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HomeMy WebLinkAboutMiscellaneous - 50 ROYAL CREST DRIVE 4/30/2018 (6) 1 a67'1 —� BUILDING FELE i .............. OF &ORTN,� ?; nom to TOWN OF NORTH ANDOVER o PERMIT FOR WIRING t `4SgCHUS� This certifies that 1 has permission to erform .., ���c�, ` 2@�t.� ►�l�c l�fs P P . ....l .r.. ...... ..... . .................................. ring in the building of....�......Y�(�.C.Q.....�''m .................................................................. at .....I...I.......ik'(1.01... ,110: .:.......n:............ North Andover,Mass, -1 ee.....Q.9.........Lic. No. J, � /j`(� "T EL,CTRICAL�INSPECTOR Check# �� ///`b�tJ Commonwealth of Massachusetts Official Use Only ~ Permit No. � o Department of Fire Services Occupancy and Fee Checked ,M BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07j (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: (4 y4 U 5 t (� , City or Town of. NORTH ANDOVER To the Inspector of Noires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) '50 Q 0 U q-1 CCS.s+ D R- Owner or Tenant Arm t C © 1-46R d°+N ©av-e-✓' C.. Telephone No. Owner's Address U i I&rl I 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: C ked< 6elp-jce-1 CC9r)ri e-C-E-t0n`S 0-4 P-XS,0-6csk,-,,-Ct erste- :2i c, j•ko—+ Line poi g 4-h.crwtOS}g,1-S O-ncL CAr'Co; k btect-kzrS R-to►vigj --t-h-e-S e 'V t l i-�-- ' S Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil: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 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. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump I TonsKW No.of Self-Contained Totals: - ' ' "�'�'��"�"""""""""""""" Detection/AIertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ElOther 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: Attach additional detail if desired,or as required by the Inspector of Wires. .—)Estimated Value of Electrical Work: 300 r©� (When required by municipal policy.) Work to Start:N a le I ' 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:) X certify,under the painsand penalties of erjury,that the information on this application is true and complete. FIRM NAME: J).4.1-41 e.I P, V t a)e— LIC.NO.: A I 5-79 ©t Licensee.DW i e-1 PA V1 1,,xj e— Signature 6,,- , P MLJ-e- LIC.NO.:3 16 0 E (If applicablefienter "exempt"in the license number line.) Bus.Tel.No.: Address: t`lO D R I C S4n- WCU Ki6 i" I('Yl i4 (3 a L1�j Alt.Tel.No.:` a� *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. The Commonwealth of Massachusetts Department of Industrigl Accidents Office of Investigations 600 Washington Street Boston,MA.02111 www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information (� Please Print UP-% y Name(Business/Organization/Individual): ru� Address: A-- City/State/Zip:�C�LKAC,,-W) Mk COILS) Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4 4. El am a general contractor and I 6. E]New construction f employees(full and/or part-time).* have hired the sub-contractors 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. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3111 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.[i Other comp.insurance required.] *Any applicant that checks box Of must also fill out the section below showing their workers'compensation policy information. T-Homeowners who submit this affidavit indicating they hie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:- A Policy#or Self-ins.Lic.#: `JCC)WQ S aW q Expiration Date: Job Site Address; Jr ���4� ' City/State/Zip: MA G 18 0 S 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb cert under the pains and penalties ofperjury that the information proviCdeed above is true and correct. Sh atare: �vw—� `y� Date: U t a t a t g- Phone#: 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#: QrCOMMONWEi4LTH OF MASSACHUSETTS;:<:>' Aw(.r-TRR'19!I ANS ISSUES TH.E,. FOLLOWING > SE ' . . ... A S .A: 'i ;R:EG'I,STfRED MAST,E.R :ELECTRICIAN::; ::;D:AN .