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HomeMy WebLinkAboutUntitled (2) Date......................� /,,�� ................ OF NORTI.�,� F�•: :•. oea TOWN OF NORTH ANDOVER * PERMIT FOR WIRING 'yam•'',;;.::•"'�R0 This certifies that �`' "j'Y►/is .................................................... has permission to perform .....c„ .�° c.�? �.. SS�e-1 wiring in the building of................f..✓?,)................................................................................. at ...0200 ........ ................ rth Andover,Mass. .............. ................. . ...........Lic.No��° n...11.14............... W ....... .. ELECfRICALINSPEC Check# Ar, ,r) peu-u;.tNo, ' BOARD OF:FIRE PREVENTION REGUL'ATf DNS accu It-Y andFuaclteckza p fees ark p t:o eX ctnr a s e IP 11171 (Ieavefilank} copiracf# bldgermffOffaA�r��cabf� APPLICATION FOR PERM&TO P9RF0 RM EL CIF-RICAL WORD. • ,��1I�'orkfobapezfozm�divaacorct�ncal�+itb.�fie��'asseclinsetts�7eciricalCode(N173C)�527G�iR.1�OQ . . 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'-��- CCK ONE: RMLam' Ui 0 1301.[`�3 [( UTM X ft eoey:}9eX7 SMGl4- cisenderfhe rir a7xdpe aftie of e7tcr�'xtlia`trigLiformatiolzoniUvappZtcrRtio7afStraemzdear lets 1XC N9 g 172 e xsee: onlas .x ce S e TAC.NTO,: 0 I72 .1 pp crr$te,etster<`exerrm?,•in iFie case m�rrbzr?are C__ / T3tLs.T'e 1�1a. address. 1v C\.\,,No, �c• kvwsAN� (� 0 Alt, `a trltp�'ysfezu€�uu Loz�uenseragv�zedrsrfDis ork;xiappJica6le,ezderikelic se herb ce: GOW9 OWN-Mg XI'9O-t :,WAIM: IambvraratbattlaLlwmmdoesnothavetTteliabflityinst upacavempnormally rc-:;R ad bp•law.3ym'si,Pafiire Mow, !harebyYaiveOtis gniremEnt �ritlt (ouet .oze��(o xte, ❑owilzr'sa e . �guatrxxa _ Teldpha�x�No_ (e �2 1. CERTIFICATE OF LIABILITY INSURANCE DAT09125/20113 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 I, certificate holder in lieu of such endorsement(s). PRODUCER CONTACT 'O Aon Risk Services Northeast, Inc. P ONE FAX Morristown N] Office (Arc.No."): (866) 283-7122 A�No.): (800) 363-0105 a 44 Whippany Road, Suite 220 ADDRESS: 0 Morristown N3 07960 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Zurich American Ins CO 16535 ADT LLC INSURERB: American Zurich Ins CO 40142 ADT Security Services 1501 Yamato Rd INSURER C: Boca Raton FL 33431-4408 USA INSURER D: INSURER E: INSURER F: - - COVERAGES CERTIFICATE NUMBER:570051395419 _ 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. Limits shown are as requested LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDIYYYY) 1MM/DDfYYYYI LIMITS A GENERAL LIABILITY GLO EACH OCCURRENCE $2,000,000 DAMAX COMMERCIAL GENERAL LIABILITY REMI ORE $1,OOO,OOO PREMISES a oc cuwrrence CLAIMS-MADE X❑OCCUR MED EXP(Any one person) S10,000 PERSONAL 6 ADV INJURY $2,000,000 In GENERAL AGGREGATE S4,000,000 rn GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $4,000,000 O-- X POLICY PRO- LOC El � AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT Lo a acciden .. • ANY AUTO BODILY INJURY(Per person) Z ALL OWNED SCHEDULED BODILY INJURY(Per accident) IV AUTOS AUTOSPROPERTY jp HIRED AUTOS NON-OWNED (Per accident)DAMAGE r0.. AUTOS d UMBRELLA LIAB OCCUR EACH OCCURRENCE V EXCESS LU16 CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND wc509589701 10 01/2013 10 01 2014 WC STATU- OTH- A EMPLOYERS'LIABILITY YIN WC509589801 10/01/201310/Ol/2014 X TORY LIMBS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $2,000,000 OFFICERIMEMBER EXCLUDED? N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,000- DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) � J� Y1 �S CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE _ EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE ti- POLICY PROVISIONS. TOWN OF NORTH ANDOVER AUTHORIZE DREPRESENTATIVE INSPECTOR OF WIRES a�S 124 MAIN ST. �r ;r�}/�,-/�NORTH ANDOVER MA 01845 USA �y/ ey%d�Y�e/ry e eJ/lL A�///ss4 �fti1 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD M Will s -- ADT Security services - - ---- 1S Clinton Drive _ Hollis NH OA® 9_._ i ¢ ._.. .. - 6. wa (Pall afe mar. 5N;t rrix� a � "f .L; f-fral i�i e r T7 G43�1 dJ`t$ :Yr a�3tMw ¢ e _ .� I3�i1 a, �' x �ai �i ~: i ems-r � � �:_u64�� �, �-,r ,.��� ~n,� �rr�fiEr➢��9t�s!� •' �:�s'+'T� �{ii4�'�.IJ EfGr Y•F Y 9q'.�, ` NU W—r q{i^'-� ',Ofrepid-s r ,):Syfyy Vora e g. r9rieci� ►wo g SecuritVS stem 7 „4 r ; �9�i�ir�`�cte�rr�1��:3iofii�i�t��•ct��T;�e�•' t�7saii�7�•,��ic�➢:r�3a�9aaG�u. a .tis6ttssi .�:�Ls�Gsr�a'a'�• t i �yY�iL�"9J?flt�l��GfSC�IC�4?S��"a'�ll4�lr# t , i`T-��4��ai�seM6�7LOH�tS., . ��i���ea�i'e� •�aE�, g€��i��'G6d�>sa.�.f�i�X>��9�1��v�t�ra�.e���'�m]�'��s��'��i�'r��'Yit���a�4i��5•u� -- --- # �'4.f6W6.6!73�•L�r4��`O.�-''5�'x-?` m➢T�ig�� � d�u ti1f3 ttGy7,,—,ffIg 4Onhore uNUM, -T T� ZurichAm2Y(can Insurance Co. _ * 0/01/20'[� I T anca all �� ,� 11�C509 89701IUUC5o958980'( . .., c �jy�'� Oks bb Me Aunty COMIV UrMtia4iQL, . � _E � R1010 to 0 COO t 60tie 3-594-59 YS r •Trap, ��N of pre m g,w adgaRAMINK9 Mod" ,