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HomeMy WebLinkAboutMiscellaneous - 531 JOHNSON STREET 4/30/2018 531 JOHNSON STREET 210/098.A-0014-0000.0 I 4 4 l I Phone: 978-632-2660 Fax. 978-632-2662 JAMES A. TRUDEAU Adjustment Service Inc. P. O.Box 7 Gardner,MA 01440 claimsQ)trudeauadi.com Notice of Casualty Loss of Build, ing Under Massachusetts General Laws, Chapter 139, Section 3B April 14,2016 uilding Inspector 120 Main Street North Andover,MA 01845 i Board of Health 120 Main Street North Andover,MA 01845 Fire Department Dept. of Records 124 Main Street North Andover, MA 01845 Insured: Mary& Stephen Derby Loss Location: 531 Johnson Street,North Andover,MA 01845 Insurance Company: Preferred Mutual Insurance Co. Policy No.: PHOO100825684 Date of Loss: April 4,2016 File Number: 16-14434 Claim Number: 16106673 Type of Loss: Water Damage Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000.00 or cause"Mass. Gen. Laws, Chapter 143, Section 6"to be applicable. If any notice under"Mass. Gen. Laws, Chapter 139, Section 313" is appropriate, please direct it to the writer and include a reference to the captioned insured, location,policy number, date of loss, and file or claim number. Claim has been made involving loss, damage or destruction of the above-captioned property, which may exceed $5000. If any notice under Massachusetts General Laws, Chapter 175, Section 97A is appropriate, please direct it to the attention of this writer and include a reference to the above-captioned insured, location,policy number,date of loss and claim number. On this date, I cause copies of this notice to be sent to the persons named above at the address indicated by first class mail. Sincerely, David J.Valley Claims Adjuster Date- 2- 16 ............................................. of Nonrh,� co TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........................................................... ........... ............................ has permission to perform c-,kc,",...4o PA, ..\uar�iuj ..........p .................V.................:;� ........... 12 wiring in the building of..... ........ .......................................................................... at ......... \......... ............. ..... ....... orth Andover,Mass. ..... . ........... ...... ..... .... ----9't— Fee... ............Lic.Nodl%l .... .. ...... ..................................................... ELECTRICAL INSPECTOR Check, 4%20 C)\ DocuSign Envelope ID:D05A0177-DC4E-4AEA-A54A-42EE50732200 Commonwealth of Massachusetts Official Use only Permit No. �L-)U� - Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS IRev. 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: -�%-k. �S City or Town of: NORTH A-NTDOVER To the Inspector of Wires.- By ires:By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 51s Owner or Tenant m1 '�C`L,,` "} 3 �t Telephone No. ,-3,3 Owner's Address -15 N 1�k Q \A atN 0)) A Is this permit in conjunction with a buildI!in permit? Yes — No El (CheckAppropriate Box) Purpose of Building Q�:kV —7 Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Elndgrd © No.of Meters Number of Feeders and Ampacity ,7--D IL-� Location and Nature of Proposed Electrical Work; Conipletionofthefollaii�injo,table may be waived by the lns ector o W res. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers K to No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires, Swimming Pool Above [In- ❑ o.o Emergency Lighting g rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones and No. of Switches No. of Gas Burners o.o et Initiatin Devices No. of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No. of Waste Disposers Heat Pump Number Tons KW o.ofSelf-Contained p Totals: I I Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other p g Connection No. of Dryers Heating Appliances KW ecoSystems: DevicNo. or Equi alent No.of Water KW No.o No.of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent a Bathtubs No.of Motors Total HP a ecommunrcations ging: No. Hydromassage No.of Devices or E uivalent OTHER: Attach additional detail if desired, oras required by the Inspector of iFires. Estimated Value of Electrical Work: t� `i l(Ci( °C� (When required by municipal policy.) Work to Start: 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 cov7age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Q BOND ❑ OTHER ❑ (Specify:) ]certify,anderthepainv andpenalliesofterjury, that thetinfornurtion on this application is true and complete. FIRM NAME: Docusigned by: LIC.NO.: ` C-m _ Licensee:lam~ T 1-� � {� Signature Avis LIC.NO.: I��( A applicable,enter"exempt in the license number( ,Address: � � a �" �rl `4- ( ('i�`( (-4,,}�o�3�zq�asnacs.. Bus.Tel. l �...� Alt.Tel.No.: *Per M.G.t,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 hm,e 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: 4 I $• I PROJECT DESCRIPTION: wv-1 SITE PLAN&VICINITY MAPINDEXPROJEcr �J �nr 40 K 255W ROOF MOUNTED PV-2 ROOF PIAN & PANELS Home e SOLAR PHOTOVOLTAIC MODULES PJ-3 ROOF ATTACHMENT DETAILS SYSIEII SIZE: 10.200 KW DC STC PJ-3A ELECTRICAL&SIDE ELEVATION DETAILiP SOLAR PJ-4 ELECTRIC UNE DIAGRAM ARRAY AREA PV-5 LABELING r, 2 (R-1):327.02 fe PV-6 SPECIFICATION DETAILS (R-2):33.03(i' PV-7 SPECIFICATION DETAILS r o f Vin eS PV- I8 SPECFICATION DETAILS /\ `�' $`s as LL, (R-3 ):53.74 1P PJ-9 SPEC DETAILS c �e .rs as PV-10 SPECIFICATION DETAILS / PV-11 SPECIFICATION DETAILS PV-12 SPECIFICATION DETAILS / N U I-- R-1 —R-1 DRNEWAY a 4,s Q / 18 Pvv U / MODULES yy LLI R Fdn Mo�QuitoO o+P�1E�� w r IL Na Estates&+!eights Pttl a / R w / R-3 \ 2 VICINITY MAP / 3 PV MODULES R-2 P/-1 SCATS: NIS / 19 PV MODULES , PROJECT SITE W ,m POOL (E)unm METER T ILIul LuO / HWE NH DL to u I z W OC�Q Au N R� 100, N` oLLI z — / a 841- TMG Ro Bw -- / Date: 03 JULY 15 • / TITLE SWEET.