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HomeMy WebLinkAboutWiring Permit - Permits #12138 - 115 JOHNNY CAKE STREET 2/3/2014 Date... ............... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 88ACHU e This certifies that .............. I..................................................................... has permission to perform /2 ............ �........I........................ ....... ....... .............. wiring in the building of,,.,,..,..., .......................................................... ........... at ............. ............ .......f. North Andover,Mass. ..............Lic.No.(, A I t- ................. ....... j......................... ....... ELECTRICAL MspEcToR -,V Check# cornmonwearth of 1wasszachasafts ofidal uso�o PY Depadmant of Flm Sarvfcas PEUnit No. BOARD OF FIRE PREVENTION REGULATIONS lease R P codes-& ama ea e Zev,1107J (leave ) f. gonfrad ffi&bfdpermlt M ffaPoLl abfe, APPLICATION FOR PERMTTO PERFORM ELECTRIC,AL WORK All work fo bapeformerd is accordance with the Massachusetts Eleutdcal Code(AEC),527 CMR 12.00 (PL WgPPOTMRV-KORYYPEALTNFOMMYZON) C i o en of ty r Tor AlDd v eiz-:,, zqrfia Invector of Wires: By this app Roaf ion the undersigned gives nof i c,a ofhis or her intention to perform the electrical work des cf 11 rA b el ovi, Locaff-on(Street Omer or Tenant , TeleNo, 2 OTMax-IS Address U No (Check Appropriate,Box) is rnrpose of Building Utility Anthorization No. M�tffag Service Amps I Volts Overhead❑ -ffindgrd .No.of Mtrg J. c, Amps, Volts Overhead❑ -Undgrd Q No.-oxmterg 'um er 0 e-ders and Ampacity CoWlegon ofthe-fiolluwing table may be waived by the Insp ector ofWh-ea. 0.of 'Total- -addle XVA No.ofLuni-�ah-a Outlets of Hot Tubs Uene:raforg KVA efq IN.0 NO.QfLuminaireg gpool Above E] In- El -No.ox-Emergmcy)-ighAnti --T -zad. gmd. lBatteryMlm f mn "mj -ra Oallelg:_ja,tj, -unu NO.QfT Re--�pta-t�rd- ..hes es No>of Gas Burners OfVetection and r No.fhlffatingDevices Totg 11TO, ge:S TonslNo.ofA1,rff,,gDvic, I . HeatFum Number ITaus JXW INo of Self-Contained kTa.of Wasto Dusers To= 1 Heating Heating k-W rAc,a I Ef ikL .'No.of Dishwashers 8 /A Hti Coaston g Appliances ei.(m s--* OfDry KW Sy No 0ex-res,or/-5 a 13X ersr 1 Equiv-T,/t No.of Water No.of No,-04- Heaters xW u4 Data Wiring: Signs Ballasts No,ofDovices or Equivalent No.Rydro Mass!aga Bathtubs Ila.offyxbiors Total.HE Telecommunications Wiring: No.ofDoyireq oi:)?quNaJeai- 'Ron required by municipal policy.) Esffmated Value ofBleGtdcalWQ&, 12,?,1,, (W workto Start fuspec6ons to be xequasted,inaarordan-ca with NJEC Rule 10,anal upon conTletion. AW I NSLT1�NCF,C 0;VER A GE: Unless waived by the owner,no p eru&for the p 6do rm�c e of el e Ghi cal work racy issue e,IMI e s S the liceztsee provides proof bfliability insurance including."cnmplei ed operation"coverage or i subst�tial equivalent The nudenignod ceroos that such coverago,is in force,and has wjabiti<d proof ofspmo to the permit issaing office. CHECKC)N--R, INSUBANCE 0 33OND El OTMR X, (Sp SGIMSured X�-McetMj�oanderthe wdperzffh of & td tfi-�z'z:woa this apZkadox is z�va an core plefc , p Wpy g p ,`TAM.- ADTTLCDBAA1)TSwmitY — LIC-NO.., C-172 Licensee: Thomas T.I&D Cigaatuie, 7 'e. r Irmot, U11. hewe Biig�TeL 1\6- Address; -Lis A11V Alt Te, (,�c -S,," !o,M:L,&r the licenso)=ber heraz'ify.System CautracforLic8;RsE5 required 6 this wont;if applicable, 001779 OWNER!S MULME WAWE-R- I aware at the Lice nsee does not have the liabily insurance coverage noingy required by law. By my signature below,thereby waivP this. xupkem�a I amtho(oheok one)D owner El owner's agent 0wAer/Agent 11EPLYU FWM s S S Sipatcwa yool g g�zxerw CYIUA JUM,COMMO-1910--afth OffIlfammudiffiscifs am wq uslet wmm 15 MARC—?01"Oss3 rtions 600 area Vamp,MA WITH Aly Own. Printitt"P T-4 ,11',__ADT Security.Services Adivesse ­101 Clinton Drive .00., -6-03-59 -5930— io Yu El-0 bi W PTOY o r?Ch uk 9-4 0-M p pr 0 0 Irim!be W,x- 4F C a fha calplopces(Vill.100T-pamil.me)2 Haeadmith.a."i'M cask-v. PI-EIMOM,Ing 2,11 AT an a Am*(ermiloy e-es In.lese,mib-cojlv ammn halre, xquircd.] 