HomeMy WebLinkAboutMiscellaneous - 3 Royal Crest4
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Datel-A
... ....................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
�ACWV12
rD
—D .1. �e_ .... . � I
(Dw
This certifies tha U -e 4v? -c
......................................... .......................................
4e
has permission to perform . .. ............................... ...................................
,,winng in the building of . .... . P .... OoKr, ..........................................................
at ........ 3 ........... ... O��-Q . ..................... North Andover, Mass.
......... .......... F.4" ..... .. ... .. .... ............ .
Fee . . .......... Lic. No. \5 I .... .... Mb .........
-5��P50 ELE TRICAL INSPECTOR
C
Check
13 0 2 15%
70
0 cY;E se Onl
Commonwealth of Massachusetts
2-55
Permit No. IZTC),
Department of Fire Services
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. I/o7l (leaveblank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00
(PLEASE PNNT INJAW OR TYRE ALL INFORM TION) Date: De -(L 61% 14 -
City or Town of. NORTH ANDOVER To the Inspector of Wires:
By Us application the -undersigned gives notice of his or her intention to perform the electrical work descrqffied below.
Location (Street& Number) So
Owner or Tenant ArAiLn TelephoJe No.
3 U t "n -- t
Owner's Address L
Is this permit in conjunctionmith a building permit?
Purpose of Building
- Existing Service Amps volts
New Service Amps volts
Yes 0 No [�J� (Check Appropriate 13ox)
Utility Authorization No.
OverheadF] Undgrd 11 No. of Meters
Overhead [:] Undgrd [:1 No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Nf-e-Y, el-ttc-4a-ic�j Conoec-4=t0r)15 1,�,k &Sk ro(
e-ke c,��c -�4�-L L -in e- Vot 6a -q,-- 44ne s i�A I S C,--n(:k C ict) ut 4- V:� f- --- 6 6 r S i� --- 4-1 V� e4
-VA.e C- 0 % r�- 1-1 <� Completion ofthe followiniz table may be waived by the Inspector of Wims-
No. of Recessed Luminaires
No. of Ceil.-Susp- (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Above Ei In
Swimming pool grnd. grnd. El
No. of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FUZE ALARMS
JN'o. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
I.KW ...........
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Municippi F1 other
LocalEl Connection
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water KW
Heaters
No. of No. of
Signs Ballasts
Data Wiring.
, No. of De�lces or Equivalent
--]—NO-
No. Hydromassage Bathtubs
of Motors Total HP
Telecommunications Wiring:
No. of Devices or Eguivalent
OTHER:
-0 Attach additional detail ifdesired, or as required by the Inspector oj Wires.
Estimated Value of Electrical W I ork: 16�,o . () (When required by mimicipal policy.)
Work to Start: Q_1 mi::� t ka Inspections to be requested in accordance with I�EC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no pertnit for the performance of electrical work may issue un ess
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.
CMCK ONE: INSURANCE [-I BONDE] OTHERF] (Specify:)
Icerfify, underthepainsandpenalties ofperjury, thattheinformation on this application istrueandcom
plete.
FIRM NAME: LIC. NO.: A 15
Licensee: 'I)A�jjd (2 VjWp Signatureko&,ua P Vjt7,� LIC. NO.::3 1 @)!5'6 G
(Ifapplicable enter "exe!npt" in the license numbe Bus. Tel. No.:
Address: ( CtO D R- I C S+ Wrilline. a VA Alt. Tel. No.:
*Per M.G.L c. 147, s. 57-6 1, security work requires Department of Public Safety "S " License: Lic. No.
OWNER'S INSURANCE WAIWR: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) El owner El owner's agent.
Owner/Agent
Signature Telephone No. [A"ITFEE.-s 12-5-
0 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the
permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed
on the prescribed, form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an
electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the
notification of completion of the work as required in M.G.L. c. 143, § 3L.
Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he
or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written
application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the permit application.
El The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of
the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this
purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With
limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was
"in effect or existence" during the qualifying period beginning on August' 15, 2008 and extending through August 15, 2012.
