The URL can be used to link to this page

Home My WebLink AboutWiring Permit - Permits #12992-1 - 815 CHESTNUT STREET 12/31/2016 u "'AK NORTH °� "`° '•,� TOWN OF NORTH ANDOVER PERMIT FOR WIRING CHu5� This certifies that P has permission to perform .... ......... ........ .: ./........................ wiring in the building of .. ...� d n-l- at ............ .•... .; .......... ' ........ .........:..:...................................,North Andover,Mass. Lie. No =' `�t- ELECTRI C AL IN SPECTOR Check# `a Commonwealth of Massachusetts OIFIJ�l—Use Only Department of Fire Services Perinit No._j Oy and Fee Chec BOARD OF FIRE PREVENTION REGULATIONS [Rev.cc upanc 1 1 991 ileave blank)ked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perrormed in accordance with t1jo Nfa3$aclju3Ctt3 Electrical Code(NIEC),527 CNI 12,00 (P1Y,ASE PRINT IN INK OR TYPE ALL INFORAM TION) Date. City or Town of: to---if Wh-es: ale?el, To the htvpee ' i By this application the undersigned gives notice of his or lier intention toperform the electrical work described below. Location (Street&Number)_Y v, 15, Owner orTenant Telephone No. Owner's Address Is this permit in conjunction with a builoing permit? Yes No ❑ (Check Appropriate Box) Purpose of Building__ Utility Authorization No. Existing Set-vice Amps Volts Overhead El Undgrd ❑ No. of Meters New Service Amps Volts Overhead Ondgrd El Na, of Meters �j Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Cara lotion of the 611a4v1n table nigy be ivait,ed by the In,v, ector 0 Wires. No. of Recessed Fixtures No. of Ceill.-Susp. (Paddle) Fans I No. of , ota N Transformers KVA No.of Lighting Outlets No.ors-lot Tubs Generators KVA �n- ❑ NO. of Emergency Lighting No.of Lighting Fixtures Swini Illing Pool El grndi r-grnd, 0 Batte Units No. of Receptacle outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners 0. 0 etect on all In 114 —Total No.of Ranges No. of Air Cond. Tons No. of Alerting Devices No, 0 Receptacle OU"ets-- N N N o 0 0 o 0 f f 'In Bur ners rn Burners e of Cond. Eai�� W' V jul Na of Waste Disposers eat Pump I.Nun=br Tons 0. of Self-Contained f C' Totals; D s o. i wastle rs Space 11 1 til g �oca I Mullicipa Devices No. of Dishwashers Space/Area Heating XW Local Space/Area �V Connection 0 Other q rs ea ti ng pli 11 eating pli ces CCU tnity Systems: No.of Dryers Heating Appliances KW 0 0 No. No—.—o TW a t—er 0 0 No.of Devices or Eguivalent C0. 0 .'' 0 0 Heaters KW 110. 0 Data Wiring: 'Signs Ballasts No.of Devices or E( Uivalent F - No,Hydromassage Bathtubs No. of Motors Total HP elecorn m u n icabana ring: OTHER: No.of Devices or E(Luivalent ,4ttach odditional detaft if dviired,or as required by the hispector of;Yrres, INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"Completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office, CHECK ONE: INSORANCE/9 BOND [] O'lTfER [I (Specify;) Estinlatcd Value of Electrical Work: t ell 01; (When required by 1111.1niCipal policy,) Work to Start: Inspections to be requested in accordance with NIEC Rule 10, Wid Upon completion. I certify, under lire pains and penalties of perjury,that the information 011 this application is true and coin)fete, , 1 11 FIRM NAME: / A 7- 1 L LIC. NO.: Licensee: x Srgrratu aLIC. NO.: t1fapplica5le en fempt"in the license number linc.) Acldrcss:� fills. Tel. No. —OWNEWIS INSURki�(-,r��VkIV71 Alt. Tel. lam aware that the Ucifsee clues not hai,v the liability insurance coverage normally required by law. fly Illy Sigll.lftlre below, I hereby waive this requirement, fain the(;heck one)0 0%,wiler El owner's agent, Owner/Agent Signature Telephone No. PERJ117'rEF.- S (-J e The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www,mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Infor ti Please Print Legibly Name (Business/organizatiowbdividual): To C_CO o Address: L Cooie S- Ci /State/Zi : $r c.e is 2► c,A. A of SLl Phone#: 9 7 8-6P4o 3 -oZ 9 2. Are you an employer?Check the appropriate box: I.® I am a employer with__2j _ 4. ❑ 1 am a general contractor and I Type of project(required): employees(flail and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees v These sub-contractors have working for me in any capacity. employees and have workers' g' Demolition (No workers' camp. insurance comp. insurance.i 9. ❑ Building addition 3.❑ required.) S. ❑ We are a corporation and its 10.0 Electrical repairs or additions 1 am a homeowner doing all work officers have exercised their myself. (No workers'comp, right of exemption per MGL 1 t'❑ Plumbing repairs or additions insurance required.) t C. 152, §1(4),and we have no 12 ❑ Roof repairs employees.(No workers' 13.0 Other comp. insurance required.] •Any applicant that checks box#1 must also tiff out the section below showing their worker'compensation policy information. t Homeowners who submit this affidavit indicating they am doing all work and then him outsida contractor must submit a new affidavit indicating such. tContraetor that check this box must attached an additional sheet showing the name of the is do Contractors and state whether w not thoseit entities omployees, If the sub-contractors have employees,they must provide theft warfare co policy number, es have mp.p y l am an employer that Is providing wo information. rkers'compensation insurance for my employees, Below is the policy and job site Insurance Company Name: �4g� �t,��t� L� c �oR�QS r^ n+e! ..i,f.4r1o.J sE1F /NS"R CRoG Policy#or Self-ins. Lic.#;__�Q$e Expiration Date:_ l a- 3 Job Site Address: City/State/Zip: Failure Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine Of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct r S' ' Qh` Date: a c Ph 978 —S28_86 Z [0t e only. Do not write in this area, to be completed by city or town official wn:''' Permit/License tf thority (circle one): Boa Health 1. f3uiiding Department J. City/Town Clerk d. Electrical Inspector S. Plumbing Inspector K prson: _._ Ph- N. ComM!RN&M6TN Ot MASS CH SETTS • • • - - • •BOAAD OF A ELECTRICIANS ISSUES THE FOLLOWING LICENSE AS A REGISTERED MASTER ELECTRICIAN TOCCO CORPORATION JOSEPH V CAMILO 29 COOK ST BILLERICA MA 01821-6o44 21659 A 07/31/16 95098 TOCCCOR-01 ASTRAZZULLA A Ox DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/22/2015 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 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 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Salem Five Insurance Services,LLC PHONE FAX 445 Main Street A/c No Ext:(781)933-3100 A/C No): (781)933-9048 Woburn,MA 01801 ADDRESS:insurance.services@salemfive.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Citizens Ins Co of America 31534 INSURED INSURER B:Allmerica Financial Tocco Corporation INSURER C:Hanover American Ins. Co. 36064 Tocco Building Systems 29 Cook Street INSURER D: Billerica,MA 01821 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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. ILTR TYPE OF INSURANCE NSD WVD POLICY NUMBER POLICY MM/DDY/Y YY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FV1 OCCUR ZBNA142050-02 10/31/2015 10/31/2016 DAMAGE TO RE TED PREMISES Ea occurrence $ 250,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY a PE0 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 POTHER: $ AUTOMOBILE LIABILITY Ea COMBINED LIMIT $ 1,000,000 B ANY AUTO AWNA130312 10/31/2015 10/31/2016 BODILY INJURY(Per person) $ ALL OWNED r SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) X HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident) $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE UHNA142051-02 10/31/2015 10/31/2016 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Proof of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main St ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Client#: 1035260 TOCCOBUI ACO�''rDTM CERTIFICATE OF LIABILITY INSURANCE r ATE(MM/DD/YYYY) 12/23/2015 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 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 certificate holder in lieu of such endorsement(s). PRODUCER NAME: Kathy Wagner USI Insurance Solutions, LLC ac°0NN,Ext:413 750 4222 FAxA/c : 610 537 9481 123 Interstate Drive E-MAIL ,No West Springfield, MA 01089-3600 ADDRESS: Kathy.Wagner@usi.biz 855 874-0123 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:ABC Mass Workers Comp Self-Insu 99999 INSURED INSURER B: Tocco Building Systems R C:INSURE 29 Cook Street RE Billerica, MA 01821-6044 INSURER D --- ----- INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER M( M/DD/YYYY) (MM/DD/YYYY) _ LIMITS COMMERCIAL GENERAL LIABILITY -EACH OCCURRENCE $ I_J PREMISES Ea occurrence $ CLAIMS-MADE OCCUR _ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEIN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 71`1POLICY[_I JECOT LOC PRODUCTS-COMP/OP AGG $ _ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED i P BODILY INJURY(Per accident) $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I RETENTION$ —— - ----- ------- ----- A WORKERS COMPENSATION ABCMA00502416 1/01/2016 01/01/201 PER oTH- I- �1_ AND EMPLOYERS'LIABILITY Y/N _ STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE� OFFICER/MEMBER EXCLUDED? �"J N/A E.L.EACH ACCIDENT $1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 OOO OOO If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Proof of Massachusetts Workers Compensation Coverage CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Electrical Inspector ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S16912443/M16801319 KXWCD