HomeMy WebLinkAboutWiring Permit - Permits #13369 - 700 CHICKERING ROAD 6/10/2015 I�
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Permit No..
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—Departmen't a .7ille err.eico-i Occupancy and Fee Csl"teciced
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APPLICATION FOR PERMITTO PERFORM ELECTRICAL WORK
All work to be I:re,°fon-ned in ,accordanc with tht,'Mt aMdIUSet,t�s EE ectr•icid Code(MEQ, 5�27 CMR 1100 �
(PLEASE PRJAI"T IN INK OR TYPE ALL 1W"ILCIMATION) Date-
C,ify^ol-`T"oww in of f(�Ck�]. IS�f] C To rho hz..pexcrn erf wires:
!3y rlras czlal�dlccrrrurr the r�rrrrJersti rrerl rr'it-e�s nolie cK of lrls oi-her iniemirrrr `0 rover form the clear is al fvork clescrldre:et below. Fie
Location(Street&� r5e��--�;•�i �G�' �1 .-_...._,__�W._._._ ._.___.�.._.�,...___W_._ __._,..__.___..___
j Owner of-Tenant�... � 'reter)hone No,
Owner's s Address
Purpose eofBuifctiororo"l rrctit�rt wwitlt a Iyrarlrliarog paetrrorort ° Iles 0 Now._Cj ._. (Check Appa-opriate Box)
Utrltty Author nation No. _
!� Existing Service .__ Arn)ros / _ colts Own
0! t1a"relg,"rsd [� No.of Meters
Aon s
f ,��._.._.....1__,._.,..__.. ero9t~a C7verh€."rr°7 0 t.lrarlrtl No,rafMeCcr•s
Number of Feeders and Anip ac ify
Locatiorw and Nature of Prr posed Electric«af Work: r carrrlrlm'rrrrr r/'"vice frrd9r,9+arp.0 teff5te ma);be rrezivecf by the limpeciorof wires
NO.'Af Recessed T.urnin.aircw No,rd Ce,il, Strsfw (PmJtdle)Rfwh No.of
7ofal
VA
---�-�---. Transformersy��,n;
No of`Lmnin.fire Ou0c..ts
No,r.sl'k drat TrrCrw C"e wen atnl n I_..1 75KW
d'C unwu crilta
_I nrJ C I�Pr9 cued r1.w_ No.of I nwr_rgency Lk-litr"ntg
FIRE'
t rr l nitr,
�t"r.rl1lccr Ilvl (fufl
f oil f ur'�ror.° R I P l fi Rh95 hCre,of,Zone,
n.�rl urlcrw�"" �vur k"d ,I,f.tlrrwtIS _.-_,_._...,..._._.. erf Ecru ir.rrl and
Cnrtlrtin Dcvicwe
I�irr,of it ur c
No,of Aif,con I. �'(�OIaI 1 orr,� No, lw�Devices
of,Al rti
Ow;ar.rrf\grusie fJi,•aw r,,, a .._ .___._w,. ..��._.,. .._..,..,......_...-
i t cr, llc It 'a,nnwl7 urnlrcu f oawa 6syM1r C°a'r.rrf el"-Contained
irat Ifs I�rcicctiarlw/Afettirw Devices
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Connection 0 01lwer
of,IrivCr' !Yc Itrlr ACwtwir tewr:c iti1h' `wct~tntlp 5yrsdelroww .
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�t ma.sst No of Devices or Equivnlrnt
s J rr, (y�clrunwrr. "r t,
u,f I f3arthtulas __. _.__
No+ 'A'riMwuif � 'roull C-1G'
Tf decojlitounicutifwnv Wiring:
Nft of Devic
es or F Iuialc,nt
t C)°d"6i KR
�ryry//^�� ��^yy//ryy�yy �y�y 4rtrer dr a+t/Ch araro<rl rlrrrrr/rf./r�carrtB,r�r tas�required by rice Iat.rlaecim-(tf 4Klire,c.
