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HomeMy WebLinkAboutMiscellaneous - 451 ANDOVER STREET 4/30/2018 (6) _ . . . _ . _ _ n � � �y>J S f Date. ... .... ........................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING s,C14U �' V r 1 Thiscertifies that ......................................................................................... has permission to perform VL .:5.... . ..A. .(.c.... ...rI io ...�(A-41 e C pn the building � wiring .............................. .......... .......................... .... .. .......................... ............. .... .... . North Andover,Mass. ........ .... Fee . ....... Lic.Noo.1 ....................... 7...... ELECTRICAL INSPEL�',TOR Check# M1r Official Use Only ►r>rrxo�u+,�uCrl�.r� li���ac;�c�ai DI Permit No. \ O�RI'tY,Yi4'J�& b4P�' Qd'tf1CQ3 UT, 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 ALL INFORMATION) Date: April 02,2015 City or Town of: North Andover,MA_ 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) 451 Andover St Ste G6 Owner or Tenant Mandy Chan Family N Cosmetic Dentistry At North Andover Telephone No. (781)640-8973 Owner's Address 451 Andover St Ste G6 Is this permit in conjunction with a building permit? Yes E] No1-(Check Appropriate Box) Purpose of Building U,-�i C .1'1fiC t Utility Authorization No. Existing Service Amps / Volts Overhead F! Undgrd M No.of Meters New Service Amps / Volts Overhead rl Undgrd M No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: _Installation of a low-voltage,wireless burglar alarm system Completion of the oItowin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans o.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA_ O.,of Luminaires Swimming Pool Above In- No.of Emergency Lighting rnd. grnd. � Battery Units No.of Receptacle Outlets o.of Oil Burners FIRE ALARMS o.of Zones No,,of Switches o.of Gas Burners o.of Detection and Initiating Devices No.of Ranges o.of Air Cond. Total o.of Alerting Devices Tons g eat Pump umber ons W o.of Self-Contained O.Of Waste Disposers _Totals: Detection/AlertingDevices No.of DishwashersMunicipal pace/Area Heating KW Local 0 Connection Other No.of Dryers Security Systems:* Y eating Appliances KW __ No.of Devices or Equivalent No.of Water KW o.of No.of Data Wiring: Heaters Sims 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: $850.00 (When required by municipal policy.) Work tip Start: April 02,2015 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE W BOND M OTHER M (Specify:) I certify, under the pains and penalties of perjury,that the information on this pI* ation is true and complete. FIRM NAME:Defende Security CompanX J. LIC.NO.: C 1355 Licensee: L' 1 Signature LIC.NO.:D 434 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: 800-689-9554 Address: 3750 Priority WU S Drive,Suite 200 Indianapolis IN 46240 Alt.Tel.No.: 866-502-3559 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety "S"License: Lic.No. 9SCO-001258 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)M owner 0 owner's agent. Owner/Agent Telephone Signature No, [PERMIT FEE:$ 141) Pea U 1 , r The Commonwealth of Massach11setts Departrnent of IndustrialAccidents Office of Investigations 1 Congress Street, Suite 100 ;z Boston, MA 02114-2017 tv►vtu.rriass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers licant Information Please Print Legibly tz (Business/Organization/Individual); ' Defender Security Company,. ress: 3750 Priority Way S Drive Suile 200 /State/Zip: Indianapolis, IN 46240 Phone 9:800-68,9-9554 cu an employer? Checlt the appropriate box: Type of project(required): I am a employer with 3 4. ❑ I am a general contractor and 1 6, ❑New construction have hired the sub-contractors employees (full and/or part-time).* I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-con Tactors have g_ ❑ Demolition working for me in any capacity. employees and have workers9 ❑ Building addition [No workers' comp. insurance comp. insurance,I requirzd.] 5. ❑ We are a corporation and its 10.� Electrical repairs or additions I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself,,[No workers' comp. right of exemption per MGL 12.