Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 1600 OSGOOD STREET 4/30/2018 (22)
�. r V ~ ~ �' Date . Jo . . . . . . . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . ..rp .0. . . p. . . . . . . . .. . raj S. . . . . . has permission to perform . . . . .V r S . . . ?7 . . . . . .. wiring in the building of . . . .W.4-�$ . . . at . . . (app CSG�1c*' _ . . . . . . . . .horth Andover, Mass. Fee . . . ic. No. .10 x.41!4- . . . . . . A � EL C CAL INSPECTOR Check# 79e, 2 11129 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordanee-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- abandoned_and_invalid_ifhe—. ._ 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. . ❑ 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 extendingthrough August 15,2012. vle8—Permit/Date Closed: ***Note:Reapply for new perrua�>'t� ❑Permit Extension Act—Permit/Date Closed: Commonwealth of Massachusetts r Official Use Only Department of Fire Services Permit No. 'f J Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leaveblank i APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusett,Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 9— 1 a- 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) 1609 Q S G0 J61 Owner or Tenant We cK-,, R_pwlpAyr: Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service =_ Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: T h S Al OW Room or ),; UM SY S y Completion ofthefollowing table may be waived by the Inspector 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 ❑ In ❑ o.o Emergency Lighting rnd. rnd. Battery 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 Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: .............. Detection/Alerting Devices + No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances Kms, Security Systems: No.of Water No.of No.of No.of Devices or Equivalent Heaters KW Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the informati oil th-11 a 1' atiBn s true and complete. FIRM NAME: p!' LIC.NO.: d V Licensee: 70kia, F k/i if 1 • A!S Signatur ,NO,: 10 (/fapplicable,enter "exem i"in the license number line.) Bus.Tel.No.:�SC-fo1�3-oaf- Address: &/ Alt.Tel.No.: 47IGbb3-Col ar *Per M.G.L c. 147,s.57-61,security work requires Departure t of P blic Safety "S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the L cen e 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 agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 5 oo r ................... Date. gORTI� TOWN OF NORTH ANDOVER . PERMIT FOR WIRING �,SSAaw - This certifies that .................... . . ..... ..... 4 has permission to perform ...2...... ►v` e.I V-''a �. g us � .. ..'0....... .................... .......... wiring in the building of P `Z. 40�v ..................4....4"x.... .� ...... ..... ............................... � 6 DO Q dt ............... .North Andover,Mass. Fee..................... Lic.No./.. .�..� ...... . ........ . ..t ... ELECTRICAL INSPECTOR Check # 9156 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. r S� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 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: 12-07-2009 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) 1800 OSGOOD STREET Owner or Tenant WATTS INDUSTRIES- Telephone No. Owner's Address 851 CHESTNUT STREET Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building office space and computer center Utility Authorization No. none required Existing Service Amps Volts Overhead ❑ Undgrd❑ No. of Meters New Service Amps Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity wLocation and Nature of Proposed Electrical Work: No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No. of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA Above ❑ In- El o. o Emergency Lighting No.of Lighting Fixtures Swimming Pool Grnd. Grnd. BatteKy Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No. of Detection an Initiating Devices No.of Ranges No.of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Num er Tons KW No.o Self-Contained Totals: - - Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection Heating Appliances Security Systems: No.of Dryers g PP KW No.o Devices or Equivalent No. of Water KW No.of No.of Data Wiring: t Heaters Signs Ballasts No.of Devices or E uivalent No.Hydro massage Bathtubs No.of Motors Total HP Telecommunications Wiring: g No.of Devices or Equivalent OTHER: relocate existing 200-amp buss duct INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licen- see provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certi- fies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE N BOND ❑ OTHER ❑ (Specify:) 09-30-2010 (Expiration Date) Estimated Value of Electrical Work: $5000 (When required by municipal policy.) Work to Start: 12-07-2009 Inspections to be requested in accordance with MEC Rule 10,and upon completion. I cert, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: WILLIAM J.IANNAZZI,INC. LIC.NO.: 13592A Licensee: WILLIAM J.IANNAZZI Signature,� ��1c LIC.NO.: 13592A Bus.Tel.No.: 978-686-7300 Address: 191 CHANDLER ROAD ANDOVER,MA 01810 Alt.Tel.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 agent. Owner/Agent PERMIT FEE: $ S Signature Telephone No. 3 i Date.... �................©....... �•ORTM, o� TOWN OF NORTH ANDOVER t - ' PERMIT FOR WIRING �SsAcmUS �^- This certifies that ................................................Vel�h�i� � `.. C- has permission to perform /,G14�:;' E (>,a-T� wiring in the building of.... .... ......w ............................ ............ at.&�o.. ST © ...... ,_N orth Andovvr, ,Mass. J ..... Fee....I.ZS. .... Lic.No..tel¢. . ELECTRICAL INSPECTOR Check # I 0 7171 The Commonwealth of MassachusettsOfficeUse Only� Permit ao._ J Department of Public Safety Occupancy 6 Fee Checked BOARD OF FIRE PREVENT10N REGULATIONS 527 CARR 12OO 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Massachusetts Electrical Code. S27 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFOR2MION) Date 1/19/07 City or Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 1600 Osgood Street Owner or Tenant Watts Regulator Owner's Address Same Is this permit in conjunction with a building permit: Yes ❑ No 0 (Check Appropriate Box) Purpose of Building Office Space / Data Center Utility Authorization NO. Existing Service Amps _/ Volts Overhead ❑ Undgrd❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Above in- No. Swimming Pool grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency LightingBattery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No. of Heat s Total Total No. of Sounding Devices Tons KW No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local 1:1Municipal ❑Other � Connection No. of Water Heaters KW Not of No. of Low Voltae Si ns Ballasts ring 18 Voice & Data Drops 1 No. Hydro Massage Tubs No. of Motors Total HP Backbone Extension OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES[M NO 0 I have submitted valid proof of same to this office. YES[J NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ® BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work $ Expiration Date Work to Start 1/16/07, Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAMEV Af LIC. NO. Licensee Signature LIC. NO. Address 850 E. Industrial Pk Dr. Manchester, NH 03109 Bus. Tel. No. 603-622-9010 Alt. Tel. No. 508-326-5400 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial 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 $ Sienature of Owner or Agent ........................Date... �-?.. - r o:;•�``- "�°� TOWN OF NORTH ANDOVER PERMIT FOR WIRING �,SSACMUS� This certifies that ................................................ ..... . ............................ has permission to perform ....... .....P�'!2_............................................... wiring in the building of...UJk}: 5......................................................... 16 a°_ 2 at... ............. ............ .................. , Orth Andover,Mass. Fee.f(L��' '. Lic.No...)A�A........ l ELECTRICAL INSPECTOR / Check # � /! 10707 f commonwealth of Massachusetts Official Use Only - a Department of Fire Services PernutNo. /67 0 7 BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked [Rev.1/07] (leave blank 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 SEPRNT)NMKORTYPEALLINFORMATION) Date: ,3 M— 12- City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice ofhis or her intentiopp to perform the electrical work described below. Location(Street&Number)lbololL.$ �csbuj F�a2 �u r Tenant ZZ r0 e✓_ C S Pte'�o Owner's Address 00 S pv Slf e tF Telephone No. r� ` t 2�� FLau� Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / VoIts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of feeders and Ampacity / —/00,4 �20O 12 Q V Xeecl ej Location and Nature of Proposed Electrical Work: l� a aN FL. !� -� L'p -4- MCC/ D A-#q C W61 f'� COM.0 ofthe ollowin table m be lvaived b the Ins ector o 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 ❑ In- ❑ o.o mergency Lighting rnd. r, El 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 InitiatingTotaDevices No,of Ranges No.of Air Cond. Tons l No.of Alerting Devices No.of Waste Disposers Heat Pump Number _Tons '. KW No.of Self-Contained Totals: """'" Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local El Municipal El Other ' Connection No.of Dryers Heating Appliances KW Security Systems:*• No.of Watero. No,of Devices orE uivalent Heaters KW No.signs Bal as Data Wiring: Si ns Ballasts No.of Devices orEquivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or E uivalent Attach additional detail ifdesired,,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start; g —f c�, Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,nb 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;. BOND ❑ OTHER ❑ (Specify.) X certify,under the gins and penalties ofperjary,that the information on this application is true and corpl'eie FIRM NAME:14 r L L E Laftl)'C. CO. .SNC - LIC.NO.:W02 1 Licensee:FVA ;1C W _S S Signature � LIC.NO.: 16 5'03(Ifapplicable enter"xempt"rn the icense numb line.) �30 Bus.Tel.No.-l-&03-7G.S'`j 7n?o'� Address: C/`?t v Alt.Tel.No.: *Per M.G.L c. 147,s.57-6f,security work requires Department of Public Safety"S"License: Lie.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 agent. Owner/Agent Signature Telephone No. RiRT FEE:$ r . / .". �JUJCt�l.�AJ.t{.`V(j1r�(•••�rfL'.�•�QJ�r-.��-•l(.'fL")�.�/,�S�Y•�®��•�vyyp�j�'( f�•� y.`-..{iJJ.JI:!'UJ4JS�J.\Jl`eL'.L�J.•.�� — ,�JF-f.L1LJ.Jl`LfI.L.G34�.(JLZNJ.JJL./��./,[�.~. • .•. ._ ^ — • •. �_ • . .lr.C40U1Y1-/• F7.C/�tCTION, �• •. - - Passec _ +ailefl--j I P-e-Inspection regt&ec't($:5O.OQ)~ j �iispectors'co�xn.e�ufs: - Vlauectoxs'sloature Womtfals) r Pate 2.MAL WS°PXCTION•, passed �aiTed--[ ) � �e3nspectiou�equzzecl($50.00)~[ � Xnvectors'co nfs: (Crispectors', z afore xco' tials) Pate 3•TJ.�TD�R+IRODND)K9.e)TCTXOW. 'assetl- f ] aiTecl—[ ) die-inspection aequixetl($50.OQ)~[ ] Inspectors'comments; (Iuspectorsl lsignature~)ao initials) date 4.l�PtSPECTl07—�E3 ►�J CE': DATE C,f 7 IED,NATIONAL C3 I I ; N•AM rassecl--[ ) I+'ailed•-j e-nspectionxequixed{$50.OQ)- • liuspectbrs'coxnmepfs: (hasp ectors'signature-io initials) pate INSPECTION~OMR: ' x+,ailed--F.). I?e-insp ectioxt z equirecl($50.0 0)- [ ) aspectoxs'cozivm.enfs: ' 17 sp ectors' ignafure~xto zn 'ahs) Date DC)OR TA(gS.APS TO$E Pff,EED O'UTAM IEFT OX RITsE-`TM.APXA TO?3E AI' STETTED IS NOT A AND A P-V►gar.Qp'Pvrrov e-►t{V40 0n r..q rrn'z'V.CgYA p V-TF.n � . The Commonwealth of Massachusetts Department of IndustriqlAccidihis Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0bly Name(Business/OrganizatiorAndividual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have]fired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity., workers'comp.insurance. 