HomeMy WebLinkAboutWiring permit - Permits #12447 - 156 BERKELEY ROAD 6/11/2014 I
i
Date. ::. . .£.1JA....................
NORTH
TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
83ACHUgE
P
1 '
This certifies that .... ....... ... ..a.
E� ELF` ���. "'d -
has permission to perform ......�1 ......, ..
wiring in the building of..:::....:..:..�. ";�` ` � .
9
at ..`. �" �.d...... North Andover,Mass.
Fee..:..... Lic, No. . te
. . . ,
ELECTRICAL INSPECTOR'
Check# r "�
(f1mnwruuea&ol MamacLmth Official Use Only
Permit No.
2epartment o1JIre Set-vicei
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),521 MR, 12.00
V(PLEA SE PRINT IN INK OR TYPE ALL INFORMATION Date:
City or Towii of: A1AJDeyi",APr To the lnspecl�rlof Wires:
By this application the undersigned gives notice of hi, or her intention to perform the electrical work described below.
'44
Location(Street&Number) o—
Owner or Tenant ell) Telephone N K&-
Owner's Address 77) .
Is this permit in conjunction with a building pp trait? -1 No (Check Appropriate Box)it? Yes F
Purpose of Building Utility Authorization No.
Existing Service Amps Volts OverheadF_1 UndgrdF_1 No.of Meters
New Service Amps Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Loca 'on and Nature of Proposed Electrical Work: Z,)/,,��2�6,<:
axl.��Iel/,es
Conipletion qf the.1bllowing table niq be waived by the Inspector qffires.
No.of Recessed Luminaires No.of Ceil.-Sus
p.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators ICVA
No.of Luminaires Swimming Pool Above In" No.of Emergency Lighting
grnd. grnd. El Batter v Units
No.of Receptacle Outlets No.of Oil Burners ,JFIRE ALARMS ]No=ofZones
No.of Switches No.of Gas Burners lNo.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total
Tons 11No.of Alerting Devices
No.of Waste Disposers eat umber Tons KW No.of Self-Contained
Totals: I I I Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑F� Municipal F� Other
Connection
Security Sy stems:*
• No.of Dryers Heating Appliances KW No.of Devices or Equivalent
No.of Water 0.0 No.of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or Efluivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications W
No.of Devices or EiiiUrlivnint
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Valugr of le tric I Wor (When required by municipal policy.)
Work to Start: "I. ..... Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCEZ_ O ERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liabili1 insurance including"completed operation"coverage or its substantial equivalent. The
�, �y
undersigned certifies that such 96ve age is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE; INSURANCE BOND D OTHER [I (Specify;)
I certify,under the pains and "enallies ofpeijury,that the information on this application is true and complete.
. an
FIRM NAME: '�,PCA?eiLi IYV, LIC.NO.: Al Z.
Licensee Signature( , LIC.NO.:
(�f applicable, enter "exeinpt:,Jn the nu ber lin 61 s.Tel.No.:
9
1627 Alt.Tel.No.Address: 17S'e.7) Al "n A"..,J)
*Per M.G.L. c. 147,s. 57-61,secunity w"requires Department of Pubrie Safety... I i,"ense- 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)0 owner [I owner's agent.
Owner/Agent 77777,
,Signature Telephone No. T FEE: S
in( Commomroealth of Yassachusetts
Department of Public Safety
x tinur4i.ti .lrm. ti I rn.. -'''�,
License SS-001895
CHR[STOPHER J TREMBLAY ,:
393 Jericho Talc S6 -
Mineola NY 11501
Expiration
C o rnnn s s i O1`'r 05124/2015
,
• C�4'"•�.ta.t��'�;?"�ta3N�(i'-t p R(_y; �l.�i�.�,�.��,��i��n
BOAC114
xf:t': z ��
.v::It..,C`.".`'t�, �...<.ti:.;;.:y e,,�:lu•�i„r 't'S'�I:i �'.�
�$:.f1tJ i vtS:J
5--a
• 0612442t)j J
. iCURI�
CERTIFICATE OF LIABILITY INSURANCE """"
osrffaoof�
"n C MMCAi•Et IS E18;UED AS A WATM OF WORMATWN ONLY AND CONFERS NO RMTS NPM SM CgEt'[t!'MTEE HOUMIL
'Ef W Qi?ATEMOA 9 DM tt0rlr'AffWJMMEi.Y OR EE+tE6ATi MY AMEW, fRffW CR ALM 7W COVOME AFFOMP EBY THE
POLMM SKOW. TENTS CEtt UMCAYE OF WORMCE OM Ft T CONSTtFM A CQNWGT Et EMM 7W ftiSIM tNBUAte M,
Ati`ttlOA D PRQOltC AND 7HE qj i&1rE K0L0ER.
