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HomeMy WebLinkAboutWiring Permit - Permits #12587 - 18 INGLEWOOD STREET 8/5/2014 i 'z"a ......Date... .. . 1).1) .. .. ................ NORTH TOWN OF NORTH ANDOVER a PERMIT FOR WIRING � sac►+ug ,, e. Ave This certifies that •••• `y has permission to perform ...� re o ... ......... ..,.�. .......................................... k wiring in the building of ... ::: �� �`. ) North Andove ass. lat ... ...................... �.n.... Fee.2.. Lic.No.)rt�...��. .................................... .. ELEcTRICAL INSPECIR Check# " ellmmonwea&ol Mamac4ujettj Official Use Only Permit No. Apartment olgire Services Occupancy and Fee Checked 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: :Z ,30 ., I q City or Town of: A112ivra A1V;)vvpL 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) Owner or Tenant -X-:-Mk1 I FEk N,F A tZ i A Ni Telephone No. Owner's Address J-1 I/V6-LCwcoN I 1� C)1 5/,-t Is this permit in conjunction with a building permit? Yes El No FV (Check Appropriate Box) Purpose of Building Utility Authorization No. t 2q 3q V Existing Service '70 Amps /IV /,?yo Volts Overhead Undgrd ❑ No.of Meters New Service '2,c>o Amps t&V Volts Overhead Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: i>c a KC.)c Completion of the.following table ma be waived by the Inspector of Wires. No. No. of Recessed Luminaires No.of Cefl.-Susp.(Paddle)Fans Tr of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above n In- 0.of Emergency Lighting grnd. g nd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones No. of Switches No.of Gas Burners No.of Detection and Total Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices Heat Pump I.Nymb.er]Tons KW No.of Self-Contained No.of Waste Disposers Totals: Number.... .......... Detection/Alerting Devices In Municipal No.of Dishwashers Space/Area Heating KW Local Connection 0 Other No. of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs I No.of Motors Total HP Telecommunications Wiring: I No.of Devices or Equivalent OTHER: i 1 00,00 Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: - 7//q Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CbVERAGE: 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 BOND R OTHER R (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LTC.NO.: 14 3)C Licensee: MAILC_ 3, Mz-uy CXI Signature LTC.NO.: 13 (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.: Address: b, u3Q/4Ro-i) SNcVM ' M11 0 0 1 Alt.Tel.No.: *Per M.G.L.c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.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 El owner F1 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ connMoNw a� H of M s acwUSETTS ® ® • ® ® rop,mom E1ECTRICIANS � ISSUES THE FOLLOWING LICENSE ` qS A Rl„G JOURNEYMAN ELECTRICIAN' S a , MARG. J MELUCCI z z 442 F+ARRW60D DR ;W �tADFORD MA o1835 8446 143 7 64407 . . ,150 E ---- - OP ID:OUJA .4CUl2O', E(MM/DDNYYY) 1�- CERTIFICATE OF LIABILITY INSURANCE 707/01/14 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(les)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 endorsements. PRODUCER Phone:978-688-6921 NAME CT Macdonald&Pangione Insurance P.O.Box 428 Fax:978-688-5350 a"c°N E. Ext: I A No)-. 104 Main Street E-MAIL North Andover,MA 01845 ADDRESS: Donald Schemack PRODUCER CUSTOMER CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED Marc Melucci INSURER A:Preferred Mutual Ins Co 15024 442 Farrwood Drive Haverhill, MA 01835 INSURER B: INSURER C: INSURER D: 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. ILTR TYPE OF INSURANCE DDL UBR POLICY NUMBER MNWDY EFF MM/DDmY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY BOP 0100 70 5105 02/24/14 02/24/15 O(Ea occu D PREMISES rrence) $ CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION STATU• OTH- AND EMPLOYERS'LIABILITY Y/N TOR WC Y LIMITS E ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED' ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If,yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I O W N OF- /J 6r/e-F IA A Nz)Ov�` MA- THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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