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Home My WebLink AboutMiscellaneous - 315 TURNPIKE STREET 4/30/2018 (7)- 1-7 1 1 ! i a Date..... ..... .... ..... + ..e0 FT� ``° '• "a TOWN OF NORTH ANDOVER PERMIT FOR WIRING �5 �r c This certifies that ............t�tl/4-L) Z ............................................ T11 n has permission to perform � �y �C �� .......... ...................................................... wiring in the building of 1�!Mf� �..... ��re 9<— ................... ........ .... ....I.............. 31-5- at...................................................................... , North Andover, Mass. Fee.(L .... Lic. No. �Ol ��//T.........l................ Check !f ELEc"mcAL INSPEET1OR /. � %ZZ 2 93u:- �t A _\ Commonwealth of Massachusetts OffiELM cial Use Only Department of Fire Services Permit No. �o BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1107] b] eave auk 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 PRINTW INK OR TYPE ALL INFORAVUTIO Ni Date: -2— —/() City or Town of: NORTH ANDOVER To the Iector of By this application the undersigned gives notice of his or her intention to perform the el� electrical wok dies nbed below. f14)r� Location (Street &Number) 3l s '3 vg Owner or Tenant ,/�Ci?)� ►M CA �vL C C S �✓ 1 1P,4/ C Telephone No. Owner's Address ► l/ i?N c Is this permit in conjunction with a building permit? Yes Purpose of Building ❑ N0 ❑ (Check Appropriate Bog) Utility Authorization No. Existing Service Amps _ / _Volts Overhead ❑ Undgrd ❑ Na. of Meters New Service Amps ----'L—Volts Volts Overhead ❑ Undgrd ❑ No. of Meters .A Number of Feeders and Amps Location and Nature of Proposed Electrical Work: No. of Recessed Luminaires No. of Luminaire Outlets No. of Luminaires No. of Receptacle Outlets No. of Switches No. of Ranges ------------ No. of Waste Disposers No. of Dishwashers No. of Dryers Heaters KW Hydromassage Bathtubs OTHER: c omp/etion of the o. of Cei7.-Susp. (Paddle) Fans No. of Hot Tubs Swimming Pool Above 13d. No. of Oil Burners No. of Gas Burners No. of Air Cond. Ta Space/Area Heating KW Heating Appliances , No. of Motors Ballasts vintablemay be waived b the Ins ectw No. ,f— Total Transformers KVA Generators KVA Z_ o mergency ig sg Batte Units 7-7 ALAWYIS No. of Zones No. .of Detection and Initiating Devices No. of Alerting Devices o. of Sef-CoteInaind DetectiowAle ' Devices Local ❑ Municipal Conneetinn ❑ Other No. of Devices or Dasa Wiring: No. of Devices or Total HP P elecommunications No of Devices or Estimated Value of Electrical Work: Attach additional detail if desired, or as required by the Inspector of Wires. Work to Start q- /a (When req 'f municipal policy 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-.) under the pains and penalties o fperjury, that the information on this I certify, FUM NAME: appticafson is true and complete '� 1 NC . Licensee:fib F� G LIC. NO.: av 14 � 4 (If applicable, enter exempt ithe yGlic license number line.) Signature �~ v v\ LIC. NO.: y 0 (D 1 U Address: 3 .n T T j,.0 J 12� �) ' Bus. Tel. No.: 9 -3i *Per M.G.L c 147, s 57-61, security work requires Department of Public Safety "S" License: Alt. TeLicl No.: OWNER'S INSURANCE WAVER: I am aware that the Licensee does not have the liability required by law. By my signature below, I hereby waive this requirement I am the (check one) ❑ owner coverage oo owner's normally Owner/Agent Signature Telephone No. PERMIT !a �, Jr i. r� The Commonwealth of Massachusetts Department of Industrial Accidents Dice of Investigations 600 Washing ton Street Boston, MA 02111 Workers' CompensationInsuraaee Affidavit- B,uiiders/.Contractors/Eieatricia 1iicant Information ns/Piumbers Name (Business/organization/lndividual): Address: City/State/Zig: Phone #. . Are you an emp{oyer? Check.the appropriate box: I. ❑ I em a employer with 4. ❑ I am a genual contractor and I Type of project (requt�; 2. ❑employees (full and/orparl-time).* I am .a sole proprietor or have hired the sub -contractors Iisted 6• ❑ New construction partner. ship and have no employees on the attached sheet $ 7. ❑ Remodeling working for mem ty. �peci These sub -contractors have workers' insurance. 8• ❑ Demolition [No workers' comp. insurance comp. 5. ❑ We are a corporation and its g ❑ Building addition 3. ❑required_) I am a homeowner do' officws have exercised their 1Q•❑ Electrical repairs or additions seI f all work RlY [No workers' comp. right of exemption per MGL C. i52, § 1(4), and we have no I I .❑ Plumbing repairs or additions insurance required.] t .employees. [No workers' 12.0 Roof repairs "f+nyappiicarrtthar checks bo> !i t must also fill COMP. iinsurance,required_] 13.0 other out the t Eiomeow s d who submit this aff'i'davit indicating they ;Coatrac•fnts that check this box must attached section below showing their workers' immpensetion policy information. are doing all work and then hire outside con Out must submit _ additional sheer sho a new af"ridavit indi08* such. wing the me of the sub.cwftctrns n,1 Ls... • yrs enrplOyel that is provi tg workers' compensation insurance for RV employem' Below is the off -, W �N1L rrt}ormation, P 1Y md job site Insurance Company Name: Policy 9 or Self -ins. Lie. #: Expiration Date: Job Site Address: Attach a copy of the workers' txt CitylStaiter ip: co pensation policy declaration page (showing the policy number and expiration date). Fallut to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties ipenalties nes of a n the form of a STOP WORK p Of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of a fine Investigations of the DIA for instu•ance coverage verification. I1_ L___, - .v —agy anaer the pains and penalties gifpedwy Mat the injormafioa provided above is true and con= Sitmattur: ofj`iciaf use only. Do not write in this area, to be completed by or town official City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. CitYlTOWn Cierk 4. Electrical Inspector S. Plumbing inspector 6. Other Contact Person: Phone # Date .�. �. i3 .................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... �..�P`— "" `.................... ........... ...................... ..... ........................... has permission to perform . 1 C-.-en►Q-J er L.• wiring in the building of...... .. rY.. i..... - at........��..,,..... .......I..� (N. ,.�4�... 1 ...:....................... orthAndover,Mass Fee.... h'........ Lic. No.?I i�j ..!..".tom .............. �% ..... • EL CAL INSPECTOR Check # 1 v' r 647 4 Vaj.4ac1 of 0 ��cial�Uj Use Only o�..i cc�.13" �eryPermit No. ' 1 lY I I aUeParEinent ices Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [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 (PLEASE PRINT IN INK OR TYPE 4kL IN1F1O,R,MA,, TION Date: City or Town of: lud ��G1c>; C r To the Inspector of Wires: By this application the undersigned gives notice ofhisor her intention to perform the electrical work described below. Location (Street & Number)/ vQ�u !-fir Owner or Tenant /" l t rr, MaC Ol ( cit 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 New Service Amps /, Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Overhead [J Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters rR `r Comnletion ofthe following table may be waived by the Inspector of Wires. Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electri I Work: (When required by municipal policy.) Work to Start: — ? 15 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 coo rage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE (Q BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and enalties of perjury, that the information on this application is true and complete. FIRM NAME: �.tAAJ 44A r�)LG>tY?(, e I i LIC. NO.: R/(%? 3 Licensee: f:m� (3,1k --t %� Signature LIC. NO.: (Ifopplicable, enter "exempt" in ie I{'cense t tmber.line.) �j Bus. Tel. No.; 97 -50- 77� Address: I S q P. �tT QkA ers7�'�t Ica01la q Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. NDS OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance covkei�ge normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent PERMIT FEE. $ Signature Telephone No. No. of Tota No. of Recessed Luminaires Paddle No. of Ceil: Sus . Fans P (Paddle) Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires AboveIn- Swimming Pool rnd. ❑ rnd. F]Batte o. o Emergency Lighting Units jVo. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. and A�fNo. of Switches No. of Gas Burners InDetection Initiatin Devices No. of Ranges No. of Air Cond. Tota ns No. of Alerting Devices Heat Pump Number Tons KW No. of Self -Contained No. of Waste Disposers P Totals: _ " ........_.. ....................... Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent Wiring: TelecommunicationsNofDevices No. Hydromassage Bathtubs No. of Motors Total HP r No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electri I Work: (When required by municipal policy.) Work to Start: — ? 15 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 coo rage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE (Q BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and enalties of perjury, that the information on this application is true and complete. FIRM NAME: �.tAAJ 44A r�)LG>tY?(, e I i LIC. NO.: R/(%? 3 Licensee: f:m� (3,1k --t %� Signature LIC. NO.: (Ifopplicable, enter "exempt" in ie I{'cense t tmber.line.) �j Bus. Tel. No.; 97 -50- 77� Address: I S q P. �tT QkA ers7�'�t Ica01la q Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. NDS OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance covkei�ge normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent PERMIT FEE. $ Signature Telephone No. Date ..J./ ............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING Com- . /P � ,� This certifies that ...................7.. Av ................................................................................................... has permission to perform/....M.-P ....... Z14. wiring in the building of ............. ein . ......................................................../'OCG' 0........... I .................. I at ....Northn Andover, Mass. IN I Fee./o?.5 ... ...... Lic. No-'./.PZK ..... ...... ELECTRICAL INSPECTOR I jCheck # 1766 04 ti Cmnonw �Vama LLA O ficiallU/se Only Permit No. 14q q aLJeparfirtertt o`�ire �2ruises Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK c: All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE A INFq TION) Date: I/l 2, City or Town of: AO%100/1/ To the Inspector of Wires: By this application the undersigned gives notice ofjt.is or her intention to perform the electrical work described below. Location (Street & Number) 016— ti iP;� , /Ck, k3 - Owner or Tenant m Ina G 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 New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Completion of the followingaztable may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total T ansformer$ KVA No. of Luminaire Outlets No. of Hot Tubs Generators ( KVA No. of Luminaires Above EJ In -o. Swimming Pool rnd. rnd. ❑ o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners of No. InDetection and Initiatin Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Number '� Tons KW '� _ _ v No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal C1 Other Connection No. of Dryers Heating Appliances KW Security Systems:* 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 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: (-/-)5>- 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 cov rage is in force, and has exhibited proof of same to the permit -issuing office. CHECK ONE: INSURANCE [N BOND ❑ OTHER ❑ (Specify:) I certify, under the ppains and/penalties of perjury, that the information on this application is true and complete~ FIRM NAME: P;4AJ 6;t --(W Eje0+f!-(- r-7--) , P R LIC. NO.: �2I0-?J Licensee: b A-rH Signature / LIC. NO.: (If applicable, enter "e�xe�mypt" in re I'cense i Unber.line.) f �1 Bus. Tel. No.: c1,7`S 77r Address: 1,S L/ W e -M ��7 QJ -V- l ensW Nia 0,1a 7 Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. 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 a ent. Owner/Agent PERMIT FEE. $ Signature Telephone No. The Commonwealth of.11assachusetts Del mrtment of industrial Accidents Office of Ittresti;ations 600 TV hitt tort Street _ Boston, IIA 02111 ecn�et. plass.; oe /ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ant tion rint utile I lialtitltZ�> tyro -Ir 7iL?tr• I::dt1--- Address:---- Cits-'State/Zip: ae.[lns4rd Ju ____ Phone #-:_ _- Type of project (required): 6. ❑ \cw construction 7. ❑ Remodeling S. ❑ Demolition 9. ❑ Building addition 10 -Electrical repairs or additions I I N Plumbing repairs or additions 1?.❑ Roof repairs 13.❑ Other °Ane applicant that checks box =i must also fill out the section be.oa- showing their worker: compensation policy irfouration. Honwo%mers who submit this atiidayit indica-:re thec .ae doing all %%ork and then hire outside contractors trust submit a ne%y affidavit indicaiing such- =Contracior: that check this box must attached an addiiiona! sheet showing the name of the sub -contractors and state ahoher or not those entities ttaye etnployces- If the sub -contractors ha%a cinployees. they riust pro%ide their workers' comp. policy nurnb: r. I ant an emplcte•er that is prm•idin; barkers' compensation insurance for mr emploe'ees. Beloit, is the police• and job site iitforuurtiott. lk Insurance Company Name: -.