• Rule 8 *— Permit/Date Closed: 1 Note: Reapply for new permit 0
• Permit Extension Act — Permit/Date Closed:
Trench Inspection
Pass
Failed
Re -inspect ion Required 0
Inspectors Comments:
Inspectors Signature:
Date:
SERVICE INSPECTION:
Pass[M
Failed M
Re- Inspection Required 0
Inspectors Comments:
Inspectors Signature:
Date:
PARTIAL ROUGH INSPECTION:
Pass n?
Failed
Re- Inspection Required 0
Inspectors Comments:
Inspectors Signature:
Date:
ROUGH INSPECTION:
Pass[M
Failed IN
Re- Inspection Required 0
Inspect ors Comments:
16
Inspectors Signature:
Date:
FINAL INSPECTION:
Pass
Failed Ed
Re- Inspection Required 0
Inspectors Comments:
Inspectors Signature:
Date:
DEBWEINHOLD ... TOWN OF MERRIMAC, MA . ....... dweinhold@townofmerrimac.com
The Commonwealth of Massachusetts
nts
Department ofindustriqlAcci&
Off ice of In ' vestigations
600, Washington Street
Boston, MA 02111
www.mass-gov1dia
Workers, Compensation I insurance Affidavit: BufldersfContractorsfElectricians/Plumbers
A licant information Please PdRiLSI�
Name (Business/organizatioiVIndividual):—
Address:
Citv/State/ZiA _)cJ(Aa.c,,_w) A- 09WSJ Phone#:
Are you an employer? Check ithe appropriate box:
4. El I am a general contractor and I
1. El I am a employer with
employees (full and/or part-tim
have hired the sub -contractors
listed on the attached sheet.
2. 1 am a sole proprietor or partner-
These sub -contractors have
ship and'have -no employees
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. El We are a corporation and its
officers have exercised their
required.]
3. 1 am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
Ti
c. 152, § 1 (4), and we have no
employees. [No workers'
insurance required.]
comp. insurance required.]
Type of project (required):
6. El New construction
7. Remodeling
8. Demolition
9. n Building addition
10.0 Electrical repairs or additions
11.0 plumbing repairs or additions
12.El Roof repairs
13.0 Other_____L_
*Any applicant that che As box #1 must also fill out the section below showing their workers compensation policy information.
t Homeowners who submit this affidavit indicating tbeY aie doing all work and then hire outside contractors must submit a fiew affidavit indicating such.
TContractors that check this box must attached an Witional sheet showing the name of the sub -contractors and their workers' comp. policy information.
lam an employer that isproviding workers'CoMpensation insuranceformy employees. BeloW isthepOlICY andjoh site
information.
T_ . On any Name*
1\J k I C. -VI Q
a LU CLU.
Expiration Date:_JaLM_iq__
policy # or Solf-ins. Lic.
JobSiteAddress. 156
Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as requireclunder Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a
me
fine lip to $1,500.00 and/or one�-year imprisonment, as wen as civil penalties in the form of a STOP. WORK ORDER and a f
ofup 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.
.1 do Z1 . ergbucertify under thepains andpenaldes ofperjury that the information provided above is true and correct
V, Date:
4;2� - � qa�
Phonefl:
Official use only. Do not write in t1lis area., to be completed by c4 or town Official
City or Town:
Permit/License 0.
Issuing Authority (circle one): wn clerk 4. Electrical inspector 5. Plumbing Inspector
1. Board of Health 2. Building Department 3. CitY/TO
6. Other
Contact Person;
Phone
I
LIM
s
A
,A*.'.,COMMONWEALT-H.0 CHUSETT..:.,-'
BOARWO s
ECTATOT"A N
... ... .........
Wl GX L::::I'C E N'S E
I,MES T-HEJOLLO
�:d::�iij:669NIEqMAN. ELECTRIcIAN..
IbAkttt P VITALE
196 D A 6 T'- LU
-3 7
-WA::L:TH'A:M 7
02451
31850":.E:�::::�':*:;':'O�7'/3�l/�.-I.-6�.�.i�-:�:i�;::;�:�..:��i' 35002
/4"'o 05C,000
i irtrall ITY INSURANCE 8/26/14
�0 CERTIFIGA I r— %JI7 NO RIGHTS UPON THE CE9171FICATE HOLDER THIS
ATTE OF INFORMATION ONLY AND CONFE COVERAGE AFFORDED BY THE POLICIES
F CATE IS ISSUED AS A MATTE IVELY AMEND, EXTEND OR ALTER THE
CATE DOES NOT AFFIRMATIVELY OR NEGAT T BETWEEN THE ISSUING INSURER(S), AUTHORIZED
E OF INSURANCE DOES NOT CONSTITUTE A CONTRAC
THIS CERTIFICAT R AND THE CEffrIFICATE HOLDER. be endorsed. f lS'wv'!1J1�ffD, subject to
E ENTATIVE OR PRODUCE 'u confer rights to the
tilicate URED, the pollcAles) "1 5 Ificate does not
,pORTANT: if the cei ol er is an ADDiiibii ��TL ii�i§ nt on this cert*
e terms and conditions of the policY, certain policies MaY require an endorsement. A staterne
certificate holder in lieu of such endorsemen0). C NTACT LESLIE HANN)N (978) 667-0587
NAME: '(A'l N 0)
PRODUCER PHONE (978) 667-615
James O'Connell Insurance Agen E AIL jIMINS@OCONNELLINS-COM
572 Boston Rd A DRE S: INSURE, I's AFFORDING COVERAGE NAIC #
Unit 7 INSURER A: Merchants
Billerica, MA 01821 IKIQIIQFIZ 13: A. I M. I isur ice
INSURED DANIEL P VITALE ELECTRIC iNSURERU:
190 DALE ST INSURER D:
WALTHAM, mA 02451 7i INSURER E:
INSURER F:
__= REVISION NUMBER:
IFICATE NUMBER' �ED 'NAMED ABU,E I Uit I I IE P LICY PERIOD
COVERAGES OJE �EEI,I I�SUED 1 0 1. IEII WHICH THIS
UI::b!1'I''JCE_LISTED BELOV_ ENT WIT H RESPECT
POLICIES OF INS 104OF ANY CONTRACT OR OTHER DOCUM SUBJECT TO AL THE TERMS,
I I lIS IS To CERTIFY -111,1!1 1 11 IE REOUIREMENT, TERM OR CONDII
INDICATED. NOTWITHSTANDING ANY NSuRANCE AFFORDED BY THE POLICIES DESCRI13ED HEREIN IS —
ISSUED OR MAY PERTAIN, THE I S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CERTIFICATE MAY BE POLICIES. LIMIT CY EFF P 0 Cy EXP LIMITS
EXCLUSIONS AND CONDITIONS OF SUCH D POLICY NUMBER MM Nyyy MMIDDI 1 000 000
INSR TYPE OF INSURANCE 9 12/14 9/12/15 EACHOCCURRENCE $
LTR 9098053 DAMAGE TO RENT $ 500 000
A GENERAL LIABILITY BOP a occlo go) 15 000
X cOMMERCIALGENEPALLLABILITY MED EXP (Any one perscn) $ 000 00C
CLAIMS -MADE [i] OCCUR PERSO NA L & ADV I NJU Ry $ 1
r.rNF-PAL AGGREG E $ 4,Uyuly—
PRODUCTS - COMP/op AGG I $
Additional Re n1a rks Schedule , if Ore space is required)
EHiCLES (Attach ACORD 101
DESCRIPTION OF OPERATION51 LU1A'1V
ELECTRICAL WORK
TOWN OF NORTH ANDOVER MAL
120 MAIN ST
vrr%'DrvTJ ANDOVER , MA oIB45
I
ILESLIE HANNON
I -------- q
w 1988-20i0A I
The AC ORD name and logo are registered marks of ACORD
E -Mail:
ACORD 25 (2010/05)
.) I Phone:
Fax:
M
Z.�
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES �BE CANCELLED BEF
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
