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Home My WebLink AboutMiscellaneous - Royal Crest 7w AN Date... ...... ................... TOWN -OF NORTH ANDOVER PERMIT FOR WIRING This certifies that :.�) .................................................................... I . ....................................... has permission to perform............................ *'**'***"* .. ............................................. wiring in the building of........ A.-V.V*l .. 0......... 0 c0. ......................................................................... North Andover, Mass. JV—I k0'1A CIV-6-� Ur -%'V .1 ............. i ............... *i*********'*'*******************'*** ..................................... I�tq-.125 . ........ Lic. No. \615 M47- ... ....................... E.. . .... .. . ............. TRIC 1��P�E-TOR ELF. -3 Check .14 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked ,w BOARD OF FIRE PREVENTION REGULATIONS [Rev. l/07j (leaveblank 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 PRINTlN NK OR TYPEALL INFORMATIOA9 Date: Auqu t ;( 6 I L City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) '5 ® Q p U CL.1 C.r4 $ 4� -OZ Owner or Tenant 4rA % (,0 V46 rZ 1-h A N Dtiv<-v- O.. Telephone No. Owner's Address U i lctl Is this permit in conjunction with 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 ❑ Number of Feeders and Ampacity No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: C' e cK Gje�tce( Cann e -c- --t6n 'S ft -4 PJ0-S26&,--Ct en1ee n—; C, )-ka-+ r tj n e- vo 1 V,cq e. 4-h {r r,4 o S bq��S an c!` QA r( -g L 4 b r tc-k c r S P<e- a r n cj e— 't s n 14-. ° 1�, Completion ofthe following table may be waived by the Inspector of Wires. 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- Swimming Pool ❑ o. omergencyig ting rnd. arnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No, of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers p 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 Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices ox Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of *Tures. Estimated Value of Electrical Work: �jt°�(� r ®� (When required by municipal policy.) Work to Start: 8 ( a le l Inspections to be requested in accordance with MEC Rule 10, and upon completion. , A"�CSURANCE 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 dersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) X certify, under the pain wand penaltie+s'of erjury, that the information on this application is true and complete. FIRM NAME: D A�11 e.1 P, Y l I Gc i G LIC. NO.. A 15 701 q Licensee"DW e-1 Pz, Nit k -a 1 e— Signature O,,, -X P MtJ� LIC. NO.: 3 16 50 E _ (If applicaba enter "exempt" in the license number line.) Address: NO IDR le SA-- WeLt o a L1 c Bus. Tel. No.: e Q� Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. 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) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ 2- Signature Telephone No. /`17 le -,$- 114 0 The Commonwealth of Massachusetts :1 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA. 02111 UV. www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Name (Business/Organization/Individual): �� ` C_ 1' y t �A- k(e PJ Address: Let 6 D ip�� City/State/ZipA k_)CA_ (_i)AC._W) M Qa Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 EIectrical repairs or additions 11. ❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. i -Homeowners who submit this affidavit indicating they tie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. lain an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site in Insurance Company N A cn C Policy # or Self=ins. Lic. #: `JG� (4`� �J CIW) `1 Expiration Date: Job Site Address: 5 () 12 l cy-<s �_- -D rL City/State/Zip: N, �,1J pOLvCV' M .4 418 4 S Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one=year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine ofup to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereblt�certify under the pains and penalties ofperjury that the information provided above is true and correct. Phone 9: 'S a8 -^SGA— a9C Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector 6. Other - - - Contact Person: Phone #: ;o,-' 9 <>COMMONWE lc,00 oSCcspO ISSUE St L:ECTR"I C'1 ANS THE FOLLOWING LICENSE...: e JOURNEYMAN;:;ELECTRICIAN. ACORN ®CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `.� 8/26/14 THIS,CER)IFICATE 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). PROWLER CONTACT NAME: LESLIE HANNON James O'Connell Insurance Agen PHONE (978) 667-6150 (FAA/X, No: (978) 667-0587 572 Boston Rd E-MAIL ADDRESS: JIMINS@OCONNELLINS . COM Unit 7 MED EXP (Anyone person) $ 15,000 PERSO NA L & ADV I NJU RY $ 1,000,000 INSURE S AFFORDING COVERAGE NAIC# Billerica, MA 01821 INSURER A: Merchants INSURED I NSURER B : A. I . M. Insurance INSURERC: DANIEL P VITALE ELECTRIC INSURER D: 190 DALE ST INSURER E: WALTHAM, MA 02451 INSURER F: COMBINED SINGLE LIMIT Ea accident $ CAVFRAGFS CERTIFICATE N LIMBER- 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 LTR TYPEOF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/Y POUCY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FxI OCCUR BOP9098053 9/12/14 9/12/15 EACH OCCURRENCE $ 1,000,000 PREMISES DAMAGE (Ea occcu RENTED c $ 500,000 MED EXP (Anyone person) $ 15,000 PERSO NA L & ADV I NJU RY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AG G R EGATE L IMI T APP LIE S P E R PROj{ POLICY JEC LOC PRODUCTS - COMP/OPAGG $ 2,000,000 AUTOMOBILE LIABILITY ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ F oacEcd ntANLAGE $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICE RIMEMBER EXCL LID ED? (Mandatory in NH) If yyes, describe under DESCRIPTIONOFOPERATIONSbelow N/A WCC5006538012009 10/11/13 10/11/14X WT I C STATU- OTH- I FIR E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE -EA EMPLOYEE $ 100,000 E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is requ red) ELECTRICAL WORK TOWN OF NORTH ANDOVER MA 120 MAIN ST NORTH ANDOVER, MA 01845 y110lh 31wd111O11` I 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 51 o LESLIE HANNON in 1988-2010 ACORD CORPORATION- All rights reserved ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E -Mail: 9937 Date ...... ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .............. .................................I xform has permission to pe . ...... ......................... wiring in the building of .... . ................................... -7 North Andover, Mass. at ..................................... 40x��5 F137 6,,e ..................................... Fee .J) --<I ...... ; ........... Lic. No. ........... k ECTRICAL INSPECTQR 16 D3 Check r i' ti (fommonwealth of Maaeac4aieth Official Use Only c� Permit No. Aparlment o f Sire Service. Occupancy and Fee Checked y BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (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: March 3, 2011 City or Town of: North Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 50 Royal Crest Drive Building Owner or Tenant Royal Crest Apartments _ _ Telephone No. 978-681-1822 Owner's Address 50 Royal Crest Drive North Andover. MA 01845 Is this permit in conjunction with a building permit? Yes ElNo ® (Check Appropriate Box) Purpose of Building Commercial - Apartment BUlldingsUtility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install 6 Gell Packs! No. of Meters No. of Meters Completion of the following table may be waived by the Inspector of Wires. 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 Swimming Pool Above ❑In- 1:1o. rnd. rnd. o Emergency Lighting Batter Units 6 No. of Receptacle Outlets No. of Oil Burners FIRE 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 No. of Waste Disposers Heat PumpNumber Totals: . . Tons I.......................... KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal E] Other Connection No. of Dryers Heating Appliances Kms, Security Systems: No. of Devices or E uivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Eq uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: $ 600,00 (When required by municipal policy.) Work to Start: 03/03/2011 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 coverage 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 perjury, that the information on this application is true and complete. FIRM NAME: The Electricians & Co. Inc. LIC. NO.: A10737 Licensee: Michael J. Parziale Signature LIC. NO.: E20269 (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 781-322-9344 Address: 50 Branch Street Malden, MA 02148 Alt. Tel. No.: 781-322-3100 *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. SS CO 001021 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) ❑ owner ❑ owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 125,)0 � �7