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Home My WebLink AboutWiring permit - Building Permit - 296 BERRY STREET 2/11/2016 I Date ........................ NOArN { o� •'• °o� TOWN OF NORTH ANDOVER m PERMIT FOR WIRING low BACHUg� 4 I ( "I This certifies that €d fcr has permission to perform - - - ,& $ r.... .....r.. .f. / '.. r ) wiring in the building of a J pr..... ....... ..... at ......�P� .�t .,....., # ' ...a' Ando ver,Mass.No Fee, .�...............Lie.No,,c�lr ', A SP ELECTRICAL INSPECTOR .:...:......................r.....r........ Check# Commonwealth of Massachusetts Official Use Only Department of Fire Services PermitNo. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(M Q,527 CMR 12.00 (PLEASE PRINT 1NINK OR TYPE ALL)NFORMATION) Date: l City or Town of: NORTH ANDOVER To the Ins e for of?fires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. ` _ Location(Street&Number) f ' 100- Owner or Tenant i. Telephone No.&- —MY- % r Owner's Address I` - 'I Is this permit in conjunction with buildi g permit? Yes �No ❑ (Check Appropriate Box) Purpose of Building hme, Utility Authorization No. Existing Service^ Amps / ,dvolts Overhead Undgrd❑ No.of Meters New Service � Amps 1,'10/ Lqo Volts Overhead Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: <4r Completion of the following table maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans No.of Total Transformers t9 KVA No.of Luminaire Outlets No..of Hot Tubs Generators �j KVA Above In- o. m o ergency ig tmg No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE AL o. of Zones t No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Dis osers Heatpump Number Tons J.KW. No.of Self-Contained P Totals: Detection/AlertinLy Devices No.of Dishwashers Space/Area Heating KW Local ElMunicipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* y ( No.of Devices or E uivalent No.of Water KW No.of No.of Data Wiring: Beaters Signs Q Ballasts No.of Devices or E uivalent No.Ilydromassage Bathtubs 0 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 Wires. r Estimated Value of EIce teal Work: tpM (When required by municipal policy.) Work to Start: e Inspections to be requested in accordance with MSC Rule 10,and upon completion. INSURANCE CO 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 cov age is im force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I certify, under the pains anjdpenalties ofperjury,that the information on this application is true and complete. P�FIRMWE: �, 1'I L`F�Gr �D LC�I� >nC4 LTC.NO.: h t Licensee: . h ' Signature LTC.NO.: f (If applicable,enter "exempt"in the lice se number line.) Bus.Tel.No.: eat:?777R 2W Address: � h1 4 al Alt.Tel.No. *Per M.G.L c. 147,s. 7-61,security work requires Department 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 below,I hereby waive this requirement. I am the(c cls one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE. $ l/Q Signature �_ Telephone No. i ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, §32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass M Failed Ed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSP CTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: zce Date: FINAL INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massa.chusetts Department of lndustrialAccidents 1 Congress Street, Suite 100 _ Boston,MA 02114 2017 www.mass.gov/dia s�• Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY- Applicant Information / Please Print Legibly Name(Business/Organization/Individual): Address:_ r-)q� �l � I S City/State/Zip:tl A C,CYOeff /�1 r fl � Phone#: d Are you an employer?Check the appropriate box: Type of project(a'equired): 1.Q I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑Building addition <1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.# 14. Other 6.Q We are a corporation and its officers have exercised their right of'exemption per MGL c. [] 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] `Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for•my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Liic..#: Expiration Date: Job Site Address: -(U ut� S 7� �I UrL(1(yyr��[— � City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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 of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb certify/under the pains and penalties ofper jury that tlae information provided above is trite and correct. Sienature //�� Date �� — Phone#: 12,�7 7 /� 3 9e) Official use only. Do not ivrite 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.Plumbing Inspector 6.Other Contact Person: Phone#: 1 COMMONWEALTH 8F NIASSACHUSETTS FRI a . � Boa1�n 0� EUECTRI C;I ANS ISSUES THE FOLLOWING LICENSE AS A RER JOURNEYMAN 'ELECTRlC�1AN S DAN I FL J MCGRATH 1 14 BOY L STON- ST IU � MA 02148 793.1 • ' � �.^.COMMONWEALTH'OF MAS�ACHUSE'i"['S.. •� B,LJARp"OF ELECTR I C1 ANS V ISSUES THE .f OLLOWI NG GI CENSE AS A � W � REtISTE�RED MASTER, ELECTRICIAN 1 � I UU TED 'SOLAR ASSOCIATES LLC J.OAN I EL ' MGGRAH 114 BOYLS7"O9 ST 1W 3U i g MALDEN MA 021.4 7931 ' 206-16 A 07I31./1:6� 37�92 From:NowCerts AMS Fax:(888)586.4792 To:+17813211128 Fax: +17813211128 Page 1 of 1 0210912016 12:37 PM 0 FAC"RL> CERTIFICATE OF LIABILITY INSURANCE DATE 219/2016 IMMIDDIYYYY) 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 INBURED,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 this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: NE FAX Asset One Insurance A/C No Ext): 714-625-8204 (Arc,No): 714-625-8290 C: AIL 575 Anton Blvd.,3rd FL ADDREss: are@soladnsure.com INSURER(S)AFFORDING COVERAGE NAIC# Costa Mesa CA 92626 INSURER A: Westchester Surplus Lines Insurance Company 10172 INSURED INSURER B: TRAVELERS PROPERTYCASUALTYCOMPANYOFAMERI( 25674 United Solar Associates,LLC INSURER C: 376 V\hshington Street,Suite 104 INSURER D: INSURER E: Malden MA 02148 INSURER F: COVERAGES 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. N07W THSTANDINGANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (M JDD/YY1'Y) (MM1DDNYYY) LIMITS Cl COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR PREMISES(Ea occurrence) $ 50,000 MED EXP(Any one person) $ 10,000 A G27527966001 11/10/2015 11/10/2016 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2,000,000 ❑ POLICY JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY $ (Ea accident) ANY AUTO BODILY INJURY(Perperson) $ ALL VvNED SCHEDULED AUTOS AUTOS BODILY INJURY(Par accident) $ NON-OWNHIRED AUTOS AUTOS ED (Peracddent) $ UMBRELLA LIAB ❑ OCCUR EACH OCCURRENCE $ 5,000,000 A ❑ EXCESS LIAB CLAIMS-MADE G27527966001 11/10/2015 11/10/2016 AGGREGATE $ 5,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION ElSTATUTE ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? ❑Y NIA 7PJUB-5850763-8-15 7/23/2015 7/23/2016 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes describe under DESGRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 Property ER07771654 5/26/2015 5/26/2016 522,302.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULDANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE W LL BE DELIVERED IN Daniel McGrath ACCORDANCE WTH THE POLICY PROVISIONS. 296 Berry St. AUTHORIZED REPRESENTATIVE North Andover MA 01845 9`lte 4 9�1 fCt ll O 1988-2014 ACORD CORPORATION. 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