13 Avlt�aw avorpi, aj- 'h c!d their plinlibing_mPair,qu x Ight rRexanglion per MOL §If4),and eve ha me-no aakpIciYegg,[No lvo&kors" Low Voltage Omv,hmuraflcerquirAl ecuj .System ARY lipplit-omi.Ona `*boxn Rivat glo fill.out&ft T FRwoomem.who vdmit fh!4�9Ii4vft mdacnfl%-May dralaut All midi mnd thptk him- I.rarmom-must nb - TC a h ft-d c t II j"R Th a t c ft Lv k Ifil 5 box i n i i s u d m n dO ifi,�ff;J'A eia A ami it]V Ib a Al m 0 o I It 0 ugb c 0 Litm 0 f d T5 MIA:stRfv vvI I W.0 r n ot 1.71 as C,gull hIle av a Erie- havo vm.plqyea_q�fty pmvih Ag-re Relow ts Oeivolicy andjohshou Zurich American Insurance Co. ( � FO - . L. ", WC509589701MC609589801 E W onoate. 10/01/2014fliq 0,I *4In3. Iv,Mh xpirg TO SiO Aftes's.' temp. N� -A il a,COPY Ocf 4,50 porigy dedmratoo pgr(g,"howing the PORPY Wimimer nwid ffpirnflon dnl�j. FI-i-AT"re to secu-TO covuogp a crcHjuircd Under S�,'elau 25A uMUL 0.152 Cod lead in,IILIR WO WOU-1 Of :Ofa fine MR I'D$1 D.�_ioo 00 aft-Wo r cnc yead ntgsw ell an civil p .difia.inthe,Toren of g Uro-P. WCAA ORDER and,a rme ofilp-to$2,50.00 P1. day;kpimn Me violatm -13-f..040sed thda a copy of is slate tent rumay be,faartl mantled to Shp Offilcm-- 011" Date, 603-594-591,,6, .................... w Other ........................ "�J�•� DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/25/2013 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 z~— certificate holder in lieu of such endorsement(s). a, PRODUCER CONTACT .� NAME: Aon Risk Services Northeast, Inc. PHONE (866) 283-7122 FAx (800) 363-0105 Morristown NJ office (A/C.No.Ext): A/C.No.): 44 Whippany Road, Suite 220 E-MAIL p Morristown NJ 07960 USA ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Zurich American Ins CO 16535 ADT LLC INSURERB: American Zurich Ins Co 40142 ADT Security Services 1501 Yamato Rd INSURER C: Boca Raton FL 33431-4408 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570051395419 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. Limits shown are as requested NSR TYPE OF INSURANCE ADD S BR POLICY NUMBER POLICY FF POLICY EXP LIMITS LTR INSR WVD FOLIC EFF MM/OD/EXP A GENERAL LIABILITY GLOS 5 9 1 EACHOCCURNTE $2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGES(RENTEDEa occurrence) $1,000,000 CLAIMS-MADE X❑OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $2,000,OOO °2 GENERAL AGGREGATE $4,000,000 GEN PRODUCTS-COMP/OP AGG $4,000,000 ch 'L AGGREGATE LIMIT APPLIES PER: � X POLICY PE CT LOCCD AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) Z ALL OWNED SCHEDULED BODILY INJURY(Per accident)AUTOS AUTOS 2 HIRED AUTOS NON-OWNED PROPERTY DAMAGE M AUTOS Per accident w GI UMBRELLA LIAB HOCCUR EACH OCCURRENCE V EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND WC509589701 10/01/2013 10/01/2014 X WC STATU- OTH- ,y EMPLOYERS'LIABILITY Y/N WC509589801 10/01/201310/01/2014 TORY LIMITS ER ANY PROPRIETOR I PARTNER I EXECUTIVE E.L.EACH ACCIDENT $2,000,000 OFFICERWEMBER EXCLUDED? N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,006_ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 701,Additional Remarks Schedule,if more space Is required) J v e CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. °-F TOWN OF NORTH ANDOVER AUTHORIZED REPRESENTATIVE �-• INSPECTOR OF WIRESA 124 MAIN ST. �� NORTH ANDOVER MA 01845 USA eX1i'ITl2, `r/'GlG��111t'l•D c✓/�r�y✓ A ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD