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Home My WebLink AboutWiring permit - Building Permit - 90 BRADFORD STREET 12/19/2013 f.Date ............. ......... ......... ...... R'r" NORTH ANDOVER TOWN OF PERMIT FORK WIRING CHU ..................................................... This certifies that ... ....................... ...................... 411 0 '1.�.................... percussion to perform . .1�............... ......... has ...................................................................... wiring in the building of....... Mass. North Andover, ............. at .......... ............................ ............ gr ryp t.......... Lic.No. ......... Fee..... ................. ... di-C-n-UCAL INSPECTOF( Check# G" 74 &WW"W4441 4 W4"4AeUM Perrnit# Depawnent of Public Safety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Effective: 1/98 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527CMR12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) k, 14AA�1;6" K'- DATE d,�)- —/0 -1 /,�� To the Inspector of Wires,, 111110111111m:The undersigned applies for a permit to perform the electrical work described below. Lo(,ation(Street&Number) 01 _a) Rp- i"If IS i�70 A Owner or Tenant Owners Address(if different) Is this permit in conjunction with a building permit (Check Appropriate Box) Yes Noac_ --" Purpose of Building Utility Authorization no. Existing Service- Amps Volts Overhead E] Underground #of meters NEW SERVICE- AMPS VOLTS OVERHEAD[] UNDERGROUND[] #OF METERS Number of Feeders and Ampacity Location&Nature of Proposed Electrical Work (0- 3 #Lighting Outlets #Hot Tubs #Transformers Total KVA #Lighting Fixtures Swimming Pool ABOVE IN ground #Generators KVA #Receptacle Outlets #Oil Burners #Emergency Lighting Battery Units #Switch Outlets #Gas Burners FIRE ALARMS: #Zones #Ranges #Air Conditioners Total Tons #Detection&Intiating Devices #Sounding Devices #Disposals #Heat Pumps Total KW #Self-Cont'd Detection/Sound Devices #Dishwashers Space/Area Heating KW Local[] muni.connection Other #Dryers Heating Devices KW Connection Location #Water Heaters KW #Signs #Ballasts Low Voltage Wiring #Hydro Massage Tubs #Motors Total HP OTHER: 114SURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws, I have a current Liability Insurance Policy Including Complete rations Coverage or its substantial equivalent. YES NO I have submitted valid proof of same to this office. YES a, NO [:] If you chocked YES,please indicate the type of coverage by checking the appropriate box. INSURANCE r--"' BOND 0 OTHER (Please Specify) LL6 Estimated Value of Electrical Work $ JER-p-ffr-51716-577a tit Work to Start Inspection Date Requested- Rough: Final: Signed under the penalties of perjury: FIRM NAME Lic,#_ja 6 awn Licensee i,-_>C 5'rC Signature Address a Bus Tel.# Alt,Tel.#�-7- :5t-J-4v OWNER'S INSURANCE WAIVER: I am aware that the licensee 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 or Tel,# cash ck# Per it e GENERATOR APPLICATION DATE: i �- _ 1 l LOCATION: 67 R &P. OWNERS NAME: = GENERATOR kw Ac,p"n4 4 L, NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: PHONE NUMBER: ELECTRICAL GAS RESIDENTIAL COMMERCIAL TEMPORARY, 1-. A' LOCATION OF GENERATOR: ki T- e-v Al '4 � *ZONING DISTRICT: *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL Nov-18-06 14 : 16 "town of Anclovar 978-623-8320 P.Ol A The C'vtrrtrronweadth a�'�lassuc�hus�trs Department ojIndus-rrial Accidents Office of Investigations 600 Wasliinglon Street Boston, it'll! 02111 Wtvw.tttl7sS.