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HomeMy WebLinkAboutWiring permit - Permits #12591-1 - 35 BEACON HILL BOULEVARD 8/17/2015 Date.....�1.. .... ................... tkoR'rij 01# TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........................................................... has permission to perform ........ .........................I..................................................................... wiring in the building of. ...................... ................................................................ at .. ................. .......... ............... Ndrth Andover,Mass...... ............ .............� Fee ?d... ......... ..............................Lic.Now............... ELECTRICAL NSPEcrOR Check# (flmmonwea&ol Vadjaclwetb Official Use Only • permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1107] (leave blank N, APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK V All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFOR TION) Date: r vi /11 2 it,- VUr City or Town of: N , 02 _vit, o v,el' To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perf the electrical work described below. Location(Street&Number) im Telephone No. 6' Owner or Tenant Do V1 viti- "a-C,�l e,V1 v"i V, 0 b) f6 -11 /f7 Owner's Address & cc v i Is this permit in conjunction Wit a building permit? Yes F1 No EV (Check Appropriate Box) ing PurposeofBuild _Re<,\,t w Utility Authorization No. Existing Service Amps Volts Overhead 0 UndgrdE] No.of Meters New Service Amps Volts Overhead n Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location af(��t'ur�eafPr�•o���UUVtaL��i�1Wo�lt".td.�l �t�°�..posed Electrica : Td 10 'Kvi 41,eyvuw 1-01- (AiAl6C _. j CoMletion of the followingtable may be waived by the Inspector of Wires. No.of T No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Trans otal formers KVA No.of Lumifiaire Outlets No.of Hot Tubs Generators 1 KVA Above In- rin No.of Emergency Lighting r-i No.of Luminaires Swimming Pool gd. LJ grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones o f D etection and No.of Switches No.of Gas Burners No. Initiating Devices --T-o No.of Ranges No.of Air Cond. Tonsw- No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons KW No.of Self-Contained Totals: ­­­­Number I...................................................... Detection/Alerting Devices Muni No.of Dishwashers Space/Area Heating KW Local 7 Connectiocipaln recuri D Other — S t No.of Dryers Heating Appliances KW No. o ty f Devic 'or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No of Devices.or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eguivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 1yo 0 (When required by municipal policy.) Work to Start: 'r'b J) 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 covet-age is in force,and has exhibited proof of same to,the permit issuing-office. CHECK ONE: fNSURANCF a BOND F] OTHER F (Specify:) I certify,under the pains an d penalties of perjury,that I'le inforinatto 1 wn this application is trite and complete. FIRM NAME: 'rX e- LIC.NO a5�:3 Licensee: WAVIV& A.10 � Signaturej, LIC.Nwsl) 7 (If applicable enter 'exempt"in the icense number line) 'Bus.Tel.No.: -6 3 (o IV-XIM Address: &I.-, Vq x '77 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 nbt 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 agent. Owner/Agent PERMIT FEE. $ d/ Signature Telephone No. �a �Q Go'& NERATOR APPLICATION DATE: X/f 1)( 5- LOCATION: ?, .5- 1-3 co d /y, ()jyq�- 3 OWNERS NAME: , D 6 vt 0 A- ­zct6vlv'l ko GENERATOR kw— I o k LA) NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: 6 ewervtfo f copjpeel�d PHONE NUMBER: 6 3 6 6 q - 7-'117 ELECTRICAL GAS RESIDENTIAL COMMERCIAL TEMPORARY LOCATION OF GENERATOR: sl Ai Lcl-ck *ZONING DISTRICT: �)) K- *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL fl v . _ on M o ,W�TALTH�O 11�I 1 USE' �x OT-TI I ►�'Qt IrSSU� S 7HE 'FO1LL!]W�1 l L1tt GIt: A$��l ��� J011R�NIEYh1�A3N 1EL;�CyTf�a'I :S�f N - � 4 1 1 3V} P `5cz 4�'62g : ©lVINlflNU1dFRA,LTE ,.OFx 'NS 1. C' 11CA s tSSIlES :TH{w FOLyLOWING LECI=NOSE ASS l I TEi2W5AN -TT4R ( L�EC�T_R�CAI 1 OQCr Tl 1 - -RU ATGR C[N,NECT �� WAYN;E t ` NCYESEllE � 1 ��� AM 105T CAt '� N 1 GHWA s � ��Ana P(1 �4X 471 - I�AI�R I N�TcN NH `c3$25 0471 � ; CERTIFICATE OF LIABILITY INSURANCE 08/11/2015DN ) 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 . NEACT Paychex Insurance Agency Inc PRODUCER NCAO PAYCHEX INSURANCE AGENCY,INC. 150 SAWGRASS DRIVE PHON E , 877.266-6850 IFAX (AIC No): 585-389-7426 ROCHESTER,NY 14620 E-MAIL Certs@paychex.com ADDR SS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Wesco Insurance Company 25011 GENERATOR CONNECTION INC. INSURER B: P.O.BOX 471 BARRINGTON,NH 03825 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, INSR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO E RENTED n�) $ EACLAIMS-MADE�OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ NEILAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY =PROJECT=LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED SCHEDULED BODILY INJURY(Per AUTOS AUTOS (Per person) HIRED AUTOSE71 AUTN60WNED BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I TENTION$ $ WORKERS COMPENSATION AND X WC BTATU- OTH- EMPLOYERS'LIABILITY WWC3136814 05/10/2015 05/10/2016 E.L.EACH ACCIDENT $ 500,000.00 ANY PROPRIETOR/PARTNER[EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000.00 (Mandatory in NH) Y NIA E.L.DISEASE-POLICY LIMIT $ 500,000.00 If yes,describe under DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 1600 OSGOOD STREET DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY BUILDING 20,SUITE 2035 PROVISIONS,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR N. ANDOVER,MA 01845 LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ! ACORD 25(2010/05) @1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD GENER50 OP ID: BJ AC'©RO° CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DD1YYYY) 0811 1/201 5 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 endorsement(s). PRODUCER NAMEACT IMMANUEL Ins Agy Inc& IMMANUEL Insurance Agy-SAN PHONE FAx PO Box 300 3 Brittany Lane Arc No Ext:603-335-4300 (Arc,No): 603-822-7101 Barrington, NH 03825-0300 IMMANUEL Ins Agy Inc& ADDRESS;david@imanuelins.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Preferred Mutual 15024 INSURED The Generator Connection, Inc INSURERS:Harleysville and GEN CONN LLC INSURER C:Admiral Insurance Company PO Box 471 Barrington, NH 03825-0471 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. ILTR TYPE OF INSURANCE INSD WVD POUCYNUMBER MMIDD F MMIDD LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE FXI OCCUR SPP54546G 07/01/2015 07/01/2016 DAMAGE TO RENTED PREMISES 000 PREMISES(Ea occurrence) $ , MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY ❑PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGO $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) _ A ANY AUTO PCA 0100713589 07/01/2015 07/01/2016 BODILY INJURY(Per per son) $ ALLOSWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS J OPERTY DAMAGE HIRED AUTOS X AUTOSNON-O ED (per accident) $ $ X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 1,000,00 C EXCESS LIAB CLAIMS-MADE EX000013416-03 07/01/2015 07/01/2016 AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y 1 N STATUTE ER ANY PROPRIETORIPARTNERIEXECUIVE E.L.EACH ACCIDENT $ OFFICERMIEMBER EXCLUDED? 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 I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St BLDG 20 North Andover, MA01845 AUTHORIZED REPRESENTATIVE i . ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD a { North Andover MIMAP August 17, 2015 i N l� �y if ldi a liu 0 Oe�C°�Hi11 �ouie�aC� 0 MVhC Be Interslales Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Meters Data Sources:The data for this map was produced by Merrimack —SR NORTH Valley Planning Commission(MVPC)using data provided by the Town of Roads Nodh Andover.Additional data provided by the Executive Office of „Z,q�t4ao r+eti00 Environmental Affairs/MassGIS.The information depicted on[his map is q""¢Easements 6 Parcels .' L for Planit No r purposes only. r may not H adequate for legal boundary N »— '"" defini[ion or regulatory interpmtation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING {t - M THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION �SSACHus�� 1"=42 ft