-1 L P V I TA L E` 190 D At: E''S`f`>"<;: ., Z R 4t`'LTH`A J j. .. M..:.. ..:.:::..::::::::: : Ma o 2 451-3�j;3'><::<.::: >< _ 1579:9. A'=:: 07/31/1,6 35001 �4=::.COMMONWEALTH OF MASSACHUSETTS;;:::::;;;° • • • - • • B.OAE?D DF E L EC7�t`I Cl ANS ISSUES THE FOLLOWI-NEN S E,;::: - AS ` JOURNEYMAN:;ELECTRICIANS • a 190 DA "E""'5<T>: `z. W � ;: 4LTHAM _ ..: .-,;:MA MA::..:02451 3773`':<: :><" 35002 . I / Q o o S Ce c�C3 0 i ® DATE(MM/DDYYYY) A�o CERTIFICATE OF LIABILITY INSURANCE 8/26/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS v 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 CONTACT LESLIE HANNON James O'Connell Insurance AgenPHONE FAX (g78) 667-0587 (978) 667-6150 A/ No: 572 Boston Rd ADDRESS: JIMINS@OCONNELLINS.COM Unit 7 INSURER(S) AFFORDING COVERAGE NAIC# Billerica, MA 01821 INSURER A:Merchants INSURED INSURER B:A.I.M. Insurance DANIEL P VITALE ELECTRIC INSURERC: 190 DALE ST I NSURER D WALTHAM, MA 02451 INSURER E: INSURERF: 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY BOP9098053 9/12/14 9/12/15 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENE RAL LIABILITY DAMAGETORENTED $ 500,000 CLAIMS MADE a OCCUR MED EXP(Anyone person) $ 15,000 PERSO NA L&ADV I NJU RY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE L IMI T APP LIE S PE R PRODUCT$-COMP/OPAGG $ 2,000,000 X POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS _ AUTOS Per accident 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- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 100,000 OFFICE RMIEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yyes describe under DESIRIPTIONOFOPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is regui 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 � L LESLIE HANNON �' L ©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: Date..... 11427 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ssACHU Thiscertifies that...................................................................................................................... has permission to perform........... ............................................................................... plumbing inV he buildings f.-4- 4 :5 —u at.. ...I............. ........................................................ North Andover, Mass. v...-......FW�..... Lic. NoC1%.U.35.. ................................................................................ PLUMBING INSPECTOR Check# I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING Wpm + F CITY PT �, MA. DATE [O 1(0/l 5 PERMIT#j JOBSITE ADDRESS Dr.H ni II OWNER'S NAME DINNER ADDRESS: TEL: �-ito AX:G78fo(y-'ico5 TYPE OR N OCCUPACY TYPE: COMMERCIAL Y9–Y1– EDUCATIONAL ❑ RESIDENTIAL❑ CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ No FIXUTRES 1 FLOORS Aunt 1 2 3 4 3 6 7 8 9 10. 14 ( BATHTUB 11 12 13 CROSS CONN DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GASIOILtS.AND SYS DEDICATED GREASE SYSTEM - --- , — � DEDICATED GRAY WATER YS DEDICATED WATER REUSE SYS I DISHWASHER DRINKING FOUNTAIN FOOD WASTE GRINDER UNIT FLOOR I AREA DRAIN 1 INTERCEPTOR INTERIOR KITCHEN SINK t LAVATORY SHOWER.STALL. j ; 'SERVICE 1 MORSINK + . TOILET I URINAL WASHING MACHINE CONNECTION.` WATER HEATER ALL TYPES WATER PIPING INSURANCE COVERAGE I have a current Ii9 t insurance policy or its substantial equivalent which meets the requirements of.MGL.Ch,142 YES-0 NO If you have checked YES,please indicate-the type of coverage by checking the appropriate box below.. LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER.I am aware that the licensee does not have the insurance coverage required by Chapter 142'of the Massachusetts General Laws,and that my signature on this permit application wa!ves this requirement. SIGNATURE OFOWNER OR AGENT CHECK ONE ONLY: OWNER E] 'AGENT ❑ 1 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to e be of my I Knowledge and that a!!plumbing work end installations performed under the permit issued for this application be i'7./ompllance {h all..ettinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General.Laus. ,% °� PLUMBER NAME: LICENSE# M�t�Co t L•�� SIGNATURE COMPANY NAME: ADDRESS: I CITY: STATE: ZIP: G- •' 'I FAX: ! TEL: CELL; EMAIL: i MASTER . ,JOURNEYMAN❑ CORPORATION d# nth PARTNERSHIP LLC❑.f# vU OVER �o . Date....... ............. ..... .. ........ r TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION SS�CHU This certifies that ........................... has permission for gas instalation ........�&AC-7 �+ I ............... . .h................................... in thebuildings of*....... ...... at . ........ ver, Mass. .).0.... A......."- .........�t .....0 North Ando FeeZQ........... Lic. No.10......... ..................................................................... GASINSPECTOR Check# 10230 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY: ©`( MA. DATE: b PERMIT# �^ i JOBSITE ADDRESS: 1�It�K� _ ` Dr E 17 O�ER'S NAME: OWNER ADDRESS: TEL FAX. 78 (OCX� /(p TYPE OR OCCUPANCY TYPE: COMMERCIAL PRINT - EDUCATIONAL ❑ RESIDENTIAL❑ CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:'§ PANS SUBMITTED:YES❑ NO'S] ` APPL.IANCESI FLOOR- Bsmt 1 2 3 4 5 g 7 BOILER g g 10 11 12 13 14 � BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN ....... POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER I have a current lkt insurance policy or its substantial e'qui allen which meets the requirements of MGL.Ch.142 YES ❑ NO If you have checked YES,please indicate the type of coverage by checkingtheappropriate ❑ box below. LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required b Cha ter 142 Massachusetts General Laws,and that my signature on this permit application waives this requirement. y p at the SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER ❑ AGENT [] hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best m Knowledge and that all plumbing work and installations performed under the permit issued for this.application will be in compliance with all a nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME: D LICENSE COMPANY NAME:MAL.f, pl SIGNA �z —ADDRESS;_17- c, � v CITY: i STATE: tti2 14= ZIP: ©i95. l_ FAX-_j 4-�_ OO TEL:._� S-( - /o�"�- CELL: EMAIL: MASTER JOURNEYMAN❑ LP INSTALLER❑ ,CORPORATION(�# CCG{L PARTNERSHIP❑# LLC The Comwnrvea7ln vfM4vsachaa.se& DeParftftent vf.Industrid Acacideaft Ojf,fine o,f'Invesfigativns 600 FYtasht`rrgttrtt street 1 Bast^MA 02111 WWW S.g0V1&a Workers=Compewati n Jnsumuce AMdavif:Buffde Con actors[Reciiiamffllumbprs ApRhcant uformation Please Pant Legibly Name Musii en/0 eIzation&dividuat)' MacCoMck Plumbi a.g� Inn, AddresS: 17 B3rsdge St~teet . City'/SIaWzip: W-Ilerlca . mA 0182.1 Phwe#:. Are you an employer?Geek the appropriate'bog: e af:project � (reI ), i.9 I am a.employer with 379 4.j-1 I am a general eon r wr and I �, n.New construction employees(full and/or part-time),* have hired the sub-contractors 10:1 am a sole proprietor or partner= listed on the attached sliest. 7. :0 Remodelling ship and have no employees These sub-coritractors have g, 0 Demolition ' working.for me in any capacity. employees and have workers' 9. addition [No workers'comp:insurance comp,,insurance.: repaired] S. We are a corporation and its 18.x].Elect im repairs or amitions 3. I arzr aahams rloin alI wait . . officers l Ve cxcrcised Ih* 11.