�'r1 v�dla WOrkers' Compensation Insurance AffidaMt: I3>1ilders;t:rinf:actors//�Icrtr irittns!Fln;rrtbt`r� Aptkeaxl4l>�i�rrntion N=e {13usin siU:��T132i1:U11'ti�llvidu2l): t� tf � Address: -- CY City/ 4ale/Zi C!`>l LiL1�,� 1 fLl ----- Phone P. 7 Are y ola an employer? C,_iieck the appropriate box: _ �'1 Ville of project(requirs(i) 1.E0 i am a cnrployer with l 4. [j lain a genera!coi,u'acmi and f 5. ❑ New construction I employees(fall andfor part-time).* lamp,hired the;ub-contractuTs i 2.❑ 1 ani a sole proprietor of paTwv- listed on tht att:u;hmI shrct 1 i 7 F-I Remodeling ship and have,w ompioyees Tbcsc sub-contractors have, S. nc nolidun working fos me ill any capaciry. workers'sump, insurancc p. [� Bididing addititrn (No Avrkcrs' comp inswance s ❑ We are a corporation and its . required.] 09"Is have rxcmiscd tbaix 10.11 F.lcelrical repairs of ticddilions 3. 1 am a homeowuci doing all work right Ofcxctuption per MGL 11 ❑ Plt:mbing repair, or additions myself. [No woikens' comp, c. 152, §1(4),and we have no 12.[ ] kauf ieigirs insurance rcquired.]t employees- (No workers' _ camp.insurance requii-cd.) 13,0 Clther _ *Any applicant that checks box lit Tii•i Y also fil',nut the socticn below xhotiriny,their worked'mnipansanon policy informaton t Homeovmcrs who aubrnil'.his aftidev,t indicating they arc doing all workard thou hire outride contnnetorr mast submit a new iffi wvit indicating such. tCourractOts[liar check this box mum attuched an additiuual slieet slowing tiro name of the sub-conirncturs Lirad their wurkerr'comp,policy iufvrmation I am an employer that Ls pror"rlinp►Dar kYr:r'CuhiPettsatiott insurance fur illy mph yens. Re-lon,is the policy dart",job vile.— infur•ntrrtian. `` hA 11 AE 4 VI ,-a -b 9 X4,,i a !UAMInce CorTany Name lF2C- Policy#or Self-ins. Lie. Expiration Matt : Job Site Address: U 8� i7� G,k&.lam A- City.;State/zip:/V, #41V Attacb a rupY Of the noraers' contipem(ion polity deelarut.iort page(showing the policy- atimber and expiration dime), failure to secure coverage r;s w(jaii'ed under Section 25A.cf AIGL c. 1.57 can lead k, t)ie i1nl,oSitic7a of crimiaal penallics cif"<, fine up tc,$1,500.00 and/oi one-year imprisormc:ni,ai wrl; jts civil pmaltics in the form of a STOP ( RDE-R and a fine Of up to $250.00 a day against the violator: Be a0visref that a copy cif this starcmen;may be forwarded to the Office: t;,f' Investigations of the DIA for insuratire coverage verification. I do hereby ceerrjtify under tl,c lmirm and ienaltks afperjttry ihof the information p,vl-idcd ubaz!e is true and Correct. Sim titre: Official use vidy. Uo nor,trttr. i►t rlri.� rrraa,la be e'oniplPtecf bye cit3 ar larva vffrsiat, — ___—_ _ City or T(twn: Permit/License# lii.uing Authority(circle one): 1. Board of Health 2,Building Department 3.C:it••i l'own Clerk 4. Electrical luspcctor 5. Plumbing luspe:ctur 6, Other Cont2c.1 Person-, Phone#: .:OMMONWEALrjHj OF Mtn tEG'Ctl C1 A(�S > :i SSUES THE .FALLOWING AS,- REG,ISTBEA MASTER. ELECTRICIAN GAUA; TTE ELECTRI G :tit HARD,W G��}{3 TE t(A p 1$63 1621 GFtELMSFoRA 27426 5868 . . A /3�1 :6 Town of North Andover Your permit has been nt back to you fgr the following reasons: 1) Check amount incorrect / 2) No copy of current license 3) Insurance Binder not on file or expired / �� 4) No Workers' Compensation Insurance Affadavit Form V. Please call with any questions 978-688-9545. Workers' Compensation Form and Schedule of Fees can be found on the Town of North Andover Website under Building Department. //` ,