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HomeMy WebLinkAboutMiscellaneous - 874 SALEM STREET 4/30/2018,� N O_ (T Q OO A w 0 0 0 0 0 ............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING j / 1 This certifies that ,,,..,''.......!..G�� ..................k��l� ??.........fin //.........................../................. has permission to performcx`'0...S to ..........{!.......4� .wiring in the building of................� "� .......................................................................................... at ....V.....7..1.4,: �1 �......--S\... ........................ . North Andover, Mass. Fee.,.:.......... Lic. No.1.3.��f....................................... ELECTRICAL INSPECTOR Check # -779/76 1321&-,I _ tno►nrrwAIA-M L o/ Maddaartu644 Official Use Only ry��• SPermit No. e Liopar(�n�rn o ira aroi w Occupancy and tree Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1107] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perrormcd in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 3124/g" City or Town of: L404, "ova►' To theIn p ctor• of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 101 541e4-_S+- Owner a,(e,4-_St•Owner or Tenant )nl+ti (,,,� S Telephone No. (017 —(Qaq - dAj Owner's Address Is this permit in conjunction pith a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd Q Number of Feeders and Ampacity No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: Install Solar Electric - Photovoltaic (PV) system [d ] panels rated [ Wj31 kW Q STC Grid Tied. In conjunction with a Buildina Permit C'o,7miction of the folloirine table nrar be irnived by the h.snector• of Tfires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) FansNo. of Total Transformers [CVA No. of Luminaire Outlets No. of Hot Tubs Generators RVA No. of Luminaires Above n- Swimming Pool rod. rnd. ❑ o. o mergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o• of Detection an Initiating Devices No. of Ranges No. of Air Cond. Toota nsl No. of Alerting Devices No, of Waste Disposers Heat Pump Totals: I Number I Tons KW No. of elt ontarned Detection/Alerting Devices No. of Dishwashers Space/Area Heating I(W Local ❑ iunrcrpal ❑ Other Connection No. of Dryers Heating Appliances KW Security stems: No. of Devices or Equivalent No. of Water KW o. of i o. o Data Wiring: Heaters Signs Ballasts . No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP TelecommunicationsWiring: No. of Devices or Equivalent OTHER: Attach additional detail If desh�ed, oras required by the Inspector of 1-Fires. stimated Value of Electrical Work:000 (When required by municipal policy.) Work to Start; ASAP Inspection tos 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.) ` T certrfj,, under rile pains and penalfies of perjury, tint the h1 fortnadon on this tipplication Is true and complete. FIRM NAME: SOL ARCITY CORPORATION LIC, N0,:1136MR Licensee: MATTHEW T. MARKHAM Signature GIC. NO.:1136MR (If applicable, enter-exr►npr" In Iiia license nrrnrber line) Bus. Tel. No., 774-258-818,5 Address: 24 ST MARTIN DRIVE (eu1LDING 2. UNIT 11) MARLBOROUGH, MA 01752 Alt. Tel. No.: 774-268-8505 *Per M.G.L. c. 147, s. 57••61, security work requires Department ofPublic 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) Qowner owner's a eat. Owner/AgentPERMIT FEE: $ SignatureturaTelephone No. CA #,'f /C.1'i L�s'Sf /�C1'(-+K;•tiiisi St` 1. f'JT67.