HomeMy WebLinkAboutWiring Permit - Permits #12577-1 - 595 CHICKERING ROAD 8/11/2015 ,i
Dat ,
TOWN
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OF NORTH ANDOVER
PERMIT FOR WIRING
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-mission to perfortn _.,
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wiri
ra av� tea,building i�6 � � . .� � `����.".'4' . .. ... ,� ,� . .,. .
at
-th Andover, Mass
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ELAWTRWAL INSPECTOR
Chuck#
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Commonwealth of massachtisetts Official �y
Department of Fire Services Permit No
Occupancy an Fee Checked
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BOARDC� FIREPREVENTION REGULATIONS Jev 1!(17] ._
_._... (leave bl un
APPLICAAD work lo be TION
IO �Fr rPE 1T T �I�4�<t�M(MEAL� "FORK
PIRFCR LtTRIC
a°tirr`til dirc.�. w al.h llac t r��,,.ar.tstr eGts Ide trioEC`l,527("4'1t� ➢2,00
(PLE t5f,PRINT IN IN ('Y? TYP.P>'IILL INF ()RAL4710N) Date:
City or`owrt oh 1�JOR141 A bra the 111s ec-toyx rrf G rre�v
Location �+treet ,!VnanMae�r �" f
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By this atrlrli.ctwttcrtt tlrc uauo9ersr gnccl �rve.� s�c,rut teas or tao c ur�at�^ taorat to Der&ut�t�itra electrical woar�clescrube<f l ;losw..
(
Owner or Tenant
Owner's Address
Felephone No.
jIs this permit in conjunction with as building permit?mm~~� es �� p Nn � (Check Appropriate Box)
j Purpose of Building
_ Utility Authorization No.
Existing lertrioeAmps _ t w,.._ Volts Overhead
t.G'radrd� No.of Meters
j New SaWry icc' _. w. Amps .._w_... __... Volts Overhead w"
(Judged d No.Of Meters �
nmNaeu~ail" ^eedea's,and Amlaacaty,
Location and Nature art"Proposc d L!; ctricaal Work:
l rrm xfe'trrrn a u/rc rrdf<rra�rwr r
.�_.. 0111y d/r4 Is L
NLuminairescfrrr r�z
_ .__ l raaasfirrmo Transformers re c,a
jNo.of Recessed N a of C eel4easp.(Puddle)Funs Or ° otua
No.of L.urmin,aire Outlets No.of Hot Tubs --
eoeraton XVAt
` No.rat"l.nnuica,airos Swimming Ps of �aac �� - � or.o auner cncy ,at;a.and 1
ff
and rod. llntter units
�,
No.ofReceptacle outlets Nn nt`Oil ILaaraaers
_ Pn, FIRE ALARMS
n 14n ti ti w n 'Nea.cul`;t ones °
0
�._..__
Nor.Of Switches No rat`Gas Burners an
_....... ...._� ..w...�,...... .._.,_ l)oavaces
_.
yNo.of Ranges No,of Air C ond.
Tons No.of Alerting Devices u
N'o.of Waste Disposers e�t�*aiunp camera loans � � _..-- �
p Space/Area lleaa oa��rk Aleratnaaae
__. .._ Total ILateeri<rnl lertaua kMev'
No,of DishwashersHealing L,o➢c°aal.�r,,Waiaeapaa
Inc" Other
No.of DryersHenting ApplimteejKW �ecaarat r steams:
No.o aatcr � of erara;w ore i a nnnlcntp
f eaaters K
Nn.Llydo�rrmaassn a iLaxthtnbs No out, na -___._. all�sts Nor,of Lfevuces aa°Ise navulewaB ,.
____...
Nn Ldarv�
rrf E ate. entar� _
CIT`LLI<L» '. .._ Foatrras LoataalllL' � ..
a I o o.a,oaaaaaaaanacnfaons gran
to tanra:ut€d Vaahao of Electrical hark yh�lrcrr raoaal Y / I f a.s�r c, x tr..r e�f y,rdrt frartrerIor�q P1,7res. 1
6 J
t Work totaart: ( �usrtcl frrxrazrrroaYral�rrrrluc p/;
... _ I f ( o 1,
IN�sl,11�a�NC' COVERAGE- Irv�,irroetartci by tier.outwratca�oCrs�accordance
t/ww,�rtfa lt�sC fttalt, ., atpaa.
l,: (.laths wtrcrnd for frc ( ur he,performance of electrical work completion
t
ttl aracl tsaoaaa cot
.na ry ussuoa ranlcss /
undersigned certifies tlYiat stucM ;overage is uct ti.Mrcce;ar°rot has exhibited f or its:substantial„eq equivalent, "I'1re Jl
the licensee rrtar✓atles rrtxoa6°orf'IsaCrclrty insurance srrtloa<fan a,arnro wla,koscf cro ao^ratir°arr"°corwt,c ;e
irrotruf Of same for the pernm issuing orffrce�, t%
CHECK ONE: fN"sl�F�'. NC,E BOND � CDlffER i �r (,Spe ifw)
FIRM NAracXertDre rrrr s rrrrear r f u➢ .. .,M rrrrr ,.aa�f'o&o�r��ecerat�on is true and complete f
_._.
