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HomeMy WebLinkAboutWiring Permit - Permits #13186 - 18 FOUNTAIN DRIVE 3/30/2015 Date.... ..................... TOWN OF NORTH ANDOVER #0 PERMIT FOR WIRING CHU Thiscertifies that .. ....................................................................................................... . ........t ...... has permission to perform ... ...... ......................................... ................ .........wiring in the building ......... ................ at ....... J North Andover,Mass. .............. ............................................ ...... ...................... .............. ....... ...11A ..Lie. NO.", CECTRICAL INSPECTOR Check# (f"Mmonwea&of kadjaclWeffi Official Use Only Apartment olgipe Servicei Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]/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: '3­ a,-i - 15 City or Town of. 06, AtJuovC-yt. To the Inspector of Wires,- By this application the undersigned gives notice of his or her intention to pet-form the electrical work described below. Location(Street&Number) 00 F7o u pi T A s tj "ba I V Owner or Tenant Uo AtoWvGV?- . 14aUtz jmG- Telephone No.W.itka-,13 Owner's Address Mloakerc-ILk. 106 elle`)Lus )Ve) i1fam 6L AIA 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: WA-660C LIOACCW-k ( 6 MAY&TAU.6b 1� Ze Irayti 15 tv rr 6ve.,% a wun rt�rw.),A# 4"Fay Completion of the follo'wing table tnay be waived b) the Inspector oyff,ires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above r-1 n of Emergency Lighting grnd. L-J grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and — Initiating Device, No.of Ranges No.of Air Cond. Tons Total No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons I.K.W........... No.of Self-Contained .......... Totals: I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local n Municipal El Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.o Water No.of No.of No.of Devices or Equivalent KW Data Wiring: .... Heaters Signs Ballasts No.of Devices or Equivalent ...... ;Wurinj: No.Hydromassage Bathtubs No.of Motors Total III I No.of Devices or E . i ent OTHER: i IV Ce C,rt,f;(-'EaV,-AL- -7a6o ' 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: 5 -19- 1.5 — inspections to be requested in accordance with MEC Rule 10,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 cove,pge is in force,and has exhibited proof of same to the permit issuing office, CHECK ONE: INSURANCE [Er BOND F-1 OTHER F-1 (Specify:) I certify,under the pains and penalties of perjury,that the inforination on this application is true and complete. FIRM NAME: Jupiter Electric, Inc. ............. LIC.NO.: A9679 Licensee: James E. Marshall _ Signatur LIC.NO., A9679 (1fapplicabie-,enter "exempt"in the license number line.) In,.Tel.No.:978-499-777 A Address: 142 B Lafayette Road, Salisbury,/MA O 52 Alt.Tel.No.: *Per M.G.L.c. 147,s. 57-61,security work requires Departm8pt of POic Safety"S"License: Lic.No. SSCO-001---3-9-3 OWNER'S INSURANCE WAIVER: I am aware that the Lic�ensee`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)[:]owner El owner's alrent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 6- C 41A ), ,-e ,0 ) �� 0 ALTH OF M��SpCH , ;GOMMONW� • �� s � • • Bpi �'�i AN . AS T \NG1C11 �1 ANC SHE F��i'�TAR ELE��Ri tZ SAES MpS iG ANC t � �UPr MARS 1 RpNppL .. 01949 �45 219a3 SET p OP ID: CD DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE03/18/15 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 certificate holder in lieu of such endorsements. PRODUCER Phone:781-935-8480 NAME:ACT DeSanctis Insurance Agcy, Inc. PHONE FAX 100 Unicorn Park Drive Fax:781-933-5645c Woburn,MA 01801 E-MAIL __---- ADDRESS: PRODUCER JUPIT-1 CUSTOMER ID N: _-_ INSURER(S)_AFFORDING COVERAGE I NAIC N _ INSURED Jupiter Electric, Inc. INSURER A:Harleysville Insurance 26182 142 Lafayette Rd. INSURER B:Technology Insurance Company -- — f 42376 Salisbury, MA 01952 -- - - INSURER C INSURERD: 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. INSR ----- ----- ---------- jADDLSUBR; -i POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MMIDDIYYYY LIMITS GENE RAL LIABILITY EACH OCCURRENCE S 1,000 000 12/23/15 DAMAGE TO RENTED — PREMISES{Ea occurrence $ 100,000 C —� ( X XCU Coverage MED EXP(Any one person) $ 5,000 CLAIMS-MA X OCCUR -_-- ---_ ...._._ - . I COMMERCIAL GENERAL LIABILITY SPPO®000076460P 12/23/14 I,� g PERSONAL&ADV INJURY 3--_ 1,000,000 X Contract Llab GENERAL AGGREGATE I S 3,000,000 GENT AGGREGATE LIMIT APPLIES PER: —L —-- - PRODUCTS-COMP/OP AGG�$ 3,000,000 'r POLICY PRO- i I LOC ( IDEDUCT. S -- ---0 JECT j AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT — j ( accident) $ 1,000,000 I ANY AUTO --- --- _ rBODILY INJURY(Per person) S ALL OWNED AUTOS — A X� SCHEDULED AUTOS IBA76461 P 12/23/14 12/23/15 BODILY INJURY(Per accident) $ -.-- PROPERTY DAMAGE X HIRED AUTOS ( (Per accident) $ X 'NON L -OWNED AUTOS S ` X UMBRELLA LAB X [OCCUR EACH OCCURRENCE S 10,000,000 i EXCESS — — A _ LE 1 DEDUCT BILE CLAIMS-MADE CMB00000078286P 12/23/14 12/23/15 LAGGREGATE 1 S 10,000,000 _ IS X l� RETENTION $ 0 $ WORKERS COMPENSATION OFFICER/MEMBER EXCLILITY UDED? N I f L X EACH B ANY PROPRIETORIPARTNER/EXECUTIVE Y/N I N/L,� TWC3442671 1 12/23114 12/23/15E. $ 1,000,000 -(Mandatory In NH) iMA,ME,NH I I If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000 00 I — --- ---.-- --__. - .__._ DESCRIPTION OF OPERATIONS below ( E.L.DISEASE-POLICY LIMIT $ 1,000,000 I A ',install Floater iCIM00000088587P 12/23/14 12/23115 I.F. 2,000,000 DESCRIPTION OF'OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) "ADDITIONAL INSUREDS LIMITS ARE NO GREATER THAN THOSE REQUIRED BY WRITTEN CONTRACT." North Andover Housing Authority, Fountain Drive, N. Andover MA; Electrical Repairs; Town of North Andover, North Andover Housing Authority is add11 ins'd as respects to the GL policy. CERTIFICATE HOLDER CANCELLATION NANDO-5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE N.Andover Electrical THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Inspector 1600 Osgood St. AUTHORIZED RESENTATIVE Bldg. 20,Ste 2035 N.Andover, MA 01845 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD