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HomeMy WebLinkAboutWiring permit - Building Permit - 440 BOSTON STREET 12/23/2013 iDate.. .. ... � ......... p►ORTq ?°p•�``�.'•.,''�o� TOWN OF NORTH ANDOVER PERMIT FOR WIRING v �BACHU•j� p This certifies that ........t' .......................... ` � ...... . � �'t........................................... � t tie E has permission to perform , wiringin the building of............. ... .............................................................. i�� e North Andover,Mass. at s ...........� ...... .... .. Fee...� ......Lic.No. .... ....... . E ECIRICAL INSPECfoR Check# a _ _ (fo��mnwnweaR of Mama�chuaetb Official Use Only - oL.Je�nar$mznt o��ire Jervice9 Permit No. Occupancy and Fee Checked Ss BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank) �- APPLICATION FOR PERMITTO T 1 L 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 I FORMATION) Date: v City or Town of: To the n�tor of Wires. By this application the undersigned givei noti e of his or her intention to perform the electrical work described below. Location(Street&Number) jOwner'or Tenant ��O S<�7 !//�G [rfi/ e Telephone No.! AL Owner's Address „o - Is this permit in con' action with a building permit? Yes ❑ No (Check Appropriate Box) - Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters tJ New Service Amps / Volts Overhead❑ Undgrd ❑ No,of Meters r— Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �' [ ,�� �'� /G'-L�h✓ �' �17'.�Go/�`l..�iLi�/� 1�t2C_s r'�t!P.:�5' �ys 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 Lighting 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 and Initiatine Devices No.of Ranges No.of Air Cond. Total `1 No.of Alerting Devices Tons No. of Waste Disposers Heat Pumpumber Tons KW No.of Sell'-Contained ........_................................................................. Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipai ❑ Other Connection No. of Dryers Heating Appliances KWSecurity Systems:* � No.of Devices or Equivalent No, of Water KW No.of No.of Data Wiring: Heaters Si Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total IIP Telecommunications Wiring: No.of Devices or Equivalent OTHER: S Attach additional detail if desired,or as required by the Inspector of{Vires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:��' /—.5' Inspections to be requested in accordance with MEC Rule 10,and upon completion. r(1 INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless N 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 and ldes ofperjury,that the information on this application is true and complete. FIRM NAME: Aries Electrical Service and Controls LL,C LIC.NO15650a Licensee: No Arid Michaud Signatu,-w`- K.NO.• 39594e (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: 978 687 0 544 Address: 290 Broadway suite 117 Methuen ma 01844 Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.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. PERMIT FEE: $ T-�- Comwnw-gaM OfMaUachusefts DePayfteld OfIndwhMAccidents Office ofinvesagadons, 600 Washington street r Boston,Mass 02111 awns. mov/dia ®rkers' CO elllsa `®la ce ARIdavit Buflders/Contractors/EI '�� berg A la t m ati®� Flea -P ' t-Le 'bl NaMe(BusineWOrga dndonllndividuat): .S,�LECTRIC .L SERVICE AND CONTROLS LLC Address: .290 BR()ADWAY Sj.L T' i i 7 City/,Stu ip._Me hua Ma to r R44 Are you an employer?Check the appropriate box; 1.10 1 am an employerwith .4 0 I am a Tyke of project(required): employees(full and/or �ehe contractor and I 6.0 New construction Part time�� have ffiesob-contractors 2 !T am a sole proprietor or partner- listed on the attached sheet. 7.0 Remodeling *hip and have no er•plcyees These sa'b-con ractors have wor3dng for rue in any capacity- employees and have workers' 8.0 Demolition [No workers'comp.insurance comp.horranee.I . 9.0 Building addition - requ1red] 5.0 We are a corporation and its I O_ ectrical 3.0 I am a homeowner doing all work officers have exercised their repairs or additions myself'[No workers'comp. right of exemption perm MOL I I-©'Plumbing repairs or additions rnstu="erequirecqt . c.152,§1(4),and we have no 12.0 Roofrepairs employees-[no workers' comp.insurance required.] 13.0 Other -Any aPPffcanttLat checks basi€imoaYsofitloatthes�tiona&gawingttzen-evorkess'�mpetagoniwiit!'intormatiofl. tHomeownerswho • this - . . #CuntadQ=_ Mt chethitha box m atterh an the�domgaII wwtand then hire onwe oontca0WSbMftetors ma t§albmit a new atiPdarrit iodicating ssieti. rhesnb-coatraceorshaex #hersameoTihesabtwabectois and state whetkeror not these enaths have emptoy If a mt�t theirwariass' H rmmber: I am rot enrplgyerihat ispmvWMg x1_h033'coftqeasafwn• eeformy mWroye Belomv i/te policy andjob site information. is Insurance Company Name: ®Tl ave eYS; ;Tns. Policy#or Self Ins.Lie w _ — �i 5B3�R�'+ 7 ExpirationDatFZ/21:J2 Job Site Address:__/ City/Studzip: y7�`af Attach a copy of the workers'comp'ensation Policy declaration page(showing the policy a krer and expiration(date). Failure to secure coverage ( ) as required under Section 25a of MGL 152 can lead to the unposition 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.B&advised that a copy of this sta DIA for eova verification. temerrt maybe forwarded to the Office of Irrvestigations of the I do Irerby cerzw under the p ' enaltias ofpe irry that the iftfonna&n provided above is true and correct Pj1n1Name:. Normand Michaud Phone#: 978 687 0544 VOfflCial use only .Do not "e in this area to he co°o by ci&or town official City or Town: Issuing Authority(c a one): 1.iBoard of Death Z. Building Department 3.CityjTown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact person: Phone#: pan n Division of Professional Licensure: License Search Page I of I The Official Website of the Office of Consumer Affairs and Business Regulation(OCABR) Division of Professional Licensure Mass.Gov Mass.Gov Home State Agencies A-Z Topics Home>Division of Professional Licensure> ONLINE SERVICES Check a License Cheek A Professional Liceiise Locate a Licensed Professional By the Division of Professional Licensure Online Address Change Contact the Agency Mom- LICENSEE Name: NORMAND D. MICHAUD REFERENCES& WINDHAM, NH RELATED INFO NEW SEARCH Disclaimer Regarding "This Licensee has additional Licenses click here to view them." Website License Searches Enforcement Process Glossary Licensing Board: E.LECTR-1-CIANS Glossary of License Status License Type: MASTER ELECTRICIAN Codes TYPE CLASS:A License Number: 15650 Mom— Status: CURRENT Expiration Date: 7/31/2016 Issue Date: 4/22/1996 Exam Date: 4/13/1996 School: This web site disptays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Monday, December 23, 2013 at 8:18:59 AM. 0 2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http://license.reg.state.ma.us/public/pubLicenseQ.asp?board—Code=EL&type_class=—A&I... 12/23/2013