certify,
_._._... I t(.'.NO..
rrar es rs `ra r rr r,that the rrt oer^trt
Licensec Signature
(ffa _.._..._._.
rrenter
NO.-
Address: emrca�r �voMra�a�� trrzes,i � ..._.. „,
tart err tdrr^6acua°rtir�rrzrearrtr�r � �� L,l�l. NCI'
Bus-Tel.No /„
" Alt.'Fe. Nor .._ f rt
Per M,G f c 147 s 57 Ev l sec¢ur�ty work agate that ieyitl'p�afa:ue�raarrt ftx S w I icertse: l is No
cl Is u o: craa r strain o rro
OWNER'S IN'alll� N(.l " ^�l` l+,l�: I
Licenseethe Crrubrlttnorma l
required b law, fl rrty sa aaattarc,below,f Irerofay ur'live dlis re a irernent, I suet the(check orrae artsacrewrtrrccrveaa�pvvner'sa,,rf nt.
Owner/Agent 1
Signature, N
erase rr. ��!",l'�'il'J�TF1_�"`
as I tl
C� L
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ACORN .caAi e�nn u�aiYYYY _
CERTIFICATE OF LIABILITY INSURANCE 8d6/2015
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 DOE'S NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IMPORTANT: It the certificate holder is an ADDITIONAL INSURED,the pollcy'(les�most Ne endorsed. I' SSUBROCIATION IS VtlWAVVE13,subject to
the terms and conditions of the policy,ozertaln policies may require an endorsement, A statement can this certificate does not confer rights to the
certificate holder in Ilou of Such ondorsomant(s.
PRODUCER COWT T C' +ra,l. Hawkins
P O pac 1.260 _.... _...._.__
D.B. Warlie:k: & Co. PbdCfiPE � f602y954 6065
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69 Lafayette Rd.
j aNsuRE I AFFORcn vERAOE rrAno
North FI
__._. _..__amptoaaM,.,... H... 0556 �. _,_..w B suriERA.Patriot Insu �
j INSUREr INSUFW-$a„ a f!ety InACdrek k
Stimuli Sight & :3pun.cl, LLC
_....___ .... ___,......._...........
652 Central Ave BwIsuRERGa:
SuiteP ........._.._._m.__�__..w_w_
INSURER E:
% Dover NH 0 520 INSURER F
j COVERAGES CERTIFICATE NUMBER 2015 2016 MASTER REVISION NUMBER.
j T HIS IS TO C RTIF'Y THAT TH POLIK IE p INSURANC E LISTED BELOW 1 YAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE F CYLI "Y 6'WC7€a
INC}YCAFECI. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY C7NTIRACY OR OTHER DOCUMENT VNITH RESPECT- CC}V*IICH THIS
CERTIFICATE IWA,Y BE IS rUE D OR MAY PERTAIN, THE INSURANCE Ar l'C71'CP.DE D BY THE POLICIES tDESC@',WEID HERON IS SUBJECT'TO ALL THE TERUS,
10 EXCLUSIONS AND CONNTIONS OF SUCH POL dC"IES,UMITS SHOWN MAY HAVE BEEN REDUCED BY PAI D C;LAIMS,
_..__ .. _ -----.. _.... ..._
_.. .. .. _._......_.
D IN7R TYPE CF'INSURANCE —Am p e~r ...... PpLYCY EI"F` PWOO Eiyy
PCLIC'd'PddJ lfABER ,BN!@IIFI71DdYYYX� YubYfEd&YrACMYYY EY@EkTfi
GENERAL LIABILITY
_.. FACHR.CCURRENCE` 1 1,000,000
l rJMtvdG.C"AL GENERAL IJAE B.rf"i' "p �e ta'T`pEC °9" ,,....
wR&P t�D LE4�aa D 500,000
A CLAIMS>MAB�r [ OCCUR C'46fDDe!32D �'xeA ea afDel2¢Die
L.,m.� 5,000
IS, _... .___.,..,_.....___.._,_._.....__._,._._...... PDIS NAL&ADVNJURY '" 000,000
GE.NERAL AGGREGATE F 2,000,000
LEI4'`L AGfrFCRCA'FL L.PMIipu4--°f'I ql Fx6_Vk-
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DC RDLIcv a
AUTOMOBILE LIAMLITY
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_....._.,........,..._...._,.._.."__'_a"._"�.._..,.000,000
op ppl
ANY n.rr DILVNJURYgPuam v) $
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NON OWNED
hIRSLA0.IPCS A l „ PROPER t1P9F &
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C71ur8PdEL9.A LIAR OCCUR
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COMPENSATION .. .�� .. ,. ..„ „m„�,�
DYERS"LIABILITY WVPG W G/k CVJ
ANY Yoh"OPRF E�r('.$RI"h'R p NErb IEXE,4 M I auVC; W r%I &.dX4.Y
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DESCRIPTIONOFOPERATIONS/B..pCAYIeMfS'1 VfEw9NrY,kik;W IAkkrgCTI AC�07 101,Ae�R1ffio"';I RrArpuAarYaAi�Sckpesdr+lar.1W rr0.r,,�r'm apace,Bas reeW,eaBrrod,l
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CERTIFICATE HOLDER � CANCELLATION
1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE'
THE EXPIRATION GATE THEREOF, NICE VWLL OF 0ELPICRED IN
Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS,
120 Main Streets l
North Andover, 02845 AUrwoRUEDREPRESENTATIVE
L7eVLid 'dWarl.xc"k/CA I' ........_.___.�«d' f!i.. 6„,..+`...__........ j
ACORD 25(2010/05)
trl 1955 2010 ACORD CORPORATION, All rights reserved.