[]Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp, insurance required.] pplicant that checks box I must alsofit out the section below showing their workers'compensation policy information. owners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new afdavit indicating such. actors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have ccs. If the sub-contractors have employees,they must provide their workers'comp.policy number. -in employer rhat Ls providing workers'compensation insurance for my errtployees. Below is the policy and job site nation. ince Company Name: MJ Insurance Inc — /N orSelf ins. Lic. ?;TC2JuB110BL22613 _'Expiration Date: 1017/; C� ice Address: � J Iand' NV- r0 City/State/Zip: ))o 1 [)V(_y, AA :It a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). re to secure coverage as required under Section 25A of MGL c. 152 can lead.to the imposition of criminal penalties of a :o to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a Fine to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ci-ations of the DIA for insurance co-verage verification. 4ereby certify larder the pains and penalries of perjury that the information provided above is true and correct. Date: �r Iy 8665023559 `ficial use only. Do tar write in ,h L;arca,to be completed by city or tow", offlcial. II ty or Town: PermitfLicense 4 suing Authority (circle one): Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector Other ontact Person: Phone 0: y Commonwealth of Massachusetts Department of.Public Safety Securit}5estems-S.License _ License: SSCO-001258 STEPHEN C EHRLICH, 3750 PRIORITI'WY S DR#20C, INDIANAPOIAS IN 462i40� & L Commissioner Expiration: 12/03/2016 1 J 6 OMMONWEALTH.OP MASSACK SETTS.: <'. o s o • o s •• :-:80AAQpF E,tE.CTR 1 C I ANS;-::°_t r` : ISSUES, .THE FOLLOW NG` L`I"CENSE I`:-' ,W A '°Rf G',I STERED SYSTEM TECHN I CIA '` s STER:REN C EHRLI'CH' " Xff z 39 6 CENTR'AL� SIRE-E•T ='. .'` ±W UN;I T_,9 y =F:OXBOROU.GH:- MA 02035-2637 434D 07/3t/.1;6 45560 n3:uulo.s�Mile Please visit our wcb site at hLLp://%..ti-Aq.niass .gov/dpl/boards/EL DEFENDER SECURITY CO / PROTECT Y STEPHEN C EI-lRL I CFI (F A) 3750 PRIORITY WAY SOUTH STE 200 INDIANAPOLIS IN 462110-3815 Y 9 ,I Fold,Then Ootid,Along All Pufarations. COMMONWEALTH OF_MASSACHUSETTS "111. BOARD OF OF ELECTRICIANS ISSUES THE FOLLOWING LICENSE AS A REGISTERED SYSTEFI CONTRACTOR Q a DEFENDER SECURITY CO / PROTECT Y u STEPHEN C EHRLICH W 3750 PRIORITY WAY SOUTH W STE 200 INDIANAPOLIS IN 46240-3815 1355 07/31/16 38220 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§3L,the �P • permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed "p 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 4 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 maybe_deemed.by the_Inspector_of_Wires abandoned.and_invalid.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: l ***Note:Reapply for new permit ermit Extension Act—Permit/Date Closed: 1 �'�) Date.. . ..`�..l......... w NORTp TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSACHUSf� This certifies that ..�✓..�✓ ..� .l�I..c,���.. ..�.�.�.� `........ has permission to perform . «�o 4,6 7...iLJ f'.�? ..... ....... ............. c i✓a it T/f' wiring in the building of...�.....�. ..N..�.................................................. at...V.,S./...... ....64.,!- ...�.--.77...$ ................ . rth Andover,Mass. Fee...... "�.. Lic.No../...1..3YZe/�:.............. . .. ........ . . ' ELECTR�CALTO INSPECR Check # —�,d� S� 90U1 (.ommonevealth o//�l�j�� amacLo Official Use Only e apinwnt o Permit No. (� p ��ire�ervices BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/0/07] (leaveblank) APPLICATION FOR PERMIT TO PERFORM EL All work to be perfornied in accordance with the Massachusetts Electrical Code( 527 CMR TRICA 0 WORK (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: y Q1 Cite or Town of: Nr,r�� na�� �,�. By this application the undersigned gives notice of his or her intention to perform thTo the e electrical ector w�rk�described below. Location(Street&Number) L\S ' G Owner or Tenant a_N k J Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes ❑ No IJ *K � (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 a Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: n Puy 16vt5 a ►�PCI k Com lesion of the follon,in table man be waived bn the Ms ector of 11'ires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Transformers ota No.of Luminaire Outlets No.of Hot Tubs KVA Generators KVA No.of Luminaires PO01 Swimmingb Above In- 0.0 mergency ig trig No.of Receptacle Outlets M rnd. ❑ rnd. ❑ Batter Units No.of Oil Burners FIRE ALARS No,of Zones No,of Switches No.of Gas Burners No.of Detection and " No.of Ranges lnitiatin Devices No.of Air Cond. Total _ Heat Pump Number Tons ns KW No.of Alerting Devices No,of Waste Disposers No.of Self-Contained Totals: ........................ . No.of Dishwashers Detection/Alertin Devices Space/Area Heating KW Local❑ Municipal No.of D ersConnection ❑ Other No.of Water Heating Appliances KW Security Systems:* or E Heaters KW No.of n No.of No.of Devices uivalent Signs L Ballasts Data Wiring: No.Hydromassage Bathtubs No.of Devices or E uivalent No.of Motors Total H Telecommunications Wiring: OTHER: i© 4 No.of Devices or Equivalent �I�div J Estimated Value of Electrical Work: !'t Sop_QQ Attach ad itio al detail if desired,or as required bn the hasp ct�f 11 res. Work to Start: (When quir d by municipal policy.) 9 0 In pections to be requested in accordance with NEC Rule 10,and upon completion. INSURANCE CO tE 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 substantia]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 7 BOND I certify,under the pains and penalties o ❑ OTHER ❑ (Specify:) FIRM NAME: IPerjrtrt,that the information nn this applicatioh4cl_Allb�/1-vi n is true and complete. Licensee: �yt ��_ YV�C1.�11/lo)nn f trn g _ LIC. NO.: 17,41 P (If applicable.et,;e Sign LIC.NO.:! ( ea m t the lic a nun Address: M10502+22 Bus.Tel.No-617.¢14 Q! e)cf *Per M.G.L.c. ]47,s.57-61,se urity work requires Department of Public Safe S"License: Alt.Tel.N'o.: Zq OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage nonnall Lic. No. required by law. By my signature below, 1 hereby waive this re uirement• 1 am the(check one)❑owner Owner/Agent q Y Signature ❑owner's agent. Telephone No. ET1117ITFEE: $ The Conzinonwealth.of Massachusetts UVDepartment of Iizdustrial Accidents Office of,Irzvemigations 60C R'ashington.Street Boston, hSA 02111 ►�.��.mass.gav/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers Ant)Iicant Informi6onPlease Print Le�ibiv Name nseaess/0r � H � Lr,,t, (B gattiaation/1ndi�ddtial}; 1� J Address: LL t✓J e _.o S�1 { 0 -;I 1ZPhone 0: I City/StatelZip:�t� � � -y-"1�4_ O Are you as employer? Cbeck the appropriate box: Type,of project(require4 1.[ 1 am a employer with �oa 4. ❑ I am a general contractor sad 1 6. 17Ncw construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner• listed on the attached sheet.I ? ❑ iO°e ship and have no employes These sub-contactors have S. ❑Demolition worlang f0•,me in any capackt. work=' comp, insurance. 9. p Btu'ltiing addition [No walk=' comp.insurance S• ❑ We are a corporation and its required.) OEM=haue exercised their 10.[]Elccizical repay or additions 3.❑ I am a homeo AMrJ doing all wort; right of,a;.emptim per MGL 11.[3 Plumbing, repairs or additions myself.[No workers' camp. c. 152, §1(4): and we have no 12.[]Roof repairs itssraance required.)t employees.[No worked•(' IS.❑ Oihw comp.iasutaace rnquimd.) 'Any applic®t treat ehecica boo:til must also fiD out$e s COM belm,showing 6cir work='cotnpeasetim policy mioimetiaa fi Homoowners vino submit this da-davit indieadng they arc doing all wort:and fix=has ousidc eonaaators mst usnomit e.nea,afndavil indica* �Contrentors tat eheot thio bog:must ananited as additioal sbeetnshorty the ' e _ dreg awe of the sdt-connsaars and theirworksrs'camp.Peyer.information 1 am an etnp1 per that kprovrdo:g workers'compenation.insu vp=for nz emplofrees BeIox�is tlec pou"cy and Job rite it.for�natrnn. . Insurance,Company Name: cr-- PoIic3T or So} las.Lie.#- 6(' 2 S QF respiration Date: X50 ._ASA_ \ c Job Site f�ddress:STs 1 `naoVQ�lf c7� . City/State/I.ip:NO � {�t\�OVe,1� �R + l��s Attach a cope of the workers' compensation poiicl,declaration page (showing the police number and expiration date). Failure to secure coverage w required under Section:5A of MGL c. 153 can lead to the imposition of criminal penalties of a tine up to 51.500,00 and/or one-year imprisonment.as well as civil penalties in the form of a STOP WORT;ORDER andatine. of up to 5250.00 a day against the violator. Be advised that a copy of f6s stat„-meat may be forwarded to the Ocoee,of Investigations of the.DIA for msttraace c v g . a e;xa.�e veriiicaiian. 1 do herebP cert t+i9k,-the pains pena.Wes ofperjurp char the inforn=ion provided abnve is true and.correct. Sizmn re- JqJ Date: Phone. FOtther on1u. Do not►(+rile in this area, to he completed hp.ctrl or mwn o fficial n: Permit/License,n hority(circle.one): Heath 2. Bubdire Department 3. Ctty/Tov�n Clem; 4. Electrical Inspector 5. Plumbin. Inspector son: Phone t: 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§.3L,the r �-• permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be fled' on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.01 c. 166,§32,an electrical permit shall he issued to the person,firm or corporation stated on the permit application.Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shallbe limited as to the time of ongoing construction activity,and mayhesleemed by thednspector of_Wires abandoned_and_in uliddf 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 ofthe 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. Ap VRule 8—Permit/Date Closed: ` ***Note:Reapply for new permity� Permit Extension Act—Permit/Date Closed: �,� Date.....1...' O'er �I 4 Of NORTH o: .�,r -•. �,, TOWN OF NORTH ANDOVER i PERMIT FOR WIRING 'fir +O+•.�°•���'l� ,SSACMU`�� Thisce,Ttifiesthat .............'5.z..C.&)..................... ................................ has per,Fnission to perform ....... ... .5................................. wiring in the building of....... .. ..... .w. ,,..................................... at. . -�`�1... '` ...5�'^..................-�North Andover,Mass. t Fee j Z �s "r... Lic.No.A6 f5 4......... .��f F,../z !/�I /jELECTRICAL INSPECTOR% Check # �-�-� 885 I Official Use Only Commonwealth of Massachusetts Permit No. � Department of Fire Services 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 TYPE ALL INFORMATION) Date: '-1110 n5 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) 451 Andover Street Owner or Tenant TD Bank North Telephone No. Owner's Address Same as above Is this permit in conjunction with a building permit? ❑ Yes ❑ No (Check Appropriate Box) Purpose of Building Commercial 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 Old work,2 new outlets. ti Completion o the following table maybe waived by the Ins ector of Wires. y No.of Recessed Luminaires No.of CeilSusp.(Paddle)Fans No.of Total : Transformers KVA No.of Luminarie Outlets No.of Hot Tubs Generators K-VA No.of Luminaires Swimming Pool Above ❑ In- Elo.of Emergency Lighting rnd. grnd. Battery Units No.of Receptacle Outlets 2 No.of Oil Burners FIRE ALARMS No.of Zones o.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 No.of Waste Disposers Heat PumpNumber .Tons KW No.of Self-Contained 1. ......... ....................... ....................... Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection a' No.of Dryers Heating Appliances KW Security Systems: �( No.of Water No.of . No.of No.of Devices or Equivalent Imo' 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: $600 (When required by municipal policy.) Work to Start ASAP 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:) GENERAL ACCIDENT INS. 7/31/09 (Expiration Date) I certify,under the pains andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: REILLY ELECTRICAL CONTRACTORS,INC LIC.NO.: Licensee: JAMES J.REILLY Signature Ayi.l LIC.NO.: 16666 A (If applicable, enter "exempt"in the license number line.) Bus.Tel.No.:508-230-8001 Address: 14 NORFOLK STREET,EASTON,MA 02375 Alt.Tel. 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.