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HomeMy WebLinkAboutMiscellaneous - 1019 OSGOOD STREET 4/30/2018P.- 0 Date ...... . G� .... �? ©.7 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... 67 �S ..... has permission to perform ....... 4 ren"...'Y y ....................... wiring in the building of "o at .... ..................................... . North Andover, Mass. Fee ..:� ... Lie. No. ... , ". A.A. .......... , ELEcnICAL INSPECTOR Cj Check # -13Z 7 74 4 7 C'ontmonweatth o/ccMamahuco"m Official Use Only aCleparfinenE o� tire �ervuea Permit No. )w Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. l/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All -.vork to be performed in accordance ," ith the Massachusetts Electrical Code (MEC). 527 CMR 12.00 (PLEASE PRINT INIATKOR7TPEALL INFORMATIOA) Date: April 30, 2007 City or Town of: North A n d o v o r 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) 10k? Osgood Street Owner or Tenant John Currao Bella Vita Sal tin 9 ilay Cn--r? Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes El No ❑ (Check Appropriate Box) Purpose of Building Commercial — Salon/Day Spa Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: Low Voltage Security System Completion of rhe follotit>inz table mm, be ivaived by the Inspector of Wires. No. of Recessed Luminaires No. of Ced. Susp. (Paddle) Fans o. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above In- Swimming Pool md. El In- El o. o mergency Lighting No. Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners of o. In Detection an InDetection Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers p Heat Pump Totals: Number Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local 11 Municipal El Other Connection No. of Dryers 1'Y Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water Heaters I Nof No. of o. Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP TelecommunicationsNo. of Dev cesor Equivalent OTHER: Attach additional aetatt t aestreq or as regutrea 01' the inspector of vvtres. Estimated Value of Electrical Work: $750.00 (When required by municipal policy.) Work to Start: 5/h07 Inspections to be requested in accordance with MEC 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 a BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information ont�pp�filatlo n is true and compiete. FIRM NAME: SOS Securitv ConsultarLts_ Tnr ��� LIC. NO.: SS CO 000302 Licensee: R. Prescott Smith Signature (Ifapplicable, enter `exempt" in the license number line.) Address: Suite 102 10 South Main Street _ LIC. NO.: 1199C/390D Bus. Tel. No.: 978-887-8341 Wt. Tel. No.: *Per,M.G.L. c:.147, s. 57.6 1,. security work requires Department of Public Safety "S" License: Lia No. 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) ❑ owner ❑ owner's ent. Owner/Agent FE.RMIT FF_F_: S Nlgnature Tcicphonc No. Date............................. 7.. TOWN OF NORTH ANDOVER PERMIT FOR WIRING 4K This certifies that ............. . . L....... ........ ............... has permission to perform .......... .................................... wiring in the building of ....................... at ........................... -5 ... ....................... . North Andover, Mass. Fee.4........ Lic. No.49P.5 4.415F ........ .... . ............. .......... ELECTRICAL Check # /421 Commonwealth of Massachusetts OfficialUseOnly Department of Fire Services Permit No. / I Occupancy and Fee Checked g BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 1 All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: pg�, I a4 `� 0 0.l �, d S fin" City or Town of: NORTH ANDOVER To theIn pector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 10 j q oso, OQd , Andove Owners a06.1 CVrmo Delp, sAIdv�l 2 Telephone No. Owner's Address 1 019 OSQArno� S-� ,� 1-3he�o�7Pf, iM� Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building C omwvere-is I c©r40 Utility Authorization No. Existing Service Amps / Volts O,av_erhead ❑ Undgrd ❑ No. of Meters New Service W (� Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: J6 I"4er;or eleeA rtkal 2DCCfPT S+Pi`y t C� a bt,4. Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans o. o Tota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- ❑ rnd. rnd. o. o mergency ig mg Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total No. of Alerting Devicesns No. of Waste Disposers Heat Pump Totals: Num er .. Tons W No. of elf -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or_Equivalent No. of WaterKW Heaters No. of No. o ` Signs Ballasts Data Wiring: No. of Devices or E uivalent . No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Equivalent No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 43 0 , 00 O (When required by municipal policy.) Work to Start: 1 Inspections to be requested in accordance with MEC 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 insuranee 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 E4 BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: -DO hQ) p) 't? J rr,e, Signature LIC. NO.: 2oSo i E (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: S90_gq (j2 Address: 2S Lbring , W, A 01$ N Alt. Tel. No.: *Per M.G.L c. 147, s. 57--0, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: 1 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. 1 am the (check one) ❑ owner ❑ owner's agent. Owner/Agent FPER7MIT FEE. $ SignatureturaTelephone No. The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations 600 Washington Street t Boston, MA 02111 M s� www.mass.gov/dia f Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: I . ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. $ These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure 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 andpenalties ofperjury that the information provided above is true and correct. Signature: Date: Phone #: Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Code Start :P84S apo