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Home My WebLink AboutWiring Permit - Building Permit - 41 GARNET CIRCLE 1/8/2016 Date aORTM,h TOWN OF NORTH ANDOVER �� :'��•`:��' °°c [RING ,8814CHu9� i �- p ....................... i This certifies that .................... ( , erform ........... . has permission to p y ' ` t � ��:. A. ..... ................... ..... fa . _ the building o wrong in the E c North Ad over Mass. ........ [ at .............. , Lic.NO. ,,.... ELECCRICALI'SPECTOR Fee..e/:.. ....... ...... >' Check# Lam" urnciai use unry (fommonwaa& ol VaijewLieff,4 Permit No. rt/racz,�nacrrt,,( er bl'� oruiec�� ` Occupancy and Fee Checked �` ww 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),527 CMR 12.00 'PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: December 17, 2015 City or Town of: North Andover, MA_ To the Inspector of Wires: 3y this application the undersigned gives notice of his or her intention to perform the electrical work described below. :ocation(Street&Number) 41 Garnet Cir owner or Tenant Chandra Prakash Telephone No. f978)688-0228 owner's Address 41 Garnet Cir [s this permit in conjunction wit ha building permit? Yes No (Check Appropriate Box) ?urpose of Building,;t A t iK,, Utility Authorization No. Existing Service Amps / Volts Overhead[- Undgrd No.of Meters Vew Service Amps / Volts Overhead[-- Undgrd f _..No.of Meters number of Feeders and Ampacity :ocation and Nature of Proposed Electrical Work: Installation of a low-voltage,wireless burglar alarm system. Completion of the following table may be waived by the Inspector of Wire 1o.of Recessed Luminaires o.of Ceil:Susp.(Paddle)Fans o.of Total _# Transformers KVA Jo.of Luminaire Outlets No.of Hot Tubs Generators KVA 1o.of Luminaires Swimming Pool Above In- LJ o.of Emergency Lighting nd. grud. Battery Units 1o.of Receptacle Outlets No.of Oil Burners FIRE ALARMS o.of Zones 1o.of Switches o.of Gas Burners o.of Detection and Initiating Devices 1o.of Ranges No.of Air Cond. Total o.of Alerting Devices Tons 1o.of Waste Disposers eat Pump umber ons No.of Self-Contained Totals: IN Detection/Alerting Devices 1o.of Dishwashers Space/Area Heating KW Local Municipal `) Other Connection Securitysystems:* 1o.of Dryers HeatingAppliances KW No of Devices or Equivalent lo.of Water KW o.of No.of Data Wiring: Heaters I Signs Ballasts No.of Devices or Equivalent Ito.Hydromassage Bathtubs o.of Motors Total 10 IT elecommunications Wiring: No.of Devices or Equivalent )THER: Attach additional detail if desired, or as required by the Inspector of Wire ;stimated Value of Electrical Work: $850.00 (When required by municipal policy.) Vork to Start: December 17 2015 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 1e licensee provides proof of liability insurance including "completed operation"coverage or its substantial equivalent. The ndersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. ;HECK ONE: INSURANCE ✓� BOND OTHER t-J (Specify:) certify,under the pains and penalties ofperjury,that the informati r}on i application is true and complete. IRM NAME:Defender Securty Comnany LIC.NO.:C 1355 ,icensee: Signature _ _ — LIC.NO.:D 434 f applicable, enter "exempt"in the license number line) Bus.Tel.No.: 800-689-9554 ►ddress: 3750 Priority WU S Drive,Suite 200,Indianapolis,IN 462 Alt.Tel.No.: 866-502-3559 Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. SSCO-001258 )WNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally -quired by law. By my signature below,I hereby waive this requirement. I am the(check one)' owner __.i owner's agent. )wner/Agent Telephone -ignature No. ER 7 FEE: $ The Commonwealth of Massachusetts Department of Industrial Accidents MI Office of Investigations I Mr-_ ; 600 Washington Street Boston,MA 02111 www.mass.gov/dia _r Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Infolrimation Please Print Legitbly_ Name(Business/Organization/lndividual): Defenders Inc. dba Protect Your Home Address: 3750 Priority Way S Drive Suite 200 city/state/zip: Indianapolis, IN 46240 Phone#: 317-810-4720 Are you an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with 3 4. [] I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed an the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition animWi y A-erc° working for me in any capacity. j'1_,__ "._1. 9. U Building addition [No workers'comp.insurance comp. iusurance.I required.] 5. ❑ We are a corporation and its 10. j Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]fi c. 152, §1(4),and we have no employees.[No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their wotkers'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. #Contractors 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site - information. Insurance Company Name: NI J Insurance Policy#or Self-ins.Lie.#: TCJ U B 1116 LO3015 Expiration Date: : 07/01/2016 Job Site Address: I Gc,f� 1. i r City/State/Zip: I V WoiV I A4 1 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 a 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 verific001fi. I do hereby certify u de the pains and penaId f perjury that the information provided above is true and correct. 5i afore: ��'�� v Date: Phone#: oL6-5o2- 3�5q 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#: COMMONWEALTH OF MASSACHUSETTS CONTROL # a BOARD OF s IMPORTANT ELECTRICIANS I S S U E S THE FOLLOWING LICENSE Ads If your license is lost,damaged or destroyed;is inaccurate;or A :REG I'STERED SYSTEM CONTRACTOR r}, � needs to be corrected,visit our web site at mass.gov/dpl for instructions to ensure the proper mailing of your Renewal Application and any other correspondence. DEFENDER SECURITY CO / PROTECT Y �} STEPHEN G EHRLLCH >zW This license is subject to Massachusetts General Laws and s n regulations.Your license is a privilege,and cannot be lent or 3750 PRIORITY WAY SOUTH assigned to any person or entity under penalty of law.Keep this ' —"� license on'your person or posted as required by law and/or STE. 200 a...,_, I ND I ANAPO L I S I N 46240-3815 regulations. 1355 C 07/31/16 38220 , COMA` ONVVEAI_TH OF MASSACHUSETTS CONTROL# k_i `." ' J BOARD OF - IMPORTANT ELECTR I C'I ANS m; ISSUES THE FOLLOWING LICENSE If your license is lost,damaged or destroyed;is inaccurate;or A REG:I STERED SYSTEM TE CHN I C I0. needs to be corrected,visit our web site at mass.gov/dpl for instructions to ensure the proper mailing of your Renewal }� Application and any other correspondence. STEPHEN C EHRL I CHN This license is subject to Massachusetts General Laws and t �'N regulations.Your license is a privilege,and cannot be lent or 369 CENTRAL STREET ,z assigned to any person or entity under penalty of law.Keep this }_ lu U license on your person or posted as required by law and/or UNIT.9 } regulations. QnBOROUGH MA 02035-2637 434 ,D 07/31/16 45560 Employer: DEFENDER SECURITY COMPANY SSCO-001258 STEPHEN C EHRLICH 3750 PRIORITY NVY S DR 9200 INDIAINAPOLIS IN 46240 12/03/2016 For DPS Licensing information visit: www.Mass.Gov/DPS NOTICE OF COMPLETION OF ELECTRICAL WORK Pursuant to M.G.L. c. 143, § 3L, Stephen Ehrlich hereby provides written notice to the inspector of wires that the electrical work outlined in the preceding permit application has been completed.