ACCORDANCE WITH THE POLICY PROVISIONS -
�U �®RIZED REPRESENTATIVE
RD CORPORATION. All rights reE
GEN'L AGGREGATE LIMIT AP LIESPER
COMBINED SINGLE LIMIT $
Pol In M r.=R,?i F ILOC
E a accident
BODILY INJURY (Per pers,n) $
AUTOMOBILE LIABILITY
BODILY INJ RY (Per accident) $
ANYAUTO
ALLoWNED SCHEDULED
pROPE. Y DAMAGE $
per accident
AUTOS AUTOS
NON -OWNED
$
HIRED AUTOS AUTOS
EACH OCCURRENCE $
UMBRELLA LIAB OCCUR
AGGREGATE $
EXCE 03 CLAImS-MADE
WC STATLJ- OTH-
DIED RETENTION $ wCC5006538012009
lo/11/13 10/11/14 X
$ 10010(
VVORKERS C MPENSATION
E,L. EACH ACCIDENT
10010
B AND EMPLOYERS'LIABILITY YIN
E.L. DISEASE - EA EMPLOYEE $
ANY PROPRIErOP/PARTNERIEXECUTIVE NIA
$ 500101
OFFICERIMEMBER EXCLUDED?
E.L. DIS EASE - PO LICY LIMIT
(MandatorY in NH)
if ves, describe under
.-.. -- — 11nMq h.10W
Additional Re n1a rks Schedule , if Ore space is required)
EHiCLES (Attach ACORD 101
DESCRIPTION OF OPERATION51 LU1A'1V
ELECTRICAL WORK
TOWN OF NORTH ANDOVER MAL
120 MAIN ST
vrr%'DrvTJ ANDOVER , MA oIB45
I
ILESLIE HANNON
I -------- q
w 1988-20i0A I
The AC ORD name and logo are registered marks of ACORD
E -Mail:
ACORD 25 (2010/05)
.) I Phone:
Fax:
M
Z.�
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES �BE CANCELLED BEF
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
ACCORDANCE WITH THE POLICY PROVISIONS -
�U �®RIZED REPRESENTATIVE
RD CORPORATION. All rights reE
Date ...... 7,9 ...... f'.L
I
TOWN OF NORTH ANDOVER ,
PERMIT FOR WIRING
This certifies that
........... ........ . ......... Z ... .. C"D .....
has permission to perform ........
of
wiring in the building ........ P ....... . . . .......... C.
a .......... ......... I ........ ............. ....... :r . ....... North Andover, Mass.
Fee j:�N T-
12, Lic. No. -7/ . . ............. /., .... . h .. P-6 .. ............
LECTRICAL INSPEH.6R
Check #
12-5-0,9
1.0
(fllnunonwea& ol Maijackwalb
BOARD OF FIRE PREVENTION REGULATIONS
Official Usc Only
Perin it No. . / 2-5-;�9 I
Occupancy and Fee Checked.
I[Rev. 1.1071 (leavc blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perl'ortned in accordance with the Massachu.wits Electrical Code (MEQ, 5.27 CM..R 12.00
(PLEASE PRhVT W 1,VK OR TI -PE ALL.TVFORVA T101V) Date: July 7,2014
City or Town Ofi North Andover Tothe Inspector qffires:
By this application the undersigned gives notice of his- or her intention to perform the electrical work described below.
Location (Street& Number) 50 Royal Crest Drive Building # 3 Apt 3
OwnerorTenant Royal Crest Apartments Telephone No. 978-681 J-822
Owner'sAd.dress 50 Royal Crest Drive North Andover, MA 01845
Is this permit in conjunction with a building permit? Yes El No I (Check Appropriate Box)
Purpose of Bui , Iding Commercial - ftartment BuildlnCIS Utility Authorization No.
Existing Service _ Amps Yolts Overhead Uncigril No. of Meters
New Service Amps Volts Overhead Undgrd No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Replace Baseboard Heat
Completion ofthe fi)1lowin.Q table mav� be wah�ed bi., the-Impector of J-Eires.
No. of Recessed Luminaires
No. of Ceii.-Susp.,(Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No.. of Hot'lubs
Generators KVA
No. of Luminaires
Swimming Pool Above r-1 In-
grnd. grnd.
No. of Emergency Lighting
Battery Units
No. otReceptacte Outlets
No. of Oil Burners
FIRE ALARNIS
No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
Noe of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Fu-]H-P-Twumber
Totals:
I ...................
I Tons.
[ .............
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Sppce/Area Heating XW
Local EJ -Municipal EJ Other
Connection
No.:of Dryers
Heating Appliances KW
Security Systerns:*
No. of Devices (it Equivalent
No. of Water
KW
No. of No. of
Data Wiring:
licaters
sigIns Ballasts
No. of Devices or Equivalent
No. Hyd romassage. Bathtubs
No. of Mot I ors Total UP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach adilitional detifil �fiiesire(l, or as, required bv; the Inspector (?f'Tf ires.
Estimated Value of Electrical Work: (When.required by municipal p0liCy.)
WorktOrStart: 07/07/2014 Inspections to be requested in accord ancew ith MEC Rule 10, and upon completion.
INSURANCE, COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue UnIeSS
the licensee provides proof of liability insurance including "completed. operation�� coverage or its substantial,eqUivalent. !he
undersigned certifies that suchcoverage is in force, and has exhibited proof of same to the permit issuing office.
CRECK ONE: INSURANCE W BOND Ll OTHERE] (Specif�;:)
Icertify, underthepains andpenaltiev ofperyury, thatthe information on this application is true andconyVele.
FIRMNAME: The Electricians &Co., Inc._ LIC. NO.: A10737
Licensee:- Michael J. Parziale _ Signature LIC. NO.: E20269
ff applicable, enter "exemlv " in the livense naniber line.) Bus. Tel. No.: 781-322-9344
Address: 50 Branch Street Maiden. MA 02148 Alt. T . el. No.: 7RI -�379-31 nn
*Pcr M.G.L. c. 147,5.57-61, sccurit), work rcquirc5 DcpvtLucnt of Public Safcty"S" Licciise; Lic-No. 33C0001021
OWNER'S INSURANCE WAIVER: I am aware that the. Licensee does not have the liabilit�y inSUranCe coverage normally
required by law. By my, signature below, I hereby waive thisrequirement. I am the (check one) M owner El owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE. $ 125
The Commonwealth of Massachusetts
M Department of IndustrialAccidena
Office of Investigations
600 Washington Street
Boston, MA 02111
WWW.MUSS.guv1diu
Workers' Compensation Insurance Affidavit: Build ers/Contractors/Electricians/Plum bers
Applicant Information Please Print Lezibly
Name (Btjsiiie.ss/,Organi&,itioit!'Indivi,dual): The Electricians & Co.. Inc.
Address:— 50 Branch Street
Phone#: (781) 322-9344
Are you an emplover! Check.the appropriate box:
Type of project:(required):
i. I am a ernp loyer witli 15
4� E] I am a general contractor and 1
6. [:j New c6tistruction
dnlployees (full and/or part-time).,*
have hired the sub -contractors
2J:1 I am -A. sole proprietor, orpartner-
listed. on the attached sheet.
7. Ej Remodeling
ship And have, no employees
These sub�-contractors have
8. —1 Demolition
working for me in any capacity
employees and have workers'
9. E] Building addition
[No workers' comp. insurance
required.
comp. insurance.*�
5. Wc arc a corporation tuid. its
J <91 Electnealrepair.-.1; or additionq
3. El lam a homeowner doing all work
officers. have exercised their
I 1,Fj PlUmbing repairs or additions
myself [No workers' comp.
right of exemption per, MGL
12..E] Roof repairs;
insurance reqU ired.]
c. 152. �5,1(4), and we have no
13. El Other
employees. [No workers'
conip. insurance reqUired.]