->li lir 1)111ce ol'Consunier Affair and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 021116 1-lomc Improvement Contractor Re( istration SOLAR CITY CORPORATION MATT MARKHAM 3055 CLEARVIEW WAY SAN MATEO, CA 94402 a -,O'" a.. - - .r Offire ofComumer:'ill'uiri & llusine1g ttrpula:ion . HOME IMPROVEMENT CONTRACTOR Registration: 199,672 Typo: I Fxpratiorr: -12-017 Supplement Card MATT MARL- iP.1 24 ST MARTIN S RtLL i 13LO 2UNI- i�,ANLBOROUGIf, MA 01757. trniiersecre------ Registration: 168572 Type: Suppipment Card Expiration: 3!812017 Update Address and return card. Mark reason for change. Address Renewal Employment !asst Card I •ic•ense or registratioss valid for isxlivitlul use ottly before the expiration (late. 1f found rcturn to: Office of Consumer Affairs and Business ReCulwtion 10 Park Pian - Suite 5170 Boston. NIA 62116 Not valid without signature st 0 m . � • s • . s ss 1 DOARV or EL C' R1CiANS ISSUES THE rOLLOWING LICENSE AS Af% }2E(� i STERCO MASTER ELECTRICIAN � SOLARC I Ty Cf RPORA1 I I.1N MAt'THLW T MARkNAIA 24 SAINT 14ARTIN OR SL DG 2 UNIT 1 t 1AARi,81.1Ri'?IJt"H MA 01752-f0604)41 AR xi - W 0 I The Canintortitteallh ofMassacbusefts klDepartment of IndustrialAccidents Dike of Investigations 1 Congress Street, Steele 100 il Boston, MA 02114-2917 tvww.otassgov/deer Workers' Compensation Insurance Affidavit; Builders/ContracturdEleetricians/Plumbers Applicant Ii fairmation Please Priat Le ibi Name(13usincworganizadon/IndividuaD., SolarCity Corp. Address: 3055 Clearview Way L:tty/btate/L1 : San Mateo L;A. y44UL ytone g: 000-/ UJ-L�FO� Are you an employer? Check the appropriate box: Type of project (required): 1.1r P am a employer with 5,000 4- D I arts a general contractor and I 6 n New construction emplgays (full and/orpart-time).* 2. ❑ 1 am a sole proprietor or partner.- have i» red the sub -contractors listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub -contractors have S. 0 Demolition working forme in any capacity, employees and have workers' 9. []Building addition [NQ -workers' comp. insurance required.] comp. insurance, 5. We are a corporation and its 10.[] Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their I LEI Plumbing repairs or additions myaei% (loo workers' camp. Pierof exciimptdon p£r iwGL 12.❑ Roof repairs insurance required,] t c. 152, §1(4), and we have no employees. [No workers' 13 then Solar/PV comp. insurance required.] }Any applicant that checks box U l must also frit ow the section below showing their workers' coatpcnaation pottcy information. I Homeowners win submit this aff'idwit indicating They are doing all work and then hire oWsidc contradars mast submit anew affidavit Indicating such. tContraetors that check this box must attached an additional sheat showing tits name of the sub-conaactors and state whethei or not those entities have employers. If the sub•eontrwim have employees, they must provide Omir workers' camp policy number. 1 ant an employer that isproviding workers' compensation Insurance for my employees. Below is the paltry and job site informatlon. IrtsuranceCompany Namc: Zurich American Insurance Company Policy -9 or Self -ins, Lic. #: WC0182015-00 Expiration Date: 9/1/201 .fob Site Andress: $"7H Sc -le, c5(. City/state/zip: A/. GAMd 'rA 611r`1S Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure ro secure coverage as required colder vection 25A of MOL c. 152 can lead to the imposition ofcrirninal penalties of a fine up to $1,500.00 andlor one-year irnpristmment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of tip to $250.00•a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office, of Investigations of the DIA fbr insurance coverage verification. I do hereby cedf& under the palms and penalties of perjary that the inforn:aden provided above is true and correct. phone N. Offidal use wily. Do not wrile in this area, to be completed by city a town ojytelat. City or Town- Permialeense # Issuing Authority (circle one): I. Bon rd of Health 2.8altding Department 3. City/Town Clerk 4, Electrical Inspector 5. Plumbing Inspector 6. tither Contact Person: Phone 4; A00R�® CERTIFICATE OF LIABILITY INSURANCE DATE {120`15 YYY1r) K `..