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Home My WebLink AboutMiscellaneous - 15 Saville Street G �, �� Date . . r •• IMP`t�6'.,....� toTOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that has permission to perform . . . . .�. . . . . �O!, . . . 2 . . . . . . _ . wiring in the building of . ` ?.`. . . . at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,North Andover, ass,' Fee . . . . . . . . . Lic. No. . . EL CfRICAL INSPECTOR ' Check# 3 71 ' `11100 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.G.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 Wiresappointed pursuant to M.G.L c. 166,§32, an electrical permit shall he 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. V Permits shall be limited as to the time of-ongoing construction.activity,and may be.deemed_by the,Insp.ector_of_Wares abandoned.and-invalidaflie_ or she has determined that the authorized worl�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. ❑ The Permit Extension Act was created by Section 173 of Cba tep r 240 of the Acts of2010 and extended by Se4ons.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 flus 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 15,2608.and extending through August 15,2012. ule S—Permit/Date Closed: _ /$— '� *Vote:Reapply for new perm ❑Permit Extension Act—Permit/Date Closed: I \ l I 1 r �cc�� '•l�i officktvse aU�o �u+o Jwaiea� Permit Nv._ 41.!2- BOARD OF FIRE PREVENTION REGULAnONSOccWmicy and Fee Checked 0avcbb.k) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Ail wort:m be p"m nead is wft aw I code(hHn R7 CM 17-00 {P- &M PRI D[B fK OR ME AU MOM MTIOM Date:_ ,g126 QtY or Town of �Cfo21?-! r,,,,,� ?'o the Inspector of iYrres: Bp this applicaZtian.lite g�notme Of Ins or her i it udion to petfwm the electrical work descnbed below. Location(Street&Number) / OwnerorTenant �9vl� v�/U.�✓ TedepltoaeNo. Owner's Addre� _ Is this Permit in conjaastion With a building pernmr. Yes No ❑ (Check Appropriate Buz) Purpose of Bnildfmg UtiLy Antltorbatioa No. Ensting Service Amps ! Volts Overhead❑ Undgrd❑ No_of Meters New Service -Amps 1 VOhs Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampseity Location and Nature of Proposed Electrical Work: lG L be waived the t ro No.of Reeessed L No.of Cell,-SURL(P )gkms - of Total Ttanslbrme rs K VA No.of Luminaire Outlets No of Hot Tubs Gators. KVA No.of Lumb aires Swi oubg POoI ❑ ❑ o.of cy BatfuTUnits No.of Resxpi$de Oathda O,of O8 ALUMS Ne.of Zones No.of Switches NiL of Gas Hamm o.OfIleftetion an No.of Ranges No.of Air Card. Ton a of Aletimig Derhes No.of Waste Disposers Had _ Devlees No.of Dishwashers SpacdAn a Hadb g KW ❑ ❑oto No.of Dryers . Heating Appliances Kw No.of Water0fNa Of �or Equivalent Heaters KW o.Signs Ball asts Data Wig: No.of Devises or Equivalent Me.Hydromassage Bathtubs No.of MotorsTotal IIP nmusuons inTm . No,of Devices or t OTHER: efUadtdatmtiJdesirrd;ora:ragwred by the h apectar of FFwm ' Estit�ted value of Electrical work (wheat by policy.) Wozk to Start: Iespucdons to be mquested in accordance with?MC Rule l0,and Wou GwWietioa. II+ISi MCE COMMAG& Ujdm waived by the Owner,no PcMuthr&cP0fim==of electrical work may issue unless the Foyidcs proof of liability incl aComPhtcd A ta34etage Or its SuWtwtial t. rnidelsigned motes that such cOvem9t is m�,and has exhibited e�irdiefl The pioo�f afsan�to the Permit issuing alytr:e. _ CHECK ONE: 94SURANCE BOND ❑ OT*M ❑ (Spetafy-) I certiifp,under the pmRsmrd peau es of jury,g1wMe brftnn don an th& ` [rrte rurd otrmptete~ FUM NAME; I7 i!) �#.c f.T.Qi CAL Cavi jtZ i i�ln Lt-ts m1AC.NO.: Lieeosee: �et9 Efal6b:d Menture L G Nd.: f' `1 L 111 a carer`errarpt'in dxlmiae a rm Ba4, .No.