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Home My WebLink AboutMiscellaneous - 20 INGLEWOOD STREET 4/30/2018N Date.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............ permission to perform .... h -5 ��7. .... . ............................... as ...... wiring in the building of .............. ru " 6 * -z-, at ...... ..... North Andover, Mass Fee ..L/S—' '':.. Lic. No.... .......... .. ......... ELEcrRICAL INSPECrOR/ Check# 35-3VXLI r"C7 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 instrallation 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 -invalidif_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. ❑ 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: �*** Note: Reapply for new permit"""" 0 Permit Extension Act — Permit/Date Closed: R f ( Occupancy and FeeChecked EUAR17 OF FERE PREVENTION REGULATIONS Lev. 1/071 (leave blank) APPLICATIONFQR PERWT TO PERFORM E , C IC L WORK . All work to be performed in accordance with the Massachusetts ElectHcal Code (fac), 527 CMR 12.00 (P.LE'XS 'PRI.NT ININYOR 7.'Y.P A JWFt 0 ZkUTION) Date:. (City or Towu ofa_ To the Inspeefor of Fires: By this application the undersigned gives notrce o)'f his o her intend to pe orm the electrical work described belo ;v. Locations (Street&Number) . ' Owner'or''extant L elephane No. %�i�y p�— Ownerla Address ` .Is this permit in conjunction, with a E@lding.perinit? YeS ❑ • No �fl (ch'ac CAppropriate Box) rurpose 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: . Completion of the following table may be waived by the Xnsnector or I',llres. No. of Recessed Luminaires jNo. of Cell.-Susp. (Paddle) pans iso. 03 x oral Transformers Ki A. No, of Luminaire o.atlets No, of Hot Tubs Generators ' RVA• No. of Luminaires S�+in, &g Fool p bove ❑ fn- nrd. aznd. ❑ o„ 0 �inergency Mfg Battery Units No, of Receptacle Outlets PI'o, of Oil Burnes FW1 ALARMS No. of Zones Pro. of'Switclies No, of Gas Burners Pio, of Detection and r I, itiatinrr Devices JNo, No. of Ranges No.. of Air gond, dotal 'Pons _ ofAlertingDeAces No. of WastQ Disposers Heat Pump 1\TtxTnik 'i`ons I��iY 'Totals; NO. ofuelf-Contained -Detection/Alerting DeAces�-- FN0. Dishwashers Space/urea Heating it unfcipal Local ❑. onrte&ion QtIzer Dryers Heating Appliances XW Security Systems: o. or Devices or Equivalent 1 Y No, of SrYater KWNo. Heaters of No. of Signs BallastsNa. Data Wiring: of Devices or Ecui'valent No. Hydromassage bathtubs No. ofMotors Total HP ;telecommunications IYIring: I No. of De vices or Ecuivalent O'I'gER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: )57v (When required by municipal policy,) I 'Work to Start: inspections to be: oquested.in accordance with MEC Rule 10, and upon completion. %NSIIRA.NCE 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, ChECI, ONE: INSURANCE 0 BOND ❑ OTHER ❑ (Specify:) X cerfi, under the pains and peizalties ofperjwy jhat the information. on this application is true wid complete. FIRM NAME, -5' •flse_�.ct j 5-e v�, t � _ Mc. NO,: L� V51 : fcensee: 1`�i exrY� � Via. � Signatuz'e� �� 'LIC. NO,: (ifapplicable, enter "exem t"in the licensenuwber - e , " 1 �adt. 5 7yt- ' Bus, el.l�,ra.: Address: 1 C_ _e r� —La -11 d� I`. 1 O 8" Alt. 7 eI. No-, *Per :M.G,L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: L ic. No, OWNER'S INSURANCE WAIVER.-. I am aware that the Licensee does not hcive the liability insurance coverage normally required by la,,i. By my signature below, I hereby waive this requirement. I am the (check one) ❑owner ❑ o�yne;'s agent. Owner/Agent Signature _•� _ Telephone No. -PBR( 'IYTFE UP.' � G� ' . �.' ` � Up '. ' � .. SR :ER ^. , . '4 ^ ' ' 1�0�n=ow�,^�»^ '�="�u ' .'/ .. . . . . ' . . i' '--- --- xe»p�P �receipt ` . . IDneCmC, . . .DEPARTMENT.6F pu13LIdaxFsr( ' . S-Lfc'ense oaco ()00.953. . ` . . — .` o ' ��n� 1o5� —r— ' ' ' ' ''� . ^ AoT. .. . �� aRoPHY�� ^ � *10oNIVEnaITY*«E o/g o��L� ' ��of4��oa. ^% wEaTWoo�wao2u� . axr=CENTER:°. /. . commissioner_--. . . . . .. . . ' . . .' . . . . . . . . . - ' . . . . ' ^ ' -'' . .�' . . �. . . .� ^ . . . . . .. . '. ` � The Commonwealths of Massachusetts °ttlCe Use Only Peratt :to. !� Departmmt of Public Safety occupancy t: Pee chacked_2,,_ BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 3/.90 (tease Blank) /0/3 APPLICATION APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Ma"L"chuserts Electrical Code. 527 CMR 12:00®® (PLEASE PRINT. IN INK OR TYPE ALL INFORMATION) Date y (6 City or Town of _111W �%! jJPj To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address Is this permit Purpose of Buil Existing Service /yc,� Amps Volts f® Overhead Undgrd ❑ flew Service �Dl% Amps %2 D / ;� Lf� Volts Overhead Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Lighting Fixtures No. of Receptacle Outlets No. of Switch Outlets y No. of Ranges No. of Disposals No. of Dishwashers No. of Dryers No. of Watef No. of Hot Tubs Swimming Pool Ab gr No. of Oil Burners No. of Gas Burners No. of Air Cond/ Space/Area Heating Heating Devices No. of Meters-, No. of Meters No. of Transformers e ❑In- grnd. ❑ Generators KVA al Total no KW KW KW S KW Noy of No. of Signs Ballasts Massage Tubs INo. of Motors Total HP FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Selg Contained Detection Sounding Devices Municipal Local Connection❑ Other Low Voltage Wiring -ff L l• j, , tV�D t , i ! INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws �. I have a current liabilit YE Insurance Policy including Completed Operations Coverage or is substantial equivalent. NO I have submitted valid proof of same to this office. YE NO D If you have checked YES, please indicate the type of coverage by checking the appro date box. INSURANCE BOND ❑ OTHER [I (Please Specify) � �� /2�-f-2 / r Estimated Value of Electrical Work Syye) xpirat on ate Work to Start 6" 9� Inspection Date Requested: Rough / Final(p �91p Signed under the penalties of perjury: FIRM NAME��' Licensee_ -,A Cei, �z�� _Signature Address 2/ - LIC. NO.,, �a LIC. NO., 2 Z�J 7S` y —BUS. Tel. No" - OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or is 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) PERMIT FEE S V l Signature of Owner or Agent Telephone No. i a/ KZ1 a