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HomeMy WebLinkAboutWiring Permit - Permits #12233 - 257 BRIDLE PATH 3/17/2014 ................. Date....'......... . ..... I �yORTH rop,.••�`.�ticb TOWN OF NORTH ANDOVER a PERMIT FOR WIRING ' 88ACMUg� a ......................... This certifies that ................. d has permission to perform .... ....... i e 4, ................f.:.......... wiring in the building of ..: .............................................. 21 a North Andover,Mass. at ... r r r ...... ;9� .... ................ . ...... 1 7? L1c.No. ............... ELECM AL INSPECrOR Fee ... ..................... E, # Check _----- 1 Commonwealth of Massachusetts official Use Only 9=5 Department of Fire Services Permit No, o2l W BOARD OF FIRE PREVENTION REGULATIONS Official and Pee Chocked tj�ev g (Please add ir 71 z�p codes&docti ian's cell .,contract#&b1dpermif#if applica,bled [Rev.1/.071 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 011/ All work to be performed in accordance wit-the 1,fassaohusetts Electrical Code X�Q,527 QdR 12.00 PLEWSE,PBWW)IVK OR TYPEALL LVF0P_&f4T10_7V) Date: Cify or 'own oh. To the Inspector of Tfli'res: Bythis application the undersiped giV&snotic fh' her.intention,to yrform the electrical work described below, Location(Street chi Number} Owner or Tonant Owacrls Address Xf 1"�dte Is this permit In conjunction with a bliffaing Penn it? yes ❑ No NN ' (Check AppropriQfeBox) Purpose 0fB`9ding Utility Authorization Not. Existingservice— Amps / Volts OverheadD . -undgrd[I No.of Motors Net t'Service Amps / —Volts Overhead El UndgrdE] No.of il2eters Number of Feeders and Aimpacity .Location and Nature of roposed Electrical Worjz: ofYhqfqlToii,h�g table=y- he ivaived by the Impector of 13-11res. No.of Recessed Luminaires Na of CeilSusp.(Paddle).Vaas a NO.of Total 'Transformers XVA No.of Ltomnalre Outlets No.of Hot Tubs Generators XVA No.of Lnminalres 15`tiqmmffig pool grod)oye 'a-cru El 0'OrEm -gency 19 txng attery Units �� No.of Receptacle Outlets No.of KRE A LA.P_9S No.o Z --- . I f Oil B ............I I I No.of Switches I No.of Gas B INO.O�Detection and orruen Total -.1pitiatiogDevices No.of Ranges No.of Air Cond. On NO.of Alefting Devices No.of Waste Disposers Heatpu Totals: Detection)Alertt�F Dec ices No.of)Dishwashers Space No,of Dryers lHeati Na.of Devices ar Equivalent No.of—Water _ No.of Efeaters KW Datawidng: No.of Devices o I- —--c—o quivalent W, Na.of Xotors IT2 Jecozonrawcatlo"T No.of.Devices;or ZqTly'Nent OTHER. Attach additional detail ifdefire4 or as required by the Inspector o TY s- . tor f i�,e (Wh 4)en,required by municipal policy.) . Work to Start: Inspections to be requestedin accordance with NMC Mille 10,and upon completion, INSURANC COVERAGE: Unless waived by the owner,-no permit for the performance of electrical-work may issue unless the liccosea provides proof of liability insurance including"completed.op-cration-',coverage or its substantial equivalent..The undersigned certiffas that such coverage is in force,and has exhibited proof of same to the permit isstting office. CHECK ONB: )2\TS(JRANTCP, E] DO ) El OTHER.X (Specify.) Selffisured I certify,under the pains and penalties of perjury,that MIC infOrYlatfOlt 071 this appHeation is frue and complete. FERI)II NAME,�.ADT LLC DBA ADT Security LIC.NO.: C-172 Licensee: Thomas J,Lop Sign re; C-17-7 LTC.NO_ (1faPPlicahk 811tel'­eWnTf A-license nuinber I"e) Bus.TOL No., Address:ty : \? * " ovl, t',�V�r ci' 1>cH9 �) C\ \ors Alt.Tel.No SyMm Contraetor License requixea for MIS work,if dpPlicaffi,enter the license minber here: 001779 OWNERIS 1NSfj-RAA1d WAIVER: I am aware that the Licensee does nothmic the liability insurance cover—age normally required by law. By my signature below,I hereby waive this requirement I am the(check one)El owner El owner's agent Owner/Agent Signature Telophonelllo_ P ERITHT nv: "AC DATE(MM/DD/YYYY) A� oRO CERTIFICATE OF LIABILITY INSURANCE 1 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 r~ 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 a)Morristown NJ office (A/C.No.Ext): A/C.No.: .a 44 Whippany Road, Suite 220 E-MAIL a Morristown NJ 07960 USA ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Zurich American Ins CO 16535 ADT LLC INSURERS: 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 INSR TYPE OF INSURANCE ADD SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MM/DD/YYYY MM/DD/YYYY A GENERAL LIABILITY GLO509589901EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $1,000,000 PREMISES(Ea,occurrence CLAIMS-MADE X❑OCCUR MED EXP(Any one person) $10,000 PERSONAL B ADV INJURY $2,000,000 �2 GENERAL AGGREGATE $4,000,000 - AGGREGATE LIMIT APPLIES PER:GEN PRODUCTS $4,000,000 M 'L � X POLICY .PIE O LOC r T El AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT to Ea accident ANY AUTO BODILY INJURY(Per person) 0 ALL OWNED SCHEDULED BODILY INJURY(Per accident) y AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE v AUTOS Per accident ;E L 4) UMBRELLA LIAB OCCUR EACH OCCURRENCE U EXCESS LIAR CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND WC509589701 10/01/2013 10/01/2014 X WC STATU- OTH- A EMPLOYERS'LIABILITY YIN wc509589801 10/01/2013 10/01/2014 TORY LIMITS I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $2,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $2,000,000 If es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,000_ -- DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) �—i 4F_ J >iJ ty� CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXP RATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF NORTH ANDOVER AUTHORIZED REPRESENTATIVE INSPECTOR OF WIRES 124 MAIN ST. NORTH ANDOVER MA 01845 USA ��g. i`�tJiZ81GdlD c.//lILGfI ✓9Yst ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD va ommR7 Am aa 11 C-Coml P—ongalOon Ed Ffigh ff-ARIPAPON.-9 -AA -LIMM P ADT Security.Services 100 Clinton Drive 'Chem, o vI am.a a7jplyo.rlth 1pyc "oil Qlap ayco fi-nd'hava lfl'o�t xro a iito rpri r-affo bi ml d M.4 Re -aw -cd tholy RA "'AllmixT" owl ""log ad ar", boyme-ovev d mg �ys To kumlao R- oarrevalh're matmano qHlxp'JjV L 0 w Voltage 5ecuri S stern ,-, .awt-,ef-A-who lCohividom that cANk Ihj'.5 bo,,�t toWa-4rbod 0 nA 1.6gal.AM d moltig.tho llrj.,fri 0 ofghQ inlgb�wmh r3fd-TT,9W��tuul vyllf.&E ---------------— Zurich American Insurance Co. WC609589701MC509689801 filho ahftrijrtv„rvar ftprkoymnorit,sl, wvll fla -0 form't-R-1, "B"WIP WORY,MOE Rand,a flylo IFAll,40 F, G I a,a-Of 1-1 ea MI I N A wo �3.C.1 I Owl ------ ----------------- ........