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HomeMy WebLinkAboutMiscellaneous - Exception (231)Date ... ......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... ,../.(1.��..o ............. �.41 has permission to perform ...... . ............................... wiring in the building of ..... 2 . . ........... . .............................................................................. at ..... -F.b....... � ......... .....North A ver, Mass. .................. c. No . ................ Fee..125� .......... Li ELECTRICAL INSPECTOR S Check# A Commonwealth of Massachusetts st Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official t'.1se only Permit \No, Occupancy and Fee Checked �Rev. 11/991 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All uwrk to be perfomed in accordancc with thoMassachuscirs Electrical Cmlc(MEC), 527 c.MR 12.00 (PLEA,SF PRIJVT hV LVK OR TYPE ALL 17VVORNIA T[0JV) Date. City or Town of- dlAc ev- To the &Tpector of TVires' By this application the undersigned gives notice of his or her intention to perform the electrical work described below, Location (Street & Number) Owner or Tenant /— - Cin Telephone No. .V Owner's Address Is this permit In conjunction with a building permit? Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps I Volts OverheadUndgrd No. of Meters New Service Amps Volts Overhead Undgrd No. of Meters Number of Feeders and Ampacity Location and. Nature of Proposed Electrical Work: No. of Recessed Fixtures No. of'CeiL-Susp. (Paddle) Fins TNo. of tal ransformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool A ove r-1 In- M F 11 11, 11, 11 L -J d. jAmd� grn 0. o mergency ig Ing Battery Units No. of Receptacle Outlets No. of Oil Burners FIREN: ALARNli o. of Zones a No. orSwitches No. of Gas Burners etection ars Initiatine Devices No. of Ranges No. of Air Cond. TatNo. Tons of Alerting Devices No. otwaste Disposer eat i m um er Tota ons KW No. 01,Self-contained Do g"ti r!/Alertin., Devices No. of Dishwashers Space/Area Heating XW Local C] ConnMunicipa El other ection No. of Dryers i3o. of Water Heaters KW Heating Appliances KW --of— NO I - N6 -757-- I Signs Ballasts --wecomMunic2tions ge"—Cuhtys. ems: stems: or Equivalent Data Wiring: No. of Mvices or E ulvalent No. Hydromassage Bathtubs .................... No. of Motors 'postal FH' I iring: No. of Devices or uivalent OTHER: ,Ptachad INSURANCE COVERAG E: 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: NiSURANCE Qg BOND [I 01 -HER [] (Specify) Estimated Value of Electrical Work: (When required by municipal policy) Work to Inspections to be requested in accordance with,%IEC Rule 10, and upon Completion. I cerdfy, ander floe pains andpenalfies (if perjury, that the iftfOrl"adon Ott this application iv trite and complete, FULM NAME: L I C, N 0. - Licensee: 1JZ:lrt Signature (19"applicil ""'Pe - in the Ucetise n wff,bcr jj,,Je:) Address: k"', VVv ER IMSUKANCE WAIVER. I am aware thattl e required by law, By my signature bel()w, i hereby waive this requirement, Owner/Agent Signature _ Telephone No. LIC,. n04 have the li-mbility insurance coverage normally lam the Wwck, one) El owner - �Rl I T �FF F. The Connnonwealth (?f Alaiwitch iattt-v Deparintent of Indtaft I Congress Street, Suite 100 2 Boston,,,114 02114-2 0,17 IVIVIVx1ass"govIdia IVOI,kers' Compensation Insurance Affidavit - TO BE FILE.D WITH THE PEILMITt'ING A1,11110RITY. Appliunt Information please Print Leitiblv Nafne T — D-CCQ—C-,QrP— Addi-ess: 29 Cook St City/Stat e/Zip:,.l3iILgriqa,_Ma 0182 Phorke#: 978-663-0292 Are you in eluployve? Check the appropriate bo -c F 1),I)c of project (req ulred)� l.2jIarnaenj)IoYcr,vhh 79 emplovecs (fall art(Vor pan-titr&).� E] Ncw construcition 2.[] 1 rats sole Proprietor or partnefship ond have ric, -miployecs, wort inn li,,, rre in j 8. E] Remodeling my capacitY, jNoworkers* compinsui ince tequirc(t) 9� El Dcmolifioti 3,[:]1 ania howekiwgw doing, kill wort,mysetf, [No workem' ccs. instim, licc i-equimt) 4,[] 1 am a honvownct andwill be, hiring conriactom locondmi ffl work on my, propwy I �k Of i JOEIBuilding iaddition k, , I lmsurc to all coenactors either have %vorkers' comflcrisalion insurailce or me soic I i.XEIcctrical repairs or additions proprietors with no employees. 