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Home My WebLink AboutMiscellaneous - 761 DALE STREET 4/30/2018 (3)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. 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 t 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-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 puipose 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: 0 Permit Extension Act—Permit/Date Closed: * * * Note: Reapply for new dt 01 i8 Date.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... 4 ... 'r? ..... /��. .................. ..... ... .. .. ......... .. .. ....... has permission to perform............................................... wiring in the building of .........&'%.. .............. z x at .....z ..... #,) --- .A .................................................. .North Andoyve,, Mas, Fee.. r........ Lic. NolZ.�Z....4.-..,O� ... ........ - A-62, NSPECTOR ............ Check # 4`1 x�.or�uraea R96 Official Use 0217 r. PernEitx. rfixa� r Occupancy and Fet-Checked M BOARD OF EIRE PREVENTION REGULATIONS �Pe�•-. i}C�r lea: vl� .APPLICATION FOR PERMIT TO PERFORM: ELECTRICAL Wi _ All, vorl tti be flea-fo med in accordance with the Mass a cihmev Electrical Code(NEC).327 C1Y9, L-101 3. (HEASE PP.EN7 D R, �K OF YTT'EALL JINOPM .A t?1?) Date: Monday, May 23, 2011 City or Toru of: N. ANDOVER T', PheInspectm° �fT hts By tlris apphcadon, the undersigned ves notice of his°or her intention to perform the electrical work described below. Location (Streeter Number) 761 DALE ST. Owner or Tenant BRIGHTMAN, MARC Telephone No. 9786551618 4 Owner's Address same - Is this permit in conjunction witls a building exmit?` ye's . No P ,� r p ❑ X] (C1rPck:ltppropr•iatP-Bos) Purpose of Building Utility authorization No. Existin.4 Service Amps volts New Service Amps i _Fritts Number of Feeders and Ampaciq Location and Nature of Proposed Electrical Work;. O er•hea t ❑ Undgrd ❑ 'o. of Meters. Overhead ❑ Undggrd ❑ lits, of Meters CntnnP rrn€t n{`eha k1J'nichfa fnhli tom, JW rk� htma rrnr of Wirrr No. of Recessed Luminaires No. of Cer7: 8usp. (Paddle) Fans Traof, 7,0tal nsformers niers Iii No. of Luminmrf Outlets No. of liot Tubs'- Generators K1 U. Of Luminaires Above ❑ n- El �CIrtl.Llrlrr 'o S' g l'Dl _rnd. rrrd. - 'o. o Liner fency' ig irng Battery Lnits No'. ofReceptacle Outlets Nd of Oil Burners FIRE ALARMSi\o: of Zones No. of Snitches llo. of Gas Bur'uet's ='o. of Detection an IIlitiatinx h'el'ices No. of Flanges No. of Air Crnd.; oto ons "'o. of Atertina Devices No. of Waste Disposers Heat FUMP Totals,.. um Pr oris'o. o . P - •ontarne DetectroulAlerting Devices No. ofbiahwashers Spacel ihea Heating KWLocal [] ' nnlclpa' El Other Connection No. of I}r.1 Heatiti � fiances g pP F �ecur�rt` 7stems:& No. of lietiices or E uivalent 12.00 No. of Water aterKN1 Heaters ` `O. o ` �o. o � Sim Ballasts Data ��k'lrrrt�' No. of 5u gas or Equivalent 0.00 o. Hydromassagel3atlrttrbs 10. of f®fors Total HF ecommunrc:ations. Wiring. No. of Device- orE uivalent 0.00 OTHER; Attach arnWhiibmaitdetail ifdezhAjeararequired bt-fix Iaspecrartai`rfres.. Estimated Value of Electrical'tkork: $800.00 (�AE'heu.required Lw nriuiicipal policl .) Work, to Start:_ Inspections to be requested in accordance kvitla INIEC' Rule 10. and upon completion. LN SL7R A_ CE ER�CE C76 : Unless iva i4 ed'by the owner, no penuit for the performance of elecmical work may r .ue unless the licensee prc .-ides proof of liability insirrance includinc, "completed operation" covera;�e or its substanti l equivalent- The undenieried certifies; that such coverage is m force and has exhibited proof of same. to the permit issuing office. CliECK PONE: i'4 SUR.,kNCE. El BOND [I OTHER ❑ (Specify.) I.ceatij -, rrrarlei tl ep�ifrs eiiad l* rrtritres nfplaer iar)� fdro# f1i rrafarirr ttrnri qtr tdfis tip a Es tare �tnd ' complele. F'IRI'I NANII: American Alarm & Coin i a nicatiorrs.l11c.. l certLIC.. N0.: 1 2 12 C M rA Licensee: R i c. Ii, a r d L, S a in p s o tr, S r. Signature LIC . ti`Ct. S 0 2 D g1rc plictr?r1a v ter• "exempr" it zhe lirme nurnber iaas:) Bus.. Tel'No.. 781-641-2000 Addr•*ss: 29;r Bro adyrav,, Arlingto41< MA 02474 alt Tel.No.: *Per M.G.L. c. 147, s. 57-61, securihr work requires Department of Public Safety "S"License: Lic. No. SSCO 40009MA OW ER S ISS! R.IiNC'E iVAI ER. I ani wware that the Licensee does, rot haiv, the: liability insurance coverage normally required by law. By my signature below, I hereUy utaive this requirement. I fire the (check oni) ❑ owner ❑ o. ner`'s agelit. Owner: Agent Stantur•e Telephone No. PEkIffT FEE: S 45.00 Date ....:...12:......