❑Plumb' g attg firs or additions i ii ofeietti hors mysel;.(No workers'comp: p W per IVIt}L 12.0 Roof repairs ittsurartce Mpired.i f e,152,§1(4),and we have no employees.[No workers' 15.0 tither comp:.insurance requircd.] *may*attpIicanttlietahecksbox isnaaalsoFitlaurthesudonbelowshovAugtheirwotmme .tompEnssfianpolicyiniormation: f HoTneowners who%ubinittt>$aftidnit iudicafiug Ita a*doing all work od taco hire outside coatraatoramm submit anew.aTdMt Mcatan.sach. �Gonttaetois that dterk ihis:box must attached as additional sheet showing the same of thesub tors and stars who therornotthese ad.ies have ewpkwem tft e_mbabntractorshave emplo}em they mu de their warttars'comp pat-y=mber. 17.am.an eiriptajw that as providbag Svgrkerss compensa kn irssurarrce,for my mptoyam Bev is Ike paNcy:rtnd Job ske Insurance Company Name:_,aitm card Insurance Campanv Policyig or Self-iris.Lie,#:__EU3AWG578693 Eviration I?a —'tt 11/12015 Jbb Site Address: OitylStatel %p:.. Attuh:a copy of the workers'compensation policy declarmion page(showing the policy number and espiration.date). Faflum to secure coverage as required under Section 25A of Mtn,c.152.can lead to the imposition of criminal penalties of a ! line up to$1,500.00 and/or one-Year imprisonment,as well as civil penalties inthe form of a STOP WORK ORDER and:a fine of up to$250.00 a dale against the violator. Be advised that a copy ofthis statement maybe forwarded to the Office.of lamestigabons,sof the DIA for insurance coverage verification. ]-do Itembp cm9fy under thepam andpenahms ofperyury that the mfonnadan proyMed above k&%reand carred Sianatir Date: Piro 663--95:30 €3, ktai'use only.. Do not wrIti in this area,fig be completed by city or town r, al City.or Town: PermitlLicense ff .. IsstrittgAuthorityy(circle one): i.Board ofBealth I BuRding Departmmt I City/Town Clerk 4.Electrical Inspector S.Plntrtbingl nspector 6.Other ContaetPerson: Phone'ff: s ACC7►R[7R OP ID:PP DATE(M M0D�y M �.,,...r CERTIFICATE OF LIABILITY INSURANCE 10114114 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOWER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR.NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE.AFFORDED.S$ THE POLICIES BELOW. THIS CERTIFICATE OF.INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUREk(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 poticy,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). PRODUCERCONTACT } DeSanetis Insurance Agcy,Inc. Phone:781-935-8480 NAME 100 Unicorn Park Drive Faye 781-933.556 PNCNE Eno: FAX Woburn,.MA 01801 -RM &MAIL . DRESS:. cUs°0fflgK 10MACCO-1 INSURED Mac.Cormaclt Plumbing InG, INSU S AFFORD=COVERAGE much 17 Bridge StrseeESuite 203 INSURERA:American Southern Home 419$8 Billerica;MA 01821 INSURERS-Plymouth Rock Assurance Group 1.4737 INsuRERc:Am uard lnsurance Com ggtj INSURERD_Nautilus Insurance Company 17370 INSURERE:Nlerchants Nkdwi Insurance Co 23329 fNSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS f$TO CERT[FY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE.FOR THE POLICY PERIOD INDICATED.. MOTWiTHSTANDING.ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT W!T(i RESPECT TX?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: LTR TYPE OF INSURANCE V"DPOLICY NUMBER MRS EFFLMM J P GI3IERALUA61LriY EACHOCIURREr10E $ 1,000; A X'° cotJetEa'cgL dtN.E#i t.'uAaturi'......:. 1 1 0001567 10H1/14:' 1Wid/i5..:, a :fQ.a., PREW CwMS*dADE:OX OCCUR. MID EXP A one person) 8 10,00 X XCUHBlkt zardfuat PERSONALAADVtWURY X XCU Hazards I GENERALAGGREGATE S Z,000R GEN'L AGGREGATE UMIT APPLIES PER: � F1tODUCTS-COMPlOPAGG $ 2,000,= POUCY X PRO- Loc $ AUTOMOBILE UA8tU7Y COMBINED , INME LIMIT s 9,000,00 3 nrrYAtrro. I ALL OWNED.AUTOS BODIt.YINJURY(per penm l 'S B JC SOHEOULEDAUTOS PRC00001003155 10!79114 9011111.5 BODLYMURY(Peraa3dent).