12, El Ill tim bing rcpairs or additions S -C] I am a gemml contractor arid I have hired the sub -cone actors listed cm ritedacted sheet, 13.oRoof repairs have employeLsvoid have workers' comp, irisurance: 6.E] We am acorporation and itsofficershavemmiscd Vicirright ofcmnixior per -k1(;L c, 1 4, [:]0ther . . . . ........... H52, §44),alid we have no employ -co. insu mce requiredj `Any applicant that checks twos 91 imist also fill out the section b0mv shoving their workers' corrrvlvation policy infiommlion, r Hollicowmem who Submit this liffidavit indicating dwy are doing alkvork and digin faire maside contiactms, inost submi, a rk�v all idavit. indicating such. 'Coramm ciors that check this Wx rmist attached an odditional sheet sho%-On- die name of 0,,c sub-comractors arid slate whether or not !))use entities have CIVIsJOYCM if the sub-00TuYPCtQM Nwc employees, flrvy must pievide their worKtrs* comp, policy mmihcf, I am aty emplojer thal is pre) viding ) vorkers I conipetisation insitra it cefor my cmptqyees. Belo P hT the poliq atidjob site hiforinatioti. Insurince Company Name:_ABC Massachusetts Workers Qompgrls�q#qij Self Insurance Group Policy Pr or Self -ins, Lic. Ex )iraiion Date: Jot) Site Address� C Attach it Copy of the wor•kers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MCA, c. 152. ',,2 -SA is a c.-iminal violation punishable by a fine kip to $1.500M and"or one-year imprisonment. is well as civil perialties in lhe form of a STOP WORK ORDER and a fine of up to $250.00 a ay against the violator, A-c-,upy cat this stiterrient may be forwarded to the Officc of Investigations of1he DIA for insuranec � 0 Nwrage veri City or Town: wider the the is trite raid correct, t: atv I /2016 Do nol Dar is in this nrea, if) be vonij)leted ky city or town of PeriniflUccrise, P-, Issuing Authority (eircle one): L Boarti of Health 2, Building Department 3. cit,vrrown Clerk -4. Electrical Inspector 5° Plumbing Inspector G. Other Contact Person:— Pholle k- TOCCCOR-01 ASTRAZZULLA '7 '4CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/22/2015 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 Salem Five Insurance Services, LLC 445 Main Street Woburn, MA 01801 CONTACT NAME: PHONE (781) 933-3100 AX No): (781) 933-9048 Ext E-(AICMAIL ADDRESS: insurance.services@Salemfive.COm INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Citizens Ins Co of America 31534 INSURED Tocco Corporation Tocco Building Systems 29 Cook Street Billerica, MA 01821 INSURER B:Allmerica Financial INSURER C: Hanover American Ins. Co. 36064 INSURER D INSURER E : INSURER F: n WOMAe-00 rC07ICIrATG M"RARPR• 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. ILTR TYPE OF INSURANCE ADDLSUBR INSD WVD POLICY NUMBER POLICY MMIDD EFF MMIDD POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR ZBNA142050-02 10131/2015 10/3112016 EACH OCCURRENCE $ 1,000,000 IMAGE TO RENTED PREMISES Ea occurrence)$ 250,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT O- FLOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS AWNA130312 1013112015 10/3112016 COMBINED SINGLE LIMIT Ea accident $ 1,000 000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ OidenD$AMAGE Pera c C X UMBRELLA LIAB EXCESS LIAB X DCR S -MADE UHNA142051-02 10131/2015 10131/2016 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Proof of Insurance CERTIFICATE HOLDER CANCELLATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main St North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD rri:..I,su. inzegan IIfiT*T*Ti1:111 ■ —- %, lri"We IV— —-- — — — — AOORD,. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/23/2015 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(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 USI Insurance Solutions, LLC CONTACT Kathy Wagner PAIC HONNEo Ext):413 750 4222 p/C No):610 537 9481 ADDRESS: Kathy.Wagner@usi.biz 123 Interstate Drive INSURER(S) AFFORDING COVERAGE NAIC # West Springfield, MA 01089-3600 INSURER A: ABC Mass Workers Comp Self-Insu 99999 855 874-0123 INSURED Tocco Building Systems 29 Cook Street Billerica, MA 01821-6044 INSURER B: INSURER C: INSURER D INSURER E INSURER F: $ COVEMAGEc 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 CONTRACTOR 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 LTR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER MM/DD/YEFF � ) MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DREM, E 7 RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY I JECT I I LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLA LIAR EXCESS LIAB HOCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? F -N—] (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A ABCMA00502416 1/01/2016 01/01/2017 ISPTATUTE ERH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Proof of Massachusetts Workers Compensation Coverage Town of North Andover Attn: Electrical Inspector 120 Main Street North Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Ccs 1988-2014 ACORD CORPORATION- All rights reserved ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S16912443/M16801319 KXWCD Please visit our web site at http://www.liass.gov/dpi/boards/EL TOCCO CORPORATION JOSEPH V CAMILO, (EL) 29 COOK ST BILLERICA MA 01821-6044 Fold, Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS -4 BOARD OF ELECTRICIANS --..