tltdPWANT: if 00 kokWr Is an ANAL INSU Ms tM PdkrA(ts) faug be ondaMd. Elf SUBRO"WIN IS WAS.
to the bolls and emee Mom O1 ON POUW,cwt110 Pdk:ks may mquka alb aadoraan mtL A atatanoM an tSEa CoMcdo does ns:t
"TI(as tothetodf dob"rto1koo} s
PRODUCE R
all
LDCldact Campwlsas,LLC r. —
5047 SM Felipe,We Sri
Hanlftn,TX 77057
�sra cavel�:a� r�
L'a.at AfrweSc+� 43S?6
tip
ommm,Et—ucw BR-G:
oeDaaf vma W-aPEsuocaaalvc �' . ..
�sawcoo,�crr�so � ,�.
COMS CAUfU:lflt3tGN NllMHER:
THIS is to Ck;Mr-Y THAT THH POLICIES OFF ENSUt ARM LISTtt:D BaaW HAVE E SEN ISSUED TO TK INSURED NAMED ABOVE FOR UW POLICY PERIOD~
INDICATEi<!. NOW4TWA[ IU0 ANY REOMAWNT, TERM OR GONI?MW OF ANY C0141PACT OR OTHER 60CUMEiNT WITH RPSPECT 10 WHICH THIS
CERTiFtCATS MAY 86 ISSUED OR MAY PERTAIN, THE INSURAAl6>~ AFFORDSR BY THE POLICIES DESCRIBED HEREIN IS WOJECT 10 ALL THE TERMS.
1 JtCLIlSEDNS TWO CONDEYIQIES OF SUC}i PtiLtcw E.fEAi M SHOWN MAY HAVi:9WN REMED BY PAID CWMS ».
txzpt
Q�FR/�t.LtA>STttiY ��
6 •ilABA.3iY pAQA4.8 - r��ca
MEDF�fP ona
Hk1.a AS3NIZNlptY
AtitfRF.f3AT1;LIL�TRAFitSSE 7t M—WM=- Ada
f7 LCC P LIA91LiTY S
AUTO}lG6lLEtlABRiIY ..� #
ASI1G LYt22{t�Pam) _
aSARJBD SOWN= if po $
Foe WWAW E
LNe OIx1ER EAGtiOCCURf�MC£ S
SE)W�B CLXWMAM
f
LIANUTY
A pR A taCU?tVE: COMMA
1C101ROE� tGlDt�ttt4 k["YU=
E]tCRUGt107 EttJ1 L L S !l3gD
rr.t..als�a•Ea�aLclrau S =SIQt?
ONhF &1»RlAFA4&.PQ3,IGY6EN4tT �i �t�
rt
14f, nesteR# r. (t1Ct�Rp4C� �� .
CER7'I<i11t;A'1�Ht�L!liER CANCf+IIA'tiDbl
LnANYopTtt� t3
BEFCRE3
UM IJ'GWA=K IDAU THEItEOEs�ttQriG>:WIt.1.8Ia CE1EV 0 W
ACCMMCE WITH THE POLICY FROVEdti3EES
AlEitiCEEl2E:D mommme
E3PFAMtT .IKC. ��.�
393, tQ TPIEE8tE too
SiHiEgLA„!lY t1Elilt•1�19 ...--.
