HomeMy WebLinkAbout- Permits #12446 - 39 HEPATICA DRIVE 6/11/2014 r
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Date...�:. .. .......................
A�aowrh��o TOWN OF NORTH ANDOVER
® PERMIT FOR WIRING
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This certifies that ..... ..
has permission to perform..
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wiring in the building of........ ...............................
�N �� ..<". . North Andover,Mass.
Fee....� t t . ` .,...Lie.No.�F �� ..
ELECTRICAL INSPECTOR
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cc--�� Permit No.
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.�.lJeparimenl ol.,_fire Seruice�
Occupancy and Fee Checked
r 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"C527 CR J2*0
(PLEASE PRINT IN INK OR TYPE, LL INFORMATION) Date: '�m � f
City or Town of: w To the Insp ctor Wires:
By this application the undersigned dives notice of his or her intention o perform the electrical work described below.
Location &Number)
Owner or Tenan ..... .,w�' �
w"„„ °�� Telephone Na.
M
ress
IIss this permit in conjunctio it buildin�^permit. Yes ❑ Noy H' p g (Check Appropriate Box)
Purpose of Building " �` f^ "`„� � ;�� „ '° _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: zzLmt.
Corn letion gl'theJbIlowing table tnav be waived by the Inspector o'Wires.
No.of Tal
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ® o.o cy ig ng
rnd. rnd. Batter Units Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones
No,of Switches No.of Gas Burners o.of Detectijn an
InitiatingDevices
No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices
No.of Waste Disposers eat ump umber Tons KW No.of elf- ontained `
Totals: —T --Detection/Alerting Devices
No.of Dishwashers S ace/Area Heating KW Local❑ Municipa Other
p g Connection
No.of Dryers Heating Appliances KWecurity ystems.* a
No.of Devices or E quivalent
No.of Water K,,i, No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or E uivalent
Na.Hydrornassage Bathtubs Na.of Motors Total HP a ecommunYcations WYrang
No,of Devices or Equivalent
OTHER:
« " Attach additional detail if desired,or as required by the Inspector gfWires.
Estimated Value lect�lcal Works« (When required by municipal policy.)
Work to Start- ° "' tW Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE OV RAGE- Unless waived by the owner,no pen-nit 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 andpenaltles ofperjury,that the information on this application is true and complete.
FIRM NAME: ">.'rt �;t" l `t LIC.NO.: ''�34-,S
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Vj , Licensee: �l L}S°�" � �°' i/tit ,: �w(,B Signature a�� _ . LIC.NO.: _
(If apply"cable,enter "exempt"in the license number lin .) � Tel.No.: jai m
t,..a Per M.G.L.c. 147 s.57-6 �,
.t Address: .� N �^. �„� . � ��" .
t l * security k requires m i m
1 �� �` Alt.Tel.No. � �
' y q es Department of Public Safety"S"License: Lio,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('cheek one)❑owner owner's a ent.
sOwner/Agent PER�ITT FEE: °
Signature Telephone No.
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CERTIFICATE OF LIABILITY INSURANCE
'i W CEt;MMTH 1318 UM AS A VATTER OF WORWOON ONLY AW COW MS NO RMTS UPt1 UM CEEttrEWATE IiQLttER•
YM CmRY DOES f+IWr AfMUM MEi.Y OR ME8ATE &V AVOW,E ffW OR ALTER 7W COVMM AFFORI P BY THE
POLECM&MAW. IM CEIMCATO OF OMRANCE OM XW CONSTEf S A OONTRACT 6L''VWM THE ER8 M MUR9M,
AUTHOR20 RMfIgBENTATiY GR AND 1HE CM V=1rE KOLOER.
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PRGfitECER .
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THIS is jo CWmFY THAT TKE POLICIES CF IHBURANCE LiS71rD BE3Low HAVE mmH issue TO THE iNdURED NAMED ABOVE FCIR THE POLICY PtRlCfJ
IbMICAyFA "TVVMWTAKRINO ANY REQLq RE14SF.NT, TERM OR CONOMOH OF ANY CONMACT OR OTHER VOCUMkiOT WITH RESPECT TO%VK(CI4 T9I6
CE"FlCATE MAY SO MUarD OR VAY PERTAIN, 714E INSURAM AFFORM BY THE FOLIC(ES DESCMEO HEREIN IS SUBJECT TO ALL THE TERMS.
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CERTIFICATE OF LIABILITY INSURANCE °A //412013
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THIS CERTIFICATE IS ISSUED AS A MATTER OP INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.'flits
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AM6ND1 EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES-
BELOW- THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BMVeEN THE ISSUiNe INSURER(S), AUTHORI2lr0
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLOM
IMPORTANT: If the certificate holder IS an ADDITIONAL.INSURED,the tsollcypes)must be 8ndorsed. f 9UBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain Policies may squire an endorsement. A statement on this ceroneate does not confer rights to the
certificate holder In lieu of such endorsements.
PRODUCER mes Phone.616-676.040
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Group,Inc.
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Suite 400 Fax:616-6761177 c
Plainview.NY 11803 No).
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INSURERS AFFMWra COVERAGE 1. NAIt:0
tNSUAEAA:TWIn CE Fire Insurance Co. 129459
Speed [tic,DBA Spee !re WSUM :HarKard Casua[ Insurance Co ;284ZA
Speed Wire Networklie J Services muRa c:;Hartrord Fire insurance Co 18882
398 Jericho 7pke.,Sulte 106
Mineola,NY 11501 utSMD:
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CC CERTIFICATE NUMBER. REVISION-NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEe ISSUED TO THE INSURED";IM ABOVR'FCR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY IM ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLtolg$ DESORjgW HEREIN IS SUBJECT TO ALL THE TSRMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .
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cERTIFICA HO ER cANCEi.CATIaN
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