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HomeMy WebLinkAbout- Permits #12483-1 - 59 HEMLOCK STREET 7/13/2015 (3) .......... Date........................... i 0*,",oRTH;;tiOo TOWN OF NORTH ANDOVER 0 9 PERMIT FOR WIRING ,88ACHu5(a g This certifies that 6 Ciuk € r � has permission to perform.... .:.......................................................... .................. wrong in the bmld•ng of......... °." �o o' ,North Andover,Mass. at ....... ... .. Lic.No. �Pf ,..... Fee............... t ELECTRICAL INSPECTOR ke Check# ;�,., Print Form (fomnwnureAt of official Use only �s arlmant o .tiro Jordice� Pemtit No, � °2q S 3'� P Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev, i%07] leave blank APPLICATION I IT" TO RFORM ELECTRICAL WORK All work to be perfonncd in accordance with the Massaehuseus Electrical Code(MEC),527 CMR 12.00 (PLEASE PRJNT IN INK Oft TYPE.ALL INFORMATION) Date: 13 City or`I own of: _/-V or' rfi-)d.ewer To lire Inspector of Wires: By this application the undersigned gives notice ofhis or her intention to perform the electrical work described below. Location(Street&c Number) -5 4ei-nl o ck owner or Tenand Sn l 1!(`a kKf- L,C-r'Y)YYl i Telephone No:q 7 Z 8-(a$ 'a%&7 owner's Address Is this permit in conjunction with a building permit? "yes F±1 No n (Check Appropriate Box) e purpose of Building wl Solar-PV Utility Authorization No. n/a Existing Service _ Amps / Volts Overbead El Undgrd No,of Meters _ Newer Amps / Volts Overhead❑ Undgrd❑ No,of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install Solar Electric-Photovoltaic(PV)system ( ?.� panels) U rated .q9 kW-DC Q S.T.C. nr[d Tieri. in conjunction with a Building Permit. Cam lollop a%the follr>ti r'n iahte my he waived b p the Iris cclar o,W6V$. 3, No.of Recessed Luminaires No�ofCedfl.-Susp.(Paddle)i'nns o.o o al Transformers KVA Flo.of Luminaire Outlets No Tubs Generators ICVA No.of Luminaires Swimming Pool a rnd:eve In No. o.Battery Units rl ng ® � No.of Receptacle Cutlets No.of Oil Burners FIRE ALARMS Tito,of Zones No.of switches No,of Gas Burners o.o etectcon an Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No:of Waste Disposers eat Pump um er ens o.o e outs ne Totals:I Detection/Alerting Devices icip al No.of Dishwashers Space/Area Heating KW Local❑ ua Connection El other Heating Appliances KWy Security ystems: No.of Dryers No.of Devices or Equivalent o.o star KW, No.o o.o Data Wiring: Heaters Sl ns Ballasts No.of Devices or Equivalent No.Iiydromassage Bathtubs No.of Motors Total HP a ecommn vices rtnl� No.of Devices or Equivalent OTHER: C Allach additional detail if dexhvd,or as reyuirml hY the htspeetar af'Wire.v. Estimated Value of Electrical Work: f(), 0 O C) (When required by municipal policy.) Work to Start: A,S,A,P, Inspections to be requested in accordance with MEC Rule 10,and upon completion. 1NSVRANCE 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. CH13CK ONE: INSURANCE [E] BOND ❑ OTHER E] (Specify:) I certify,under the pains and pettaldev of perjury,that the Information on this application is true and complete. FIRM NAME: SOLARCITY CORPORATION LIC.NCI,: 1136 MR L(cersee= Matthew T.Markham Signature -�:• 1:: a IC,NO.: 1136 MR fy-applleahle,enter•"exempt ill t/ta license fnanlrar•1111o.) Bus.Tel.No.:7747208-8180 Address: 24 St.Martin Drive(Building 21 Unit 11),Marlborough,MA,01752 Alt.Tel.No.:714-2g§:M5 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE'WAIVERi i am aware that the Licensee does.not have the liability insurance coverage normally required bylaw. By my signature below,I hereby waive this requirement. I Ain the(cheek ono owner owner's rs cut. owner/Agent 'Telephone No. PERMIT FEE:$ Signature Q-,, rye A- (Afflee of C:onsttmer Affalm&BuNium Regulation ME IMPROVEMENT CONTRACTOR 'Registration: 168572 Type Expiration: 31812017j Supplement SOLARCITY CORPORATION MAT THEW MARKHAM 24 ST MARTIN STREET BLD 2UNI ��-- TlMI-BOROUGFI,MA 01752 Undersecretary r- FLl°RICIAN-'-'S ISSUES THE FOLLOWING LICENSE AS A ,a REGISTERED MASTER ELECTRICIAN SOLARCITY CORPORATION "> MATTHEW T M5kkk iiAM 24 'SAINT MARTIN DR BLDG 2 UNIT 11 iA MARLBOROUGH MA 01752-306o � CERTIFICATE OF LIASILITY IMSURANCE nAYI (NMrOfF7YYYY) ���� 08r�072{lt4 THIS CERTWICATE IS 15SUED AS A I &rrxR OP INFORMAVON ONLY AND CONFERS NO RIGHTS UPON THE CEI2TIFICATF-HOLgER- THIS ceRTIF!CATE D0Es NOT AFFIRMATIVELY OR NEGATIVPI-Y AMEND+ EXTEND OR ALTER THE COVERAGE AFFORDSO GY THE POLICIES 99L OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE. A CONTRACT KT EN THE I55VING INSUReR(S),AUTNORta.W RepRESEuTATIVE OR PRODUCER,AND TK9 CERTIFICATE K01,0E11. (IMPORTANT: it t8e Cert#t}Gat*holder Is an Abz)I- i Al INSUIPM tho polley(los)must Im endo"d. If SUBkOOATICIN IS WAIVED,subject bo ttte terms and conditions of the pnllcy,Oeftd!n po!iaias may require aft endorsement, A Stategient on this virtiflaate does not confer tights to the aertifivate holder In Ileu of such endorsement(s), PR MCM E . ,drat»:_ . _,. . . -• . MARSK RISK A INSURANCE MRViCSS PHONE ]]F 349 GALIFORNIA STREtCT,SUITE ia00 -MAtL jfr!e'hOI CAUFORMA LICENSE NO,0431153 •NAU SANFRRNCIRCD,CA 94ID4 Its)}UNErile}AFIsOAO!NE3 GGVERROE NA!C N 998301•STNpGAYAIE7415 snsunrnAcL&AtyMdt►8lfifafntw ncoCompany t65$B 2404 INSURED - INSItRF.tt9:LtUo haffanceCarpw4ort A .. Ph(Oro)rQ3.5100 SWsKQtYCM0IaVrA ;N5UREfiC:,tt'A - 3055C'Iew$2WWaY _ gwRIEwip.f ... ............. .. 7 . snnMalio.CA 9A4Q2 tN9OAER F: COVERAGE$ CERTIFICATE NUMBER: 5EA•Fg2AAt1769 02 REV1910Ht NUMBER:4 MIS 13 TO CERTIFY THAT THE POL}CIBSS OF INSURANCC LISTED BELOW NAVE UEEN MU[ell TO THE INSURED NAMED A9f)VH FOR THE POLICY FeMOD Im IcATEb. KOTVaHSTANDING ANY REQUIREMENT,'TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH REMPECT TO WHICH THIS CERTIFICAT9 MAY HE ISSUER OR MAY PERTAIN,THv INSURANCE AFFOIRc3CD BY THE!oOCIVS DESCR1S613 HG01H IS SUBJ5cT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS Ot SUCH POL(CIES.LIMITS StIUV%W MAY HAVIr ft eN NEUWQED UY PAIP CLAIMS. — -Yam[gUe!e' r-AOL4Y F 9*11M2015 tNYR 1YPPt71=UtStIRANOty t6 i T02SS1966P2O6 5fO 1tittrdOE4R S MAtfEljllY�Y � CYIYL�YkYhY. W iEACH ACt;�£raURARi.r+We A GENRA WsuPt RvSE Ea r +sio rcqX CameRCL GEMRAL L+ApiLITY lA 1RiY$ S$ I,0t0flU0A,t)(A}0tt x j UM EXP(Any 9rj paxonF 5 tOd}00 ct xfxrs•x+AOE ; OCCUR F'ER5DNAl+46IW itilORY (S GENERAL Af.3WM0A7A f 11 2,flDQ,DIX► Gi_Kt hC,[.,RCGP.11[LIMIT ApPL)ES PER. PRIODUCTS•COMPICIP AGG'9 2.000,000 rAUMN POLSC+r x ' LDC sr. µ9 TTEtl 5 NOWLIldlT (Map ni) $ANYRl{TO ! trtrAiLYIadURY!Parpvtsn+r} t HOINRY BtdtlRYtParacccku:I} 6 ' . AtED AALL VTn- AUTOO5W I I . Ix x I Natt•awlD {HiRFOAUFOS AUTO$ x IPh 6 Dam fNOMPICALLIiEU: i S SS 000fS1A09 y epe SUMISRVLr.R1.)Ap Oq{•,UR :EACUOCCIJitNENGE E ,„ _ t EXCE$$[JAR c CLAR.SS.MAI) � AGGR£CAT� 8 ... tl R NTia1t S g 1q{q�tptSccl{apEttst4TtOti WA7.6fiE)i)60Z$. 24 pll20A D>t0f/707 i14$Y1M11TS:.. ..1ER B :FOIDEMPLOYPATLIASILIrY Y/M WCZIEGI-0=65.034(WI) D91'0H2pi5 �£LVACIIACCIDENY., ANY PFWR1TORfPARTNEfW-XECu"vB tOf -RI Ekt!MEtERFXCLii EA? N H!A 1,OU0.040 i3 t!Alndtnory fn IIN} ' �- '41►C pE0UCT16?E:$35fI 000' E.E.!)1St:A9E•En flAPLOYF:q b, U yes,dascnbo+xl4ef E t ply 6E.POLICY LiMtT IS. 1�UD,OOit k P iflNOF T! N$4d�w I OESOMPTiONtlPOFIMAYfoNSfLOCAIIONS1VEtttSLF.S tA1t40ACDRP101.AMdQrd1R10M9"3CtreduzIfwrvsjit'.15 ; y0al EY�t!aCddlL'tS01aJiCd WRTTFIOATE HDLDE � CANCELLATION S*rCdy Cntpo.8(im 6HOULu ANY CIF Tt4E ABaUE OESCRIBED Pdt TOMS BE CAN4'at,PI3 AV-FOUR z055Cieifivi" t4 iRE rKPIRRI-IO4 DATE :.`10coI, I.:.T!CE :'SIL! 2E LYEt!VEP.E^ !PI Sw Mgm,CA 944M ACCORPANCB WITH MO POLICY PROVISIONS. AVM vw EuR6R9SWTA'rtYE d)MSRJhRfhh 4•tl,eurenca5erYlCet Chafl!'9 Maf rntlte)f1 .�'•`fir+'Y�.-"P••C.""•'-'�. (J4gga.2040ACORD CORPORATION, All fights reservadf ACCRD 26(2010105) Thv ACORD ttame and logo ara regbodered marks of ALWRO Tke Commonwealth of.l assacltuseits Depwrbnent of udustrial,flr~ci4ents tiff e of Inuesfigadons X Congress Street;.S`rafte 100 IF Wsuw.titass.gatV1 a Workers'Ctawtp008riit3n lusuraltxceAffidavit;B>l>�itdsrslCur�fractarsf�lectriei;��s1�'iu>t>��crs Apri cant Informartlign . Please Print LeLyiblv Name SolarCity Corp. T� - A.ddrem, 3055 Clearview Wa City&ate/Zip:San Mateo, CA, 94402 888-765-2489 Are you an cmployer?Cbtck the appropriatz box; Type of project(required): 1.M am a empioyer with_5,000 4. CJ I arts a general cortraotar and emginyees{full and/arpar##frne),* have hired the sub-contractors ]New cgristru>~tion 2.El 1 ant s sole proprietor or pdrtrter- listed on the allnched sheet. 7. E]Remodeling Ship and have nc employees Thcso sub-contractors have R. D Dpinolition working for me in my capacity, employees and have wcrkt xst g. ElBuilding addition [No workers' comp,insurance comp,insurat:ae. required.] •[ We are a corporation and its 10.0 Electrical repairs or additions 3.0 1 am a llomeowner doing all work officers have exercised their 1 LEI I Plumbing repairs or additions myself:[No workers,camp. Fi8lia OFffge lipiton Pay iv'r,Gl. 12 L]FagFrclrair� insurance required.]f c. 152,§1(4),omd%ve have no employees. [NG workers' DEPthcrSolar/PV romp.insurance required.] KAny applicanuthai checks box U t must v[so fill out the section below showlag their woftrs'compensHion policy information. i i3nmcowners whcr submit 0119 90idavit indicating U)ayare doing not work and then hits oulsidc contractors taust sobntit a new aftidnvit indicating such. lContractm thud check ibis box must uttached mi additior►ed shoot showing tote panne or the sub•contracrors and sttuo whether or not those entities have vmplayces. Jirhesub-cotlliaottxshaveemployees,ihoymustprovidetheir workers'comp.policyoutnbcr. .form an emptayer thut isprovidiug warrkees'eampensntion insurance for itty employees. Becht,is thepolicy avajob silo in furrnatdon. Insurance company Mann: Libertv Mutual Insurance Co. Policy I or SuI ins, uo.#:WA766D066265024 Expirmion Dale: 911/15 Job Site Addre4s: i e i'Yl i UGk- :cv-' citylstate(Lip,A,)�N-, Aid � Attiteh a copyof the workers'eunipensntion policy decluration page(showing the policy number and eypit•ation date). Vailum to secure coverage rs r uquired under Section 25A of MOL a, 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the rmin of a STOP WORK©tWSR.and a fine of up to$250,00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DFA for insurance coverage verification. I do herehy cer16 under tits paing and ponaides ofperjrrry Brat the in ormarion provided abavz is one cull correct. ftmature: Date: tsS'L J Fl luf.;.sc truly, 00 troll M foe hi fibs area,to be ivnipdeted by Deily or town-afj`ivial. City or Town: Permi$tLieer+se g Issuing AttMority{circle tone': 1.73oar d of Health 2.Building Department 3.City/Town Clerk d.Llrctrical Inspector 5,Plumbing Inspector 6,Other Contact Person: Phone#,