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Home My WebLink AboutMiscellaneous - 94 Kingston Avenue4- Date............................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ 0 ....... .... C ...... ... C ........ e... has permission to perform wiring in the buildingof .......... at .......... I ", ......... Fee .... ........ Lic. No. Check # 1151-4 13374. -T-1 ......... ..5dl ................................................. ............................. ........ - . ....... Andover, Mass l cco''mmonweaR I/ M7l_,sacLe effi "=LW/JeParEment o� %ire �eruicee rr BOARD OF FIRE PREVENTION REGULATIONS Official Use Only - PermitNo. Occupancy and Fee Checked [Rev. 1/07] (leave blank) All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE XLL INFORAL4TION) Date: (' � City or 'gown of: Nt, (, A VC61(r To the Inspector of Vires: By this application the undersigned gives notice of his orher intention to perform the electrical work described below. Location (Street & Number) O Y;n _ ./Vc(-t to A--,, ,;Vee AI ,<5 Owner or Tenant S`("J�"�° (V t �' `'p /Telephone No. ilcyner's Address '�.,, Agj0 j � .r..�4k/� f) Ye Is this permit in conjunction with a building permit? Yes ❑ Purpose of Building Cr ni o Existing Service { Uc;, Amps I_aqO Volts Overhead New Service /0�) Amps 0 Volts Overhead Number of Feeders and Ampacity No I%A (Check Appropriate Boz) Utility Authorization No. ❑ Undgrd ❑ Undgrd ❑ No. of Meters No, of Meters 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 Above In-W7o—of Swimming Poolrnd. grnd. Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burne rsFIRE 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 Tons No, of Alerting Devices g No. of Waste Disposers. Heat Pump Totals: Number .......... .. Tons ""'"""""."""" KW No, of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other —� Connection No, of Dryers Heating Appliances KW Security Systems:* No, of .evices or Equivalent No,. of Water KW Heaters No. of No, of . Si ns Ballasts _ Data Wiring; No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent _ OTHER; I 00 Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: c (When required by municipal policy,) Work to Start: 1 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 cov ge is in force, and has exhibited proof of same to the permit issuing office, CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of erjury, that the information, on this application is true and complete. FIRM NAME: te�� I A V,( e f r f, I to C 0 LIC. N'0.: cj1JA Licensee:L�O,,p�� r t'�I �' 11 Signature LIC. N'0.: (Ifopplicoble .enter "tempt"` the license number line. � �6j Cc Bus, TeL No.: i a Address: Q �.° j lA7 )r ®� LI�� Alt. Tel. No,: r '(,'`'•4> *Per M.G.L. c. 147, s. 57-61, security work requires Dep a ent 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 bellow, I hereby waive this requirement, I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent Signature Telephone No, PERMIT FEE. �� "' -1, 06/12/2015 09 ; 10 Ne i I & Ne i I Insurance Agency (FAX)14137316629 P,001/001 c Ra D CERTIFICATE OF LIABILITY INSURANCE °A 81112 20 5 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIOHTS 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 ISiUINO INISURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder IS an ADDITIONAL INSURED, the pollcy(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 thle certificate does not confer rights to the certiflcete holder In lieu of such endorsement s .. PRODUCERr. TACT Dav d Jarry Nell[ & Nalll Insurance Agency Inc PH NE , (413) 732-4137 AX No(413) 731.6629 882 Riverdale Street West Springfield, MA 01089 wl oar s INSURER A: State Auto Insurance Company STA INSURED Mlcheel Fereili Electrical INeURIER a: Acadia Insurance Co, 31326 9 Applewood Lane INSURER C Methuen, MA 01844 INSURER 0 t INSURER E IN RE P rn��eoeeee ree•r,e,re•re nrnlueeo• DCVIQIf1Nl NIIMRR0a 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 CONDITION$ OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY eFP POLICY eXP UMM A GENERAL LIABILITY BOP2745517 05110/2015 05/10/2015 EACH OCCURRENCE 6 11000.000 S 50,000 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR MED 0(An ane anon) 8 5,000 PER ONALSADVJNJURY i 11000.000 OENERALAGl3REGATfi 6 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER' I PRODUCTS - COMPIOP AGO 6 2,000,000 6 POLICY F7 TPT F7 LOC AUTOMOe1L5 LIABILITY 1 L LIMI BODILY INJURY (Par parson) 6 ANY AUTO BODILY INJURY (Per ooddent) 6 . AlL1T08 Eb SCHEDULED AUTOS P OPER AM GE 6 NON -OWNED HIRED AUTOS AUTOS 6 UMBRELLA UABOCCUR EACH OCCURRENCE 6 AGGREGATE i CLAIMS -MADE _r... __HEXCE35LIA9 R ELATION B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEIVEXICUTIVI+ OFPICERIMEMBfilt EXCLUDGDT (Mandatory In NH) WC -20.20.001461-05 03/2012015 6 OFT R11 E.L. EACH ACCIDENT i 100,000 fi,L,DIBEAGE.EAEMPLOYEE 6 1001000 Ifu, drt0dbtt under RIPTI N F P RATI N helow JN) E.L. DISEASE • POLICY LIMIT SOD 000 DE5CRIPTON OF OPIRATION6I LOCATIONS I VEHICLES (Attach ACORO 101, Addltlonst Remalfts Schedule, If more space Is required) Faxed to, 878.582-1480 Town of North.Andover 1600 Osgood Street, Building 20 Sults 2035 North Andover, MA 01845 SHOULD ANY OF THE ABOVE: DESCRIBED POLICIES BE CANCELLED BEFORE THP, 9XPIRAI" DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANC WI THE POLICY PROV1510145. AUTHORIZED 01986-2°10 ACORD 6ORPORATIW All rlohta reserved. ACORD 26 (2010106) The ACORD name and logo are regletiired marks of ACORD 0."