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Home My WebLink AboutMiscellaneous - 61 WINDSOR LANE 4/30/2018,1 a �aORT11 + TO ,SgACMUSE� Date.... WN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............... X ....................................... \ has permission to perform wiring in the /buiildi/ng of ..: r Fee.��b �.`..... Lic No l deck # 576 2- .... ............. .. North Andover Mass. ELECTRICAL: NSPECTOR CoWWo ALW 0E 9btASSAG7f�J S Department of ft l c Safety BOARD OF FIRE PREVENTION REGULATIO 227 CMR 12:00 Officiqj,U�;,�,�� Permit No. Occupancy & Fee Chli�- APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Vaassachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date_ To the Inspector of. Wires: Town of North Andover The undersigned applies for a permit to perform the electrical v:v* desk 'bed below. Location (Street & Number �iy l k' i a Ic �Q�i,P ' Ir Owner or Owner's Address_ ��i►v�p Is this permit in conjunction with a building permit Yes 0 No 6" (Check Appropriate Box) Purpose of Building_ Utility Authorization No. Existing Service ;?In-VAmps G�/ i/U Voits Overhead U ndgmd 0 No. of Meters New Service Amps Voits Number of Feeders and Ampacity Location and Nature of Proposed Electrical Overhead 0 Undgmd 0 No. of Meters INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General taws 1 have a current Liabil' -Insurance Policy including Completed Operations Coverage or its substantial equivalent YES (N No (� have submitted proof of same to the Office YES 0 NO 0 If you have checked. YES Please indicate the type of coverage by checking the appropriate box INSURANCE BOND 0 OTHER 0 (Please Specify) Estimated Value of Electrical Work$ % (Expiration Date)' Work to Stan :!S-- /'z "dJ" --' Inspection Date RqsquestedL Rough Final Signed underthe Penalties of perjury: FIRM NAME ll?i (-5 4/,f7 6" /j LIC. NO._,g%2 Licensee / ��c" f� Signature,YLIC. NO. A! -29Z-j // ///-<IV7 �y�� Bus. Tel No. Address t - L'l�.b Alt T.1 PJ�2 V .1 ./J"97 OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) If k% Telephone No. PERMIT FEE $ (Signature of Owner or Agent) — -- - r v,-. M - r - Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above 0 In 0 No. of LightiM Fixtures . Swimminq Pool and 0 gmd 0 Generators A No. of Emergency Lighti —` No. of Receptacles Outlets No. of oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS : of Zone No. of Detectio' nd Total No. of Ranges No of Air Cond Tons Initiating Devi s _. H Total Total No. of Di 1 No. m Tons KW No. of Sou ding Devices No./ of Contained No. of Dishwashers SpaCelArea Heating KW' DetectiorNSounding Devices — —� 0 Municipal 0 Other No. of Dryers Heating Devices KW Local Connection n No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP �/ INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General taws 1 have a current Liabil' -Insurance Policy including Completed Operations Coverage or its substantial equivalent YES (N No (� have submitted proof of same to the Office YES 0 NO 0 If you have checked. YES Please indicate the type of coverage by checking the appropriate box INSURANCE BOND 0 OTHER 0 (Please Specify) Estimated Value of Electrical Work$ % (Expiration Date)' Work to Stan :!S-- /'z "dJ" --' Inspection Date RqsquestedL Rough Final Signed underthe Penalties of perjury: FIRM NAME ll?i (-5 4/,f7 6" /j LIC. NO._,g%2 Licensee / ��c" f� Signature,YLIC. NO. A! -29Z-j // ///-<IV7 �y�� Bus. Tel No. Address t - L'l�.b Alt T.1 PJ�2 V .1 ./J"97 OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) If k% Telephone No. PERMIT FEE $ (Signature of Owner or Agent) — Name: Location: Ci Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: . Address- City: ddressCi : Phone #: Insurance Co Policy # Company name: Address Ci!y: Phone #: Insurance Co Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.0( and/or one years' imprisonment as_weti as civil..penaltiesin.2heinrmcfa-STOP WORK ORDFR.and.a fine_of_(.