t Ift AaoRD Tame and top aro raS@htered marko o:acmRa
asp:�tes7�
Ate' C7 sm" op 0.8F
+.�.. CERTIFICATE OF LIABUTY INSURANCE amog=m m
411141IM3
!IMPORT
IS CERTIFICATE 18 ISSUED AS A MA•rMR OP INFORMATIOI!I ONLY AND coNFER9 NO RWHTS UPON THS CER'i'IFICATE HOLI?M THIS
MICAT6 DOES NOT AFFIRMAYMLY OR NEQATW&Y AMBNO. dtTi81t0 OR Aun nM CoNERAOS At oM= 9Y THE POI<.I-ms,
LOW. THIS CEtt: RCATE OP INgURANCE DOES NOY CONSTiM19 A Ct'iKTRACT BETWEM THS ISSUING toURBR(B), AMORIZEO
f�R�386NTATIVE ORPRODW ER.AND THE C OATE HOLOM
life CZtlB potdel!s An ADDfil1lVAt.INStItiECl,fhe p}a muss be endorsed. rf MROQAMON 18 hlit ;Motto
the temts and aondwans of the prdlcy,eettaln polities may squire an awhmero4nt A statement an this aarti we dew root confer rights to the
rtN&tate holder trt lieu cf sueh endorsa�neAt
atwtoRt Phone:Sdt-578.0400
Tits fim
a to vMeG
1 urB03 SUIM400 PAZ 5is-M1i7T
cau ,art: ll
a�IMA.-Tmn gy F&C tasuounoa Co. 129M
a two 9 ,Wfre i cf�k s rvEaeS azttord Casttli [nsurattee Co i2m4
s 3 d�ticha Tpke.,&tilts 408 a•I{ettfortl Fite Insuimtt.e Co. 1IM2
Mineola,WY 11501 gyp.
at-
sawnC CAT1~ AEU2;UGAI NUl1®
THIS is TG Ci'll`1t TI WT T)i@ P01.IdES OF3U>;ADtCIr Lt8TEri MOW HAVI"Bid 185VED TO fHEr INSURED NAbS A80V8 FC)i 7 ti&POL ICY P>rRIOD
pVaiCA ED N07WRHSTANDING ANY REQUIRW4ENT.Tit OR CONDMON OP ANY C ONTRAOT OR OTHER DOCUMEW WIT14 RE8PECT TC WACK TRIO
CERl'IFICATE t4AY 82 ISS=ON MAY PERTAX TK 0MRANCE AFFORDED BY THE POLICIES DEWRISEO HEMN L4 SUBJEar TO ALL THE TEsRMS,
EXCLU6fOi�SAND CONDIT—..w OF wwwH 01 ll;gtt MITE SHOWN MAYHAVII BEAN Ft=rgD t3Y PAIR OLAMS•
7YPFcARtHB C8 ply UXtm
ie
A A.,�.. rx GDM1!8,UAWTY 12UUNW 4394 1111212013 11112JS014 ,,, 1 Colo
� uira�� S
" aSdA&At fi �LX..•OCCUA l off'{A ann asp} S 10.001
7 R�EiOxAL 3 AW WbIRY .S 'I,Q
'Cs�NERAl.RGGBEGAtE S PnQ�r
LamAWRWATELWrALftMPEfm tueonUGlEi-cXtbtPtQ?AGG s 2,000,
May X!PAG��- ',too a
A 4�Av-�•a�ttnensuAsu�x
AAU.= 12ut1NZU039A 11I72!?. 3 11f19=14 SMYatatayOWOM a) S -
! ,�Auros LSp $OC�,YtH.�tiRYtPntam�ant) S .
KAVMSCWftEO
e:t
S
$
,�u .LAt•IAi3 x
8 - accaes u1►a 12 eACN�CE s 9 t100,00
•ass Maas RRUZU0162 1111212013 11M2f2014 Aemmea a S 9,Op0,OG
aeo X s 10 000
mtavt�Wss4tnr s
ytN
sra�.
C�iSV$ NIA 8,ggq{ACtxftE S• 6 -
r lPlfCt4�Qp TtQH4 �LL.D345AJ,'�•PA $
ICI+IAt.f.tgS •PQtICYLG�Sti'. S
TE71Hl0841$ DO 2Si.Z 3 OWSOM 2sGQ?,06
A tPROPFATY-$2gj2gO 12IUNZUOS94 11/1212413 1IM212014
o&BCRta}tvFaPERgttt►CAnCHS1vEH)G)2d tames aE+aeatm,ac�tonu sgtieau�4,ntpwva)ro i�requrrodl
H c TION
• EiRDENC .
6"ULDANYOFTHEADMMOSOCRIDW P00MG38ECANC 1?6MRB
Tit@ UPIRMN OATS THERBAF, WMCD'W6L 813 VvUVWW W
GMUNCE OF INSURANCI; ACUMANC9 WITHTHB POL(GYPAGWS)*U%
AU'n(a M PaWg WTATM
P
ICORD2Ia(201Q10 el.19"10 ACORD CORPARATIM All Nhts t�essm&
The ACORD name and tcgo are mg=uw ala ft of ACORD