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Home My WebLink AboutWiring Permit - Building Permit - 66 BONNY LANE 10/8/2014 I > Date....... ,.�............................ �r OF�yORTh q� TOWN OF NORTH ANDOVER PERMIT FOR WIRING CHUg��a This certifies that � F has permission to perform •_ s wiring in the building of..............�,as � ............................................................... ............. F�••••• •••••. orth Andover,Mass. ... .. ........... Feed Lic.No G ...... ... � ........... . ELEC CAL INSPECTOR Check# y i Commonwealth of Massachusetts Official Use Only Permit No. 7' Department of Fire Services Occupancy and Fee Checked QM BOARD OF FIRE PREVENTION REGULATIONS [Rcv-1/071 (lcaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PNNTTNNK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVE'R To the Inspector of Wires: By this application the-undersigned gives notlrf of his or her intention to perform the electrical work described below. Location(Street&Number) O()jg,/)(,/ Owner or Tenant dejc)& Telephone No. Owner's Address Is this permit in conjunction with a building-permit? Yes 2 No F] (Check Appropriate Box) Purpose of Building 1�yocmg�L-;6�-tility Authorization No. Existing Service 2 0o Amps 'L01 Z-Y )Volts Overhead F1 Uridgrd� No.of Meters New Service Amps Volts Overhead n Undgrd F] No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 1-,)rk1 al&Qr- 4 RP 00,37-, j','y ie W e) Ca ei Completion'of thefo'llowin table may be waived by the Inspector of Wires.'(�O No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No. of Total 7 Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA . ......... No.of Luminaires Swimming Pool Above In- Emergency Lighting grnd. ❑ grnd. F] Battery Units No.of Receptacle Outlets 7 No.of Oil Burners FIRE D tcnARMS JN'do. of Zones . No.of Switches No.of Gas Burners Tota Initiating Devices Tonsl No.of Ranges No.of Air Cond. :No.of Alerting Devices Heat Pump I.Ny.mb No.of Self-Contained No. of Waste Disposers Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑El Municipal El Other Connection Security Systems:* No.of Dryers Heating Appliances Kw No.of Devices or Equivalent___ No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total H Telecommunications Wiring:P No.of Devices or Equivalent OTHER: L...... Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: )V_/?,,Z 4`6 (When required by municipal policy.) Work to Start: ialge� Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERNGE: 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 covera is i p n force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE �BOND El OTHER El (Specify:) I cerilry, under the pains and P nalfies ofperjuiy,that the information on this application is true and complete. E: LIC.NO FIRM NAM ? N c. Licensee: klal- ki Signature( LTC,NO.: (If applicable,qter npt"'in tpe license!number line.) Bus.Tel.No.: 035 662!�--70S'7 Address: L-`* I Dr-, /JaO( C4# Ok--) 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)0 owner El owner's agent. Owner/Agent Signature Telephone No. 1P—k-1?-M7IT FEE.- $ •❑ 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 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 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,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: ***Note:Reapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass M Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: . G Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass F?1 Failed 0 Re-Inspection Required($.)❑ " Inspectors Comments: D Inspectors Signature: Date: FINAL INSPECTION: Pass M Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com a - The Commonwealth o,f'.1V1assachusetts Department o,f'Industrigl Aceld` is Of flee of Investigations 660 Washington Street Roston,MA 02111 vww.mass gov/ciia worii:exrs' Compensation Insurance Affidavit:Buffders/Contcactoro/Electraiclans/Rliimberq AoDlicalnt Information PXease 'r nt Le x X Name(Business/Organization/in.dz`vzd al): .Address: City/Sae/Zip; .. - ''� Phone#: Are your an employer?check the appropriate box: Type of project(required.): 1.C( Z am a employer with 4. ❑ x am a general contractor and S 6. ❑Now construction employees(full.and/or pa�,--timo).* havehiredtho sub-contractors 2.Uk am.a sole proprietor or partner- listed.on the attached sheet.x 7• El remodeling ship and`have na.employees Theso sub-contractors have 8. El Demolition working forme in any capacity, workers' comp.instance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a coxporagon and its 10.[j Electrical repairs or additions required.] officers have exercised.their 3.El am a homeowner Ring all work right of exemption per MGS� 11.�(Plumbing repairs or additions myself.[No workers' comp. c.152,§1(4),and we have no UP R,00frepairs insurancerequixed.� employees.[No workers' 13.❑Other comp.insurance required.] 'Uny applicant that checks box#1 must also fill outthe section below showingtheir workers'compensationpolicy information. i Homeowners who submltihis affidavit indicatingthey ace doing allworlc and then hire outside contractors must submit anew affidavit indicating such. t'Coatractors that check this box must affached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. f am an employer tliat isproviding woykers'compensadon insurancefor any employees Blow is thepolley anrljob site information. insurance Company Name; � Policy#or Self ins.Bic.#: Expiration Date: lob Site Address, __ City/State/Zip: Attach.a copy oMe workers'compensationpolicy declaration.page(showing the policy number and expiration(late). Failure to secure covexage,as xequixeduuder Section 25A ofMGL o.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 OR ER and a fine of-up to$250.00 a day against the violator. Be advised that a copy ofthis statement may be forwarded to the Office of Investigations of'the DiA for insurance coverage verification. Xdo Iie�e cer ' UnderAep,ains a rl naft er;jury treat tree informationprovided above is true and correct, � f ' Si afore. Date: Shone#: Ofjreial use oily. Do not write in dais area,to be completed by city or'town official City or Town, 7Permit/License# Issuing Authority(circle one): 1.Board of Health 2..Building Department 3.City/Town Clerk 4.Mectrical llnspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 4<;COMMONWEALTH OF MASSACHUSETT.S BOARD OF EL.ECTR 1 C]ANS I ISSUES THE FOLLOWING. I>rEN'SE AS .;A REG° JQURN EYMAN .f LECTR I C I AN a DAUIB-J KRAFTON j . AU DR 93 CORRIVE .�(�UKSETT NH o31o6 2419 34 124095 o'