�`I7F Address: 't7 t� ,L#'t+rf T ;�N7x'Yc7Z rpt- �1 — *Per MG.L c.147,s57-61,security workAil TeL No::2i& :L3-5'73 OWNER'S INSURANCEWAIVF.it: I of public ►'� Lit"NO. aware that the lunar does iwinve the Iiabt'h'tq insutaucc gengouege nomwp p Orequired by law. By mysigiatnre below,f h w&ywaive this rapfic meet. I nut thea{ owner 1s t. Stgnatu k Telephone No. IPMWITFFm2� ' The Co»rmomveahh ofMassachuseitsPrit-Form DgmyfteW ofIndas&WAccidents Office i Cortgresso u��e�lpp y` Boston,MA 02114-2017 www.massov . /tea g Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers olicant Information Please Prhd Let>W Name(Business/Organizationllndividualy DAVID ELECTRICAL CONTRACTING LLC Address. 87 BE.LMONT ST City/Stafiel�p: NORTH ANDOVER,MA.01845 Phone#: 978-682-6262 Are you an ewployer'F Check the appropriate be= Type ofproject(fired): I-01 am a employerwith 7 4_ ❑I am a general connactor and I employees(fall anNer Pie)- * have hired the sub-enactors 6. [:]New construction 2.0 I am a sole ptmprietor or partner listed on the am ached sheet 7- ❑Remodeling ship and have no employees These sub-couftachns have g- ❑Demolition waslong for me in any capacity. employees and have workers' • 9. Burl addition vITo11Cer5'Comp.insurance comp. •s ❑ required] 5-❑ We are a corporation and its 10-FAElectrical.repairs or additions 3.0 I am a homeownwdoingall work officers.have exercised their I I.[]Plumbing repairs or additions myself 1N0 wodw&compright of exemption pea MGL 12.0 hoof repairs insurance requited.]f c.152,§1(4),and we have no employees.[No wortaers' I3.❑Other comp.insurance required-] 'AnY aPPlicaut that cheds box#1 must also fill out the section below showing their wormers'compensation policy iut'ormauon- t Hoiueownea who submit thisaffidavitinilkating they are doingall work and then hire ovlside wntracturs mist submit a new affidavit indicating sure *Cors that crock fhis boxmust attached an additional shed showing tam name of the sub-cu�and state whedw or not those a have employees. If the sorb-cow have employees dxY must provide their workers' wap.policy number I ant as employer r&atrs pmvrdmg workers' information. compensation hwuwzcefor my employee Below ist&epoNcy and job sim Insurance Company Name. THE HARTFORD Policy#or Self-ins.Lic.#: 08 WEC C18293 Expiration Date- MARCH 1,2013 Job Site Address: �J L��(�lLGC �j City/State/Z p: v D!/t�� 44 ave Attach a copy of the workers'compensation policy declaration Page (showing the policy number and expiration date). Failure to secure coverage as requited under Section 25A of MGL c.I52 can lead to the imposition of criminal penalties of a tine up to$1,500.00 and/or one-year imprisonmenR,as well as civil penalties in the form of a STOP WORK ORDER and a free In a to Inves $250.tigations 0 a day against the violator. Be advised that a of this statement cePY may be forwarded to the Office of Investigations of the DIA r insurance coverage verification. I do herby - - - ttTiar rhe" on Pr it crag and c wraa Datet Phone#. s78-6$2-s262 Ofcrat ase oaiy. uta aorwMee is f&h mrrg m bewmpieted by c ty orrowa offidst City or Town: Permitllicease# IssEdug Autbority(aQde one): 1-Board 6-other of Health 2. Department 3 Cityffawn Clerk 4.Elecft c Inspector 5.Plumbing Inspector ContactPersmr. Phone#: