HomeMy WebLinkAboutWiring Permit (s) - Correspondence - 1401 GREAT POND ROAD 9/16/2014 Date" ..�� 1 .. . ..........
3? NoarM,�oo TOWN OF NORTH ANDOVER
• p PERMIT FOR WIRING
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This certifies that '" ' "' ""�has permission to perform .....
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wiring in the building of ... ...�.. 4 ...h�' .... .,. .............................
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,North Andover,Mass.
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� �Fee �... Lic.No ....�... ..................................................................
ELECTRIcALINSPECCOR
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(--om)Pwn,tvPa1[h. Of
Permit No.
fz),j.'1nsSn-. oi- Pa
Occupancy and 1-ce Chcckod
BOARD OF FIRE PREVENTION REGLIUM iC7iy6S [Rev, 1/071 (leave blank)
AP LIB FOR PERM11T TO PERP, RM ESL ECTRICAl"L WORK
All work to be pertonned in accordance With the N/la,9S2ChW'XnS FleCidCRI Cade(YFQ/527 ClOR 1'),010
(PLF-11, PlUlff! /LYK-OR Tj1P C ALL, 11VF0RVr1-.. 770 �1'7 D,,ntte',
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o ir Tom, Out-
By t,his appliC�I[iOjl tile Undel'Signed gives notice of his or her intol
Lo",tion(Str-c-0&
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to 4A
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N u,n be r a 9'FA e ed e rt-,P,n ch' A r.r.p n c iz'y
Locnt5on and Nature of Proposed Zledric?d `,,A/Ovk:
d,
Completion of the, able may be waived bi;the insvector of
-r5i-
No. of Recessed Lum N inaires o.of Cefl.-Suqp.(Paddle)FanS No. ol
Transforaners KVA
No. of Luminaire Outlets No. of Hot Tabs Generators KVA
No. of Luminaires Swimming Pool Above ri In- o. oTEmergency Ugfi-f7mg
-end. Md. ❑ Battery Units
No. of Receptacle Outlets No.of fit 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 Co nd. Total No. of Alerting DevicesTons
Heat Punip Number K-V 40. of Self-contained _7!
No. of Waste Disposers I i
Detection/Aler-di t_i ToWs.. ...........
'.
No. of Dishwashers Space/Area Heating KW Local❑ Municipal connection
No. of Dryevs Heating Appffianc-,s K�N Security Systems:*
No.of Devices or Ear uiva."ekU
No. of Water No. of Not of Data Wiring:
a RI KW a aters TH '11h b's No.of Devicesc),�- Equh,alen'
No. Hydroy-nassage Bathtubs No of Motors 'Total HP,
'Telecomn-ninNo�of Dev�'catimm ices Or Equi mem
OTHER: ae-
41tach additional detail if desired, or as required by the hispectoroj'11l'ices.
Estimated Value of Electrical Work: (When required by municipal policy,)
Work to Start: Inspections to be requested in accordance with MEC Rule 101,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 D BOND F-1 OTHER F1 (Specify:)
I certify,under the pains and penalties,qj'perjury,that the information OH AI 5 applic is true and complete.
FIRM NAME: VAAidlc
I -r,,,, r LIC. NO.: Al
Licensee:5 keL21— Q—1—� Signature LIC. NO.:-C 2_533Y6�,
(If applicable, enter "exempt"in the liter se nionber line) Bus.Tel, No.: 9 79-37-q 13 9S
q q Sp Ie i"'I
Address- j 6 'r�6 k I e-I q n y 4 Alt.Tel. No.:1722 65SWD0
*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) E] owner El owner's agent
Owner/Agent - I
Signature —Telephone No, ---- ----FR�M1KFEE. ,
EXHIBIT A
Conservation Measures to be Performed
LOCATION'OF FACILITY: 1401 Great Pond Road North Andover, MA
Number of Units in Facility: 18
Proposed installation date(s):2014
---------------------------------------------------------------
AS
List of conservation measures and Customer's cost, if any:
uanti Description Customer Cost
14 6w LED Common Hall Ceiling Fixtures $140.00
3 6w LED Common Hall Wall Sconce $30.00
6 28w LEI)Utility Wrap Fixtures $60.00
3 1Ow LED Recessed Retrofits $30.00
19 l3w Garage Wall Sconces $190.00
12 I $I20.00
45w LED Flood Lights $40.00
25 13w Unit Exterior Wall Sconces $0.00
$610.00
Customer bate Total Customer Cost
6
- . Office n,f'.Inveytigateaps
Roston, MA 02111
at ta CIA?. phonwpx
'N'am.e�BusinessFElxgauiaationJ3vvdz`vzduat}: � �-- - � � _ �.
Are y0A<am eMpXoyex?cheekthoappropxiatebox'. Typo of pxojeet(xegTdrea):
C_ 4. d S am a general contxactox and S
1 a�n a exx�ployexwxth 6. thew cdnstctzon
employees haveI*odthe sub-contxactoxs
2—El am a sole pruxietox ex P Etrft6�
listed on.the attached sheet; ` . emodelvJg
_ T
s7�p ar�.d`liavena.employees hese snb-contxaetoxshave 8. �(Demolitzon
workbag forme iv.any capacity. woxaro comp.iiasuxance, c�, ❑Buff&g addition.
wo,workers'co-nla,Insurance 5, a We axe a have.
oxerolsagon audits 10,0 Eleetxzcalxepairs or aq tlons
xeqzixed.] o�:zcoxsltave exexczsecl.theix
light of exempt or m0f, 11.. ( lambing repairs or additzons
3.El S am a homeowuex doing all woxk g p �'
mysorK UfOworkm'comp. o.152,§Z 4}a andwahavan,o �.PROo%x6pairs
i auc�xe ed. employee,[No workers' aEl OtTiex
comp.xnsuraacG.T0Tdxed j
Auk a�plzcan�thaz checks boy#�musE also ill ouEtb e�eetion beI6w showing�teix workers'comprnsation.policy informatiou. 4
i jromeowners-wjLo sutmitIhNafftdayltindloatbAcygodpingauwor7sandthenbire Outside contractorsmust'submit'anentafftdavitfudicating&eb,
xCon�taefors��7iat'cTxeelsthis bo�mtis�atEached an.additional sheet sbovtnlgthaname o�the sub:confraefors andtheixworkers'comp,poJzcyinformazzon.
a ern rl'oy�t't�ia z p ovic% g r o diet 'co ematlan inszc eo fbrv2y royee,� Betolp btfiepoliey andjoh site
Nfumation.
:Tnstuance coxmpanyName
policy 0 ox selfins. xc.#: Ex zxatzonAa e:
�'oia Site.�.ddxes�; �� �� CityfSfate/�i�: .
ae a.COPY o t ewox e s'coxxtpensation-voixegcleelaxatlon page(sby&g•tltePolicy)a oranaexpt'atzo)l6-a
Aff
yallma to secuxo oovexage as xeg,Txedunder Section25A o9MGf,c.152 can leadto the imposition.of eximivalPenalties Of
e n to$Z,50 D,00 androx oxte�y ear im xiso nextt�as well as civillaenaZties iv the form.ofa STOP"W 0RX OlZ FR and a fmo
ofup to$250.00 a day againstthe-101atoz: lie advised that a copy ofthis statein entmay be foxwaxdedto the Office of
Snvestigationg of the D fo nd cecoverageverification.
do Xzexe y cep fyzt cr 1' X2e iai a ci ter2 of e.rp,iy attYiezz2faxrnatio proviriec�a oYe% ueanrico�ee.
Si a e: Data:
P'laon
Qfflei USC O'lly. Do not velle Al tries area,to Ire cones-leted 4v city or town ofciaf
city or TOW.rx: P'exzurt/ ice�xse#
SSsub g.A.rtthoxity(ci:00 ono .
1„�3aa~t'cl ofJ�ealth.2.�rziidingJ�e�axt�.en.t 3.cztyl9Cowu clex� �.1+XectxzcalJfus�ectox �.1?XunahingJfas�ecto�
6 Other
4
Y•COMMONWEALTH OF MASSA&USET"TS
BOARk?OF
EI»'EGTRICIANS
ISSUES THE:,FOLLOWI NG L.i CENSE 'A A ..
RE'G I STE RED MASTER ELECTRIC1gN
DANIILS ELECTRIC COMPANY LLC
. ..S EP T HEiV: J DR:NI'ELS
109 SCHOOL STREET:
SUITE :APT 1
00"VE SAND r1a 01834-162$`
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1646 .A 07/31/16 50097
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Date......�� !
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TOWN OF NORTH ANDOVER
� a
' PERMIT FOR WIRING
cHu
This certifies that
I
has permission to perform
wiring in the buildin�of ... ......
at
North Andover,
........°...... >Mass.
Fee..� ...............Lrc.Not
ELECTRICAL INSPECTOR... ..............
