The URL can be used to link to this page

Home My WebLink AboutWiring Permit - Building Permit - 269 BRENTWOOD CIRCLE 9/12/2013 E C a 3 �Nonrh,� `['OWN OF NORTH A OVER PERMIT FOR WIRING ,88ACMU`�� k f Ni C, Giqt This certifies that has permission to perform rt ,, ��T � I.................. wiring in the building of .. North Andove Massa at t a E �3 INSP Fee., ... Lic.No. ;......... ..... .. .... .. ... crxtctu Check# rt y Official Use Only elmownweah4 ol Maijaclwoffi Permit No. 0/ Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]/07] (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEQ,527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORAM ION) Date: 9 /to / '�) City or Town of: A t \ [I\ 1� To the Inspector of Wires: 3�c o2 c- By this application the undersigned otice of his or her intention to perform the electrical work described below. Location(Street&Number) by-ea600A, cky Telephone No. Owner or Tenant hr\ Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No El (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd F-1 No.of Meters New Service Amps Volts Overhead El Undgrd n No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No.of No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Trans Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA F, -N-O—. t Emergen L No.of Luminaires Swimming Pool Above In-grnd. grnd. Ba o ttery Units cy ighting No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners No.of Detection and Total Initiating Devices No.of Alerting Devices No.of Ranges No.of Air Cond. Tons Heat Pump J.NpT4er. T.o.n.s KW No.of Self-Contained No.of Waste Disposers Totals: .......... ......... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑El Municipal R Other Connection No.of Dryers Heating Appliances KW Security Systems:* Eguivalent No.of bevices or No.of Water KW No.of No.of Data Wiring: 3, Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (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 RX BOND 17 OTHER El (Specify:) I certify,tinder the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Nightwatch Protection, Inc. LIC.NO.:-7024C Licensee: Paul Delsignor Signature rza LIC.NO.: 7024C (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.:888-722-9282 Address: 22 Briarwood Drive, Westford, MA 01886 Alt.Tel.No.: .......... *Per M.G.L.c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. SS-001696 ............. 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 F]owner E] owner's agen . Owner/Agent Signature Telephone No. PERMIT FEE: $ 6e) vy)i . The Corninonwealth of Massachusetts Print Form Department of Industrial Accidents E q� Office of Investigations I Congress,Street, Suite 100 ii, o Boston, MA 02114-2017 4: www.mass.gov/dca Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ApRlicant nfor ation Please Print I�e�ily Name (Business/Organization/Individual): Nightwatch Protection,Inc. Address: 50 A Northwestern Dr. Suite 9 City/State/Zip: Salem, NH 03079 Phone #: 888-722-9282 Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 13 4. ® I am a general contractor and I employees (full and/or part-time).14 have hired the sub-contractors 6. ® New construction 2.® I am a sole proprietor or partner- listed on the attached sheet. 7. ® Remodeling ship and have no employees These sub-contractors have g, ® Demolition working for me in any capacity. employees and have workers' insurance.l 9. � Building addition [No workers' comp. insurance comp. required.] 5. ® We are a corporation and its 10.® Electrical repairs or additions officers have exercised their 11. Plumbin 3.® I am a homeowner doing all work ® g repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no SS st-L Voltage employees. [No workers' 13.� Otherec. y ow 9 comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Hartford Insurance Co.of the Midwest Policy#or Self-ins. Lic. #: 76 WEG EV7027 Expiration Date:12/10/2013 p Job Site Address: G-1Ye(1110 oU Q C f City/State/Zip: MA Wwdy 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties o erju that the information provided above is true and correct: Si nature: Date: 1 Phone#• Official use only. Do not write in this area, to be completed by city or town official. City or'Town: Permit/License# Issuing Authority(circle one): 1. Board of health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Please visit our web site at http://www.ma$S.gov/dpi/boards/EL NIGHTWATCH PROTECTION INC PAUL J DELSIGNOR (FA) _ 22 BR I ARWOOD DRIVE , t t,tr t Night watch DEALIER Protection, Inc. WESTFORD MA.oi886-1165 50A Northwestern Dr.,Suite 9 Salem, NH 03079 15 Holly St., Suite 208 Kevin Gilligan Scarborough,ME 04074 Preslder)t toll free(886)722-9282 x121 kg C nightwatchprotection.com www.nightwatchprotection.com '(^ Coll)monwealth of rInssachusetts ��. Department of Public Safety l.�cc�nse ��-F3016�f PAUL I3ELSIGNOR 22 BRIAE8i OOD DR Westford MA 01886 9 Expiratron Conunissloner 01/26/2014 Fold,'T'hen Detach Along All Perforations �ahfl atQJl?[ °�: i�g��ri �,-}`1t��ti'1.•'� I lfj='�t��}I��l`:-' BcaARj6 or E L t>CTR I C I ANS ISSUES THE FOLLOWING LICENSE AS A REGISTERED SYSTEM CONTRACTOR � NIGHTWATCH PROTECTION INC PAUL J DELS I GNOR 22 BR I ARWOOD DRIVE v ! LSTF ORD FAA 0 1 886-1 165 7024 C 07/31/16 50372 fl 4 fl 7_ 1;