9. E]Building addition [No workers'comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.F1 Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] employees.[No workers' comp.insurance required.] 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 ace doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam 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 and penalties 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#: D Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or.written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants a Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. AIso be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the 1 applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth,of Massachusetts Department of Industrial Accidents Office of Investigations 6.00 Washington Street Boston,MA 02111 Tel.#617-727,4900 ext 406 or 1-877rMASS.A.FB Revised 5-26-05 Fax 4 617-727-7749 v ww.mass,govhdia Commonwealth of Massachusetts 7 Department of Fire Services ►'enl,it 7/ Z �� _ i Occu.aw .Ind Fc'e Chlekcd j% BOARD OF FIRE PREVENTION REGULATIONS (apt); ' .� Rev. . � - I�a�c l�Ir.nkl APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK SII '.,,n•k to he I-e!'tc'rIII cd in.lccord;ulc,�',\ith the \In»;tlhu ctt, HcctricaI (-odc I\IFC!. 5' (A I R 12.0 I'LE.ISE PRL\ TLN L\KO)RTYPE.ILLL\FO)R.ILITION, Date:—. City or Town of: . A/ ,J n TO the I+�.�hrllur r}/ 1)(tTY I;y this ,Ipplication the undersi�,ncd ivcs notice of Ilis or her "!J0160111 �<ntiuno p tertor!n the vlcchical '.% Irk de�crihed belmAl. Location(Street & Number) (honer or Tenant •�n tf t'-s fclel enle No. Owner's Address -5 0 P", d: Fah ' \(;-p2 1,�, a Is this permit in conjunction with a building permit? Ves r'-_11' No ❑ (CheckAppropriate Box) Purpose of Building Cc)E i /�Z' ' Ltilitv Authorization No. Existing Service Amps i Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No. of.Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: j �, l VK_ _ 6e /) _e cQ 4 a 4J e. =4 ( rinplrlinn r�r fik i i,llrnt i6!•h l'!r;ltul r:� u:.ul:. l;a•rile Lis,i ,1'r:j 11 No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No•of Total Transformers KNA No.of Luminaire Outlets No.of Hot'rubs Generators KVA No.of Luminaires ' Swimming Pool .\bore ❑ In- ❑ . o.o mergency Lighting ,,rnd. frnd, flatteryu.- flits No.of Receptacle Outlets No. of Oil Burners 'FIRE ALARMS Vo. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices No,of Ranges No.of;lir Cond. Tons)No. of Alerting Devices 7 No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/.Alerting De"ices No. of Dishwashers Space/Area Heating KW Local®' Municipal ❑ Other _ Connection No.of Dryers Heating Appliances KW Security .Sytems: No.of Devices or Equivalent No.of Water No.of No.of Heaters KW Data Wiring: __--_ Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total IIP Iclecommunications Wiring: No. I'Devices or Eq tlkalent OTHER: Illtn:l:no/llru;rl: Jr';:t1i,% /r tftr/• I' ,s r'i,(!,N'c•/% 1 ,rlt •�i,�l�+ I' .: F,thnatcd VJuc ut Elc ctrical 'X,r i-k: t 1.1 hen raiuired by municipal p(,,licy.) ork to`Gu't: In pcction:s to be requested in accordance with \IEC. Rule iO, and upon cunlplctiun. S(_12.111NCE CO ER:k(.,'E: L nle,s waIk' d by Ilse owner. no penllit Cur the 1,crIunIIiIncc t;t clecn•iulI wt,rk I n,Iy i t I c IIIc ht: licensee hn:`.i lc, pI-0o1'')t•li;shility it,,xu;ulc'_ incltldim "'.'. mpletr+_I+;perltion" 1117"Iantial . tl, th,lt'ocll c+,+ ,;1';I^,C �; Al It I'::c ::11d IlihitCCI prod IA 'LIrIc R' the 11'!:I'I11it C hill': (dhwv. IL(_I\ •1'•�I:. ire';% :2.\�(.'i:.� -'l.`.I? � ;I I'1'IZ � .� `I .':7f/L'1' "f1k, It i,!,'1 r,t•j'. 1'1/ 7}l' ''r�Ut'','1:.1.":11 .,f '1 t.1' !.')'17'r•:!�'a.;l J .1'rr r t.'r� r: .,'17�:!+.'. % l�ress: 1. T.A.i � � e4 tf A It. rel. '''n. lu_U17'7L 5- ;ccurity :;+. te!n C ,ntr;I'at r t,i _• ,o..luirc.� h,r tf;i5 ..(.'!.: it, pylic lhll.1111cr ilc liccn_,c rurnbcr herr: 1-�- Db1 N ER'S INSI-!t.vv. E 'tib,\Iv-f ll: 1 ;'m +w:Ire `hat Ihr: '.i;:n:ec /,. m 1 l;r l:. Ih,• ILquired by law. 3} nn :,In;lttu•c blIca.,. I hcrLhy ':,:Ii";l thi: n.yuiruncnt. I r,m th,�(,.heck r,ncl❑ ,;,�ucr ❑ u ;ur') 4)w ner,',�gent �t- � B�C �� � � ��r �� �� (�� �� l3 --a 6 0� qq Date........ .�l.......".. .�� 3? �NOarh,�oo` TOWN OF NORTH ANDOVER w ` o s PERMIT FOR WIRING +r ate; This certifies that .../.. .-. �� ...... .............:.............................................. ....................�......... _ has permission to perform .................................................6s ' cl,� wiring in the building of.. . `��............ ..11.x! ......�,,T.-. ."'. ........ fi at ..... yy.. .......... ................ .North Andover-Mass. r "_" Fee.. ...... .. Lic.Nol�S �: EL"£MCAL INSPEC F6R' Check 4t 0 a LJ i tnantntantuoaL!!t o !/1Wdaclitctc/�I, Official Use Only PermitNo. _ = aL_lefta�•Intcnt o��ira�arut:ce9 _ Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev-I/071 (leave blank) APPLICAT90N FOR PERMIT TO PERFORM ELECTRICAL WORM All%vartc to be performed in accordance ivith Ilia Massachusms Electrical Code(MEC),537 ClurR 12.00 fPLR�48EPJbWTJNflVKORTEPEALL PTOMIDITION Date: /9 j City or Town of: �' To the Ii7 actor•of tires: By this application the undersigned gives notice ofltis or her intention to perform the ectrieai work described below. Locntion(Street g Number) �O c .70iI Owner or Tenant 15, 04G Tele lrone �G P No. Owner's Address Z.6 7 as /(d AA6ocer �~ Is this permit�n.Lonjuncdon with a building permit? Yes � No ❑ (Checit Approprinte'Box) Purpose ofliuildlug,Cp LA�Ak&/-C/ / Utility Authorization No. Existing Service temps I Volts Overhead ❑ Undgrd❑ No.of Meters New Service }imps / Volts Over•liead ❑ Undgrd ❑ No, of Meters Number of-Feedors and Ampacity Location and Nnture ofPraposed Electrical Work: Completion paha follolving loble menr be wafted by the Inspector of r. No. ofReccssed Luminaires No.of Ceil:Susp.(Paddle)vans No'of 'Total Transformers ]CVA No. orLuminnireOutlets No. of Eat Tubs Generators ICVA- No.afLilminnires Swimming Pool Above ❑ In- No.o ,mergencyLrg ting ` ernd, er-nd. Bnftpry Units No.orRaceptnele Outlets No.of Oil Burners FIRE, ALARMS No.orzones orDetection and No.ofSwitcltes No.of Gasl3urners No. InitiatineDevices No. aFRnnges No. afAir Cond. Total No.orAlertin Devices Tons g No.aFWnste Disposers 1-1entPump I Number ITons KW o.ofSeil=Contained Totnls: I I Detection/Alerting.Devices No.ofDishtivasbers Space/Area Bearing ItW oca Ll❑ Municipal • Connection ❑ 011ier No.of Dryers Heating Appliances Sacurity Systems:= No.ofDevices or); uivnlent No.of Water No.or Na_of Heaters XW Data Wiring: Signs Ballasts No.ofDevicesorE q uivaient No.Hydramossnge Bathtubs No. of Motors Toin110 Teiecommunlcations Wiring: No.ofAevices ori;cluivilent O TRER: Anoch additional demi/ifdesired,or as required btr ilia Inspeclt:4r of 1 Estimated Value ofElectriea[Work (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with IvlECRute 10,and upon completio;r. INSURANCE COVERAGE: Unless waived by Ilia owner,no permit for the performance of electrical work may issue u [lie licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent 'I undersigned certifies that such coverage is in Force,and has exhibited proof ofsnme to ilia permit issuing oft ice• CHECif ONE: INSURANCE {_ BOND ❑ OTHER ❑ (Specify:) I carfiA finder tli r,017111s and penalties ofperjury,flint ilia irrforinution oil!itis application is trite and cantple'tt'- FIRIYi NAME: (- �C Cd. T C = LIC.NO.: Licensee:VJaHhe Signature LI C.NO.• d (Ifoppllroble, {tet-"exemp 'in alirens timberline_ Bus.Tel.No.;`3 4, �tiiL"�l �,1� 83��17 t Alt.Tel. No 72'/-aS8' *PerM.G_L.c. 147,s,57-ti security work requires Department ofPublic Safety"S"License: Lir;_No. OWNER'S INSURANCE WAIVER: I am aware that die Licensee doesnol have the liability insurance coverage norm; required by law: By my signature below,I herrby wa=ive this requirement I am the(cheelc one)❑owner El owner's i Signature TeleplioneNo. PEIZIIrRT-EEE; $/Z.S�_ a Town of Andover ,P `' •! \ Massachusetts 36 Bartlet Street Electrical Inspector 9iP , Andover,MA 01810 Paul Kennedy (978)-623-8306 AC U ELECTRICAL PERAUT FEES Fax Number: (978)623-8320 (revised September,2012) Office Hours: 8:00 a.m.- 10:00 a.m. Commercial Base Fee $50+ $1 each device Residential New Dwelling Up to 200 amp service $225 Each add. 100 amp's $20 Multi-Family New Condo/Multi-Dwelling(per unit) $225 Residential- Service/change/alterations 1 phase-200 am $60 Multi-Family/Single Family 3 phase-200 am $110 Each add. 100 amp's $20 Additions/Renovations/Replacements (Maximum.Fee$225) $50(min.fee) Outlets,switches,plugs, luminaires,etc. $1 each device Residential/ Appliances $50(min.fee) Commercial($50 base fee+) $10 ench appliance Air Conditioning and Heat Pumps $50 Temporary Service $50 Residential Generators/Solar Panels (service additional cost) $100(base fee)+ Additional Equipment $25 each Commercial Generators/Solar Panels (service additional cost) $100(base fee)+ Per ICVA $1+ Additional Equipment $25 each Residential Audio/video/datalphone-systems/ $50 Fire alarm/security systems Codimercial Audio/video/data/phone-systems/ $50 base fee+ Fire alarm/security systems $60 Commercial .r✓q New Construction and Alterations Base fee $50+ Per 1,000 sq.R.of Construction Space $100 Service/Change up to 200 amp $150 See Electrical bis ector for rice above 200 am Maintenance Permit/Repair Blanket Permit(up to two electricians) $200 �< Over two electricians(per air) $50 / Office Furnishings/Partition Relocations $50.00(base fee)+ Per Circuit $10 Transformers(non-utility owned) $50 Miscellaneous Carnival rides $50 Demolition $50 ' Feeders or sub-feeders and panels $30 (each 100 amp.capacitor fraction thereof) ' Motors,per hp or fractional part thereof $4 Siding (re-securing service,lights,plugs) $50 Signs $50 Meters $20 Swimming Pools In-ground $100 Above-ground $50 PCV\ Commercial $200 General Fees Re-Ins ection Fee $50 Inspection after hours(minimum fee) $200 Working without a permit Double Permit fee •kyr - �yy- 7��� The Con!!!cou'fNeg11h of:.PIassac/tttsetts DepaNi ieht°of lrifirrstiIIII A'ccirlenIS - ' Office of Investigations 600 Wash region Sit-eel Boston, PJA 02111 mufmnass.gov/dia Workers' Compensation Insurance-A-ffidavit.Build ers/Contracton/.l kdi,�Of`.s/]f'Iumb:eI= MASSACHUSETTS Ulf BELOW FOR OFFICE USE ONLY PLAN REV6EW NOTES ELECTRICAL INSPECTION NOTES ELECTRICAL INSPECTION NOTES FEE: ; PERMIT# ROUGH FINAL Date..+�GL..`'` !.-�............... ��10RTIy TOWN OF NORTH ANDOVER * PERMIT FOR WIRING 8s.+cMus� This certifies that ..../.. e d t �- ........................................................................................................ has permission to perform ..............-�/G• '^ ...... . . . ....................................................... whin in the building of........ T . iat .!... .......... �.. ..<3T7rC An ........................... dover,Mass. Fee...../C°6 J..Lic.No.G, .....`.....