- PLAN SITE PLAN NORM VICINITY MAP 1 SITE PLAN WITH ROOF PLAN 3 HOUSE PHOTO PJ=1 SCALE:1/32•- 1'-0' Pv-1 SCALP WS P V—I I i ARRAY & ROOF AREA CALC'S y" nre, ROOF R-1 3�� Home ARRAY AREA =327.02 fe SOLAR ROOF FACE AREA=714.05 fP \" 327.02/714.05 -45.80% FACE AREA COVERED BY ARRAY `od�p r.P6T1FA T ROOF R-2 €xo.siexi=c HOWELL. ARRAY AREA =343.03 fe O NJ cs ROOF FACE AREA=367.50 fl' `'i• """••� 343.03/367.50 =93.34% m 1 FACE AREA COVERED BY ARRAY ® '* N V ROOF R-3CS ARRAY AREA =53.74 ft` R-t ROOF FACE AREA=97.60 fig Z U 53.74/97.60 =55.06% 18 PV MODULES i '' 0 J Lq FACE AREA COVERED BY ARRAY LNIRAC SOLAR MOUNT - Q' d Lu o ROOF DESCRIPTION Q 40 ATTACHMENT 0 48'O.0 MAX ��+ �. LL w $I COMP.SHINGLES $_3 COMP.SHINGLES ENPHASE MICRD-INVERTERS �- O O AZIMUTH AZIMUTH 155 M-215-60-2LL-S22-IG ,n PITCH 23' PITCH 22' SHADING 90% SHADING 91% R-2 COMP.SHIN= AZIMUTH 245 + PITCH 27 ! M SWING 89% ® Lu LEGEND ROOF ATTACHMENT CHIMNEY ® .� - / i \ LD F oc - RAFTER ® p-� 'O. w I to W O PIPE VENT ® SKYLIGHT ®� OC O O w p AIR VENT --- CONDUIT �_ =z SATELLITE R-3 ® ~ O 4 Q ELECTRICAL EQUIPMENT ANTENNA 2'-1 m ® ENPHASE MICROINVERTERs WHIRLYBIRD l L� W Ln� M-215-60-2LL-S22-IG O 9'-11" p O VENT �� rn �• z MODULE SPEC'S A ® i R-2 Drg.Na: --- 3'-3" 19 PV MODULES t►--.•) 9+ � 0• Dm Bw TMG li Z 2 + 00 38 ATTACHMENT 048'O.0 MAX ®� Z Z Rev.By --- 3 PV MOWIES ` Dsts: 03 JULY 15 'n 8 ATTACHMENT 0 48'O.0 MAX (E) lmLfrY METER TITLEE BH££T: PLAN 1 NORTH 1"PVC/EMT CONDUF (N)AC DISCONNECT ROOF PLAN 1 PANELS TRINA TSM-255PD.05.08 1 ROOF PLAN WITH PANELS PANELS-255W (N) PV LOAD CENTER L-GATE ION CELLULAR Trina Solar Panels PV-2 SCALE: 1/8'= 11-w PRODUCTION METER �—pV-2 nrg�' Home SOLAR 5ppea cacti, HOO WELL rNELLis y , `JLM1J NJ Mord �U U� �U O orc UNIRAC SOLARMOUNT GROUND WEER & Z W RAIL WITH ECOFASTEN MODULE CLAMP Q W L-FOOT PV MODULE a COMPOSITE ASPHALT LI_IV SHINGLES O Q Oo OC to GREENFASTEN FLASHING: ECO—GFI—BLK-812 WITH ECO—CP—SQ COMPRESSION BRACKET In z Ir 5/16"X4" S.S LAG BOLT WITH 2.5" _{.m MINIMUM PENETRATION SEALED WITH D-Lu APPROVED SEALANT Ill 111 Q I—W E Nh to w I z d) 0 to f r=z f COQ UJ C) O � z Drg.Na: -- D%BIF TMG Rev.By: -- Data 03 JULY 15 1 ATTACHMENT DETAIL TITLE SHEET: ROOF ATTACHMENT W-3 SCALE:NTS DETAILS PV-3 nr% Home SOLAR o N..31521 Him L, 4: NJ LU DX W u—Ge 0 0< (E) DOWN iPOUT 0 w to FROM PV ARRAY o L'i z 0 D 8 0 w Ln cr 0 v LLI x (L Ill FROM UnUTY PROVIDER (OVERHEAD) ly X: All J)Q� z zw °p 4=0 z0 P >-n, TO—:r ce i�- W Ln Z 13%By TMG (N) JUNCTION L(E) UTILITY METER Rev.By: BOX FOR ENVOY (EXTERIOR WALL) Data. 03 JULY 15 (N) 1 OOAMP PV LOAD Tina sHer=T.