�� 08117120`15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. PHIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT MARSH RISK& INSURANCE SERVICES AHON$ .. _ FAX 345 CALIFORNIA STREET, SUITE 1300 .0kir tl:.........._ ....... ............... .......... lA!c,.NQi�..................................... CALIFORNIA LICENSE NO. 0437153 E-MAIL SAN FRANCISCO, CA 94104 _APV99";........... .....................:......._........_............ _...............T._. Alin: Shannon Scott 4116-743-18334 YIN!; a....... 998301-STND•GAWUE-15.16 INSURER A; Zurich American Insurance Company 116535 INSURED INSURER B: NIA NIA 5olarCiry Corporation _ ......... .... .. . ..... ...... ............... . +- ......... . _. 3055 Clearvlew Way aNSURER C: NIA lNlA San Mateo, CA 94402 ._ INSURERD: Zurich insurance Company !40142 INSURER E,:... ._.._ 3,000,000 INSURER F: COVERAGES CERTIFICATE NUMBER: SEA -002713836.08 REVISION NUMBER. -4 - 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- AUTHORIZED REPRESENTATIVE _.._...... . .._.. ..... tlfILSUBRT .— . _._............... ... . POLICY EFF POLY EXP INSRT ... .... ......TYPE _. ..LIMITS ...__ ........... ............ OF INSllRANCE'.. LTR I POLICY.NUMBER D A X COMMERCIAL GENERAL LIABILITY iGLOO182016-00 _.. 0910112015 0910112016 EACH OCCURRENCE $ 3,000,000 X CLAIMS MApE I OCCUR I DAMAGE TO RENTED .. PREMISES [E.a oowrrenceZ ....' �...- .._....... t _ .3,000,000 X SIR: $250,QD0 I .........50,0. _. ...._ ........ ...... M D ExP t...E......... (Anyone personi.....� g.' 5,xoa ._ PERSONAL & ADV INJURY S ._.._ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER- i GENERAL AGGREGATE S 6,000,000 X 1 PRO. POLICY I JECT t....; LOC PROD L1CTS - COMPIOP AGG :.$ 6,000,000 OTHER S A ; AUTOMOBILE LIABILITY ISAP0182017-00 :0910112015 0910112018 Bl SINGLE LIMIT $ :.iE2 accideCelj 5,000,000 t X ANY AUTO ..... r ........... .... ..: ..._.. .. BODILY INJURY (Per person) : $ ; .... ... --- ALL OWNED SCHEDULED x..; AUTOS F X AUTOS ..... .. BODILY INJURY (Per accident): $ .... ............ X i x NDN -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE l..,_ F(Perac0brit COMPICOLL DEO: $ $5,000 UMBRELLA LIAR OCCUR I EACH OCCURRENCE $ EXCESS LIAB CLAWS MADE; AGGREGATE 5 �...... .. .... r..._ T..... ......_........ __ . _ ......... ; r .. ....... ... ....... .. .. i...... ...... DED RETENTION$ S D ' WORKERS COMPENSATION ! tWC0182014-CO (AOS) :0910112015 ;0910112016 I X ': PER OR O. ; AND EMPLOYERS'LIABILITY A YIN! WC0182015.00 MA :0910112x15 0910112016 PROPRIETORIPARTNERIEXECUTIVE F........STATUTE.;......: E. .....i._ 1,000,000 .ANY N :OFFICERIMEMBEREXCLUDED' NIAI , E.L CH ACC1pENT S r-....._--- .........................�. ..... {Mandatory In NH) WC DEDUCTIBLE $500,0x0 Hes, E.L DISEASE - EA EMPLOYEE' S _.....__....... ._ .. ._ ...... +._.... ._ . 1,000,000 defcnba under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT ' S 1,000,000 i DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD. 101, Additional Remarks Schedule, maybe attached If more space Is required) Evidence of insurance. CERTIFICATE HOLDER CANCELLATION SdarCily Corporation 3055 Clearview Way San Mateo, CA 99402 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED 1N ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services Charles Marmolejo^.,!�-- ©1888-2014 ACORD CORPORATION. All rights reserved. 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E �'c I : �: 1) o i o i z :o' 0 :o:3 2- i 'o z.. lo) 51 3:.6 m o:81- :o :o: nd z% 3 > z: 913' Z o: o o 3 3 :o: Z! a 48 m no lo. 1w �0 I S :8 wo oo Q :o c' c o a c/) W CA z 89 w w W O Oo c z@. :A: r) . . . . . ---- - w o' o 7-7 In c < - W: In w c/) + ;3 El. w v ; !A:M :� :m o c): Vf. o. i lo 18 O o : 7. ol o I i> cD co iY w <ol o: o lo <: . . . o w < <: cD cD c) CA . ...... . . .... Et + :> :E :c Int/t - : :t' I : o: :o: -: : In 10 = C= < w . . . o o o iw "'c o , i< �:c! 'o o o o m + c cD w 25 < mo 2 :> o o o o m cD HTa �o cS Z f4 W a w o�o -o c=) o :A: lo: W' q): rp !P) (E) rp, :o: al FF: : 1 :N o' w cn :w:- 3: -:3 ! A :o <: < : a :0 <: : :< <: . : : < <.< <: 3 3:c L'. x .......... ........ ....... CD o 0 W o o. :0 o o o o a > > ;3 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) <, \ NORTH ANDOVER , Mass. Date Z / NAV build �r New C! Location e Permit F yell_ Owners Name / ��. -��e Ile 1i 77 Renovation D Replacement �' Plans Submitted D FiyTIIR�::c. (Print or Type)Check one: Certificate Installing Company Name Corp. AddressAmwn—e'7' / Partner. Y'Firm/Co. Business Telephone:'�� Name of Licensed Plumber or Gas Fittera-�� Insurance Coverage_: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [Other type of indemnity Q 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 all of the devils and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowlcdge and that all plumbing work and installations petfomtcd under' Permit isseed to: this application will -be in compliance with aD pertinent provisions of tho Massachusetts Slate Gas Code and Chapter 14I of tho Genual Laws, By TYPE LICENSE: Plumber Title Gasfitter Signature of Licensed City/Town- ..aster Plum error Gasfitter Journeyman APPROVED (OFFICE use ONLY) License. Number • • • Y • ' - SII • • • • • • • rrrrrrrrrrrso ■rrrrrrrrso rrrrmrrrrrrmoons rrrrrrrr .. _ rrrrrrrrrrrrrrrrrrrrr�rrrr . 2 .. - rrrrrrrrrrrrrrrrrrrrrrrrrr � .. ... rrrmrrrrrrrrrrrrrrrrnrr ... ■rrrrrrrrrrrrrrrrrrirrrrrr .. - ■rrrrrrrrrrrrrnrnrrrrrrr . ... rrrrrrrrrrrrrrrrrrrrrrrrrr ... ■rrrrrrrrrrrrrrrrrrrrrrrrr : ... rrrrrrrrrrrrrrrrrrrrrrrrrr (Print or Type)Check one: Certificate Installing Company Name Corp. AddressAmwn—e'7' / Partner. Y'Firm/Co. Business Telephone:'�� Name of Licensed Plumber or Gas Fittera-�� Insurance Coverage_: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [Other type of indemnity Q 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 all of the devils and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowlcdge and that all plumbing work and installations petfomtcd under' Permit isseed to: this application will -be in compliance with aD pertinent provisions of tho Massachusetts Slate Gas Code and Chapter 14I of tho Genual Laws, By TYPE LICENSE: Plumber Title Gasfitter Signature of Licensed City/Town- ..aster Plum error Gasfitter Journeyman APPROVED (OFFICE use ONLY) License. Number + Date.. 6 f . .. . C/. HORTM TOWN OF NORTH ANDOVER p PERMIT FOR GAS INSTALLATION This certifies that.. ! .... . ! ! -4— . rf � % r / r........� ... . has permission for gas( installation .%..10`41, in the buildings.of . _i �fl .I.?.......... . at . 4 J/.. ........ , North Andover, Mass. Fee.,e%, .''� Lic. No..f GAS INSPECTOR WHITE: Applica0►<-- CANARY: uildQ' Dept i" PINK: Treasurer GOLD: File