$ X MREDAUTOS PROPERTY DAMAGE 5 {PeraerddeM) X NON-0wNEDAUTOS $ s X UMBRELLA UA8 X OCCUR EACH OCCURRENCE $ 6;00014 . EXCESS UAB- CLAIMS-MADE D tlP0001373 10M1i14 �0199116 AGGREGATE $ 51000,0 DEDUCTIMZ s X. RETENTION s 10,000 s. WORKERS COMPENSATION wCSTATU 10TH- AND rmmmoVERB-UABILITY X. . FR C ANYPROFRIErORfi'ARTNERlEXECUTWEY/N WC578$93 10111114 10M1N9 OFFICERJUEMBEREXCLUDED? :N/A FL.EACH ACCIDENT $ 1;000100( ' (rlarKiatot'rba. y (MAL,RJ,NH). F-L.OISEASE-EAEMPLO $ 9;000,00 ny�,�a�;r+eu a DESCRIPTION OF OPERATIONS below I EL DISEASE-POLICY LrAiTT 1,S 1,000,00 . D Pollution Llab PL201083300 01/3Qt14 01130P15 Limits MM Occu /Mold Coverage �� AM DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 161,Addrtonat Remarks$chsduta,H male space is required] vicl=ce or :Coverage CERTIFICATE HOLDER CANCELLATION EVIDE-1 SHOULD ANY OF THE ABOVE DESCRIBED.POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE VWLL BE DELIVERED IN EVIDENCE OF INSURANCE ACCORDANCE WITtt THE POLICY PROVISIONS. AUTHOMW REPRESENTA f ' O 1888-20!)9.ACQRD CORPORATION..All rights reserved, ACORD 26(2009109y' The ACORD name and toga are registered marks of ACORD f "�=: ,:t-<?�."�,,..•�s;rr�r„.'+..a ....�.:,hv..• '�`z���.�;;.""`o��a::��n"�• "�;�. is ::r.-?bzp?x?'"",;.vfiy . z r • • M • ' y � F b T luIMM .i� ?.� f... j,j' f i 9 �.' Z'L4 Y fii "<• � ®R" S ...: •. ..'•Rk; .".Y:' •. ,.Xt;1................v:t"..Yh" M,•+„:frrtcX?.,. ?::�`.,C:t``x�f� , .................................�.. .........._.....�..r.�_�- 9950 Date........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING ACHU This certifies that ................ ........................ has permission to perform ....... ...... wiring in the building of......Royvj��....rMT7.. .................................... at...V... North Andover,Mass. 7 Fee... ........r---.. Lic.No.1 7S '.�.......... .. .. ....... .. ... LECMICAL INspEcro Check # (fc"Immonweal/h of N7amac4ajetfi Official Use Only 77, Apartment ol }ire ervicea Permit No. � Occupancy and Fee Checked r BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: March 4, 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 Bullding # 11 Owner or Tenant Royal Crest Apartments Telephone No. 978-681-1822 Owner's Address 50 Royal Crest Drive North Andover, MA 01845 Is this permit in conjunction with a building permit? Yes ❑ No X❑ (Check Appropriate Box) Purpose of Building Commercial -Apartment BUildingsUtility 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: Install 6 Gell Packs! Completion o the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above ❑ In- o.of No.of Luminaires Swimming Pool ❑ rnd. grind. BatteryUnits 6 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 g No.of Waste Disposers Heat Pump Number Tons W No.of Sel -Contained Totals: ..................... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ unicipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent Heaters No.of Water Kms, No.of No.of Data Wiring: Signs Ballasts INo.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eq uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: $ 600,00 (When required by municipal policy.) Work to Start: 03/04/2011 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:) 1 certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: The Electricians & Co. Inc. LIC.NO.: A10737 Licensee: Michael J. Parziale Signature LIC.NO.: E20269 (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.: 781-322-9344 Address: _50 Branch Street Malden, MA 02148 Alt.Tel.No.: 781-322-3100 *Per M.C.L.c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. SS CO 001021 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent r Signature Telephone No. PERMIT FEE. $ 125.00