-OT Policy = or Self -ins. Lic_ _:_ iN £.� a SsgA Expiration Date: .lob Site Address: A41nMap_ Cit\- Statz'Zip:-- -- --- —.--- Attach a copy of the workers' compensation policy declaration page (showing the police 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 !ire up to S 1.500.00 and -'or one-year imprisonment. as %veil as dell penalties in the form ofa STOP WORK ORDER and a fine of tip to 5250.00 a da.- against the %•iolaior. Be advised that a cope of this siatemen, mai be fcirwarded io the Office of hivestl-attons o: the DIA for insurance co�eral e verificaiion. I do hereht• cer • 'r the airs cine! penalties of perjure• that the information prorided abore is true and correct. 7 7J Uflicial ruse onlr. Do nut it -rite in this area. it) he completed hr cit; or town of/ieial. Citi- or,l"011-11: Permilo License lssuina Authorit♦ (circle one): 1. Board of llcalth 2. Buildin'- I)cparttncnt 3. t -it% 7 o«n Clerk a. Electrical Inspector 5. 1'lunthing Inspector 6. Other Contact 1'crsun: Phone =: Are ou an employer? Check a appropriate box. � ❑ I am a general contractor and 1 I I am a emplo��er with employees (full and'or have hired the sub -contractors part-time)_* _. ❑ i am a sole proprietor or partner- listed on the attached sheet - ship and have no employees These sub -contractors have working for me in anv capacity. employees and have workers insurance. [\o xa-orkers comp. insurance comp. required.] - 5. ❑ We are a corporation and its 3. ❑ 1 am a homeowner doing all .cork officers have exercised their myself [\o workers' comp. right of exemption per MGL insurance required_] ' c. 152, § 1(4). and we have no employees. [\o workers' come. insurance rec uired.l Type of project (required): 6. ❑ \cw construction 7. ❑ Remodeling S. ❑ Demolition 9. ❑ Building addition 10 -Electrical repairs or additions I I N Plumbing repairs or additions 1?.❑ Roof repairs 13.❑ Other °Ane applicant that checks box =i must also fill out the section be.oa- showing their worker: compensation policy irfouration. Honwo%mers who submit this atiidayit indica-:re thec .ae doing all %%ork and then hire outside contractors trust submit a ne%y affidavit indicaiing such- =Contracior: that check this box must attached an addiiiona! sheet showing the name of the sub -contractors and state ahoher or not those entities ttaye etnployces- If the sub -contractors ha%a cinployees. they riust pro%ide their workers' comp. policy nurnb: r. I ant an emplcte•er that is prm•idin; barkers' compensation insurance for mr emploe'ees. Beloit, is the police• and job site iitforuurtiott. lk Insurance Company Name: -.-OT Policy = or Self -ins. Lic_ _:_ iN £.� a SsgA Expiration Date: .lob Site Address: A41nMap_ Cit\- Statz'Zip:-- -- --- —.--- Attach a copy of the workers' compensation policy declaration page (showing the police 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 !ire up to S 1.500.00 and -'or one-year imprisonment. as %veil as dell penalties in the form ofa STOP WORK ORDER and a fine of tip to 5250.00 a da.- against the %•iolaior. Be advised that a cope of this siatemen, mai be fcirwarded io the Office of hivestl-attons o: the DIA for insurance co�eral e verificaiion. I do hereht• cer • 'r the airs cine! penalties of perjure• that the information prorided abore is true and correct. 7 7J Uflicial ruse onlr. Do nut it -rite in this area. it) he completed hr cit; or town of/ieial. Citi- or,l"011-11: Permilo License lssuina Authorit♦ (circle one): 1. Board of llcalth 2. Buildin'- I)cparttncnt 3. t -it% 7 o«n Clerk a. Electrical Inspector 5. 1'lunthing Inspector 6. Other Contact 1'crsun: Phone =: I 1� Date ..q? ..h. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that............`.`.....v................................................. has permission to perform .....P.......... c ......................... wiring in the building of....... P��. ..�!!R-�. �n ilk it. ........................... at ..... ., `� t `�`<�N �1�-�,— orth Andover, .M.a...s.. ass .................................................................... ... . 1 2�u'1 �1�D r�' 2 f� ELECMCALINSPECTOR check # ✓` �L\ Commonmea& o/ /llaa64cIL6eM Official Use Only PCORM cc�� Permit No. ) 15 1 a.UeParbmen# oire �eruices Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [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 (PLEASE PRINT IN INK OR TYPEALL INF RMATION) Date: 3—O —/5City or Town of- Ajax' 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 & Owner or Tenant Owner's Address Telephone No. 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 ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 1 cr No. of Meters No. of Meters rmmplotinn nfthe following table may be ivaived by the Inspector of Wires. Attach additional detail rj aesirea, or as required by the tnapectur uj "vies. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: —( —1 3 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 cov rage 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 enalties of perjury, that lire information on this application is true and complete; FIRM NAME: - AQ -7i C 1 eCi111— LIC. NO.: �2I0-?3 Licensee: KyfyU I� Signature ZA- LIC. NO.: (If applicable, enter "exempt " in e 1 "cense mb r line.) ' t Bus. Tel. No.: 9-73-350-777r Address: I S �l PS� cS �t on S M nip q Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, 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. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent PERMIT FEE: $ 1-7 Signature Telephone No. I No. of Tota No. of Recessed Luminaires No. of Ceil: SusP (Paddle) Fans ) Paddle Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above In- Swimming Pool rnd. rnd. o. o Emergency Lighting BattUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of and No. of Switches No. of Gas Burners InDetection Initiatin Devices No. of Ranges No. of Air Cond. Tons Na. of Alerting Devices Heat Pum Num_ber__ Tons K_ W_ No. of Self -Contained No. of Waste Disposers P Totals '_- - ------_ .. Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local E] Connection ❑ Other No. of Dryers ry Heating Appliances KW Security Systems:* No. of Devices or E uivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or E uivalent OTHER: Attach additional detail rj aesirea, or as required by the tnapectur uj "vies. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: —( —1 3 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 cov rage 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 enalties of perjury, that lire information on this application is true and complete; FIRM NAME: - AQ -7i C 1 eCi111— LIC. NO.: �2I0-?3 Licensee: KyfyU I� Signature ZA- LIC. NO.: (If applicable, enter "exempt " in e 1 "cense mb r line.) ' t Bus. Tel. No.: 9-73-350-777r Address: I S �l PS� cS �t on S M nip q Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, 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. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent PERMIT FEE: $ 1-7 Signature Telephone No. I CGOSt:7) X S-7- t --2, L, COMMONWEALTH OF MASSACHUSETTS AS A REG JOURNEYMAN ELECTRICIAN ISSUES THE ABOVE LiCENSi TO: RYAN J GATH _m zw 66 PIKE ST TEWKSBURY MA 01876-25 : 52080 E 07/31/13 84054 I Date .... 7—/Vy ............. TOWN OF NORTH ANDOVER FiMIT FOR WIRING This certifies that ............ l/w .. ........... .................................................................................. —� e "—.f " --j .. . ....... '.). e r has permission to perform .... ............................................... wirinp in the buildino, of............. .......................................................................... ': .................... r -j — !! 4 ' "lprth Andover, Mass. at ........... .. ...... .... ........... P.A..4e ........................................ 1 ,,4 Fee........... Lic. No . ................. ............... .......... ; ... .... ....... .. .. .. ELECTRICAL INSPECTOR Check* 12 Official�Use Only �\ C.otntnoncvea� o� /Y/a3sac�ue�at� L c�c7 Permit No. �' - - aUeparltne►n� o� }ire SQruices Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 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 T PP f A4 INFO=6yw ON) Date: City or Town of• tN To the Inspector of Wires: By this application the undersigned gives notice of is or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant —,A=My Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Overhead ❑ Telephone No. Yes ❑ No ❑ (Check Appropriate Box) Utility Authorization No. Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed E Overhead ❑ Undgrd ❑ No. of Meters Undgrd ❑ No. of Meters �ra —ril fnttnvyino tnhly rnnv he waived by the Inspector of lfires. Attach additional detail tf destred, or as requrre i y re np 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 cov rage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE F BOND ❑ OTHER ❑ (Specify:) I certify, under thepainsandpena/ties ofperjury, that the information on this application is true and complete FIRM NAME: f?:•It` u &++1� �ltGfn� c ;L 4 LIC. NO.: 210234 i Licensee: ui1t3'i} Signature �f _ LIC. NO.: r (If applicable, enter "exempt" in to license n tnber�line.) ¢ / Bus. Tel. No.; 7� �1 Address: 1s�5� LC L YtC lrrlGf!t�a Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. 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'sa ent. Owner/Agent PERMIT FEE. $ Signature Telephone No. 1�rj 124 1 � --� -e, a,6LU e �� No. of Total No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans Transformers KVA Generators /.rm � C No. of Luminaire Outlets No. of Hot Tubs _ No. of Luminaires Above ln- Swimming Pool rn grnd. ❑ o. o Emergency!g ting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices Heat Pump Number Tons 1KWNo. —' of Self -Contained No. of Waste Disposers Totals: I - M+ Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW LOBI ❑ Municipal Connection ❑ Other Heating Appliances KW Security Systems` Devices Equivalent No. of Dryers No. of or No. of WaterNo. KW Heaters of No. of Signs Ballasts Data Wiring: No. of Devices or E uivalent Total HP Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors No. of Devices or E uivalent OTHER: d b tl I ector -,Wires Attach additional detail tf destred, or as requrre i y re np 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 cov rage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE F BOND ❑ OTHER ❑ (Specify:) I certify, under thepainsandpena/ties ofperjury, that the information on this application is true and complete FIRM NAME: f?:•It` u &++1� �ltGfn� c ;L 4 LIC. NO.: 210234 i Licensee: ui1t3'i} Signature �f _ LIC. NO.: r (If applicable, enter "exempt" in to license n tnber�line.) ¢ / Bus. Tel. No.; 7� �1 Address: 1s�5� LC L YtC lrrlGf!t�a Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. 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'sa ent. Owner/Agent PERMIT FEE. $ Signature Telephone No. 1�rj 124 1 � --� -e, a,6LU e �� if �v .1 OF Y'he'Commonivealth of Massachusetts . Department of IndustrialAccid'ents Office o,fInvestigations > 600 Washington Street f Boston, HA 02.11.1 www.masg.govfdia Workers' Compensaldon Insurance Affidavit: Builders/C~on-t ractors/Electricians/Plu-nfibers Applicant h ormatiol3Pease Print 1Le _b Name (Business/Organization/1nividual): Av4 Address: City/State/Zip. �07' 4U VPhonc#: Are you an employer? Check the appropriate box: Type of project (required): 1. X I am a employer with 4. � I am a general contractor and I 6 • New Constructio n employees (full and/or part-time).* s have hired the ub-contractors - 2. ❑ I am a sole proprietor orpariner- listed on the attached sheet. . 7. [] Remodeling ship and have no employees These sub -contractors have g. Q' Demolition working for me in any capacity. employees and have workers insurance-• 9 ❑ Duilding addition [No workers' comp. insurance " required.] comp. 5.0 We are. a corporation and its 10.0 Electrical repairs or additions 3. [ 1 am a homeowner doing all work officers have exercised their 11.❑ plumbing repairs or additions w myself: [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c.152, §1(4), and wehave no 1311 Other empJloyees. [No workers' comp. insurance reanired.l *tiny applicant that ch4dk box *I must also fill out the section below showing theit workers' compensation policy information. t Homeowner who submit this affidavit indicating they arc doing all work and then hire outside contractors must submits. new affidavit indicating such. tcontractors that check this box must attached an additional sheet showing the name of the sub -contractors• and state whetheror not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. X am an employer that isproviding •workers' compensation insurance for my employees. Below is thepolicy and job site ififormildon. Insurance Company Name:s�:-� policy # or Self ins. Lic. E •. - od c_(1 Expiration Date:_ � — 7 Sob bite Address:. i'% m aC Uri t tfP City/StatelZip; . Attach a copy of the viorkers' compensation po ey declaration page (showing the policy Number and expiration date). Fail4a to secure coverage as required lender 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 imprisotunent, as well as, civil penalties in the forst of a STOP WORD 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 DU for insurance coverage verlfication- X da hereby cerci er the join, and penalties of perjury that the information provided above is trice anftorreet. Sioature; 'Date - q - Phone #: / 73-5-67 - y% 7 ` 'Official use or,ly, 1)o not write in this area, to he completed by city or town officiaL City or Town: PermitUcense # Issuing Authority (circle one): I. Board of Health 2. Buildhig Department 3. City/Town Clerk 4. Electrical Inspector .5. Plumbing Inspector - 6, Other Contact person: Phone #: Date .5.1.. . .,.4............. TOWN OF NORTH ANDOVER, PERMIT FOR WIRING This certifies that ....................................... ....... I ... has permission to perform ..