INFSTfF2!Sd v 'i a72 Th...kAr`.opn rxgx�rxe awr@&r «n o wow w x xer Ymrc e8 ax�a&c a 6 Ar9r4rbrY 1;
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CERTIFICATE OF LIABILITY IN
SMQtI.1 THIS IFIC TI I(ATE !S ISSUErI AS A IWATTER F dNECIRIWATI NSURANCE CDp 1 lyq
CERTIFICATE OC1ES NET A��IRNIATI�P Y OR NCATIWEt AMEND, dAgEIWYBefWYWYI
REPC Il. THIS O RTIEk ATE CIS INSURANCE LOClES NET 0810 T a 1
j add Y A CkNf AL N RIGHTS C USN THE CERTIFICATE HOLDER. THIS
REI?RESENTATdyE ClR ERI7PJU ER,ANEf THE RTIFN ATE HC)LL1ER EXTEND C!R ALTER THE UUPON E Al E
ONSTITUTE A CONT
the terms R df the it � I to holder Is an AO�TlC1NAL INSURED, the pellcy�ies � CIRCIECI SY THE l'CaLlGlES
CONTRACT SE'lTVUEEN THE ISSUING INSURER S
f the termsrw danatlticrras of tPr pIlcy,de C 1UTHEy
dertiticata holder In lieu Brf such j andosemernPRODUCER
Bernar inBtranes, tB lsn p awlldles rrasv regerlre aaa elTdrxrserlazaaTt A endcwrsed' if SUER
C ;�TICYN 15 VAlV6D,32 SGII tolnc, not confer rights to theVakstsld Street
PO Box 1268
Cr9NTAC fi
Rochss*NH 0666.1269
� Msllsa Meeks E
MABk at! _ p
APfffl VR
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INsu RE'o Sti"U 1 Sight Sotlntt t L oNsarnER s AEEpRnING cowenar
4 l.}.
BN�Ukl A,,ArnTrUat
Chris rphee Andrew AMA t
Ar
652 Central Ave Ste FINSURrR B
Cover„NH 03620.6412
NSAIRER ra
NSBRERc,�
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CClVERAl,ES
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THIS!� fiCJ CIwC~ITIF'Y'YFl#4T'T'hdE E� CERTIElCATE NUIWiTEi�; n� _. 1.
lNCtf�ATED. DLIL;IgmS C7E BR}SBJR�dgvdl:'LISTLD "'.�,„.„„�,. .
IICaT'S/VTF�ST�4tllidlV4 ANr REGIlgREgi NT, IlsRtdd fIR"G3l OadlCtN CEB
CERTIF'IC�ATE �lI ISSUED RtPiit�
i�GEI.f�VW'Hy1,�/I; BEEN laa,�x"ldtCJ lir,
EXCCU5gC7N56dC! DR Y PER"CyiP�„ ANY
. H PC1LPC qF THl PW di&71 V4 lwl�kW FkA��P3- FOR THE
rNSR E UR tN�E ACF DRDPEa D RESPECT'TPOLICY CY Wm CH
TYPE b INSU &C S Ckt`SNJ AnraE kri N3r IIIN Cep d it 5 f!!gilt R3lp ISR&tN 1 HdS
SURED
GENE "� l.d'14lRTS,o.ro ... SEEN RED Sb'Pl49la x� �q U E°° 'I TC7
naa c{anfzrrw ._ 1' Las YN aMaER L p ,a ALL THE TERMS, pia'
PCS��Y EEa"
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diz E#clwdw,drew wffuwa^.ze 9r¢ ""'�..___�__ mji
:EtTt"IFICATE HCIt DER
------
TOWNI4l.5 _•� _..__ i
Town of North Andover THE,SHOULD v a TIDE ABOVE o 'oR So a of e�a�5 e�o r
THE DANCE WrrKYN THE THERE NOTICE S B.E � E L D Be OR
��
120!Wale Street ACCORDANCE Tlts
North Andover,lWA 01845 POcl Y PR atalSlcT s.
.AUT"ORIZ,ED REPRE,SE;N'aADVE,
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