<.. .......... � ... .. . ELE CAI.INSPECTOR . Check# V E n Ung Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(7`7(!:3& 7 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: I City or Town of.. MOh AV144ef 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) Owner or Tenant U-k—A�5 C I Telephone No. Owner's Address e f Is this permit in conjunction with a building permit? Yes FF-1 No IF (Check Appropriate Box) Purpose of Building _Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location/and Nature of Proposed Electrical Work: QOW. Ii_ PCK_y Cy 6',Cf e-S T'n /Ile /a v��� �(r'c ( (-/ dam 1� e �,,r� c -�od' �t c�,'�- �PLC-P.� Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming PoolAbove ❑ n- ❑ o.o Emergency Lighting rnd. id. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners o.of Detection and Initiatin Devices Tons g f a No.of Ranges No.of Air Cond. Total No.of Alerting Devices • No.of Waste Disposers Heat Pump Number Tons KW No. of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection nn No.of Dryers Heating Appliances KW Security Systems: No.of Water No.of Devices or Equivalent No.o No.of Heaters KW Data Wiring: Signs Ballasts No.of Devices or Equivalent • No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires. 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 ® BOND El OTHER El (Specify:) ((�� r Estimated Value of Electrical Work: L114113 (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under Ilse pains andpenalties of perjury,that the information on this application is true and complete- FIRM NAME:_7`Ud s . / A1 n LIC. NO.:02/63%A Licensee: �� ��( �j7'I�Signature � LTC.NO.: (If applicable, enter 'e empt"in the!/•cense number line.) j Address: e 'r, L____� Bus.Tel.No.:rj' t�- Alt.Tel. 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 agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ L�► lease visit our web site at http://www.mass.gov/dpi/boards/EL TOCCO CORPORATION JOSEPH V CAMILO (E L) 29 COOK ST BILLERICA MA 01821-6044 Fold,Then Detach Along All Perforations 9 COMMONWEALTH OF MASSACHUSETTS BOARD OF ELE`CTR'I:CI ANS E " ISSUE5 THE FOLLOWING LICENSE ASA w REGISTERED MASTER; ELECTRICIAN T©CCO. CORPORATION N JOSEPH :V CAMILO< Z 29 COOK ST BILLERICA MA 01821-6044 21659 A 07l 1_/16- 0 8 � Date.. .......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........................ ..................... ................................ /7 has permission to perform ... . .........•........................................... wiring in the building of ........ ......... .............................................. at....................... ............ .. ....................................... ,North Andover,Mass. Fee ....... Lic.No. ............. ............ 'ELECTRICAL INSPECTOR Check # �21 7160 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 716to BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/991 (leave blank J APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 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: 1-17-07 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) 1600 OSGOOD STREET a'7G Z—o l`-f FL.00 C 4,E Owner or Tenant WATTS REGULATOR Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. none required Existing Service Amps Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Renovation to existing office space No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Tota Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting d. d. Battery Units No. of Receptacle Outlets 4 No. of Oil Burners FIRE ALARMS No.of Zones No. of Switches No.of Gas Burners No.o Detection an Initiating Devices No. of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pum Num er Tons KW No.o Self-Contained Totals: . Detection/Alertina Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other existing Connection No.of Dryers Heating Appliances KW Se S ste s: ie 1 No.of Water KW No.o No.o Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydro massage Bathtubs No.of Motors Total HP Telecommunications Winng: No.of Devices or Equivalent OrHER:ADD 60A SUB PANEL,TELECOMMUNICATION PIPE INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licen- see provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certi- fies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify :) (Expiration Date) Estimated Value of Electrical Work: $ (When required by municipal policy.) Work to Start: 11-02-2006 Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certijy, under the pains andpena/ties ofperjury, that the information on this application is true and complete. FIRM NAME: WILLIAM J.IANNAZZI,INC. LIC.NO.: 13592A + Licensee: WILLIAM J.IANNAZZI Signature W1ivu . la`, L azz% LIC.NO.: 13592A Bus.Tel.No.: 978-686-7300 Address: 191 CHANDLER ROAD ANDOVER,MA 01810 Alt.Tel.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. 1 am the(check one)❑owner ❑owner's agent. S gnatu egent Telephone No. PERMIT FEE: $ 7F Date...... 14, f %ORTH TOWN OF NORTH ANDOVER FO P PERMIT FOR WIRING ��SS�cHUSE� This certifies that ....... /...........:. 11i� ..��.7.�..... �.4....... has permission to perform .......ReWA- .'... ..../.gevo.-�............... wiring in the building of...1WA7.7...s...... Sf.-R! 5................. at...�!6.�v!f� �a .... '/ �,'A if c,, North Andover,Mass. "d d r Fee..!.�:;�^.r.-.--Lic.No. ............. .... 1: �c�t � . i E ECTRICALINSPECTOR Y Check # 3 l7L� U �'r Commonwealth of Massachusetts Official gUse /Only Department of Fire Services Permit No. fsi (1t / Occupancy and Fee Checked r BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (leave blank) i APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 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: � -- —v(e City or Town of: �} �0\ To the Inspector ofWires: 00 7 By this application the undersigned gives notice of his or her intent on to perform the electrical work described below. Z Location(Street& Number) Lp00 Q Cjc-:2(o a 14�z> Owner or Tenant A" "�� t N �0S Telephone No. lum,ne..'. ..,a_.... Is this permit in conjunction with a building permit? Yes 0 No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: a Completion of the following table may be waived by the Inspector of Wires. r' No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Tota Transformers KVA No. of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above D In- El Battery o Emergency Lighting rnd. rnd. Batter Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones o Detection and No.of Switches No.of Gas Burners No. Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.o el - ontamed Totals: .......... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipa ❑ Other Connection No.of Dryers Heating Appliances Kms, Security Systems: No.of Devices or Equivalent No.of Water K`,,, No. of No.of Data Wiring: HeatersSi ns Ballasts No.of Devices or Eqivalent No. Hydromassage Bathtubs No.of Motors Total HP Te ecommunications Wiring. it f No.of Devices or E uivalenl 0 OTHER: 1 Z f—\ b S Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work:,-V,-.-,, 6-- (When required by municipal policy.) Work to Start: 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 liabili insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE- BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: `w LL_L M .'� � � ' ,Z-'A_)C LIC. NO.: ZA Licensee: o� kignatuie LIC. NO.: (If applicable, ter "exer�gt"i th licen number e.) Bus.Tel. No.: Address: (� Alt.Tel. No.: *Security System Contractor License required for this work; if applicable,enter the license number here: 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. 1 am the(check one)F] owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. ��