*AnYapplicaot that checks box#11 miist also fill out the sectim below showkig.their workers' compeiisatim policy hiformation.
Hbrrieowners,.,%ho submit this affi&vit indicating theyare doiug all work aud theo hire outside 0outractors -must submita-iiew affidavit iudicating such.
�C6nqactors that check.thisbox. must aitachedan.additionat sheet showing thename of the sub -contractors andsiate whether or not those-elilities have
,employees., If the sub-�.,orufactofs have employees, they 'must provide their %vorkefs' comp. policy number.
I am (in emplq-er that is providing workers ' compensation insurancefor my employees. Below is the V
polic andjoh site
information.
111SUrance Company Name: Hanover Insurance Company
I Pol I i I cy 4 or Self-ins.,Lic. ft: WHN 6055762 Expiration Date: 09/0112014
Job Site rAddress: 50 Royal Crest Dr. Building 3 Apt. 3 City/State/Zip: NorthAndover,M 01845
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expirafion-date).
Failureto secure coverage as required under Section 25A of MCJL c. 152 Call lead -to the imposition of criminal penalti , es of a
find up to S 1,500.00and/or one-year imprisonment., As'well As civil penalties in the form ofa STOP WOR . K ORDER ands 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 certif
y under the pains atidpenaldes ofperjur orynation provieted above is true and correct.
y that the h!f
SiarriatUre: Date: JU1Y 7. 2014
Official use only.. Do not write in this area, to be completed -by civ or town official
City or Town:
Perniit[License #
IssuingAuthority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Ellectrica I Inspector 5. plumbing Inspector
6. Other
Contact Person: Phone #:
:`�"'IISSUES ..,TH-Eg.-f 0 L L OW I NG
Rt -'dl' D MA.STf-R:,,,,.ELECTRl
Q
VMS p "�"l
'LECTRICIANS '.. AND COMP�ANY-ANC-T'
fALE
50 'BRA;kw sIr
5ULDEN 02148-4364
.j
10 7 3 0' 658'46
Litommaz LKI&I aj %I I Fj it] " I sy-,'t I gili J, m of,
E N 5 &:::!r:
-H
I SSU S, E FOLLOW
E. 'T
0 UR K E Y
M ELECTRICI
L J PARZLALE c
107 LOCUST STREETT.-`�,-.
Ol
.:.�WRVEAS M-*�:-A?u�,pvi 923-
6486S
2026qW`�' 0 1 3j,
fill" :Ikqf A *R, N 9
N
7766
Date ... .......
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ... �" 4"c.-( ... 1�'3 . 'VP..'5 -7. N ....
.... ... ... ..
has permission for gas installation ..........
in the buildings of ... ORA--�. - '*'*'*'**'***''**
at.. North Andover, Mass.
Fee.,2�-�� . Lic. No.. .. .....
TOR
GAS INSPECIJI
Check 4 -6o
Q-575
W.�
c1yTl loco
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
City/Town: k)(j4A)b6LE7k MA. Date: Permit#
Building Location:_4w Oze-ZT Pe. -A2 Owners Name: e6XtA,4-1 C 1ZC—X7-
co
Type of Occupancy: Commercial E] Educational E] Industrial 0 Institutional El Residential
New: Alteration: Ej Renovation: Ej Replacement: Plans Submitted: Yes F1 No Ej
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INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes El No 0
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy 19 Other type of indemnity El Bond R
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Signature of Owner or Owner's Agent owner F] Agent E]
By checking this box E); I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and
---Q- '- "' ""' � ... Y 11VW1VUUV C11JU L11dL c111 1JIUMoing worK ano instanations perrormecl under the permit issued for this application will be in
c,mp wrice with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By Type of License:
El Plumber
171 Gas Fitter
Title El Master Signature of Llcens& ber/Gas Fitter
City/Town O.Journeyman License Number: -?1 &0 *7
APPROVED (OFFICE USE ONLY) El LP Installer
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Installing Company Name: d0;444,N.
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Check One Only Certificate #
b Corporation
Address:
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City/Town: R5VA9!Pgoi:�E
state:
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L] Partnership
BusinessTel:
Fax:
El Firm/Company
Name of Licensed Plumber/Gas Fitter:
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INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes El No 0
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy 19 Other type of indemnity El Bond R
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Signature of Owner or Owner's Agent owner F] Agent E]
By checking this box E); I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and
---Q- '- "' ""' � ... Y 11VW1VUUV C11JU L11dL c111 1JIUMoing worK ano instanations perrormecl under the permit issued for this application will be in
c,mp wrice with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By Type of License:
El Plumber
171 Gas Fitter
Title El Master Signature of Llcens& ber/Gas Fitter
City/Town O.Journeyman License Number: -?1 &0 *7
APPROVED (OFFICE USE ONLY) El LP Installer
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Date. :� .-. 5� : ).\. . .
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that . . c t �� f -'S. .
has permission to perform CA"—
plumbing in the buildings of ... ........
at ... RQy.tA.1.L. (.&A-.6,41.41,— 3 ........ North Andover, Mass.
Fee4'3.(?'. Lic. N o. . . ..... �-�A ..........
PLUMBING INSPECTOR
Check# i�75-6o -
5- FLOOR
FWFLOOR
j5H --
FLOOR
iM FLOOR
Installing Con-,panV Name: 0-peusw 9 ChsC-k One Only
ie6A4- jr0iteK V.S-t=-w S Certificate
Address: 6LO(.AA"4 ST City/Town: &�!i&4*<--' State: M#4 El Corporation
BusinessTel:- El Partnership
Z9 1 71? 2 q -400 Fax:
Name of Licensed Plumber: T -I PK r,>C-,5y Firm/Company
I have a CUrrentRalb—ffi-ty-Insurance policy or Its substantial equivalent which meets the' requirements
If YOU have checked Yes, of MGL. Ch. 142 Yes 0 No
Please indicate the type Of coverage by checking the appropriate box below.
A liability insurance policy. Ud Other type of indemnity Ej Bond E]
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that m
y signature on this permit application M�alves this requirement.
Check One Only
S1 P11 iat�re Ot Owner or Ownees hgent Owner El Agent E]
I hereby certify thatill of —the details and 1-1-1111.1LIOn I nave submitted (orem:.,red) reg
Knowledge and that all Plumbing work and installatil 11 1 iml 111!!: plilicEl
1 C � I H e! I E! M d accurate to the best of nly
Pertinent provision Of the Massachusetts Sta Ons Performed under the permit Is'sued for this application will be in compliance with ail
te Plumbing Code and Chapter 142 of the General Laws.
By Type of License:
Title
----------- Signatu e o Licensed Ir -lumber
Dity/Town El Master
kPPRO ----
KED OF-F-i—c--- 19Journeyman License Number: S160 7 -T)
E USE �ONLyj
,4/)
A-
MASSACHUSET17S UNIFORM APPLICATION FOR
PERMIT
TO DO PLUM13ING
ity/Town.
CCitY/Town: Al.
------------------
JMA. Date:
Permitff
Building Location:
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Owners Narne:.
R-.OYA-L-
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Type of Occupancy:
CommercialEl
EducationaIE]
IndustrialEj
InstitutionalEl Residential
N W.
N .
ew: Alteration: Ej Renovation: El Replacement: Plans Submitted: Yes El
No E
FIXTURES
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BASEMENT
11T FLOOR
2 ND FLO R
3 RD FLOOR
5- FLOOR
FWFLOOR
j5H --
FLOOR
iM FLOOR
Installing Con-,panV Name: 0-peusw 9 ChsC-k One Only
ie6A4- jr0iteK V.S-t=-w S Certificate
Address: 6LO(.AA"4 ST City/Town: &�!i&4*<--' State: M#4 El Corporation
BusinessTel:- El Partnership
Z9 1 71? 2 q -400 Fax:
Name of Licensed Plumber: T -I PK r,>C-,5y Firm/Company
I have a CUrrentRalb—ffi-ty-Insurance policy or Its substantial equivalent which meets the' requirements
If YOU have checked Yes, of MGL. Ch. 142 Yes 0 No
Please indicate the type Of coverage by checking the appropriate box below.
A liability insurance policy. Ud Other type of indemnity Ej Bond E]
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that m
y signature on this permit application M�alves this requirement.
Check One Only
S1 P11 iat�re Ot Owner or Ownees hgent Owner El Agent E]
I hereby certify thatill of —the details and 1-1-1111.1LIOn I nave submitted (orem:.,red) reg
Knowledge and that all Plumbing work and installatil 11 1 iml 111!!: plilicEl
1 C � I H e! I E! M d accurate to the best of nly
Pertinent provision Of the Massachusetts Sta Ons Performed under the permit Is'sued for this application will be in compliance with ail
te Plumbing Code and Chapter 142 of the General Laws.
By Type of License:
Title
----------- Signatu e o Licensed Ir -lumber
Dity/Town El Master
kPPRO ----
KED OF-F-i—c--- 19Journeyman License Number: S160 7 -T)
E USE �ONLyj
,4/)
A-
9939
Date..................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
15; 1 :;r" -
This certifies that .... ... ................
has permission to perforf--..Z..-../.,* ...........
wiring in the building of ...... ...... .....................
at.. ��A�� aa-- 7— '�E :? � North Andovei, Mass.
.......................................
9 < -2�
Fee.J., . -_9 T
................ Lic. No.J. 6)75 74 .......... ........... .... ...
C ..
Check # 160 EL crmcm. INsPECTOR j
Official Use Only
(flmmonwea& ol Maijac4uieffi Penn it No.
2erat..t.,1Jie Semicei
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS . rRev. 1/07] (J,,v,bl,nk)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEA SE PRINT IN INK OR TYPE ALL INFORMA TION) Date: March 3. 2011
City or Town Of- North Andover To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street& Number) 50 Royal CreSt Drive BU21d2l3g # 5
OwnerorTenant Royal Crest Apartments Telephone No. 978-681 -1
Owner'sAddress 50 Royal Crest Drive North Andover. MA01845
Is this permit in conjunction with a building permit? Yes El No X (Check Appropriate Box)
Purpose of Building Commercial - Apartment BuildingsUtility Authorization No.
Existing Service Amps I Volts Overhead Undgrd
New Service Amps Volts Overhead Undgrd
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: -InStall 6 Gell Packs!
No. of Meters
No. of Meters
Completion of the followinz table mav he waived bv the Insvector of Wires.
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above Ei In- E]
. of Emergency Lighting
6
grnd. grnd.
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
I No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
I Number
I Tons
........ ... .......
KW
............ ... .......
No. of Self -Contained
Totals:
1--*
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local El Mun'c'pP1 El Other
Connection
No. of Dryers
Heating Appliances KW
Security S ystems:
No. of Devices or Equivalent
No. of Water
KW
No. of No. of
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wir!'ng:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: $600.00 (When required by municipal policy.)
Work to Start: 03/03/2011 Inspections to be requested in accordance with NIEC Rule 10, and upon completion.
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: INSURANCE [i] BOND [] OTHERE] (Specify:)
I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete.
FIRMNAME: The Electricians &Co., Inc. LIC.NO.: A10737
Licensee: Michael J. Parzialle _Signature ('L,�4-]C. NO.: F20269
(If applicable, enter "exempt " in the license number line.) -Y Bus. Tel. No.: 781-322-9344
Address: 50 Branch Street Maiden, MA 02148 Alt. Tel. No.: 781-322-3100
*Per M.G.L. c. 147, s. 57-6 1, security work requires Department of Public Safety "S" License: Lic. No. SS Q0 001021
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) 0 owner F1 owner's a2en .
Owner/Agent
Signature Telephone No. PE"IT FEE. $ 125.00