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... /tom'-." t �..... has permission to perform ...../.t"" - ............ .,( ... ............... wiring in the building of ..../ :..,� 4' .. �` ' :......:.- ............................... at .... Z ��....;. /. �-�......� .... .............. .North Andover, Mass. Fee -Z.- 0'—r ee`-2.-0'—r ....... Lic. No.,/ h,.c' ..................................................... .............. .......... ................. r ...... ..... ... ELECTRICAL INSPECTOR Check Ili 1 9291 Commonwealth of Massachusetts Official Use Only Department of Fire Services Perm" No. 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 PRINTINM OR TYPE AI L WORW TION) Date: 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) -7 < T - Owner or Tenant Owner's Address Telephone No. � � �� '(' Is this permit in conjunction with a building permit? Yes No ildin a ' l ❑ (Check Appropriate Bog) Purpose of Bu g— RI fl ��.vtmV A+t o--. Utility Authorization No. Existing Service Zcz> Amps f 7_cy / Ztf 6 Volts Overhead 9 Und d �' ❑ No. of Meters 7 New Service Amps / Volts Overhead ❑ Unilgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: No. of Recessed Luminaires No. of Luminaire Outlets No. of Luminaires — , No. of Receptacle Outlets F SwitchesRangesWaste Disposers No. of Dishwashers No. of Dryers No. of Water KW Heaters No. Hydromassage Bathtubs1 OTHER: T. , k v C.� t, No. of CeiL-Susp. (Padd No. of Hot Tubs 1 SwimmingPool Above rnd. No. of Oil Burners No. of Gas Burners No. of Air Cond. Heat Pump umber T Totals: Space/Area Heating KV Heating Appitances No. of N Si s B; No. of Motors T, of the, 11owin table may be waivedby the Inspector,gf wires. le) Fans d' 1`0• or Total Transformers KVA Generators KVA ❑ In- ❑ d. o. o mergency g Batte Units FINE ALARMS No. of Zones No.. of Detection and InitiatingDevices Total Tons No. of Alerting Devices ons KW No. of Self.Contained Detection/AlertingDevices Local ❑ Municipal ❑Other Connection KW Security Systems:* No. of Devices or Equivalent o. of allasts Data Wiring: . No. of Dvices or Equivalent Dtal HP Telecommunications Wiring: No. of Devices or E uivalent ' rivacnraa znonal detail tf desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: - 1 a (� 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 andpenalties of perjury, that the information on this application is true and complete. FIRM NAME: � � �,-� �(rc.'�-r lac- LIC. NO.: (Z3 rn PL Licensee: L �r �1,c, Y Signature (If applicable enter "eze pt "intinse n tuber 1'ne.) LIC. NO.: i2 3n► P Address: �o}( l Z (p F l r� �L � � (v (4 6 3 q q. Bus. Tel. No.:to 3- ` -Z?, 3 � i *Per M.G.L c 147, s. 57 61, security work requires Department of Public Safety "S" License: �� L cl. No. 3 I18 `� m 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. PERMIT TEE. $ J The Commonwealth of Massachusetts Department of Industrial Accidents l ! Office of Investigations stl l 600 ff-ashington Street i Boston, MA 02111 c : WWW-" ass gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriciarts/Pfumbers Applicant Information Please Print Legibly Name (Business/prganizadon/individual)• 1 C__O_ j L Address: qv O City/State/Zip: 4 Am 1P+,,A ]PAI t �W p5S- q Phone #:. %6 3 - 97f, -363j Are you an employer? Cheek.the appropriate box: 1. ❑ 1: am a employer m to er with 4, Type of project (requiret�: P Y ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 6 ❑New construction 2. ❑"fam .a.sole proprietor or partner- listed on the attached sheet. $ 7. ❑ Remodeling Ship and have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' .comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its 9• ❑ Building addition required-] officers have exercised their 10•❑ Electrical repairs or additions 3. ❑ I air a homeowner doing all work right of exemption per MGL 1 I.❑ Plumbing repairs or additions Tyself. [No•work=' $ comp. c. 152, § I (4), and we have no insurance uired .t 12.[] Roofre'pairs req ] .employees. [No workers' comp. insurance:requirrdI3.❑ Other _] ;Any applicant that checks bo)'#1 must also fill out the section below showing their workets'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors trust submit a new athda ' ' ;Corrtraetors that cheek this box mustattached vit indicating an additional sheet such e�et showing the nates of the sub-c(frtt�igtprg a,,,a «s.�_• • � � ' -- as ..nTi�i. poriryinmrtnation. I an an employer that is providingWorkers' compensation insuraece for nay. employees; below is the policy mid job site information. Insurance Company Name: ' Poli' or 4 - �Self ins. Lie. #• Expiration Date: Job Site Address: City/state/Zip. Attach a copy of the workers' coutPensation 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 ttof a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the farm 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. I do hereby c under the pains a pee ` perjury that the information provided above is true and correct 5i lure: Q�� Date: Phone #: fo03 - 9 Z Cv" 30 -1, EBla_ only. Do7oLoe): n this area, to be completed by city or town of c•.iaL n: Permit(License # orify (ciHealth 2 -Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector son• Phone # Date. `.. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .... ........ has permission to perform ......... G� plumbing in the buildings of ........... pp �-�, North Andover, Mass. Fee. Lic. No.... , / u PLUMBING,A SPECTOR Check # 8566 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Owner 6 12 1 New ❑ Renovation ❑ �0 Replacement FIXTIJRF.R Date Permit #1 �i� Amount % 0 Plans Submitted Yes ❑ No (Print or type) Check one: Installing Company Name .TJ S -��, � A,6-- /y Corp. Certificate ❑ Partner. ITFirm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity❑ Bond 11 Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and ' tallati performed under P76t Is r this application will be in compliance with all pertinent provisions of the Mass ch efts to Plumbin ode d Cha 42 t the GenesLaws. By:a1rUULU1U 01 1,1CenSeGrjrba Title Type of Plumbing License City/ Z4 ,� ice um er Master 0-' Journeyman ❑ APPROVED (OFFICE USE ONLY 111 1i `• v The Commonwealth of Massachusetts Department of Tndustrial Accidents Office of Investigations Uf 600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le�><biy Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ElI am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. [1 We are a corporation and its required.] officers have exercised their 3. ❑ I 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.] t employees_ [No workers' comp. Insurance required.] �`.�. m.rsno.,} };.,,} ,.t. --moi,_ v __. L 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.❑ Roof repairs 13.❑ Other .5 1-1itu* wnrin' Comne.ncnrin....ni...v, :«c —.tee:., n. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am 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. 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 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 $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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si atare: Date: Phone #: 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): L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 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 15.2, §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 fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) 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 tre city or town that the application for the pernmit or license is being requested, not the Departmentt 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 Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 wwu .mass..gov/dia Official /Use �Only THE COMMONWEALTH OFMASSACHUSETT5 Permit No. Department of Public Safety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy & Fee Checked-� `J APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:0`0 (Please Print in ink or type all information) Date l 7 !J - O b To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to pert the el trical work escribed below. Location (Street & Number j .7 �J'Jl Owner or Tenant Z�-> !� � / It en 114,7 L, Owner's Address l.'