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HomeMy WebLinkAboutWiring Permit - fixtures in common areas - Correspondence - 350 GREENE STREET 3/12/2015 Date_,.. .............. C NORT/.. ti TOWN OF NORTH ANDOVER 9 PERMIT FOR WIRING 00 �488ACHU5�t4 This certifies that f z � s h has permission to perform .. :... ......... ...... wiringin the building of ...........� p................................ ... . ....:.... .... ...................... ,North Andover, Mass. at ..... ........................ Fee....l..��. . ..-........Lic.No. .7�� J k' ,1 'ri f: ...fi E . ... r........ ELECTRICAL INSPECTOR :Check# Commonwealth of/Y/adeachaaetta Official Use Only cc�� Permit No. eL.Jepartment o��ire�ervice� Occupancy and Fee Checked i 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: oZ- atj City or Town of: Y)J oye�- 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 t) G-lt"we n p Y--e-&+ Owner or Tenant Qr agj Cram st r 496 r rC JI a,n Telephone No.�(7$•6 S 3• °I I o� Owner's Address 3S car � A).o careen � • /•F�tee✓ MA n(.$ N S V Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Oya t,no, Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity r.. Location and Nature of Proposed Electrical Work: Re p\c,,,t,�n o kc—A 1PN x wPe c s sn C.o ran ry,\o r� &r\A y-nk-er�6r v-�\VV, L C 0 F� xN t-r S Com letion of the following table ina y be waived by the Inspector of f,'h-es. h 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 Swimmin Pool Above In- ❑ o.o Emergency Lighting 1 g rnd. rnd. Battery Units CJ� No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices _ No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No,of Waste Disposers Heat PumpNumber Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connectionuri _ No.of Dryers Heating Appliances KW Sec No of Devices or Equivalent No.of Water KW No,of No.of Data Wiring: Heaters Signs Ballasts I No.of Devices or Equivalent l Wir Fe ecommunications ing: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or E ui-ral-.nt OTHER: Attach additional detail if desired,or as required by the Inspector q/'(fires. Estimated Value of Electrical Work: 600,� (When required by municipal policy.) Work to Start: 3-q- t 5 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. I he 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 andpenalties ofpetjury,that the information on this application is true and complete. FIRM NAME: Newport Electric LIC.NO.: A20803 Licensee: David McMullen Signature LIC.NO.: 11608E _ (If applicable,enter-"exempt"in the license number line.) Bus.Tel.No.:401-293-0527 Address: 200 Highpoint Ave. Portsmouth,RI 02871 Alt.Tel.No.: 617-908-4193 _ *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)❑x owner ❑owner's a ent. Owner/Agent PERMIT FEE: $ VX5,o Signature Telephone No. ___„ r• I "S Yr•:r;`}. .,i.(.• -,T'."K,"J�. .. `s. Ti, NEWP049 OP ID: GJ CERTIFICATE OF LIABILITY INSURANCE F DAT,/20/ DlV201 0 /20l5 5 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). CONTACT _ PRODUCER Phone:401-683-3900 NAME: Carey,Richmond 8 Viking Fax:401-683-7329 w°NN Ezt: AI NoL•__.__-____ Two Corporate Place Middletown,RI 02842.6294 E-MAIL Peter J.O'Neill ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company 12572 INSURED Newport Electric Construction INSURER B;Beacon Mutual Insurance 24017 DBA/Mister Sparky — ---- 200 High Point B5 INSURER C: Portsmouth,RI 02871 INSURERD: _ INSURER E: 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. 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM DDPOLICY/YYYY MM DD/YYYY LIMITS LTR - GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE—TO RENTED A X COMMERCIAL GENERAL LIABILITY S 2139568 12/30/2014 12/30/2015 PREMISES Ea occurrence_ $ _ 300.000 _ CLAIMS-MADE F—v I OCCUR MED EXP(Any one person) $ J,00(1 X per loc aggr appl PERSONAL&ADV INJURY $ _ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3,000,000 POLICY X PE O 17 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident) A X ANY AUTO S 2139568 12/30/2014 12/30/2015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ _ AUTOS AUTOS �X_ HIRED AUTOS X NON-OWNED PenacdenDAMAGE $ AUTOS $ X UMBRELLALIAB X I OCCUR EACH OCCURRENCE $ 1,000,000 A _ EXCESS LIAB CLAIMS-MADE S 2139568 12/30/2014 12/30/2015 AGGREGATE_ $ �DED J X RETENTION$ WC STAT $ WORKERS COMPENSATION X U- OTH- AND EMPLOYERS'LIABILITY TOR LIMITS _ ER ___-_.__.___.._.._ .._. B ANY PROPRIETOR/PARTNER/EXECUTIVEY/N 68861 01/18/2015 01/18/2016 E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? N/A ----" (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION NEWPELE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Newport Electric Construction THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS. DBA Mister Sparky E 200 High Point B5 AUTHORIZED REPRESENTATIVE Portsmouth, RI 02871 /� p ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD