HomeMy WebLinkAboutWiring Permit - Permits #12543 - 569 CHICKERING ROAD 7/23/2014 /%WN///"W10i1i//�r�vi
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rOWN OF NORTH ANDOVER
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PERMIT FOR WIRING
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BOARD OF FIRE P EV' NTION REGUL.ATIC) lS RM 1/071 leave blank
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APPLICATION FOR�PORMITT PER C RM, ELECTRICAL WORK
,. (f'LE,4S'f R1A#1YIAI OR�"t'.i'/� L INTO with � �)stteal"�adc(ME,C�� �7CM R Op
All work to be performed it accordant12.
or"of Wires.-
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( wed tv s rrtt the electrical work described below.
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Location E(Street
&' NU Inbarhe skgu � �notice of his o � fa �
Owner or Tenn �.t �... . Telephone
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y � �" �� � "��� ��, 1 clef hone No,"t l
Qwner's Address _
Is this permit:in conjunction with a b Ildlin permit? Iles No 'v (Cheek Appropriate Box)
Purpose ofBuilding flity AuthoricationNo.
E xisting Service Amps t d Volts Overhead1U'ndgrd ir'o.of hIeters
Now eLIIC,e � Amps Volts Cveriread 1lndgrd LJ No.of Meters
Number of Feeders and Ampaeity
Location am),Nature of Proposed Etc iricaf Work:
eatPatafn tame ba rvatvad b the(ras ector of"Wires.
No,pfRecesssd Luminaireso.No. rceil,-sbtsp.(Paddle Pa `' . Trans or►rtars KVA
No.ofLuminairoOutlets No."of Hot Tubs �', Canarators . INA
A ova o.o cnergeney ig t tng
lo.ofLuminalras swt�tsrnlnPool rnd. d, Matta Units
� No.otRarepfacle Outlets No.t f'41i1"Burners (% FIRE ALARMS No»of Zones
No.orswitches Np«.; f( as Itstinmts i173 i6TDotection and
InitlatinDevices
No.ofRan es � at
g Nat..iofAh-Coed, on No.of Alerting Devices r
o.of Waste Disposers rat :'temp . It bar IWts o.of al antaina
I"otalsz " Detection/Alertin Devices
No.ofDlsliwastil Spill A . aiyeating KW ° Local 0 Municipal
Connection 0 Other p
No.of Dryers lirlting Appliances ccttrlty syysta�nsa
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o.of afar No.of rievices or Equivalent
treaters ICW o,o a,o Data Wiring
ns ►�zal�sC, ' No.of Devices or Equivalent
No.tiJ etrnnrsessage tSathtubs Na.�a y of Totpl I kl a ecotnmun oat pnr 1111.
__.__._.. No.ofDavtces or E ulvn ant
,,gg rlatnc—_ lair'd srred,or cis required 1i the tnraector of Wipes,
Estimated Value of Electrical Work. t t � " (Wlaan recluitea munici'a]policy.)
Work to Stark. Inspe tions to be requested in accorklarf f vith C Rule 10,and upon completion.
IlWSl1EtANCE CCIVEI2AGE: Unless aivad b the owner,no permiti for f parfor: ance of electrical work may issue unless
the licensee provides proofofllability in uranee�ncluding"'complated op ' on,,coverage or its substantial equivalent. The
undersigned certifies that such coverage s in force,and has exhibited pro saute to the permit issuing office.
CHECK BONE: lNSUkANCE BO O Ej , OTHER a if} ";
icertl IArnd erA/te alms" ettaCties. air ttroP t/rtr ptnratio cr r .ids n4xpA.icntinta is trite and c"arrrplete.
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Licenser:_ ignatur ` 1xIC.NC►.: (, pff
ffappltcable,antar exa p "in thelicen a ab tt aJ „ " Bus. No. Vell
Address: " Alt.Tel No..
*Per MG-L.c.147,s.57-61,security w rk requites Dcpartment o Pa1r, y �S "i icansc; L,ic.No.
