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HomeMy WebLinkAboutWiring Permit - Permits #12661 - 300 CHESTNUT STREET 8/27/2014 t Date :. . ..... ............... o'',•:".`,;',�•ti�op TOXIN OF NORTH A NDOVER PERMIT FOR WIRING gSgCHU9� This certifies that ......... ... ... .........: has permission to perform r y wiring in the building at .......................................................' � � `.. .................... . North Andover,Ma tFee............. ....Lic. No .�...,"... ,.V.......:.:............. . CTRICAL NSPECTOR I Check# p � f ------------- Official Use Only THE COMMONWEALTH OFMASSACHU5ETT5 Permit No. V214 e(P Department of Public Safety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy&Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CM 12:00 (Please Print in ink or type all information) Date 4 z•1(1, To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number eJ Owner or Tenant Owner's Address 4 if/,a Is this permit in conjunction with a building permit Yes No (Check Appropriat Box) r Purpose of Building Utility Auth, ization No. 7 767 2 ;g Existing Service Amps /?,�/Z <10 Voits Overhead Undgm No.of Meters New Service —Amps-.12-1 t 4'P Volts Overhead nd m No.of Meters Number of Feeders and Ampacity CIS) tj 2, Location and Nature of Proposed Electrical Work 11 VVJz;jj-VkJ evc. As ptslc� ie, 1L,1 lk,,.­J '�71 L, fed,j 4. Total No of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above In Nq,of Lighting Fixtures Swimming Pool gmd gmd Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.ofZone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Diposal No. Pumps Tons KW_ No.of Sounding Devices Nod of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices - Municipal . Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE, Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO have submitted valid proof of same to the Office YES= NO = If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of lecrtcal Su, ` Work to Start & _( 41 Work$ ,,� Inspection Date Resquested Rough Final Signed under t!19,Pea of*1,7 FIRM NAME.- LIC.NO. '7-1- • 0 Licensees LIC.NO. Bus.Tel No. Address Alt Tel.No, OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) W h(I F1, G11 w ,�' r J . � ..� �.��: r�T� �� �� ��� �� � �s-�� �. The C'oMnt ORIVeaM qfffassachusetts -• .�e�a�€.rxaent o�'�'nr�'�rst.�rt�Z.�cczc�ent� • . Qfflce vPnvesfigavons 600 Washingtol Mrad Roston,MA 02111 vww.masv gov1dIa 'orkoxg,COMP emAon nohow,cis Af MaAt: Oxg '�'a�tft(Busir3.esslOxganiaafionitndz`vi�uat�: � .� '�, � ��. , S c� c � � Addroos' Phono 6 • 5117 A-rayorxax+ euployea:?Chocktb.o appmxlatehox; Type ofpxojeet(regdred): 4, d S am a general Contractor and x j.}�""�a�+.a ex�nPXayex�tTa '�=_� _. 6. fj New constxuetzaa employees(-fMnCCoxPatt time): have B t'edtRo mb-contxactoxs 2. rm a sOZepxopxfofar or fisted on fire aftacb.ed ABOt T `�. emodeliaag s7r3p aaxd`�aaveaza•eanpZoyees These mb-con fraetoxs have 8. E(wr oMon Vvoxldng axane iu aaz Capacity, workers'Comp.l sma-aw. 9, f]Buffdvxg addition pTO wor&rexs,comp.�isuranco 5, we axe a coxpoxatfoax andafs fo.r(EleCfxfcahopafrs on add Lions xectaixed.] oftcershave exercfsoa-theax Z am a homeowner�ofng all Work light o..exemptkm�aerMef, �z..�(�'Zumbingxe�aaixs or adt7ztzons anyseL Toworkexs°coaa2 . o.152a§1(4)a andwehaven.o 12.P R.00£xePa9xs insuxaa7ce;a ec axed. i employees.L1b workers' v.E]Other COMP.xnsuxancerecfnixed.� ''�.Anyappiicanttiaatchecksbo�#�rnuscalso�TlducthesaefionbelbYrshowiugtbeix'vtozkers'eompensatiort.�alicyint`orrnatioa. 7 Hotneov Hers vrha submit tfiis of dayz indicating they Redoing all,myVand than hire onfsido contractors must sannt a neyt affxdayif indicating snob. xConfraefoxs that ob.eckthisboxxaristattachedwadditionalsheetshoyringthezrameo tbesub-contracforsandtheiryrorlters°Comp.PORGY infozmaizan, ajnan ernp� v t�icc is p avzr ir�g t��or�e 'cornpev ation.znsu WIC �'oa�fn e rayees; Berox�z t7 e alzcy ar�r jo i�`e irz fb�.�tatiax2. ksumnrce Cam:PanyNam.e;. AA CI :'o:fay#or aSal ins. Sob .A-Ua.eI,a copy O t7iteseafters,caxnpeusatzo:Tolzcyaeclaxatamgaga�s owing, repo ayntmx taxanc e itatzon data). :'aitut:e to secures Cavexage as xeqi*od.under Seetim 25A o:i:MC.f,0,152 can Zeadfo the itnposfffon o�crian%na�penaZtzes o�a Fare up to civilpenalffes in.the f'oxxn.ofa STOI"WORK ORDER,and a fmo ofup to$250.00 a day againsttfte. 101afor. De advl od'tbat a copy ofthzs statem,entmay be foxwardedfa the O.fffce oa• 7nvosffgatfaaz9 aVhe DU for insurance coverage ve'Xifloaffon. zex e r, � cue f aieyaNy and very Neff ofvarPlY that AM!BfO xafiOB OvId69 above f9 IP96 anti eott ecs`, Sx afare. .., Date; Rhone#: .... Qfcial asa ataZy, DO noa`rvrite Al dais area,lobe eonwrefed by eliy ov tow.o•fj`WaX.' Cxty ox' 'owx�: Perm t[Lieenge# Sssuxaag. wth f y(circle One): 1.j3oaxd of f'ealtb 2.RuxZdzrzg opaa txrzeszt .CfWTOM Clerk 4.EXectxzcal xnspectox 5.33umbfng)C 8poetox• 6.0tbear - - - COMMONWEALTH OF MASSACHUSETTS n ® " ' g SOAAD`OF ELECTRICIANS ISSUES THE FOLLOWING LICENSE AS A REGISTERED MASTER ELECTRICIAN \ I� J LEE ASSOCIATES INC DBA J LEE E DANA GLEASON {Nul 753 FOREST ST i MARLBORO MA 01752-30474 6 2068 A 0 1 16 -� CERTIFICATE OF LIABILITY INSURANCE 2/27/2014 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(les)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 c Lrtificate does not confer rights to the certificate holder In lieu of such endorsements(s) PRODUCER CONTACT NAM . FIAT,Inc. (icc.No E.1): (603)669-3218 rac ND.:) (603)645-4331 1100 Elm Street ADDR ADDRESS: Manchester,NH 03101 PRODUCER CUSTOMER ID of INSURERS AFFORDING COVERAGE NA(C tf INSURED INSURER A: Atlantic Charter Insurance Company VDAC �4326 J Lee Associa(es,Inc, INSURER B: INSURER C: 753 Forest Street,it 110 INSURER 0: Marlborough, MA 01752 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 MAYBE 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 TYPE OF INSURANCE AODL SOUR POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS - LTR INSR WVD DATE(MMIDDlYY) DATE(ARNDOIYY) Ila Thousand) GENERAL LIABILITY EACHOCCURnENCE S S COTALIERCIAL GENERAL LIAD OFJAAGE TO RENTED PREMISES IIITY ❑� IEs ocnurnncn) CLAIMS MADE ElOCCUR IED EXP(Any 0Aa person) $ PERSONAL d ADV INJURY S GENERAL AGGREGATE $ GErrL AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGO S POLICY El PROJECT ❑LOG AUTOMOBILE LIABILITY COMBINED SINGLE UHIT S ANY AUTO (Es Acddmq BODILY INJURY ALL OWNED AUTOS (Pcr P—) S SCHEDULED AUTOS ❑� BODILY INJURY S (Es Avddml) HIRED AUTOS PROPERTY DAMAGE S NON•OWNDFD AUTOS (Ea Acidmi) 'UMBRELLA OCCUR UAUILITY ❑ EACHOCCURRFNCE S FXCF94 UAD❑ CLNMS MADE AGGREGATE 5 DEDUCTIBLE EI a $ S RETENTION $ WORKERS COMPENSATION AND WCV010615OI 0212WMI4 0�j26�20 tJ X STATUTORY DTH"eR A