—A e V-%-- L --'e.. . ..... ................ f ..... . ......... ... . ............................. wiring in the building of...... `.....!: ..................... ............ at....... ... ........ k!�.eA ..................................... N90 Andover Mass Fee .l� ...... Lic. No. ...... M..(� . ....... 7 ....... .. ...... .......... . . ........... ; ELEcfficAL INSPECTOR .Check # 12 -3, 5 sf-" - r Uommoaweatbh of //laesachwm aj cc�� Permit No. ' I - 2epart.d of3 im Services Occupancy and Fee Checked w BOARD OF FIRE PREVENTION REGULATIONS [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 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 5/14/2014 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) 315 Turnpike St., North Andover, MA 01845 Owner or Tenant Merrimac o ege Telephone No. Owner's Address Same Is this permit in conjunction with a building� permit? Yes ® No ® (Check Appropriate Box) Purpose of Building Temporary POWer or Commencemei Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service 100 Amps 277/480 Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity 4 wire, 100A services by generator, 4 locations Location anal Nature of Proposed Electrical Work: 3 gens at Hockey Arena, 1 at Church for AC Equip. Completion of thefollowing 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 4X100 KVA No. of Luminaires Swimming Pool Above ❑ In- ❑'Yo rnd. rnd. -7.51 Emergency Lighting 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 Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Number Tons IKW No. of Self -Contained Totals: 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 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 Wiring: No. of Devices or E uivalent (OTHER: 2500.00 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: 5/14/14 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:) certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: RobertMcCrackeni$b� Licensee: g j� Signature LIC. NO.: (1./ PP! cabl �' llc �ei�ar�nt'SiU JU O ,I'I� 01590 Bus. Tel No.•)0B-20�6e 508-865-54 Address: Alt. Tel. No.: 'Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. 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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE. $ -�?M,1�2o-i a Al2V L6V-�'d 4� :Ficcll_ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organisation/Individual): Robert A. McCracken, Master Electrician #A21863 Address: 36 McClellan Road /State/Zip: Sutton, MA 01590 Phone #: 508-294-1960, 508-865-5488 Are ,you an employer? Check the appropriate box: 1. ® I am a employer with 4. ® I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. I am a sole proprietor or partner- listed on the attached sheet. ship and nave 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.] ' These sub -contractors have employees and have workers' comp. insurance.+ ® 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.® Electrical repairs or additions 11.® Plumbing repairs or additions 12.0 Roof repairs 13.8 Other Temporary Electric *Ani applicant that checks box 9 1 must also fill out the section below showing their workers' compensation policy information. ' Ho.neowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractor tha,, crec this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. if th,� sL,b-contractor have employees, they must provide their workers' comp. policy number. 1 am an employer that is providing, workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy T or Self -ins. Lic. ;u: Commonwealth insurance Partners LLC/ PHS 08 WEC CN1727 315 Turnpike Street Job Site .Address: Expiration Date: 7/11/14 City/State/Zip: N. Andover, MA 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 5250.00 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 hereby;if5/13/14 y an !er the pains and penalties of perjury that the information provided above is true and correct. Signature: b RcaertA. McCracken Date: V Phone 4: 508-294-1960 it Official !tse only. Do not write ir this area, to be completed by city or town official. i + 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 5. Other �4 Contact Person: Phone #: FMB DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8022 14/30/2014 T�HIe/CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BKOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPOR'„-;.t':: If the Certificate holder is an ADD!T?ONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the cenificaye holder in lieu of such endorsement(s). PRODUCER CON:'�'_'N'K ATTR :NS PARTNERS !PHS CONTACT NAME' iacNro.Ed>: (866) 467-8730 iac,Ne>: (888) 443-6112 088: _-::(86E; -LE-17-8730 F:(88,8; 443-6112 EMAILADDRESS: 301 �,S PAK.K DR --V."_, INSURERS) AFFORDING COVERAGE NAIO# CL__'.___ NY 13323 INSURERA:Sentinel Iris CO LTD iINSURED INSURER B: Hartford Fire IRS CO INSURER C: • COMP/OP AGG s2, 000, OOO IROS__-,_ _-. MCCRACKE N INSURER D: i _ _ 36 \'C T L -N i,✓ INSURER E: ,-A 01-5- 310 I INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS :S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA— D. NOM11THSTA.NDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERT.r C -'--E MAY BE ;SSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM_S.D:' C _USIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ( IA'.SR I 1'YPE 0F, CSI'R-tA'Z E.41)1)1, S('IIR I POLICYNOMRER POLICYEFF POLICYE.YP LIMITS ERCIAL GENERAL LIABILITY ! 11 A;M,S-MADE' OCCUR _ �) A `: 2a __ ='zREGATE 1 :1,11T APPLIES PER: PR. C -PRODUCTS V _ I I 08 SBM TP7018 ( 07/11/2013 07/11/2014 EACH OCCURRENCE $1, 000, 000 DAMAGE TO RENTED PREMISES (Ea occurrence) $1� 000, 000 j MED EXP (Any one person) $10, 000 i PERSONAL & ADV INJURY $1, 000; 000 GENERAL AGGREGATE s2, 000, 000 • COMP/OP AGG s2, 000, OOO a, :'0.. ' o._E LIABIL17Y _ i „ �.JTC I �— --'`tNNEG r— SC EDULED ..:iJTOS ON _ AUTOS i �• COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) $ �— _.<ELLA LIAB -J OCCUR ! E: 'ESS LIAB CLAIMS MADE � r RETE:. -.C, i I EACH OCCURRENCE $ AGGREGATE --_ $ $ ( IAN, ' <--?.=TORiPARTKERIEXECUT:IVE YIN i S C°F ..: r.:19ER EXC_:,DED9 N/A B'(hla.: ;.n NH) 08 WEC CN1727 DE.� :'= D?! OF OPER, !CNS be:c\v 07/11/2013 07/11/2014 X I PER OTH- STATUTE ER _ E.L. EACH ACCIDENT $ 1 00,000 E.L. DISEASE -EA EMPLOYEE $100, 000 E.L. DISEASE •POLICY LIMIT I i i r DESCRIPFC^ %'ERAT/0NS; _OCAiIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Those -- ua_ :o the insured's C-oerations. t,rK! l.':-; - = r QLLJr-M SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE AUTHORIZED REPRESENTATIVE 7A -z- @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 2,-,(2014/01) The ACORD name and logo are registered marks of ACORD 8 13 u L 21863-R License No. Commonwealth of Division of Profess Board of State FXZ- ROBER 36 MCCLEIL5W SUTTON, W 4 A�aster Elec ' 'a r e 07/31/2016 ev009461 Expiration Date. Serial No. .............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... "'�- `.......................................................................................................... has permission to perform . P �^ p ke �� r1 �..!. LA- .................... ..... J...I.............. .................. . wiring in the building of.....'.,..? ...................................................... .............................. North Andover, Mass. Fee... lav) Lic. No.21r)-17.. % ..............................TRI........CAL INS............PECTOR.............................. ELEC IC,heck# N 04 t _� _ C.ommonwea� o�c�a��aclec�e� - - aUePari�meref o��ire �eruice9 BOARD OF FIRE PREVENTION REGULATIONS Official UseeOnly Permit No. I �,& 1 Occupancy and Fee Checked [Rev. 1/071 (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: ? of City or Town of: To the It of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) fs Vrt7 tlae, Owner or Tenant d u.0 C6 . Telephone No. Owner's Address No. of Receptacle Outlets 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 No. of Waste Disposers Location and Nature of Proposed Electrical Work: Ord Cpl /,SO KW l0UA- t wilem No. of Dishwashers Space/Area Heating KW Completion o the followina 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 /P KVA No. of Luminaires AboveIn- Swimming Pool rnd. ❑ rnd. ❑ o. o mergency Lighting 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. Tonal No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number ............................................................ Tons KW No. of Self -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 Water Kms, Heaters No. of No. of Si ns Ballasts Data Wiring: 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: -10-Inspections to be requested in accordance with NEC Rule 10, and upon completion. INSURANCE COVERAGIEs 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 cov rage 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��p^^enald of perjury, that the information on this application is true and complete~ FIRM NAME: A U 6, atGf (. LIC. NO.: QI D'?3 ,4 Licensee: &y u (S .1,Frw Signature LIC. NO.: (Ifoppticable, enter "exempt" in a /'cnse mbrrdine..) �y l/ C!$ Bus. Tel. No.- Tc 7r Address: Ill L)5QhC4rnsl Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. 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. 7"IT FEE: $ .- t, /ZF-/X pol (10 f r; ✓` .$ IyOMMONWEALTHANIASSAAH iSETT s f a • a • BQAi�R ILIUM I Veil ANS ISSUES 7HE FOLLOWIf, LII;"ENSE .. R. AS A,I JOURNIYMA1 I=LEI;TRICfA c� _ a tYA J GATH 134 ;WESTFOitU St U CHELMSFORD MA o1824 2039 208 .:.. 0713 ..:> 32589 ow.OMWEAtTH OF MASSA USETTS BOAM'Of tEC"CR1 C"! ANS #SSUES THEFOLLOW1tVG L1 CENSE - AS A } }±1 SERI=D MASTER E-LECTR I'C I AN �Z AlXAtr1 „J CATH 54 WESTFORfl St`: :..... t-TIMSFORDj MA 01824 2039 21073 A.:'...: 07/1��6...: 32588 .. The Commonwealth o f Miasachilsett-r r Department of Indctstrial Accitlents Office of Investigations -. 6411 Washington Street Boston, AL -1 02111 istviv.niass gotldia Workers" Compensation Insurance Affida;-it: Builders/Contractors/Electricians/Piumhei-s \aloe t(3:tsittz:;-vr��ani-ratt�^ 1:.t1i,Suu•::1:_.__: Address:-__. __ . Vrdl ��? (177e ' Phone I -- :ire you an employer? Check the appropriate box_ I _ I am a emplo��er,t with I am a general contractor and I. etas (full and=or time3 # have hired the sub -contractors trtnploy part ?. ❑ I ant a sole proprietor or painter- listed on the attached sheet ship and have no employees These sub -contractors have working for me in any capacity. employees and havettorl urs [\o worker- comp_ insurance comp. insurance J- required.] ?. We are a corporation and its 3. Q 1 am a homeowner doing all worlk officers have exercised their my—self (\o w --ort erg comp. right of exemption per _X4GL insurance required.] ` c I Z § 1(4)- and ue have no e mplq}ees_ [\o ,workers' comp- insurance rettitired_j Type of project (required)- i 6- Q \cv construction 1 7. Remodeling i S. Demolition j 4. n Building addition 1 O -V Electrical repairs or additions I I. Plumbine repairs or additions 1 I[] Roof repairs 13.0 Other ':1m- applicant that checks box =I mus: also fill out the section bttoty sho„ine their „odcera-- comperm-ion policy information. Ho neounen %vho sunntit this atridnit indicath's thev are doing allwork and :Chert hire outside :onuacton must submit a new alitdsrit indicating such. °C'onuactors that check this box crust attached an additional sheet shot.ins the natne of the Sub-contmetots and state whi`tha or nn; ihosw entities have enpiogets- If the imb-contme'.ors hate craploveez they runt provide their ..oekem' comp• policy number. i ant un entplo srer tliat is pros idinr it orkers' canipensation insitrance for nn' eniplis ees Belmt is the polies' and job site n formation. ((�� /` . Insurance Company- Name: — 0r4 I K F1 Polic, = or Selma ins. Lic-_: IBJ �.i.ay1 �SU tr Expiration Date:_ J ��' `V ' .lob Site address:_, St' � (Uill �� City'SF2te2i Attach a cope of the [corkers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c- I _� can lead to tate imposition of criminal penalties of a fine up -to S 1300.00 andior onk-near imprisonment. as „eil as civil penalties in the form ofa STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of -the DI.1 for insurance co,eraec ve:-ifica•.ior. I do hereby ver r tlrelprttnS and pr'Italties pf perjury that the h!1ormation prorided abor a is true and correct_ U%�c'ial use ouln Do Hatt irrite in rltir area. to be completed ht- cYtr or town of)icial. Citv or To,vn: I'ermiti'License Issuing Auihoritti (circle one): 1. Berard of Health ? Building Dcpartmenl Citi:T-trwn Clerk 4_ Electrical Inspector Plunihing Inspector G. Other Contact Person: Phone r: y�. GENERATOR APPLICATION DATE: 5II%i11l`� LOCATION: /� � OWNERS NAME: GENERATOR kw vvl_ NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* q""L 44, 3 4 pang CONTRACTOR: PHONE NUMBER: I Cl I v r�lil q- 1I (DECTRICAL RESIDENTIAL GAS COMMERCIAL % TEMPORARY LOCATION OF GENERATOR: *ZONING DISTRICT: *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL(/" -IS Date ..' Q.b..., ......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that,..-' ..... P..e... C-- ................ has permission to performL ................. .................. .......................................... wiring in the building of.,... P �� ^ « �-- .................................................. ........................ Aat .,,, 3.�. ......�. U ►yip. ........... North Andover, Mass, ............i' ... ............................. Fee . 7i� Lic. No. �ZY1i.1.:.4.................................................. ............. l 1 ELECTRICAL INSPECTOR V Check # +� b This certifies that has permission to perform D ate ...... I.Q 118.1.1.� ............ TOWN OF NORTH ANDOVER wiring in the buildin K � . '0 gof ...... .. .... q. . ..l. ... , ..... .......... G ..... at ........... ........ ...... .�� F e ...... Lic. No. /F.r. ZlIr . .................. .. Check # Pig N N Al vP wlZbIl-z' e i :, Official UsPermit No. I mq�`y Occupancy and Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NMC), 527 CMR 12.00 (PLEASE PRINT INHK OR TYPE ALL )NFORMATIOA9 Date: 4111 14S City or Town of: NORTH ANDOVER To the Inspeclor of ires: 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 Owner's Address Is this permit in conjunction with a building permit? Telephone No. 3 / Vq (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: t�r^t lj �n o �0)}N i_u It )rE I Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters U Cbmpl'etion of the following table maybe waived by the Inspector of Wires. No. of Recessed Luminaires Commonwealth of Massachusetts o Department of Fire Services 4w Je BOARD OF FIRE PREVENTION REGULATIONS Official UsPermit No. I mq�`y Occupancy and Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NMC), 527 CMR 12.00 (PLEASE PRINT INHK OR TYPE ALL )NFORMATIOA9 Date: 4111 14S City or Town of: NORTH ANDOVER To the Inspeclor of ires: 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 Owner's Address Is this permit in conjunction with a building permit? Telephone No. 3 / Vq (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: t�r^t lj �n o �0)}N i_u It )rE I Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters U Cbmpl'etion of the following table maybe 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- ❑ rnd. rnd. o. o mergency Lighting 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 Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number ................................................... Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑Other Connection No. of Dryers Heating Appliances KW Security Systems:* No.E of Devices orEquivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Elec ical Work: (When required by municipal policy.) Work to Start: /Q Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE GE: 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 information on this application is true and complete. j FIRM NAME: AA LIC. NO.:4;? T Licensee: Signature LTC. NO.: % (If applicable, enter "exempt" in the license number line) Bus. Tel. No.- g�7'f'�7o'AG Address: T Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department o Public Safety "S" License: Lic. 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: $ Signature Telephone No. ❑ 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. GL 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 inva10�� 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. ❑ 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 ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass R? Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass T Failed 0 Re- Inspection Required ($.) ❑ Inspectors omments: Inspect rs Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts - Department ofIndustriglAccidents Office of Investigations quo 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip; Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. 111 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3.01 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. F1 Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.E] Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they hie 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 Policy # or Self -ins. Lic. M 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 requiredunder 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. Y do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 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 #: *� r 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 Please till 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. Also 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 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 Mossarah-usetts Department of Industrial Accidents Office of Investigations 600 Washington Sueet Boston, Mei, 021 It TeX, # 617-727 4900 eyt 406 or 1:-877rM SS.AF.B Revised 5-26-05 Fay, # 617-727-7749 www.Mass,govldia 1 14 - �SSAQH�USE�TTS��,,o Dkt&1 '�UCENSE 94256177 EXP 03.22-2015 03-22-196q' cLas REsi AGT so D 5-05 M DEMATTEIS JOHN R " 8 WILSON LANE WESTFORD, WDA 01886-1761 t - 03-11.1964 Pel, � e14 --�- IM Location No. Date 114, 3 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL VA VIVIAS $ Check #-1 Z " �� D w; CU Building Inspector Date ///Z// Z-,-.. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... E' r? !.S.. a," e ........ . has permission to perform ..: ��....�� < <��- ............ wiring int e building of . /. �'►.......... 00 ..?!....North Ando er, Mass. Fey ......... Lic. No........ �`'�... . .... ELECTRICAL INSPECTOR Check # 0� �`'I`"J (,, Commonwealth of Massachusetts lugDepartment of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only, Permit No. ' ( C` t Occupancy 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 CodeEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: i 1 r.. I( -x 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) 3 ( S TLI 120 pJ'*:�E S T -R -66T Owner or Tenant Jt''j 1-- &! Zf m p4C((Z C- 0 L L_ E C^ t—S Telephone No.'91 f- (F � 7 - �_O 0 O Owner's Address .? / � T JW P.TJk� 57-141 Is this permit in conjunction with a building permit? Yes ❑ Purpose of Building Existing Service New Service No ❑ (Check Appropriate Box) Utility Authorization No. Amps / Volts Overhead ❑ Undgrd ❑ Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: A„AufI-SMIS ,7- & 0 Completion of the following table may be waived by the Inspector of fVir•es. 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- ❑ rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. IDetection and of Initiating Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Number Tons KW No. of Self -Contained p Totals: 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 Water K`,`, No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of !fires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: i 1I3 11 ') 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, tha; the information on this application is true and complete. FIRM NAME: '30 D:C /9A LIC. NO.-,:ZR q. Licensee: _ <A -,/►1„o Signature LIC. NO.:� / 6 (If applicable, enter exempt " ireense numb r line.) Bus. Tel No.• Address: 0-L- N" Alt. Tel. No.: 3'� *Per M.G.L C. 147, S. 57-61, security work requires Department of Public Safety " ' License: Lic. 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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE: S COMMONWEALTH OF MASSACHUSETT ELECTRICIANS AS A REG JOURNEYMAN ELECTRICI ISSUES THE ABOVE LICENSE TO: JOHN R DEMATTEIS 8 WILSON LN ZN WESTFORD MA 01886-17 28794 E 'A 07/31/13 8224 , •` Fold, Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS ELECTRICIANS REGISTERED MASTER ELECTRICIAN ISSUES THE ABOVE LICENSE TO: DEMATTEIS ELECTRIC JOHN R DEMATTEIS_ 8 WILSON LNC WESTFORD MA 01886-1 �12476 A07/31-/1 3 822420 (.:.� Fold, Then Detach Along All Ponofu ;C.1!3 'IM4 Date..... . . .. —7 . Z. ... .. ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING , � -// This certifies that ......... ...... I ........, V"w..................... .............................. has permission to perform ................. ........... tr. wiring in the building of... C- / ................. .......... at ... ............ . y .......................................... .North And ver, Fee ../.?-.5 ......... Lic. Ncv0.-.-?/PZ37 ....04x .... 7 ................. ...... ..... ELECTRICAL INSPECTOR Check # (femmonweak4 o f VaieacLem Official Use Only Apad of ive Semicee Permit No. rt (I o Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] leaveblank) .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 F RMATIO) Date: City or Town of: /)4 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) e/Y�MQC 6o)% Li ,ke Owner or Tenant �( �1t �d��Gq Telephone No. � V 8 b Owner's Address / 75-S9 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 k Number of Feeders and Ampacity f Location and Nature of Proposed Electrical Work: Iw0aa/i �� t�Q 'OVA Completion of the.following 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 16(D KVA No. of Luminaires Swimming Pool Above ❑ In-E] rnd. rnd. o Emergency Lighting 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 FN.Rmber Tons J.KWNo. .......... of Self -Contained Totals: I 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 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 Wirin : No. of Devices o: E uivag'.art 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: -/S // 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 ov rage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE r BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and enalties of perjury, thal the information on this application is true and complete. FIRM NAME t'"-) +77-1 rlez4 771 �--�� LIC. NO.: /0 -,4 Licensee: - Signature LIC. NO.: (If applicable, enter "exempt" in the license numb r line.) Bus. Tel. No.: Address: LG Pke Jsj� ?� d L4A Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. 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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ /�� 10010 10010 Date................................�,- /.... ."°° TOWN OF NORTH ANDOVER ,._ � p PERMIT FOR WIRING L This certifies that ..........° 6"—.............' ! ......................................... has permission to perform / . �10� -w('`«12, `(K ............................................................. wiring in the building of /' / 6� ��.. wl�e / L Er ............... ..... ...... ........................... l��cK�i�t 5> at..................................................................... ....... . North Andover, Mass. Fee ..................... Lic. No.4 rp.2.3 ............. ............ ........ ELECTRICAL INSPECyI OR Check # 2�0 •'11 .r Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 10 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]/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 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 13-20-11 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) f OjO j k �S* /004 kljo � Owner or Tenant 14 e/ Telephone No. Owner's Address `I Is this permit in conjunction with a building permit? Yes ❑ No XJ (Check Appropriate Box) Purpose of Building ( er1,110 6 c/«;�kr— C0^Ce, -- 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: PJ YJ -e- ,sd6:mc,-alor ��R sand S4-;t9Ir Comnletion of the fnllnwino tnhle may he waived by thv In.cnvrtnr of Wiroc No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators J KVA No. of Luminaires Swimming Pool Above El In- El rnd. rnd. o Emergency Lighting Batte 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 Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number . Tons � �� ... . .... . KW ....................... No. of Self -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 Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: (J 0 0 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: y a7 I Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C VE GE: 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 suchv rage 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 ties of perjury,tat the information on this application is true and complete. FIRM NAME: ,t) � cI �c-'G LIC. NO.: to 3 -A Licensee: I;f1.4 N Signature LIC. NO.: ,5-a 0 Addressable, enter "exem t� in the tc a number line.) O, g7 Bus. Tel. No.: CI7 C (cid L0 -/S— Address: Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Dep rtment of Public Safety "S" License: Lic. 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 a eat. Owner/Agent PERMIT FEE: $ Signature Telephone No.