$100.00)atiay.against_me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. r Date Signature ` Print name Pbon e.# Official use only do not write in this area to be completed by city or town official' Permit/Licensing City or Town El Building Dept E] Licensing Boarc ❑Check if immediate response is required Selectman's Of Contact person: Phone #: E] Health Departrr El Other .w 171gE C09WWO9V'GttE UrMOrFW,47 Department ofrnu6Gc safety BOARD OF FIRE PREVENTION REGULA O APPLICATION FOR PERMIT TO All work to be performed in accordance with the (Please Print In Ink or type all information) / N Town of NO The undersigned applies for a permit to perform the electrical descn6ed below. Location (Street & Number Owner or Offic�'u�L/ Permit No. � X175 Z/<- 527 <-527 CMR 12:00 Occupancy & Fee ChW6 IA ELECTRICAL WORK Electrical Code 527 CMR 12:00 Date � /�� To the Inspector of. Wires: Owner's Address_ Is this permit in conjunction with a building permit Yes 0 No & (Check Appropriate Box) Purpose of Buildings y -Az -'Z -'L yc' /Gy /�{p/YJ��; Utility Authorization No. Existing ServiceG"� Amps Z/ %/U ' Volts Overttead $� U ndgrnd 0 No. of Meters New Service Amps Volits Overhead 0 Undgmd 0 No. of Meters Number of Feeders and Ampacity. Location and Nature of Proposed Electrical Work 1 —vrcrv— uvvtrwut. rursuant to the requirements of Massachusetts General Laws have a current�Liabil*InsurancePolicy including Completed Operations Coverage or its substantial equivalent YES r No ave submittedof of same to the Office YES O NO r B you have checked YES please indicate the type of coverage by checking the appropriate box VSURANCE :,D 0 OTHER 0 (Please Specify) stimated Value of Electrical Work$ '16-0 (Expiration Date) York to Start �- %.Z "d. ' Inspection Date Resquested Rough Final igned. under the Penalties of periurv: LIC. NO. %fie ' LIC. NO. Bus. Tel No. r Alt Tel. No.�/_vs GAS �L S INSURANCE WAIVER: i am aware that the Eicenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) (,ignature of Owner or Agent) Telephone No. PERMIT FEE $ No. of Lighting Outlets No. of Hot fuse Total —` No. of Transformers KVA Above 0 In 0 No. of Lighting Fixtures . Swimming Pool gmd 0 gmd 0 Generators IWA No. of Emergencylighti No. of Receptacles Outlets No. of Oil Burners 11aftery Units No. of Switch Outlets No of Gas Burners FIRE ALARMSK�of ZoneTotal No.of Delectio No. of Ranges No of Air Cond Tons Initiatin=De,4 H Total TotalNo. of Di 1 NO.KW No. ofDevices No./ of Self Contained No. of Dishwashers SpacWArea Heating IMI' Detectiori/Sounding Devices 0 Municipal 0 Other Local Connection No. of Dryers Heating Devices KW No. No. of No. of Low Voltage No. of Water Heaters KWSigns Wil ng No. Hydro Massage Tuds No. of Motors Total HP —vrcrv— uvvtrwut. rursuant to the requirements of Massachusetts General Laws have a current�Liabil*InsurancePolicy including Completed Operations Coverage or its substantial equivalent YES r No ave submittedof of same to the Office YES O NO r B you have checked YES please indicate the type of coverage by checking the appropriate box VSURANCE :,D 0 OTHER 0 (Please Specify) stimated Value of Electrical Work$ '16-0 (Expiration Date) York to Start �- %.Z "d. ' Inspection Date Resquested Rough Final igned. under the Penalties of periurv: LIC. NO. %fie ' LIC. NO. Bus. Tel No. r Alt Tel. No.�/_vs GAS �L S INSURANCE WAIVER: i am aware that the Eicenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) (,ignature of Owner or Agent) Telephone No. PERMIT FEE $