EMPLOYERS'LIABILITY LIMIITS ANY PROPRIETORMARTNERlEXECUTIVE Y/N ---- OFFICEMAE1.10E11 EXCLUDED? El � Policy Coverage State:NIA EACH ACCIDENT hlenJals S 1,000,000 ry ur NH Ilyne,das aaD d,,SPECIAL PROVISIONS bMkr DISEASE•POLICY LIMIT S 1,000,000 DISEASE•EACH EMPLOYEE s 1,000,000 OTHER a I t__I I OESCIUPTION OF OPERATIONSILOCATIDNSNEHICLES(Attach ACORD Lel,Addillsnal R—artn SdmdWo,tl-pew la rogwrod) Guardian Energy Management Solutions, LLC additional named insured CERTIFICATE HOLDER CANCELLATION ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 12 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. 9 BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. UTNORIZEO REPRESENTATIVE /T `i�N✓� 's Acono 25(zoosros) PagO 1 0l( CEI21'IF1C'I'E FIOI..DER COPY 0100E-2009 ACORO CORPORATION.All rights reported. } DATE A� CERTIFICATE OF LIABILITY INSURANCE 4/23M2014 ) 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 Lynn Blanchard NAME; Y FIAI/Cross Insurance PHONE . (603)669-3218 FAX. o:(603)645-4331 IA/C1100 Elm Street ADDRESS.lblanchard@crossagency.com INSURERS AFFORDING COVERAGE NAIC 0 Manchester NH 03101 INSURER AExecutive Risk Indemnity, Inc. 35181 INSURED INSURER B;HanOVer Iris Group J Lee Associates, Inc. INSURERC:Torus National Ins Co 25496 420 Northboro Road Central INSURERD:Colony Ins Cc 39993 INSURER E: Marlborough MA 01752 1 INSURERF: COVERAGES CERTIFICATE NUMBER:) Lee Only - 2014 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. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD/YYYY MM/DDNYYY GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY DAPRE MISEMAGE S(Ea occur RENTED rence) 8 100,000 A CLAIMS-MADE OCCUR X Y VCGPO80388 4/28/2014 4/28/2015 MED EXP(Any one person) S 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 POLICY X PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED X Y AWV A287120-00 4/28/2014 4/28/2015 BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident Undennsured Motorist BA $ 500,000 X UMBRELLA LIAB X JOCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION 1897213140ILI 4/28/2014 4/28/2015 $ WORKERS COMPENSATIONWorker's Compensation WCSTATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNEWEXECUTIVE YIN certificate to be issued E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N/A - - - (Mandatory in NH) irectly by Carrier E.L.DISEASE-EA EMPLOYE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Pollution Liability CPL301641 8/19/2013 8/19/2014 General Aggregate $3,000,000 Each Occurrence $1,500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) REFERENCE OR PROJECT HERE. ******FOR INFORMATION ONLY. . . .HOLDER IS ADDITIONAL INSURED UNDER GENERAL LIABILITY (ON A PRIMARY & NON-CONTRIBUTORY BASIS) AND AUTO LIABILITY AS REQUIRED BY WRITTEN CONTRACT, WAIVER OF SUBROBATION APPLIES UNDER GENERAL LIABILITY AND AUTO LIABILITY AS REQUIRED BY WRITTEN CONTRACT. UMBRELLA POLICY IS FOLLOW FORM. . .FOR INFORMATIONAL PURPOSES ONLY****** Refer to policy for exclusionary endorsements and special provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FOR INFORMATION ONLY ACCORDANCE WITH THE POLICY PROVISIONS. FOR INFORMATION ONLY FOR INFORMATION ONLY AUTHORIZED REPRESENTATIVE FOR INFORMATION ONLY Lynn Blanchard/LM5 Cz-41= ��- ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025oninmim Tha ACr1RIl name nnrd Innn arc ranictorarl mark¢of Af nPn