HomeMy WebLinkAboutMiscellaneous - 79 GLENNCREST DRIVE 4/30/2018 (2)N
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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...: ..�n..!'�..../ ..:.... ... /1.. o...........
has permission to perform .......1.L. .!..P ..�.!...(......�
wiring in the building/of.......................................,./..'f.......................................
/i�....
..:.. .ass -
at .....;... 7.%......Northndo,vU�
Fee ....v......... Lic. No. .......... may/
ELE-C'fJt`CAL INSPE�R
Check #_
4530-
`� Lcco��»u>tonwaaf'l%i of %%��aeear�ewslEa Oliicial Usc Only
.[JsParliutsi o`.} Permit No.
in �i,rtitos
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 (XIEC), 527 CNIR 12.00
(PLEASE PRINTW INK OR TYPE :ILL INFO)WA7'IONj Datc:
City or Town of: /U O ayeQ,� .�� To the Inspector of 6Yit es:
By this application the undersigned gives notice of his or her intention to perform the electricaP work described below.
Location (Street & Number)
__..�> 2 1 r ren �'�•1e r �oc
Owner or Tenant zf>'F (1
Telephone No.
Owner's Address
Is this permit in corrjunctioll with a building permit? Yes 0 No
�-•� '(Cheek Appropriate Box).
Purpose of Building Utility Authorization No.
Existing Service Amps / Potts Overhead ❑ Und rd
g ❑ No. of Meters.
New Sen lee An►ps / Volts Overhead ❑ Undgrd ❑ No. of Meters.
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical tiYork: �r���,
Cont tenon, of the rollolvin
No. of Recessed Fixtures
No. of ceii, Susp. (Paddle) Fans
a e Wrap a ttatve,l b t/te las cctor of hires.
°- °--Total
No. of Lighting Outlets
No. of Hot Tubs
Transformers KVA
Generators KVA
No. of Lighting Fixtures
Swimming Poul A ove ❑n-
o. o mergency tg ttuig
rnd. rnd.
Batte Units
No.of Receptacle Outlets
No. of Oil Burners
FIRE ALAR,-jIS
No. of Zones
No. of Switches
No. of Gas Burners
No. of DeFe—etion an
i
Initlatin Devices
No. of Ranges
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
eat Pump
Totals:
oat er
'oro
o. o c - onta ne
_
-
DetectioNAlertin Devices
No. of Disliivasiiers
Space/Area Heating .KNY
Local Eluinc pa
Connection D Other
No. of Dryers
Heating Appliances KW
ecurtty ysten:
No• of Dc�•ices
o. of titer:
Heaters KW
°' No. °
Si tts Ballasts
or E uivalent
Data iViriu g
No. of Devices or Equivalent
No. Nydromassage Bathtubs
No. of Alotors Total HP
Telecommunications ring:
No. of Devices or Equivalent
OTHER:
eaaca aaaamona, await Vdesired• or as req,tired 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 insurmice 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. 0
CHECK ONE: INSURANCE W BOND ❑ orniER ❑ (Specify:) y
(Expira(ion Datc)
Estimated Value of Electrical Work:�0-45)' a (When required by municipal policy.)
Work to Start: .5 o;W - 0 -3 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certifj•, unde=r the pains .a,td peitaltirs of perjuq; that die inforntatio,e of ris application is trite and complete. �
FI101 NANtE: d - tJr llo LIC. NO.: I9 Y4.5
Liceiisee: •,-ifoAon A . GR j/w Signature. LIC. NO.: �4 -- l (p 7.Z
—7►�
(ljopplicabte, ruler "cr.nept " h, the license nrnuberG'nc) 7 /
Address:�. o • Ise h .y.3 S— 8 rev � lt. _ /`fA o r �s�'' Bus. Tel. No.- � %
Alt. Tel. No.:
OWNER'S INSURANCE IYAIVEIi: I am aware U t e Licensee doe s nat !rave the liability insurance coverage normally
required by law. 13a• n►y signahtrc below, I hereby waive this requirement. I am t1►e (chcck.onc) ❑owner ❑ ow a =
Owner/Agent
Signature 'I'clephonc No. PisRdIIT FL• •: $ ,� "'
Location t ���N cc'rS�
No. Date
NORTH
TOWN OF NORTH ANDOVER
O
Certificate Occupancy $
of
�l �O•�r•o �,��/
�a-1 CHUSE<
Building/Frame Permit Fee $
Foundation Permit Fee $ `-
Other Permit Fee $
TOTAL $
Check #
` 35L3�
r
Building Inspector
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Name Please Print
Name: 14, .Geld 6"1 (5-
Location: `7 9 J9l� - C deer? 1c Beiy e
City xQ9,e7-* tfl11:�,0VelL_. Phone #
1 am a homeowner performing all work myself.
fI am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working on this job.
Comoanv name
Address
City Phone*
Insurance Co Policy #
Company name:
Address
City Phone #:
Insurance Co Policy #
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00
and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signatu
Date bc4- j, 1999
Print name S7e drl I iia G� Phone # Gd'2-�as2
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensing
❑
Building Dept
F-1 Check if immediate response is required ❑
Licensing Board
❑
Selectman's Office
Contact person: Phone #: ❑
Health Department
❑
Other
.��
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HOME IHPROVEMENT''COWAGTOR
`
Reg`ist"ratign 101846
Type = INOTVIDUAL
Expirat-ion 06'/29/00
STEPHEN 'M. KEISLING
'
68 6lenncrest, Dr'.
nutiuras�v►1�
�� '4
•;�,� �,ilt!��4«Della
g6Ai D OF BUILDING REGu L'ATIONS
Number: `CSS 027489
Birthdate++. 7118. 955
�iExpirss;,D7l9fi►2A01 Tr. no: 11352
10: 00
• STEPHEN M KEISWtVG j % � �:
• 68 GLENCFtESTOR '�.�`%�, f
N ANDOVER, MA 01845 Administrator
arm DECLARATIONS PAGE 1
CONTRACTORS ADVANTAGE SPECIAL
Family,POLICY NO.2005XO431
Casualty Insurance Company
ire Glenmont, New York
NAME OF INSURED AND MAILING ADDRESS: AGENT NO. 2591 OFFICE NO. 2591
STEPHEN KEISLING JAMES W UGONE
68 GLENCREST DR FARM FAMILY INSURANCE
N ANDOVER MA 01845-1315 10 S MAIN ST STE 208
TOPSFIELD MA 01983-1832
978-887-8304
RENEWAL TRANSACTION EFFECTIVE 03/21/99
POLICY PERIOD FROM 03/21/99 TO 03/21/00 12:01 A.M. STANDARD TIME AT THE LOCATION
OF THE DESCRIBED PREMISES
THE NAMED INSURED IS: INDIVIDUAL
BUSINESS OF THE NAMED INSURED: CARPENTRY-NOC
LOCATION OF DESCRIBED 68 GLENCREST DRIVE PROTECTION CLASS IS: 04
PREMISES NO. 01: N ANDOVER MA 01845 CONSTRUCTION IS:
FRAME
PREMISES 01 BLDG 01 BUILDING MATERIALS / EQUIPMENT STORAGE
BUSINESS PROPERTY COVERAGE:
BUILDING
BUSINESS PERSONAL PROPERTY
BUSINESS INCOME AND EXTRA
EXPENSE
LIMITS OF TERM ADDL/RTN
INSURANCE PREMIUMS PREMIUMS
0 0 0
5,000 74 74
ACTUAL LOSS SUSTAINED NOT
EXCEEDING 12 MONTHS INCLUDED INCLUDED
BUSINESS LIABILITY COVERAGE:
BUSINESS LIABILITY - PREMIUM IS SUBJECT TO AUDIT
BODILY INJURY/PROPERTY DAMAGE 500,000 PER OCCURRENCE
1,000,000 AGGREGATE
500,000 AGGREGATE FOR
PRODUCTS - COMPLETED
OPERATIONS HAZARD
MEDICAL EXPENSE 5,000 PER PERSON
FIRE LEGAL LIABILITY 50,000 PER OCCURRENCE
CODE DESCRIPTION
91342AA CARPENTRY-NOC
PAYROLL TERM PREM ADDL/RTN
15,600 276 276
THE LIMIT OF INSURANCE FOR THIS BUILDING SHALL BE AUTOMATICALLY INCREASED
BY 5% ON AN ANNUAL BASIS DURING THE POLICY PERIOD.
ACTUAL CASH VALUE (ACV) - BUILDING OPTION DOES NOT APPLY.
DEDUCTIBLE: $250 DEDUCTIBLE APPLIES EXCEPT WHERE NOTED IN THE POLICY OR ENDORSEMENTS.
COUNTERSIGNED BY:
BF 30 05 01 98 INSURED COPY PROCESSED DATE: 02/02/99
y Page No: of Pages
�ro�.o�ttl
s STEPHEN M. KEISLING
Building & Remodeling
68 Glencrest Drive
NORTA ANDOVER, MASSACHUSETTS 01845
S MA Lic. 027489 Home Impv. 101846
Phone 682-2072
PROPOSAL SUBMITTED TO
Z
PHONE
DATE
lyyz
STREE
JOB NAME
CITY, STATE and ZIP CODE
22,1
JOB LOCATION
ARCHITECT --
TTE OF PLANS
JOB PHONE
We hereby submit specifications and estimates for:,
OdLG
L4- G � G�,� .
[�Jc�Q�Y�-1-�/Q,. W�-�l /1W�. '/cal �G� L(./Q..f�J��R.1".�E'�,�ts'-�-G�, l.�/'►'�"'� .M•v�C.ciJJ.s•..� G�r,� Gux.-�i�0 �r1
l !.7 / � , �vwc�fc�..sC�O .��*�(' P� ��Gi.n-� ,�%,tiG�•cc�I �O-e — /u�uG. /��a�ws^' u�r�r1./`�
UvA
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���.4y���� (iG{tGQ�G'1^GN''�6.�o/i�L�✓'�i^ .�il•� �Ea�"`�ai.r71�" �-4ci(i"'+'�/KJ 4f��f�rr!4Pt/.
f
' We propose hereby to furnish material and labor — complete in accordance with above specifications, for the sum of:
dollars ($ ��od )•
Payment to be made as follows:
All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized '
manner according to standard practices. Any alteration or deviation from above specifications Signator —iY
Involving extra costs will be executed only upon written orders, and will become fn extra
charge over and above the estimate. All agreements contingent upon strikes, accidents Note: This proposal may be
or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. ,withdrawn by us if not accepted within days.
.... ... ,.a,.,— -... .....—A ti., w,.ri..nan-c r—nnncatinn Insurance.
Arceptance of Proposal— The above prices, specifications
and conditions are satisfactory and are hereby accepted. You are authorized Signature
to do the work as specified. Payment will be made
as outlined above.
Date of Acceptance: �LL/ l ! Signature
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