- CENTER (EXTERIOR WALL) (E) TO MAIN SERVICE PANEL ELECTRIC-Al. I (INTERIOR WALL) BIDE ELEVATIO i (N) L-GATE 120 CELLULAR ELECTRICAL&SIDE ELEVATION DETAIL DETAIL PRODUCTION METER (N) UTILITY AC DISCONNECT PV-3A SCALE:NTS — (EXTERIOR WALL) (EXTERIOR WALL) PV-3A SERVICE INFO INVERTER SPECS MODULES SPECS HaT* UTILITY COMPANY:-- ENPHASE QTY:40 SOLAR MAIN SERVICE VOLATGE:240V INVERTER TYPE M215-60-2LL-S22-IG MODULES TYPE:TSM-255PDO5.08 MAIN PANEL BRAND:SQUARE D QTY:40 WATTAGE:255W CO AA MAIN SERVICE PANEL•200 A WATTAGE:190-27OW NOCT WATTAGE 19OW MAIN CIRCUIT BREAKER RATING:200 A SERVICE VOLTAGE 240Y FRAME THICKNESS:35MM FRAME COLOR:BLACK Rm3tezl i MAIN SERVICE LOCATION:SOUTH-EAST WALL CEC EFFICIENCY:96.5X HD WELL, x SERVICE FEED TYPE OVERHEAD Voc:38.10 MAIN SERVICE PANEL GROUND:EXISTING GROUND ROD VPmCDC 30,50 �e, IDc:8.88A IMP:8.37A U L� I -ANCIIOI emc TO UTLffY r (E)MAN SEANCE PANEL 20DA BM URUTY FUSED oM FlISEO AC L-GBE 120 © 1 -L-GIDE 120 PRODUCTION MUM RATED BUS BAR AC DLSOSINDW 3=24F1.T w HI001)LTIp1 IDAD SOLARCENTEONLY JRCFM BOX W 1 - 1aw SaLAR aNLr LOAD OO4fEA ego MP ISMP FUSES 3 4SITP RI56 3 BMBBt 3 C tDVb 2 A 1 BRANCH ;�1 SOLARAlmposOD INele1 W RIVER © - MOP SUM MAKER I - 2OA/iP DAM BREWER O eoe AD- IL lLE3. IN PMAEEL OONMMWED N BRANCH Q Z �UTILITY —_-1_- 14 MODULES TRINA SOLAR TSM-235POOBAB Q 1 -BOA FUSED AC DISCONNECT WITH METED >�DG1AF EFmM�tl110119 O Q 43A FUSES 3- THWN-2 1@Iy.p.>14.mE�0 J 1- O THWN-2 ECAC/GEC O Q I -EGA FUSED AC DLSCONNECT WON IN 1'EMF CONDUIT a 4E) E PDA FUSES BRANCH 2 MP 1 -U E-SIDE W NT I 1MODULES N PARALLEL CONNECTED N FRANCA CIRCUIT -- ---'---1.— ill�ttiL11JJI 13 MODULES TRNA SOLVE TM-255PD05AB Ln me DORM 015_0- M W BRANCH +#3 (L�j O N TIES: 1. ALL MODULES WILL BE GROUNDED IN ACCORDANCE WITH CODE AND BBeMm.El LU llJ Q 2. Nl PV EGIUPMENT WALL LISTE'D�AY A C0�E111�TESTING LAB. ��n RMCHROURT N PARNIEI CONNECTED N BRANCH a NOTIFY SERVING UDUTY BEFORE A TIVAMON OF W SYSTEM. - -- -Z— i�LtlJ JI 13 MODULES nDNA SAAR TSM-255PO05AM 4, WHEN A SAMI D BREAKER IS THE METHOD OF UTILITY ' (� INTFRCONNECIION.BREAKER SHALL NOT READ UNE AND LOM. & WHEN A BACXFED BRR IS THE METHOD OF U UITY �yp'O,By,�.M I FNLEz INTIMONNECfON.THE BREAIOR SHALL BE INSTALLED AT THE tRA/1� _ �'O> B. WORK CLCLEARACEND ES ARCUNND F1THE US�EtctMRi L EQUIPMENT T W0.i BE WEATHER STATION O MAIWXNED PER NED 110.2DW(1),1102E(A)(2)a +1o.Ze2A1(31 — ©° INFORMATION a Z Q 7. ALL EXTERIOR CONDUITS.FlTYINOS AND BOXES S}I/Jl BE RNN'BONY -_ — --_ F ,�=z AND APPROVED FOR USED N WET LOCATIONS PER NTD 314.15 LAWRENCE MUW & ALL METALLIC RACEWAYS AND EQUIPMENTS SHALL BE BONDED AND 2-t12 THWN-Z MONITORING ASWME 2<AVO. 32'C ~ O Q ELECTRICALLY CONTINUOUS. I -/12 THWN-2 EGC/GEC CURB 13-90 MM ABOVE N 3/4'FLT CONDUIT SURFACE TELP 84 M 11.1 LO O 3 2 1 1 z 3-(B T"MN-2 3-/S nWN-2 3-#5 THWN-2 CONDUCIM6 AIE �nAx EoIOIGE CARIE• CONDUCIOIS ARE EW"CANE t 1- /B THM-2 E00/00G 1- /B TNWN-2 E00/903 1 -fa TERM-2 ETEC/OBC SLIPPORIED ON w OND BARE COPPER SUPPORTED ON w am COPPER N 1'EMT CONCUR N 1'ELT CONDUIT IN 1'ENR CONDUIT RACIONG SYrfFl)NDT N FREE AIR s,R� D N FREE NR VOCE 240✓AC VOM 240✓AC VOD:24WAC DIPOSm TO DTTtECF VO1k 240VAC E1IP0SU lb DNDCF VOC:240MC D%Na: --- Lsa 3&WC TSC: 11.7AAC tSc 12.SN1C + I= 11.7AAC SUNUOIIt ISD 12.6410 3;Be- TMG ENPHASE INVERTER TOTAL SYSTEM CALC'S JUNCTION BOX TO LOAD CENTER CALC'S JUNCTION BOX TO LOAD CENTER CALC'S ENPHASE INVERTER BRANCH 20 CALC'S ENPHASE INVERTER BRANCH 1 CALC'S QTY:40 MAX AC:45.00A QTY:13 MAX AC:14.63A QTY:14 MAX AC:15.75A QTY:13 MAX AC:14.63A QTY:14 MAX AC;15.75A Rev.Hy --- NOC:0.9 (MY.NOW x 1248 NOC:0.9 (ON x NOD)x 1231E NOC:0.9 (GTT x Noe)x 1= NOC:0.9 (GTP x Bao)x 1.= NOC:0.9 (CIT x NOD)x I.= Date. 03 JULY 15 WIRE GAUGE#8 WIRE OCP:47.00A WIRE GAUGE:#8 WIRE OCP:33.50A WIRE GAUGE:#8 WIRE OCP:33.50A WIRE GAUGE#12 WIRE OCP:23.50A WIRE GAUGE#12 WIRE OCP:23.50A TITLE SHEET: ELECTRIC TEMP RATING:75'C APF Row x TEMP DE-INTE TEMP RATING:75C AMP RATaO x TEIF DE-RATE TEMP RATING:76C ALP mmo x TEMP DE-RATE TEMP RATING:75'C ALF RANO x TEMP DE-RATE TEMP RATING:75'C AMP RATING.TEMP DE-RATE UNE AMP RATING:50A MAx AD TO BE LESS ESR EGwL ro AMP RATING:5GA MAX AD To BE LESS OR IDDUAL AMP RATING:50A MAX AD ro BE LESS OR EQUAL AMP RATING:25A No AD ro LE LESS OR mINL AMP RATING:25A MAx AA TO.... E.GR. DL4GRAM WIRE OLF FOR WIN ro BE TO WEE OLP FOR WIVE T BE ro wRE aTr FTNt wGE ro DE ro MITE DLP FOR WEE ro ee ro WEE OOP FOR WIRE ro BE TEMP DE-RATE:0.94 APPROVED BY 201+NEC TEMP DE-RATE 0.67 APPROVES tM 20+1 VIED TEMP DE-RATE:0.67 APPaouFD EG++NEC TEMP DE-RATE 0.94 APPROVD BY so++VIED TEMP DE-RATE:0.94 APPROVED B+'2011+� - P Y-'4 9WOH _� I1 � � [1J } 1 LQ U7 ,1, Cj ) LY Cil rl t G' T C_ �. cx� m ry IF11. p t cv .y c UJ o Commomweauh of Massachusz&s rr sues,Suite 100 BaAon,AfA 02114-2017 Workers'Compe; awi Inst zre AlfisVit T0 BE FILED WME 7IT9 f c trs i» r sr l c ers. ' rift Lel; . 4 Ape you `=*,Ye?ism,Ike a r "4 bay 2,�s prrr atter r h and mat n ay e 7. New W'.�truotion VT �_ f ars . nYU [No 'rzrr b zrt *rc '; a�is� t ? x r* � �all"ate of y , k 1 Ct ra%laf � , 1 bra W3tr� ' om' y e�cyc i � so r»pas or adios 11 cm 4n dm arm*td marthm��and� IF a=Poratkm and; Y*ra zr ir M 3 $0,f P, �, 14.� bor P,(4)aaS vvft bzv 10 e r��a} :rND�AIne ��.mice tt y 0ek1 box#i ms's 1 t",sz torr wow mwng far _ � -b"Pub=�1 zffldayh r4mdn`may Am*Omg in"Aml him � reams*Axa t.r�a bow: of tm srtb e i and fttz�n;^�mx twa e J6t$hart ��ye"s, �y �bz�esr wvtrfa° ., h rn�aa+ ^ e I w-,eAVLOYe t t d p^t mi fi g �irr�n rr m -wIn ens. Bdcw is 2hcO s,irmce Co parry Nam-_- • �ob Sid A�d&=: Aftach„;*pyatt2seter to; °e rs�� e t t� �C•?,.RaVor one-yew ., ��aPoul �Ie by a tae IDP+-. day des e 'C3�? OPOSR a�of W0.00 e �� e 10dol , spy �`re fc�x�to � .! a e A fb bstm Zen tr y, o Wrr't-*fn MtP MV42,tV be Nq4e&dOr tCfWn'a AL Cid or owt: eta L Rownd of Real& 1.DuadjAg 6,� pact 3.QtyvTcr m Clerk 4 yedzitg IMPOctor .5> 'lual Al��a DATE(MM/DD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 7/15/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT l M Darlene Mulcahy Y Malcolm 6 Parsons Insurance Agency PAH/CNE Etl_ (781)344-3200 NC No:(791)344-1425 713 Washington Street IL ADDRESS: P.O. BOR 527 INSURERS AFFORDING COVERAGE NAIC# Stoughton MA 02072 INSURER A Northland Insurance Company INSURED INSURER B:Sentinel Insurance Company Ltd 39098 Certified Safe Electric, Inc. INSURER C Nautilus Insurance Company 50 Tower Avenue INSURER D:CNA Suret INSURER E: Marshfield MA 02050-5131 INSURER F: COVERAGES CERTIFICATE NUMBER:CL157602635 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 DOLTYPE OF INSURANCE S R POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD MMIDD/W X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DANIAGE TO RENTED A CLAIMS-0AADE ❑X OCCUR PREMISES ffa occurrence $ 100,000 8 ISO Form CG0001 TBI 7/15/2015 7/15/2016 MED EXP(Any one person) $ 5,000 X Contractual Liab PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑PRO-JECT F]LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: General Aggregate $ 5,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 0 Ea accident ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED AUTOS X AUTOS 08UECZJ9251 3/7/2015 3/7/2016 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS er accident $ % ISO CA0001 PIP-Basic $ 8,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 C X EXCESS LIAB X CLAIMS-MADE AGGREGATE $ 2,000,000 DED I I RETENTION TBI 7/15/2015 7/15/2016 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ H gas,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ D FIDELITY- EE DISHONESTY 62447764 7/1/2015 7/1/2016 $50,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION certifiedsafeoffice@gmail. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Amne Parsons/DARL ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) BRIXF A DA�IS 50 TONk ER A%0,L L NIARSHFIf.LD Nt.% OZW L�JINVil'ONWLALN OF MASSACHUSIEl-TS A5 A RITC k';lv'm Aki E E C TkI r COMMON WEALTH OF MA,-rACHUSEI-TS 130A9,0 OF It wf 1 0A. 3 -ibJUJ A License or registration valid for indiNiclul use only tit unsurner wairs Rmices.-Rv, --ll "4JOME IMPROVEMENT CONTRACTOR before the expiration date. If found return Eo: Registration; 1,60io4 Type: Office of Conbumer Affairs and Business Revotalmn Expiration: &254120',6 `lnva.'e corr'oralkon' 10 Part,PI;Ml-Suite s1'(! Roston.NIA 02116 ZER-IFIED SAFE E-ECTRIC.INC BRUCE IDAVIS 50 T C VV E R AV-: VAPSHFIELD MA C)2C,5-- Not kalid without+is!nnture 011ice Use Oriiy / Permll No. Occupancy&Fee Checked of 0vminuniuecilllj of 9111 uadjuudw 3190 (leave blank) iucilli illenl of vittilic 0111clu ward BOARD OF FIRE PnEVENTION REGULATIONS 527 CMR 12:00 Area APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance will, lite Massacltuselis Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INF:OR ATION) data p�)2J1/• lb tile Inspector of Wires: City or,lawn of P ov-� l The undersigned applies for a permit to perform the electrical Work described below. r Location (Street & Number) 53 jyc�hn�v>n Floor �i 5 Tal. No.5o����'333 Owner or Tenant Owner's Address — --- Is tills permit In conjunction will, a building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Aulhorizallon No. Existing Service Amps __•_J Valls Overhead ❑ Undgrnd ❑ No. of Motors New Service Arr,ps _J Volts Overhead ❑ Undgrnd ElNo. of Meters Number of Feeders and Arnpaclly Location and Nature of Proposed Electrical Work Total No. of Lighting Outlets , No. of Hot lobs No. of lranslornters I<VA Above In KVA No. of Llghling Fixtures Swhnming Pool grad. ❑ grnd. ❑ Generators No. of Emergency Llghling No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No.of Zones Total No. or Detection and No. of Ranges No. of Air Cond. tons Initiating Devices No. of 14981 lbtel Total No. of Sounding Devices No. of Disposals Purnps Tons KW No. of Sell Contained S ace/Ates Fiealing KW DelecllonlSounding Devices No. of Dishwashers P Local Municlpet Other No. of Dryers I-tealing Devices KW ❑ Connecllon 9 Lcrr Vc!t�go No. of No. of c No. of Water Floaters KW SignBallasts Wlring Secure ,7c�Ste-�r1- No. Flydro Massage Tubs No. of Motors Total VIP OTHER: JUN 1 1 1997 Includ INSURANCE COVERAGE: Pursuant to Ilia requirements of Massaciwsolls General Laws I have a current Liability Insurance Policy e to Ilse Office. Completed Operations Coverage or Its substantial equivalent. YES V NO 1,1 1 Irnve submitted vnlid proof of sam . YES V NO lJ 11 you Leve checked YES,Pease Specify)lire type of coverage by checking Ilia appropriate box. INSURANCE A:t BOND rid' OTHER L/'I (Please P y) (Expir`ationn Data) Estimated Value of EI chic I Work S__6(-)! ry I Final J Work to Start 3d Inspection Dale Requested: Rough Signed under the Ponalll s or Perjury: r, LIC. NO.—JT5 C FInM NAMC 13r' j—�LJLIC. NO. I64 G Licensee ��� CoS� Signature pm 4 kk ei, ry1. , Bus.Tol. No. . Address g �3S eRai 10- All.l•91. No. OWNEF1'S INSURANCE WAIVER: 1 ern swore Ilial Ilre Licensee does not have Ilia Insurance coverage or Its substantial equiv8len es re- qulred by Massechusells General Laws, and Ihat illy slgnaturo on this permll application wolves this requirement. Owner / Agent (Please check one) telephone No. PERMIT FEE$ " • (Signature of Owner Agenq „ nnrlrnr Knill Insnsclion.Permll must be oldalnrl WelWell; mm commencing any,and all work In compliance with G.L.C. 141 6 all 9pplica• °k c� Date......... 996 NORTIr " TOWN OF NORTH ANDOVER PERMIT FOR WIRING g �,SSACHUSE� . If l This certifies that ...... ......S/. ............. has permission to perform ....... .�� s.�l.��IYk.............. wiring ng the building of.... �i C"e .......................................................................� v+ at.....�I,,��� .�.......�4�......�.�..[.. .... YLECMTRIC ,North Andover, Fee..�.�. a)..... Lic.No.113. ..L ..... . . ..... ALI WHITE:Applicant CANARY: Build",.'9 Dept. PINK:Treasurer