Loading...
HomeMy WebLinkAboutMiscellaneous - 9 ALCOTT WAY 4/30/2018R N N W F 2012 Massachusetts EIectrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with theprovisions of M.G.L. c. 143,'§. 3L, the permit application form to provide notice ofinstallation of wiring shall be uniform throughoutthe 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. CrI 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 maybe.deemed_bythelnspector_of--Wires abandoned.and-invalidiflae—.. _ or she has determined that the aufhorized 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 of2010 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, forfour 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. ule 8—Permit/Date Closed:-7i� / f1%** Note: Reapply for new perm4 ❑ Permit Extension Act—Permit/Date Closed: 9 77- 6 Date ...... 11:7.(A.- / 0 ........... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......................... A....� ............................................. ................... e -c e-, '? , ? — has permission to perform ............. 15 .......................... �/ ........ 5�' .............. wiring in the building of .............. . .............................. ........ .... W.WK ......... . North Andover, Mass. at ......... Lic. No-...�..5^,C-......................... Check # 3-519 36 ELEcrR C INSPFCTO r Q� �// // Official Use Only cammonruaal4fh o� �ad3achu�attd O— cry�, cc77 Permit No. 1 ?OEM 76 .[JePariment o� fire �ervice� 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: City or Town of: /!%U4.71-71 ' 4^�dJe/L 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) '? 4 eL d,' —F —/ AM +1/ __ Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service _— Amps ' / Volts New Service Amps _ / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Telephone No. Yes ❑ No. X. (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd [I No. of Meters Overhead D Undgrd tJ No. of Meters -_ Completion of the follo-winz 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 Swimmin pool Above E]In-❑ g rnd. gnd. 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 o. Detection and In nitiating Devices No. of Ranges g Na of Air Cond. Total Tons No. of Alerting Devices No, of Waste Disposers Heat Pum p Totals: Number Tons.,- KW o. of elf -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ unicipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water Heaters KW 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: C�'z / 3 r / / Attach additional detail ii(desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: S 16 (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 coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [X BOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete.'/ FIRM NAME: a , (( ('( Se LIC. NO.: SSC_ Licensee: Pi L eG� _ Signator r LIC. NO.:%oZ 42� (Tf applicable, enter "ex emp ' in the license number lin l, // Bus. Tel. No.: Address: % (�� L/lj�lYl 2 �/0� !S 4)h � Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. 000 b / 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. , 3f COMMONWEALTH OF MASSACHUSETTS ELECTRICIANS A REGISTERED SYSTEM TECHNICIAN ISSUES THE ABOVE LICENSE TO: ARTHUR W PIERCE _ 1 UPHAM ST n SALEM MA 01970-251 1024 D 07/31/13 874092 r � �sie �o-�rcm4n�ueaQii. o��� G[aJ:fac�ec[LeL�f DEPARTMENT OF PUBLIC SAFETY Certificate of Clearance Number: SS CC 000517 w 4 Expires: 08/30/2012 Tr. no: 91.0 S -license: ADT ARTHUR W PIERCE is CLINTON DR HOLLIS, NH 03049 Commissioner 1 _ t Date......... . .. ....... .. .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .................. L ......... LG v 4 has permission to perform ..................................... D ....... 7.......... T4./ ............ wiring in the building of ...................... ....................... at .................... rQ 7. .............. . North Andover, Mass. ;� Fee..s.... . ...... Lic. N .. ............. ................ -ii�c /-�'C2A!L--I-N--S-P-E;CMR Check # ,7658 Commonwealth of Massachusetts Otficial Use Only Department of Fire Services permit No. b 5 Occupancy and Fee Checked r 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), 52 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: L d J0 7 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) 9 A L Cy -7 tc/d y Owner or Tenant L Q v i' S M v l t', ape 5 Telephone No. Owner's Address 9 t9 L CO 7 k Is this permit in conjunction with a building permi . Yes ❑ No E2< (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service /d C) Amps (10 / 2 qO 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: e-9 �C 2 a o��t'c7ir't 4t Completion of the ollowin table may be waived by the In ector 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 No. of Luminaires Swimming Pool Above ❑In- El 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 No. o Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pum Totals Number. Tons K No. o 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 K`,`, Heaters o. o No. o • Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications firing: No. of Devices or Equivalent OTHER: 'L G0 L e7L G'i-pf / Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 2. (When required by municipal policy.) Work to Start: 9/19/07 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 .Q BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penaIt' s of erjury, that the information on this application is true and complete. FIRM NAME: Ati,krd( l� �� f!I; r 4' The Commonwealth ofMass Depart`rrent o achusetts f Industrial Accidents Office oflnvestigations 600 Washington Street s. Boston, MA 02111 Workers' Compensation Insurance www.ntassgovIdia `� itcant Information Affidavit: Builders/Contractors/Electrician Name (Business/Or / s/Plumbers ganization/Individual); OV7 P Please Print Le ibl Address: 3 S�i� t'�cSIJ� Q �' City/State/Zip: �� �L!y Areyou an em Phone #: 9 7C1 plog/S yer? Check the appropriate box: I ❑ [ am a employer with �remployees (full and/or-- 4. I am a Type of project 2. SSI I am a sole proprietor or artner-) # have hired the sub -contractors conractor and I P Iect (required): ship and have no employees listed on the attached sheet. 1 6. El construction working for me in an capacity. These sub -contractors have Remodeling [No workers' comp.Y pacify. workers' co insurance mP• insurance. 8' ❑Demolition 3. ❑required.] 5. ❑ We are a corporationand its9. I am a homeowner doing officers havexercised ed their ❑ Building addition g al] work right of exemption Per 10'&Electrical repairs or additions insurancMyself e required.]st comp. p MGL 11.0 plumbing repairs or additions C- 152, § 1(4), and we have no employees. [No workers 12•❑ Roof repairs 'Any applicant that checks box #1 m comp• insurance r t Homeown it this air ust also fill out the section below showingtheir required.] 13•❑ Other ]Contractors that c eck th s box must attachit es an additional sheet showing ting y are doin all work and h workers' compensation g en hire outside ContractorspohoY information. 1 am an employer that is proyidin ng the name ofthesub-contractormust submit a new affidavit indicating information, g workers compensationand their workers' com such. insurance form p' policy information. Insurance Com y employees Below is the policy Name: policy and job site Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date. Attach a copy ,Ofthe workers' compensation fFailure to secure coverage as required under Secption 2 Alicy claration C�tY/State/Zip: ne u to Page (showing the policy number and expiration date). P $1,500.00 and/or one- of MGL c, 152 can lead to the imposition of criminal e Of up to $250,00 a daya Year imprisonment, as well as civil penalties in the form of a STOP WORK Investigations of the DIA for insurance coves advised co Penalties of i py of this statement may be forwarded to the office ORDER and d a fine Ido hereby cerci under the pain and penalties ofperlury that the inforynation provided above is tr Si nature: q ue and correcx 'hone #: � 1 D � �'/ —R` / Date: % 2C>/� Offciat use only. Do not write in this area, to be completed by ci or City or Town; 11' town offciai Issuing Authority (circle one): Permit/License # 1. Board of Health 2. Building Department 3. Ci 6. Other Contact Person ty/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Phone PERMIT FOR GAS INSTALLATION This certifies that . J.t-" ...f!.`'.►� �.? ........ 1 ......... has permission for gas installation ............ in the buildings of ..`%1 !� L [ ' 1q c y ...................... at ... ....... eo ahAndover, Mass. Fee.U''- Lic. No.. �.? .3 G .L.. . GAS INSPECTOR T�" MASSACHUSETTS UNIFORM APPUCATON FOR PERM TO DO GASG (Type or print) Date 6 NORTH ANDOVER, MASSACHUSETTS � Building Locations Permit # W�IPfi+11Amount $ 3 o Owner's Name New ❑ Renovation ❑ Replacement Plans Submitted ❑ ILI` Name of Licensed Plumber or Gas Fitter Che k one: Certificate Installing Company Corp. ❑ Partner. Firm/Co. INSURANCE COVERAGE Check one: 1 have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy M Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner1:3❑ Agent 1 herehv certifir that SII of fl» rlor—a� ....a :..c.._......: _ I L ---- __1__ 7.. ........_,.........-,,,..,,,,,1—U kU, c„iaou� in noove application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts StatirGas Codynd Cter 142 of the General Laws. ED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ® Plumber ma) -7E) ❑ Gas Fitter License Numtier Master Journeyman � w a U OV zz w O m r x y Z Z E 04 G > �d zy > Z Z wl- O x z> a° 1 o SUB-BASEM ENT BASEM ENT 1ST. FLOOR 2ND. FLOOR I I- 3 FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR Name of Licensed Plumber or Gas Fitter Che k one: Certificate Installing Company Corp. ❑ Partner. Firm/Co. INSURANCE COVERAGE Check one: 1 have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy M Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner1:3❑ Agent 1 herehv certifir that SII of fl» rlor—a� ....a :..c.._......: _ I L ---- __1__ 7.. ........_,.........-,,,..,,,,,1—U kU, c„iaou� in noove application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts StatirGas Codynd Cter 142 of the General Laws. ED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ® Plumber ma) -7E) ❑ Gas Fitter License Numtier Master Journeyman