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Home My WebLink AboutMiscellaneous - 70 HAROLD STREET 4/30/2018 70 HAROLD STREET 2101010.0 00.o f Date.—I.... ..$..........—. TOWN OF NORTH ANDOVER 0 —60eailh& PERMIT FOR WIRING tr—7— ...... .... I .... ... ..... This certifies that ............. ................................................ has permission to perform .......41..... ........................ wiring in the building of................LU.e.4..FL-lz............................................................... at............7.0..A.V D........5..>.''.............. ,North Andover,Mass. Yee-d.......... ... .. .. Lic.No..�.��Q#......... ......... Check # 4743 4 /� 00// Official Use Only l,ommonweaGth o�///a�sac�ettl Y 2epartment of-}ire Jervicel Permit No.O l V BOARD OF FIRE PREVENTION REGULATIONS [Rev 1//07)y and Fee Checked (leave blank) � APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: req MAIZ 7 City or Town of: , Wm 6k)h ere- To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) -7U /-!A�/'<Si,b �7-- Owner or Tenant -rA YLj�� [,1,C�G/1,$ Telephone No.%2 — p - ff-Cv�'�.ZJ�S` Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) KZT Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 1�Gs°CTCp� .��'ST�l� 1��„ 13761 361 Completion ofthefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No,of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency ig ng y rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection aTotnd Initiatin Devices No.of Ranges No.of Air Cond. Tons X.5— No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons......_....KW........... No,of Self-Contained Totals: Detection/Alertin11 Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances Kms, Security Systems:* Si Ballasts No.of Devices or Equivalent No.of waterNo.KW No. asts Data Wiring: Signs BalNo.of Devices or Equivalent L 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: Q (When required by municipal policy.) Work to Starti,26RA j j 20/7— 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 0 BOND ❑ dTHER ❑ (Specify:) I certify, under the pains ando4alties of perjury,that the information on this application is true and complete. FIRM NAME: Aries Electrical Service and Controls LLC _ LIC.N015650a Licensee: Nor and Michaud Signa. _ AC.NO.: 34594e (If applicable,enter "exempt"in the license number line.) ~T Bus.Tel.No.: 978 687 0544 Address: 290 Broadwav suite 1-17 Methuen ma 01844 Alt.Tel.No.: *Per M.G.L.c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERM�FEE, i The Commonwealth of Massachusetts Department of Industrial Accidents ,L 11�` Office of Investigations 600 Washington,S`treet Boston,Mass 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/]Electricians/Plunnbers Applicant Information . Please Print I.,e ibl Name(Business/Organization/Individual): ARTES:fFLECTRICAL SERVICE AND CONTROLS LLC Address: 290 _RR ADWAY RTITTF 4 117 City/State/Zip: Mp nem Ma ni Ram Phone#• Are you an employer?Check the appropriate box: 1.� I am an employer with4.❑ I am a general contractor and I Type of project(required): employees(full and/or part time).* have hired the sub-contractors 6 ❑New construction 2 t am a sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling ship and have no euNeyees These sub-contractors have working for me in any capacity. employees and have workers' 8 ❑ Demolition [No workers'comp.insurance comp,insurance.# 9. ❑Building addition required] 5.0 We are a corporation and its 3. ❑ 1 am a homeowner doingall work XX� lectrical repairs or additions officers have exercised their myself [No workers'comp. right of exemption perm MGL I L ❑Plumbing repairs or additions insurance required]t c.152,§ 1(4),and we have no 12.❑Roof repairs employees.[no workers' comp,insurance required.] 13. ❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation ' tHomeowners who submit this affidavit indicating they are doing all work policy information. and then hire outside contractors must submit a new affidavit indicating such. #Contactors that check ibis box must attach an additional sheet showing the name of the sub contractors and state whether or not those entities have employees if the sub-contractors have em ]o ees,the must Provide their workers'comp. ori number. lam an employer that is providing workers'compensation or insurance information. f my employees.Below is thepolicy and job site Insurance Company Name-.—/,; Policy#or Self-ins.Lic.#:_ d�0 ��5 Expiration Date:_ �E•�—ULOOI. ` Job Site Address: �O j�/AI?�C1, S� City/State/Zip: /►/ 0� AmCJI VS 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 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 $250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for covers a verification. 1 do Herby certify under the pains andpenalties o erjury that the information provided above is true and correci. Si -e: •___"' Da te. L9"A9 i Print Name: Normand Michaud Phone#. 978 687 0544 V Official use only Do not write in this area to be completed b P y city or town official City or Town: Permit/license#: Issuing Authority(circle one): 1.Board of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person- Phone#• rn'n. i REGISTERED.M'ASTER' ELECTRICIA ISSUES THE ABOVE LICENSE TO NORMANDY D,'.MICHAUD, . 13 SI,M.PSON', RD W,INDHAM ''' NH 03087 22I'5 15650. A 07/31/13 843727 . AS "EG JOURNEYMAN ELECTRICI ISSUES.THE ABOVE LICENSE TO N,ORMAND FD.' M ICHAUD .3 SIMPS0N RD WINDHAM NH 03087. 2215 3454.4. E 07/31/13 843,726 9