r Br.n rtr'I r IE.i nt! I 'ti it !"Volk:1G V 416.5.E a,J.ld. uw r -n rcltui ol'•� rtnurs vtn¢1 yx rd+a ,e
P it rl0t to{I III 117 ^) pt 011 kfl I 1"A'i tl lr 9 kt in iwcwcl muv' th ti tt.C..14VYtC to :I III rr17tV11 4..+xV St YQLE4 riw.d tt.1 W(I 4.(y".�.t if r r,...( vr,. -i•, t l ti h. � i n *^rs ut r w"i8r I of+�r�rw,trra ° P;•r:ru lP wn f it ..r::entry tl7c lie.rra:c;t7rm irte•'~fwe�.a.rr�rl"Ii.rh�hi}=i .u,it',
mclrpnit urrr (i LC"1 i�t,i,tCdnrr" r r ,,r,r�^r_�r,.I+ Ue ,Bat�tVa7d urlulti:rlt„nl,7-&.ru,;yprl.l�,e,6 diu9r u,CG[rl(Cti 1Y6Uk°rtlG;tY rrGIM1`41"fi�,°C i'i(l lnr4:C, 11KI 1w,eYfhibittd Ir oorof
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!carvrfs,rnnd'cr r�laty puntr rrrsea'ra�rrrr/rrr.a rr„/"pnrJrrv.r".a/aavl Y/rtv d"rrjiar'varrr7rrrra ern rhr.r npapr .rr10/
rrrpr rrrrl .......
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iccrrsee: _ _._ -..__ , n�aawaa�
G� Letazacno7r.t,_..... __..._ sr romrura_ - [Ic hC7.:-_.._Alaa l
)f,rt>ptrcibic,enter er.enfpf:""in the Hccrwac,number luwc.l
\ddrer4 offs.Tcl.No,;
'Per�C GI. c.td7.s; „,"7•Gl,wec,urrty r+"ar'it ra;crcrkk ca fJelrs reo�trcnt rrf t tul�rlic r,rfc,t,w� f,rrerrwe„_ _.....__ , AIt.Tel.No.;
l.ic.Na. _
0MINsR'S INSURANCE tVATVr,R:C tuww 14r£tr'e tlw rf rile Ucerti,ec etw,%v ar have the^liability imsur,mcc,cnVeNTe nor"ally required by lawn.By my
sigl'Wure below,f hereby w4°nrwe this requnensen f nm the(cil,,e la t)rue) C7 crw4Mwc.. C7 rwr area's rasenr.
Owner/Agent ,
Signature _ _ _...._.. Teiephone
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— uu�uuuuwuww mwwum mu LIB
j ACCNrt 0- C7 ID:RS
CERTIFICATE OF LIABILITY INSURANCE DATE(AMUS ,
THIS CRTiFtdATE is iEo A5 A.MATTES CIF INFORNIATICDN ONLY Area CC)NFE�RS NO RIGHTS UPCaN THE CERTIFICATE NdLO
ER.THIS
10128114.
CERTIFICATE CERTIFICATE
NOT TE OF INSURANCE
OR NECS NOT C AAi n EX,TEN'D OR ALTER THE COVERAGE AFFORDED BY TH pOL►CIM
BELCrW THIS CEFtTtFICATE OF INSURANCE DOES NOT CONBTiTUTE A CONTRACT
8 EN THE ISSUING INSURER(8,AUTHOFBXED
R"PRES'ENTAT►VE'on PRODUCER,AND THE CERTIFICATE HOLDER.IMPOnTANTt if the r rtrficate hOider is anAODi'T11 the terns and conditfDns of the p "y,certaln FIAT INr" re.Itha pcaltcy(1e�51 msrst!�endrNsed. If SU8ROC1ATrON IS WAIVED,Sabi to
certificate holder In Ilou Of such endDlaement a r a I an andorsO went A statement on this certificate dcoaa not confer rrprtt>�to the
PRODUCER
Cboarl Insurance Agcy,Inc. Phorts.781.935.8480 0
"5645 Unicorn park Drive
Woburn,
Fax;T81.933 NNONE Wlbum,R1A 01801 .---"------.
AAX
ELECT»j
� rNBURcts Electrical Dynamicax,Inc.;I EDI Network Systems,tnO, �_inc ,"nu�rA_
11 waare ;So60ctiwe trtsurnce Co of SC i9259
728 Concord Street eRR A card tneurancs Company
1 North Reading,MA Oi864 0""'�rd l� n42390
Oyu U dorwriter at Lto ds
wsuw m o;Libe"Utual Insurance Col
lw rrRE EEw North Rlvar Insurance Cam an
i C'OVERAGES ERF. ' 21105
CERTlF1CATE NUMORR.
