self-Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW ocal ❑ Niuntctp Other Connection No. of Dryers Heating Appliances KW Security Systems:'` f No. of Water No. of No. of r E uivalent (451 Heaters KW Ballasts Data Wiring: Signs No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent 10THER. LO �a (� Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value Iectrical Work: y T9 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with NEC Rule 10, and upon completion. INSURANCE C VERAGE: 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. CHECKONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) Self Insured I rertify, under the pains and penalties of perjury, that the i ormation on this appliPcation is true and complete. // FIRM NAME: ADT Security Services LIC. NO.: C-' i`: Licensee: Mark A, Brophy Signature LIC. NO.: C-a S f/fapplicable, enter "exempt-in the license irumber linea Bus. Tel. No.: 603 -594-S 9 2 8 Address: 18 Clinton Drive Hollis , NH Alt.Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. 00953 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. I am the(check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. FE-I MIT FEE: .% 416 Department 0-c Publlc ,- Safety \ le, R ; 1301One Ashburton Pia Boston, Nla .:02108-1618 Llcensr.: S-Lic,�nse - *� NLIrnbor: SSCC, 000353 . Expires: Rostricted To: 00 r.•=_>>.t.. _,fir`_::_: MnItJC EROPI•IY SR �., '_-- '�-"__•�,.:�-,__� 1�-_'� � --'-- — _—_ NoRwuoo, M.,\ 02067. r3 ---- \` Tr.no: 117.0 �_•� Kuap top for rocelpl and C119n0e of Dddref:s nc(lllcat 0n• )P:%•C.lt D nOM-OwpO•DOr:Ufb4d CAt00272GU8 __-_ r . . ........ ..... F— E)GIARTMENT OF PUBLIC SAFCTY 0 Nur �S CO 000053 .1 0?i0.r`.�'' X11 Tr. :o: 117.0 CCURITY SFRVI:; MARK NORwoon,.,AA n2t�_: CUmm(9>i Warr '! DIG SAFE CALL CENTER::. (888)04-A-7233 . � Fold,T1l:n L11tdt 1.1onp J.I�P ulotaik>nt � � . COMMONWEALTH-OF, MASSACHUSETTS pI 11 T�'I l 1 f 7 IT T=, . DOARD Or ELEi,'FR!C'ANS. F RF-G;STkRCfD SYSTEM C.0N TRACTOR ISSUES THI.'l LICENSE 10 TY E Awr � E.CUrITY SERYTCES ; INC . HARK A '- BROPHY SR _ C AI1. '1`i0RSE . ST ' NORWO0D HA 02062 - 46.02 353795 .15 c 07/31/10 - 3537 °5 Fold,1Ttn D,I9 ll rr.lei::hnI Date. .�f 1.. ............ 3?�NOR7h,�OL c TOWN OF NORTH ANDOVER O 9 PERMIT FOR WIRING ♦� s v 1 0„ •(q9 SSgCHUSE + `t.c .�.c ........... .J He�'tu�le This certifies that .....�. ................... 1 1�X �1-o 15 � has permission to perform tQ.... ° UP. ... .................................................... ,giring in the building of.......................!' ..............7....................................................... ..........................................................�� orthAndover,Mass. / ee..�. .......Lic. No�Pk.0 ..... .......1.,.1............:. .. _ EL CTRICAL INSPECTOR Check# Commonwealth of MassachusettsFOccupotancyand Official Use Only Department of Fl l re Services BOARD OF FIRE PREVENTION REGULATIONS 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 (PLEASE PRINT IN INK OR TYPE AL INF 0 TION City or Town of: {VOTI A ��oro�Hinterition Date; �flr"By this application the undersigned gives notice o is to perform the electrical work described To the Inspecto Location(Street&Number) �O below, Owner or Tenant ����" CC'S t r�tir2. rot-�`^-ca Na•�1�. ,t,�ve^r >_L � �c�, c�I �S4 � Owner's Address _ n Telephone No, 9_78- 6W7% 1c OC, L CY�.S ' ' r••►dav Is this permit in conjunction with a building permit? Purpose of Building ��Uv L1 YC9 ❑ N0 (Check Appropriate Box) Existing ServiceUtility Authorization No, Volts/ N ----- Overhead Amps [J d Und r Amps i g ❑ No, of Meters Number of Feeders and Ampacit_'Volts Overhead❑ Und rd 8 ❑ No,of Meters Location and Nature of Proposed Electrical Work: ►�� _ 2 Ut TS 1N din► I a _ ir.i49 VNSI��V2 i S C7LItiJA C1 YpS�,iU� Cis C CJI it No,of Recessed Fixtures letion a 'the ollowi I table ma be waived b rhe Ins ecror o Wires. No,of Cell.-Susp,(paddle)Fans o.o al No.of Lighting Outlets Transformers KV No.of Hot'Pubs Generators KVA No,of Lighting Fixtures Swimming Pool Ove n- o.o meIII gency g ng No,of Receptacle Outlets rnd, rnd' Bette Units No.of Switches No.of Oil Burners FIRE ALARMS No,of Zones No.of Gas Burners °, o etec on an No.of Ranges InitIatin Devices No.of Air Cond, otal No,of Waste Disposerseu Tons No,of Alerting Devices ump um or ons - onto ne No,of Dishwashers Totals' Deteetion/Alertin Devices Space/Area Heating KW ❑ untc No,of Dryers Heating Appliances Local onne coon ❑ Other 0.0 ater ecur ys floaters KW . 010 010 KW No.of Devices or E uivalent Signs Ballasts Data Wirin : No,Hydromassage Bathtubs No. f Devices or E uivalent No. of Motors a ecommun cat on r ng: 1}�„ Total HP �111l,, tT OTHER: 6 ��C\`rit No,of Devices or Equivalent 1 - e ��rd, lie uTil i (l,t�i INSURANCE COVE Attach additional detail!J'dettred,or al required hM>upe tdor q/Vies. RAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including`bompleted operation"coverage or its substantial equivalent.undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK QNE: INSURANCE q The (° BOND (] OTHER [] (Specify: Estimated Value of Electrical Wor � " Z (When required by municipal policy.) (�Xptrahon Date) Work to Start: a Inspections to be requested in accordance with MEC Rule 10,and upon completion, I certify,under the pains and penalties o er ur that the Information on this application is true and complete, FIRM NAME; NI� ,. fp I y, p ton. CL p Licensee: LIC. (Ifapplicable enter "exempt"in the lice se number line,) Signatur c Address: LIC, NO.: (,d OWNER'S INSU "" Par �,�� O a�� Bus.Tel.No.* -� RAN E WAIVER: I am aware that the Licensee does not have the liabili Alt'Tel,No. rewner/ g law. By my signature below,I hereby waive this requirement, I am the(check one insurance coverage normally 3 Owner/Agent Signature owner owner's a ent. Telephone No. PERMIT FEE: ell 7 ► .� ° JIM [. ,srrtsott)f�efxltl: of �rrssrichusettsf111R i°1M ' Deparon.ent. Of IIIdr.[strial Aecitlettfis Office of Investigations 1 Coe gpess Street,Suite 100 � ys Boston, MA 02114-2017 W111wdnass.govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ADMirant Tnfo;t-inxatx.. case P;tltnt Ee >!bX Name(Business/organi�,ation/Individual): r+ Address:_AM M City/state/dip: d t1'1'adGli "� Phone#�: •. , Ar ou an employer? Check the approprlstte box: 1. 1.am a employer with 4. d I am a.general Contractor and I Type of project(required): employees(hill and/or part have e). have fired the sub-conira.ctors 6. New consti action 2,❑ 1 am a'sole proprietor or partner listed on the attached sheet. 7. []Remodeling Ship and have no employees 'hese sub-contractors have working, for me in any capacity, employees and have workers' S' D Demolition n3 [No workers' comp, insurance comp. insurance.# 9, 5 Puilding addition 3.❑ required.] 5. D We are a.corporation and its 10 X Electrical repairs or additions 1 am a homeowner doing all work Officers have exercised their myself, [No workers' comp. right of exemption per MG,L I 1 Plumbing repairs or additions insurance required.]t G. 152, §1(4),and we have 110 12.0 Roofrepairs cxnployees. (No workers' 13.0 Other ' comp. insurance required.] *Any applicant that shacks box X61 Homeowners who submit thimust also fill out the sectipn below showing their workers'compensation policy information. l s affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, $Contractors thtlt check this box must attached an additional sheet showing the name of the sub-contractors and Statc whether or not thane cntitie8 have cmployucs, tf the Sub-contrpctors have employees,tlxcy must provide their workers'comp,policy number, I am an employer that isProviding workers°compensation in$urance for nay enxpkwes. Be�fow is the policy and job site iormation. nf Insurance Company Name: Q a �y Policy i#or Self-ins.Lic.#: { _ Expiration D0.,e• t3I Job Site Address:z � - '7`�' City/State/?iP;. Vfli� `�Q/�'•yl�' Attach xt copy of the workers' compensation policy declaration page(showing the policy number and espiration 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 tap to 50. 00.00 and/or one-year imprisonment,as well xs civil penalties in the form of a STOP WORD()RT�I;R and a fine Of es to$250.oU a day against i the violator„ Be advised that a copy of this statement may be forwarded to the Office of Investigations of theDIA for insurance coverage verification. .f do hereo cerci p under III aan nd enalfies o ' er urp that the in ornaaaion provided above iS true and correct. Si nature: — - _ — •— -- — .—.Date: +� p .Phone#. L'7/ � Qf�cial afse only, Do not write in tiais area,to be conn leted by city or towrx nfficial. City or Town: Permit/License# Issuing Authority(clrcle one): t. )Board of health 2.Building Department 3.City/Town Clerk 4,Electrical Inspector 5. Plumbing Inspector G, Other p Contact Person: Phone#• e ,!7OMMONWdlN OF MAS ACHUS --i DIVISIONOF • • • n` BOARD' • E�1;�::�'t'3t 1 G i ANSS.. . :�,::;:.._,;; €ISSUES THE::;:FO.LLOWING `L<t' fNSE R'1 G'[ ERED MASTER:,:ELEC`T-R7GI'Afs;' »<Nl P 'RT.'ELECTR I,C- CyORPORATII ON`l {. 19 'BUR55 `... C. 52 4 2 1 t 1039 _ _._-��--=---- R MONWEALT.H'OF MY1S CHISETTS rt' :1.55UES ;THE :4 6111 FOLLOW N, l <>: 'fi CENSE:::;::; ELE(�TR4cj . OURNEY,M. A.. It 76 KLµ,:., t , o7/.p t:6si./ 6.. 4�.�• AC�� NEWP013 OP ID: LS +►--- CERTIFICATE OF LIABILITY INSURANCE DATE("µv°D/rYYYI THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 01/0$/2014 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES NO RIGHTS UPON THE CERTIFICATE NOLpER. THIS BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED I REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADpITIONAL IN3UREp,the policy(les) must be endorsed. If SUBROGATION IS WAIVED,sub act t the terms and condltians of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsements, o PRODUCER 30 Dwyer a vanancD,F, D er Insurance A enc 38 Bellevue Avenue P E•----..___� Newport,RI 02840EMI.401-846-9629 Daniel F.Dwyer Ill A ;dfd dfdw encom (Ala No)L401.846.9629 INSURE 6 AFFORDING COVERAOE IN8UREDConstruction-- R A: INSUREForemost NAIC N Newport'Electric LNSURER0:Scottsdale Insurance _ Com an 200 High Paint Ave,Suite B6 INsuRERcBeacon Mutual Insurance -- -41297 : Portsmouth, RI 02871 — INSURER 0: _._............ . INSURER Z: CCI ES CERTIFICATE NUMBER: F _ THIS 19 TO CIE,11-1 RTHAT 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 WITHI RESPECT TO WHICH T 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. HIS ,. TY__ GENERAL LIABILITY POUC N MBER LIMITS A X COMMERCIAL GENERAL LIABILITY SCP006046448 EACH OCCURRENCE $_ 1100000 12/30/2013 12/30/2014 REFTE6 CLAIMS MADE II OCCUR =Ueao—L(gpgeL- $ __300,00 MED FXP Anyone arson S 10,00 PERSONAL$ADV INJURY $ 1,000,00 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY PRO- PRODUCTS-COMP/OP AGG S 2,000,00 LOC AUTOMOBILE LIABILITY a A 7 ANY AUTO OMB NED SINGLE LI IT ALL 5CP005046448 E acc 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) $ PR PERTY D GE $ UMBM.'LLA LIAa X OCCUR $ •_.__. B X E)(OPJSS IIICLAIMS•MADE B80019698 EACH OCCURRENCE 12/3012013 12/30/2014 $ D b TE N AGGREGATE S 6,000,00 wORK$RS C OMPENBATION AND EMP LOYERS'LIABILITY — $ --_._ C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WC STATU- OTH- OFFICER/MEMBEREXCLUDED7 N/A 68861 01/18/2014 01/18/2016 $ — (Mandatory in NH) E.L.EACH ACCIDENT $ 600,00 Ir ee describe under DE GtR PTI N OF OPERATIONS below E.L.DISEASE.EA EMPLOYEE $ b00,00 A Empl Prac Liab E.L.DISEASE-POLICY S SCP006048448 12130/2013 12/30/2014 LIMIT 600,00 60,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Aelaoh ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELL&T13N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Insured's Copy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, ALITHOPoZED REPRESENTATIVE Daniel F. Dwyer III ACORD 26(2010/06) The ACORD name and logo are registered marksofACORD D CORPORATION.. All rights reserved. / X ✓ o y poRTly O�tS�.ED 6 °L o �C 4, ��g1T�D rfp`•(� �SSACHUs�t BUILDING DEPARTMENT Community Development Division November 21, 2012 RE: Royal Crest Estates * 3� -YJ J Mr. Chabot No complaint was filed with the Building Department. The site was under construction to correct below grade drainage and foundation issues. A temporary ramp was built to egress the building. The contractor called us to view the.temporary ramp after a report of a resident falling. I made a recommendation to the contractor that the ramp should turn and land on the side walk rather than the ground. No follow up investigation ensued.. Brian Leathe Local Building Inspector 1600 Osgood Street,North Andover,Massachusetts 01845 A �� Phone 978.688.9545 Fax 978.688.9542 Web www.townotnorthandover.com '�/( tAORTol q °• O �O e ��SSACHU`���;y BUILDING DEPARTMENT tommunity Development Division November 7, 2012 RE: Royal Crest Estates Mr. Chabot No complaint was filed with the Building Department. The site was under construction to correct below grade drainage and foundation issues. A temporary ramp was built to egress the building. The contractor called us to view the temporary ramp after a report of a resident falling. I made a recommendation to the contractor that the ramp should turn and land on the side walk rather than the ground. No follow up investigation ensued.. Brian Leathe Local Building Inspector Ilk- 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9545 fax 978.688.9542 Web www.townofnorthandover.com INSPEGTI®NS SERVICES LOQ _DATE: Ar"ESS INSPECTED BY: A!� NAmE DAT PEC710N: --97(fy16R SS PAIL OTHER t'HONE / ' PERMIT# OFFICE NOTE: N NOTE! INSPECTIO4 COMMENTS: ' �NSf'F�CTION REQUEST: ESCIF0071N�G� FOUNDATION- FRAME ROUG FINAL OTHER , ITL�_r TIME IN: TIME OUT: ADDRESS G INSPECTED BY: NAME ZZ ( Qom. DATE OF INSPECTION: PASS FAIL THER PHONE PERMIT# FFlCE NOTE: ECTiON NOTE/ INSPEC CPM ENT . NSPECTION REQUEST: ES 7 FO T N F ROUGH FINAL ER TIME IN: TIME OUT. DDRESS DINSPECTED BY: ' AMDAT PECTION: _ '-LONE 1 67/ `7L�G, ! A FAIL OTHER CO' ION NOTE, INSPECTION COMMENTS; -RMIT# OFFICE NOTE: SPECTION REQU)=57: ES TING FOUNDATION FRAME OUCH FINAL' OTHER ,���G�^ TIME IN: TIME OUT: DRESS t.--- JNSPECTED BY: VIP 7 ATE OF INSPECTION: PASS FAIL )NE OTHER CORRECTION NOTE/ INSPECTION COMMENTS: :MIT# OFFICE NOTE: 'RCTION REQUEST: ESCIFODTING FOUNDATION FRAME 9 GH FINAL OTHER TIME IN: TIME O T: *x*******�*;.�**isjc3ea4ke4.t*a.*kAe*}****R**icR***;t*h*&*xkkip********+F**ic**#R******£R**E at*id;Ai•d****R.tTikS**►Ri.***RiaiA:***ki•i•irkiR*****s***R*iEkz#*s**ie**RnxR&at*h*R*v4*irk*fix*x* ?ESS INSPECTED Y. DATE OF INSPECTION: PASS FAIL OTHER 17# _ OFFICE N07E: CORRECTION NOTE/ INSPECTIOIII COMMENTS: GTION REQUEST: ESCIFOOTING FOUNDATION FRAME 7H FINAL OTHER TIME IN: _� TIME OUT: IN 6e ATTORNEYS DANIEL T CHABOT A T L A W WILLIAM J.BARRONBO GERARD R.LAFLAMME,JR. LAFLAMME, BARRON & CHABOT A LIMITED LIABILITY PARTNERSHIP 114 KENOZA AVENUE HAVERHILL,MASSACHUSETTS 01830 TEL 978/521-4737 FAX 978/373-6859 October 30, 2012 Brian Leathe Building Inspector 1600 Osgood Street North Andover, MA 01845 RE: Royal Crest Estates Dear Mr. Leathe: Please be advised that I represent Deborah Coen-Coder for injuries she sustained at the Royal Crest Estates on October 4, 2012. Ms. Coen-Coder fell on a ramp that had been placed in front of her residence at 38 Royal Crest Drive. It is my understanding that your office was informed of this incident and sent people to the scene to investigate. Please provide my office with any report that you have concerning this matter. Thank you. Very truly yours, Daniel T. of DTC/haj www.havlaw.com f ALL ATTORNEYS ARE ADMITTED IN MASSACHUSETTS. MR.LAFLAMME IS ALSO ADMITTED IN NEW HAMPSHIRE.MR.CHABOT IS ALSO ADMITTED IN FLORIDA,NEW HAMPSHIRE AND MAINE. i FFMry(l(M(p6y `•� h i�'1irYSTyt yfZ$ E EYS y y� p. t >,i�JR T• ^�:.rM M- �".il�. A T L A W LAFLAMME, BARRON & CHABOT 114 KENOZA AVENUE 02 1+P $000.450 HAVERHILL,MASSACHUSETTS 01830 r 0002816606 NOV 02 2012 MAILED FROM ZIP CODE 01830 I' Brian Leathe Building Inspector 1600 Osgood Street North Andover, MA 01845 ..r.; }_=:.:�;••.ac~.• �_�^%'•'�.. V �l�ii}}i}1f�illi}�ii�3�i[ill3F�11l iil�3i Fli3l3�i�r37Ffi3}fl��I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING 1 (Print or Type) NORTH ANDOVER Mass. Date tuilding Location s �fod�L C�PE.sT �/� Permit # aIfl2 Ow,ers Name T New 7-1 Renovation 13 Replacement Plans Submitted D FIXTUDr"C N x ul N W W Cz Otu V m r ~ y N N ydj w 0 O a O W F Q Z em (1) t F U) y 4 N O u,t — O W w W 0 W z < = a W p Q w ' ttuu t~i x c� s W o ? W t- W 0 F. W , z a W a tt r >. to = o o us = d W } .0 W O < e 4 d O O W o W F- a s v o u. 9: to u 1- o SULK—H5..IT. BASEMEM I ST FLOOR 2K0 FLOOR G1 3RD FLOOR I 4TH FLOOR I 5TH FLOOR 6TH FLOOR TTKFLOOR STH FLOOR I (Print or Type) Check one: Certificate Installing Company Name ANDOVER PLG. & HEATING CO. , "NN . Corp. 2122 Address 571- 1/2 SO. UNION ST. Partner. LAWRENCE, MA. 01843 Firm/Co. Business Telephone: 508 685-8383 Name of Licensed Plumber or Gas Fitter C.0 I nand= Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy MI/ Other type of indemnity = Bond Insurance Waiver: I , the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner u Agent El I hereby certify that aU of the details and information I have submitted (or entered)in above application are true and accurate to the best of my knowledge and tltat aU plumbing worst and InoWlations performed under"Permit issued fa. this application will be In compliaaoa with all pertlncnt provisions of the Massachusetts State Cas Gude and Chapter 14:of the General Law&. — By YPE LICENSE: Plumber Title Title asfitter- Sigreature of Licensed City/Town- Master Plumber or Gasfitter Journeyman APPROVED (OFFICE USE ONLY) License Number ...e.-c...:n,;r+csv=�a�..�`:,e�t+iWpb�'t:�•;.�»'�5e'i4�_4"�f:'�.:-:.�en',�.'``,;j '"i";a9, '�°.'�""+».�"i.^;R+�. 'i.;;a�@J a ]37 2182 Date.?o.?/. ..... ........ ORTN TOWN OF NORTH ANDOVER A F=Oh•�..ao ,e.1TOWN 9 r-y PERMIT FOR GAS INSTALLATION g . o, • + u; �y �,SSA�MUSEt co This certifies that . . . . . . . . . . . . . . . . . .o has permission for gas installation . . .H !Y. . . . . . . . . . . . . . . ..* in the buildings of . f 1e` . . . . . . . . . . . . . . . . . . . . .�. at �'?. .1�'.��:�► . .c.(�P�. . . . .7f. . . ., North Andover, Mass. Fee. !��t :. . . . Lic. No.. '". . . . . . `��%o')!)-: . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File 0376 Date.....' NORTH TOWN OF NORTH ANDOVER 3j .,e 'e o� PW p PERMIT FOR WIRING -7; This certifies that .......... ....... has permission to perform .........4<Gm ...... wiring in the building of �2..� L" STS 5 .................. ..................... r �p � .T..................... ........... orth Andover;Mass. Fee.1.7.s..7--'"'—Lic.No../L. 67.x,1 ............... .. ...... . . ...... ... ELE R1CAL INSPECTOR Check # � Z Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 10 3 76 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [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 S 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 thefollowing 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- ❑ o.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. Tonal �No.of Alerting Devices No.of Waste Disposers Heat PumNumber Tons KW No.of Self-Contained Totals: I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances Kms, 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 t 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 and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Stilian Electric,Inc 108 Tenney St.Georgetown,MA 0183 LIC.NO.: A11067 Licensee: Karl Gonsiorowski Signature LIC.NO.: E31598 (I/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 Signature Telephone No. PERMIT FEE: $125.00