OWNEit's INSURANCE IYA'LYJgTt« `turat awe a that theLieansaa cdc�s awe the liability insurance coverage normally
required by law. By my sigrtatura bald I`itoxab, waivo this rcqutrameit(�a ��the(che,
Owner/Agent j PEW Il'T"1r.Ti'E $ 1 J"
Signature _ 1 Telephone No, �
t Date 1 oviscd:1012,3112
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thank you ) I��de'7 at('800)833-3211 Oxt 1205
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Client#n 63348 SAFEHOM
AC:C9'RD. CERtIFICAT0101F LIABILITY MURANCE Da/a(MMJD
f THIS CERTIFICATE IS ISSUED AS A ATTER OF IHF ATION ONLY AND CONFERS NO RiC,HTS PON THE CERTIFICATE HOLDER.THIS
BELOW.THIS CERTIFITIFICATE DOES CATE O SVERAGE AFFORDED BY THE POLICIES
U NCE DOES N CONSTITUTEA CONTRAC,EXTEND OR T
BETWEEN TOHE ISSUING I SURER(3),AUTHORIZED
REPRESENTATIVE OR PRODUCER, ND THE CERTI ATE HOLDER,
IMPORTA T:ff the certtticate holdB►f srn AC►DITUJHA SURED,fhe pailoy(ies)must be endorsed.Pf S BRO ATION IS WAIVED,subject to
the terms and conditions of the policy,cartel"policia ay require an endorsement.A statement on this certificate does not confer rights to the
certificate holder In lieu of such endo ement(s).
PaoeticER R MarilynO"Amato
j Fradette Carlson Agency P E _ _._._._
0 Exl $60 583.004 (A/C,NoI:86a_506_8403
PO Box 2456 mdamato@fc-ins.com
1 A r __.. _._.___
Bristol,CT 06011-2456
_ INSURER AFFORDINo DcnVERADE HAIL
860 583-0843
INSURER A�Hartford Inins Group 19682
INSURED INSURER a.peerless Insurance Co. � 241"
Safe Home Security Inc,
//y, � INSURER o
Security Systems Inc,at al
INSURER D"
55 Set)ethe CIrIVe
,�. INSURER E:,
Cromwell,CT 06416
J INSURERF:
COVERAGES CE TIFICATE NUM REVISION NUMBER:
_ THIS is TO CERTIFY THAT THE POLICIES OF INSURANCE L, TED BELOW 14A'VE BEEN ISSUED TO THE INSURED NAMEDA E FORTHE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TE OR CONDITION OF ANT"CONTRACT OR OTHER DCC'"VI+,f NT WITH IRESPER.^T To VVHECtI THIS
CERTIFICATE MAY BE ISSUED OR MAY ERTAIN, THE IN U CE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUC POLICIES, LIMI HOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
MR OF INSURANCEDOL POLICY NUMBER__._... M M p LIMITS
y A I GENERALLIaBILTTY 02U 9286 8/2212013�08/22/201 EACH OCCURRENCE $1 00a 000
X GOMMERGUU GENERAL LIABILITY � TEeronas s30 a0 O0
CLAMS-MADE a OCCUR k' MEo EXP one rcon .,£10 a�l..�
E8C)Llablli InCI x r Rsw+A1 A ADV IN,IURr yIN
1 4tW aaa
GENERAL AGGREGATE s2,000,000
GEM AGGREGATE LIMIT APPLIES PER: PRODUCTS-comp/op AGG a2000000
POLICY x PRO. L.fJC y
B BAS 382 8/22/2013 08/22/201 , 11000 aaa
r X ArnAUTo
BODILY INJURY(Per peam) s
RX ALL OS
H TY DWAMLIETDOS y
SCHEDULED ;( P„graZ
I BODILY INJURY(Per accident) _
AUTOS
AUTOS
NON-OWNED PROPERA E
HIRED $
y
A UMBRELLA UAa OCCUR 02H D4613� 8/22/2013 08122/201 EACH OCCURRENCE $ {
EXCESSLIAB OLAIMs-MADE AGGREGATE $
DW RETErxnON f $ i
WCSRKE'R13 COMPENSATION O srATxa- OTH-
A AANDEMPLOYERVLIABILITY 02YV g285 0/22/2013 08/22/201 x
r OPFIC�E �EXAC� UTri/E( j NIA i E.L.EACH ACCIDENT $500000yY�.
(Mandat"ha RN) t_i_J E.L.DISEASE-EA EWLOYEEI$500 000
rtyyea.desa9re OF
DESCRIPTKNV OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $500 00a
DESCRIPTION OF OPERATIONS/LOCATIONS IVEHICLES(Attach ACORD f l,'Addlaoml Remarks Schedule,N mows apace Is rsgWnd)
Certificate holder Is an additional Ini.urt to regar o the above listed General Liability policy,per x
contract requirements and a 30•day motice of canc 114tion endorsement applies for the Certificate holder.
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CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION;DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE'
1988.2010 ACORD CORPORATION,All rights reserved.
ACORD 25(2a1a/a5) 1 of 1 "f pACORD name 1pdfloqo are registered marks of ACOR,
# 463672/M474640 FCNtFtD
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