Check#. -
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Commonwealth of Massachusetts official Use,only
E Permit No.
�? Department of Fire Services
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] 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: 9-15-2015
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) 1401 Great Pond Road -- JINAL—C AC)t.-j.- -Acke—
Owner or Tenant Sutton Pond Manqement Telephone No. 978-685-8593
Owner's Address PO Box 773 Morth Andover Ma 01845
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❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Replace Existing fire alarm system conventional vVd
Completion of the fiollowin table maybe ivaivedby the Inspector of Wires.
No. of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No,of Total
Transformers KVA
No.of Lighting Outlets No.of Hot Tubs Generators KVA
No.of Lighting Fixtures Swimming Pool Above In- o. o Emergency Lighting
rnd. ❑ rnd. ❑ Batte Units
No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No. of Zones 1
No. of Switches No.of Gas Burners No.of Detection and 35
Initiatin Devices
No.of Ranges No.of Air Cond. Total No. of Alerting Devices /10
Tons
No.of Waste Disposers Heat Pump [Number Ton s KW� No.of Self-Contained O
Totals: Detection/AlertingDevices
No. of Dishwashers Space/Area Heating KW Local❑Municipal Other x
Connection
No.of Dryers Heating Appliances X Kam, X Security Systems:
No.of Devices or Equivalent X
No. of Water KW No. o No.of Data Wiring: X
Heaters Signs Ballasts X No.of Devices or Equivalent
No.Hydromassage Bathtubs 0 No.of Motors X Total HP X Telecommunications Wiring:No.
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
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 [7 BOND ❑ OTHER❑(Specify:) X IE 191,72 6 nG
GU (Expir ion Date)
Estimated Value of Electrical Work: X GO• (When required by municipal policy.)
Work to Start: X ! ��/�� Inspections to be requested in accordance with MEC Rule 10,and upon completion.
I certify,under the pains and penalties of perjury,that the irtfor»moon on this application is true and complete.
FIRM NAME: X //� J �1�1•y,��� 1 S G✓ LIC.NO.: X�2.-,�f'
Licensee: X t cG, w Ce If e-' C'! i" Signature X LIC.NO.: X
(If applicable, enter "exempt"in the license number line) Bus.Tel.No.;
Address: X y/ L/4, 1- -6-�1 , ,/t9 �c l�� Alt.Tel.No.: X
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)o owner Downer's agent.
Owner/Agent x PERMIT FEE. $
Signature Telephone No.
The Commonwealth of Massachusetts
Department of Industrial Accidents
N Office of Investigations
d 1 Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
ACP Communications Corp
Address:41 Elm Street
City/State/Zip:Stoneham Ma 02180 Phone #:781-279-4004
Are you an employer? Check the appropriate box: Type of project(required):
1.FEW I am a employer with 12 4. I am a general contractor and I
employees (full and/or part-time).
* have hired the sub-contractors 6. New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.$ 9. Building addition
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
se m lf. o workers comp. right of exemption per MGL
Y � ' p 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
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.
#Contractors 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. Belo►v is the policy and job site
information.
Insurance Company Name:Amguard
Policy#or Self-ins. Lie. #:ACWC352943 Expiration Date:9-26-2016
Job Site Address: 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 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
of up 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.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date 9-30-2015
Phone#: 7812794004
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 Cleric 4. Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
. J 7 s
o� 72. {ano�rrr�wozweall� n�'✓��crefacliueelT
DEPARTMENT OF PUBLIC SAFETY
S-License
Number: SS CO 001108
Expires: 10/26/2013 Tr.no: 77,0
S-License: ACP COMMUNICATIONS
MICHAEL CASSETTARI
PO BOX 3065
WOBURN, MA 01801
Commissioner
:x E'os COMMONWEALTH�Lo M S 5 CH[1�SETTS..z s
• • •
• BOAf�D OF
IK'I,E In It"I ANS
, ISSUES THE FOLLO}VING�.t ICEi�SE AS <
A REO t s�T`1:RED SYSTEM ,TECHN GC
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COMMONWEALTH OF M�ISACFi.IIS�-CTS. ...
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` THE FOLLQWING iCENSE A5f ::
' A; R ,iy'f>~EtED SYSTEM "CONTRACTOR,."
GOMMUNICATIONS_CORP
MiGHdEL,J GASSY}TTARI: "' i;i
.AM';CG MtlN'IzCAT.I Ot�S YCORP W'
Po BOXY 30'6'S
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