. Is this permit in conjunction with a building permit Yes No • (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Voits Overhead • Undgmd • No. of Meters New Service Amps Voits Overhead • Undgmd • No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If you)have checked YES please indicatt the type o verage by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specify) ,�/„ 7 e� l ��i.. r <7 41a ✓la / �1 • (Expiration Date) Estimated Value of ect igal Work$ SU D Work to Start ' G� 6 Inspection Date Resquested Rough Final Signed under the' en (ties of perjury: FIRM NAME LIC. NO. Licensee_�u� —Signature p LIC. NO, S 1' / �C�/ r / Bus. Tel No. 779 Addrass �� L J . > 1 "' �� Alf Tnl Nn 7 '� (r... < `� _. hi -(/� _ 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) �i Telephone No. PERMIT FEE $ (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above In No. of Lighting Fixtures Swimming Pool gmd gmd Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di osal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices • Municipal • Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If you)have checked YES please indicatt the type o verage by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specify) ,�/„ 7 e� l ��i.. r <7 41a ✓la / �1 • (Expiration Date) Estimated Value of ect igal Work$ SU D Work to Start ' G� 6 Inspection Date Resquested Rough Final Signed under the' en (ties of perjury: FIRM NAME LIC. NO. Licensee_�u� —Signature p LIC. NO, S 1' / �C�/ r / Bus. Tel No. 779 Addrass �� L J . > 1 "' �� Alf Tnl Nn 7 '� (r... < `� _. hi -(/� _ 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) �i Telephone No. PERMIT FEE $ (Signature of Owner or Agent) Date ..," 2 � TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... ............................... has permission to perform .......................................... wiring in the building of ..... ................................................ at ..... (.�/........................................... . North Andover, Mass. Fee ..```5............ Lic. No ;.............. ELEcnucALINSPECTOR� Check # f �- 7 a 664 6 A Official /Use Only THE COMMONWEALTH OF MASSACHUSETTS Permit No. Department of Public Safety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00-J Occupancy &Fee Checke APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 G (Please Print in ink or type all information) Date L �" f3 - 6 r& To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform tthe el trical work esen ed below. Location (Street & Number / Dd e- S . Owner or Tenant d P C.. / It lfnL �— Owner's Address E Is this permit in conjunction with a building permit Yes No • (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Voits Overhead • Undgmd • No. of Meters New Service Amps Voits Overhead • Undgmd • No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If yo�uJhave chg/cke/d YES please indicat the type o verage by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specify). AJ 7ro-, ov/ C'lYi�l P ,/%%u ✓Ce t7 _ X71 r � (Expiration Date) Estimated Value of ect iya4 Work$ J � Work to Start O 6 Inspection Date Resquested Rough Final Signed under th a hies of perjury: FIRM NAME LIC. NO. Licensee 1_4 PAI Say✓ Signature LIC. NO. S Address S lei ' " 14111 ^ Bus. Tel No.Alt Tel. No. � Uri 7S9— 6� 7z ei `X � S / OWNER'S INSURAN WAIVER: I am aware that the Licenses does not have the insurance oc verage 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) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above In No. of Lighting Fixtures Swimming Pool gmd gmd Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices HeatTotal Total No. of Di oral No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices • Municipal • Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If yo�uJhave chg/cke/d YES please indicat the type o verage by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specify). AJ 7ro-, ov/ C'lYi�l P ,/%%u ✓Ce t7 _ X71 r � (Expiration Date) Estimated Value of ect iya4 Work$ J � Work to Start O 6 Inspection Date Resquested Rough Final Signed under th a hies of perjury: FIRM NAME LIC. NO. Licensee 1_4 PAI Say✓ Signature LIC. NO. S Address S lei ' " 14111 ^ Bus. Tel No.Alt Tel. No. � Uri 7S9— 6� 7z ei `X � S / OWNER'S INSURAN WAIVER: I am aware that the Licenses does not have the insurance oc verage 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) Telephone No. PERMIT FEE $ (Signature of Owner or Agent)