--ASS.UES. -TH.E- FG.L.L.OVING_ L [C.ENSE. AS.._A T REGISTERED 1MASTER. ELECTRICIAN TOCCO CORPORATION cn JOSEPH V CAtiIL0 LU 29 COOK ST 31 LLERI CA `9A 01821-6044 16 -d -. �. •. r";,.1 .._ ac .. -+e1.. rail ..�+.,.. .. .. ,j. �£ Location f `' No. Idol�� Date Check v2yql 30137 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ /Building Inspector -7co— 2-ot(— 1, , 64,,Q 3q � e.� "- IVA- of Ho oT i ao. a • �o M ��SSAC NU`�E449 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 700-2016 ON 12/8/2015 Date: March 18, 2016 THIS CERTIFIES THAT THE BUILDING LOCATED at 50 High Street - Floor 3 MAY BE OCCUPIED AS a tenant fit up - L Com - IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG LLC 50 High Street North Andover, MA 01845 Building Inspector Fee: $100.00 Receipt: 30137 Check: 2441 d 3 E-* L 11 I n 5 , a c 0 I Q r Y d s' O '••' < \ 4m o r cc %14 C.) ) L tR _ 10 �m a r N >O •�.. O C O s 0-00 > •a f/! O C Q' O 0 G O O - H �. _ CL S" .� r 00 \•v'•'6 `o ea o 'y 0 =O c GO) Q ` � ea =a c CLm _O NJ V m d W = +=-+ O O •N a. LU y O O L 'LU E _ O • V d O 2 0 0 cc 2 Q. Ott S Z m coZ CO LUw ILx LUG W a- 0 a Z � z m 0 V Z V U) J 9 O O O v O O CL O N 0 I CD •� O •� a H. cc A O �+ cc O CL C. c" Q -- 0= O Cc Cc = O +; C Z O CL 0 cc _ •C:. c CL U) t� J V "' W W LLJ 2 N y {a/f H W Z ? O Z � V W � O LU co N dC W u a+ H N G m > p Z v D Len I Lon ton Leo v a Y O O. 7 7 9 _ _ O 7 _ _ •O " O CO LL N LL = U U nC LL = {n Li- = Il m y V) I n 5 , a c 0 I Q r Y d s' O '••' < \ 4m o r cc %14 C.) ) L tR _ 10 �m a r N >O •�.. O C O s 0-00 > •a f/! O C Q' O 0 G O O - H �. _ CL S" .� r 00 \•v'•'6 `o ea o 'y 0 =O c GO) Q ` � ea =a c CLm _O NJ V m d W = +=-+ O O •N a. 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W y+ O 'r]t JO � • � � O CL ti J (e L N J � a Mn 0 ® 0 y a •O c a ® tm CD zT) .g ocm� sammo v • m - O � m • y t i cc0 d 0 LLJ -0 o O w..a LL .y U) C O •U i+ Z � °E U-0 O V O W y, 0 • (' N 0-0 d j �J Fz CL 4a) Fz (n •0 .O � _o 2 ulLU Qn G � O Z V W CL Z W 0 V V� W CL Z 12 w W O the ��.. N O c AI, O W Q N •� �E mo m CL O CD v D O CL �- � Q OM Z CD 0 -om I .i I r �an * i • f r �J .. -1. � I,ON. S r � ♦ .i '.A" %14 9 �an '.A" %14 9 Final Construction Control Document To be submitted at completion of construction by a Registered Design Professional for work per the 8' edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: FLR 1-3 L -Com Date: 03-18-2016 Permit No. Property Address: 50 High Street. N. Andover, MA Project: Check (x) one or both as applicable: —New construction X_ Existing Construction Project description: Subdivision and renovation of existing office space. I Donald M. Walter, MA Registration Number 9536 Expiration date: 8/31/2017 , am a registered designprqfessional. and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Architectural Structural Fire Protection Electrical Mechanical Other: Describe for the above named project. 1, or my designee, have performed the necessary professional services and was present at the construction site on a regular and periodic basis. To the best of my knowledge, information, and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building pennit and that .1 or my designee: 1. Have reviewed, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsib'I" ardin, IERE '51,1 V, 1<n. Enter in the space to the right a "wet" or electronic signature and seal: I .4 9 4 4 AIA `' X -D Phone number: 978 499 2999 Email: dwa.lter.@ Building OM ial Use nly BLdilding Official Name: Permit No.: Date,: Version 06112013 the provisions of 780 CMR 107. 9� ! fl—,EF L —*V; Is � W CL Q U) 2 o�a J da a Z oN V CL d � =24 7 Q,2 o C/) O O CLJ No a Z I -- r C/) N C N O N LU I.L. y sO E w W L O O U _O CL Cn o d tN �W a, > 3o c W J ~ �a Cl- Z __IF � � � � m .• m O o N 0) w. c c V m N O LL .N C O N LLJ LE V V O W i U d p U a O m: Q N do "- _O N -0C F- .0 y CL 0 0 > ti LQ i 'Iv .ti s V 0 E � o Z N ' O N •E m m CL O � c � � O V 00 O CL a. 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