THIS IS TO CERTIFY THAT THE.PfltICtEEt OF iNSU CE LISTED BELOW RAVE BEEN ISSUED TC)1HE INSURED NAMED ABOVE`FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANI�Nl3 ANT REOUiREMEFtT�TERM dJR REVISION NUMBER:
r CERTIFICATE 6WY BE ISSUED OR MAW PtzRTAIN,THE tIVSU CCaNlDITION OF
/ EaSCLUSIONS AND CONDITIONS DF SUCH POLICIES.LIMITS SHCaWN E AFFORDED try THE DOL ES DESCRIEBED HERE IS SUBJECTpTECT TO O WHICH
THIS
TYPE CE INSwaaCE a MAY H11VE BLEN REDUCED SY PIUD ALL TH CLAIMS.
Ovau L UUlaarrr
LNam
A X crMAMERCKL GERERAL LLASILITY 1916181 EACH OCCURRENCE x 1,000 00
CLAIMS-MADE 1XI OCCUR 11/01114 11/01/16 P _._...�._,_
X XCU Hazards __. ..._.,,,._..600,00
X Contractual Llab MED - "a Pc s 15100
PERSONAL a ADV INJURY s 11000.00
Gi AGGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE a 3,0001
AU'rDNDaiLE wsam {
POLICY X LDC PRODUCTS---toPAGO x 3,000.00
i
ANY AUTO COMBINED SINGLE Lear
ALL..OWNED All (Es $
U X i,000,00
$CHEOULED AUTO$ BODILY INJURY ll p i l) a
X HIRED AUTOS HAW55780717 11101114 1110111E BODILY INJURY(Par swil x .•__•••,"",_
X PON.OWNED AUTO$ PROPERTY DAMAGE
IPa,`drxldantI x
X UMBRELLA LIAN x l
X OCCUR
EXCESS LIAR CLAIM
EACH OCCURRENCE
DEDUCTIBLE � 581103471E $ 10,000,00
X NONE1110111� 11/01/15 A F's"�"'•---,. ..._ _ s 10,000,00
BETE
WC7RRERS CDMPENSATON If T
AND EMPLDYV&LDS Ury .....,_, x j
B ANYPROPRETORVARTNEnnE:I'L�CUmkryE YN 7f WC srATU- OTFF.
IN nd ERN 44 NN)EwS„unEO, N I A ELWC536066 11101/14
IMP"d"fO'II"NNI 11/01115 EL, CHAOcwr ar
X do.a9twuw.r MA„NH x _r- 560,64
ttl POPERATPONSEatavl E.L.DISEASE.EA EMPLOYEE $ ..�..�._ 506,80
C ProfasstanaiLlab ..
C 3 POI($Ion Ltab E0127291SA14 11101114 EL.DISEASE-POUCYLIMIT $ 600,00
11101115 Limits $II�1MA9
I LUST dATIOP1,GtILTalll$1 LOCATIONSFV'EMLES(Aftkca ACORD TaI,
ILLUSTRATION OF CD V6 2tAGL+ Adumaaa,r RMbrrks Sol a seam rPraa la a4ulnrd) ��
1
CERTIFI AT HO ER
C CEL T10N
ILLUS-1 y
71LLUs
TRATION OF COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE
AccORDAIvcE THEREOF, NOTICE WILL BE DELM�iED IN
wITFI THE PpLhCY PRp VIBIpN:I,
r�
AUTHGRtEDREIPRESENTA
T
ACORD 25(2009109) The ACORD name and logo are registered 1988- 0 9 ACORD
CORPORATIO It rights reserved,
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����„����LLICAL P�YNAFSIC CC ;�
� EiCttGgFL$ 46
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iG" E'No' " ERATOR APPLIL"Afluim
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DATE: 6-5-15
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LOCATION:
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GENERATOR kw 175
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NO INSTALLATION OR GROUND DISTURBANCEBEFORE APPROVALS*
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CONTRACTOR: Electrical Dynamics Inc.
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PHONE NUMBER: 978-664-1650
ELECTRICAL GAS Diesel
r RESIDENTIAL CCUM ERCIAL TEMPORARY
LOCATION OF GENERATOR: bear of
building
*ZONING DISTRICT,
re�t�
4 77 7
*PLANNING L! j� li fyr JAI
*CONSERVATION APPROVAL (IF IN ATERSHED)
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41
APPRtVAL" '`� ,""��N/� �� �` �r.4 �
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