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Home My WebLink AboutWiring Permit - Correspondence - 420 GREAT POND ROAD 2/17/2015 N Date .......:_ .. ........................ OF tAoRTpy�a o3? o�m TOWN OF NORTH ANDOVER p PERMIT FOR WIRING CHUg�4�� i Y This certifies that , F f..�:.w� ` "'... .....�. �.. .. _ ,..... t 3 has permission to perform £...... d wiring in the building of ..................... .....:; at ..... ........ ` ......... ..... E........,1N rth Andover,Mass Fee ... ............Lic.No �u ... q. �.,., �..;.... , .�.. ' I ELECTRICAL INSPECTOR i I Check# `3 i Print Form C.ImnWnwaX o f//taijacfzaaf Official Use Only cc��r� e(JePartment o�..tec//ire�arviced Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07,p- ] (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:2/6/15 City or Town of: North ANdover To the Inspector of Wires.- By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number)420 Great Pond Road Owner or Tenant Town of North Andover DPW Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Water Treatment Plant Utility Authorization No.NA Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install 1600A emergency feeder in WTP Install (2) Manual Transfer Switches and associated wiring in low lift plant Completion of the fiollowing table may be waived b 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 Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained ...................................... Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection t- No.of Dryers Heating Appliances Kam, Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: r 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. (T Estimated Value of Electrical Work: 78,720 (When required by municipal policy.) _�- Work to Start:2/16/15 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 ❑✓ BOND ❑ OTHER ❑ (Specify:) I certify,under thepains and penalties of perjury,that the information on this application is true and complete. FIRM NAME:Systems Electrical Services Inc. _ LIC.NO.:13646A Licensee: Nicholas D'Angelo Signature -- LIC.NO.:50754 (Ifapplicable,enter '.exempt"in the license number line) - - Bus.Tel.No.:617-466-0920 Address: 5 Wesley Street Chelsea, MA 02150 Alt.Tel.No.•617-799-4824 *Per M.G.L.c. 147,S.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: 1 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: $ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Systems Electrical Services, Inc. Address: 5 Wesley Street City/State/Zip: Chelsea, MA 02150 Phone#: (61 7) 466-0920 Are you an employer? Check the appropriate box: - Type of project(required): 1. XO I am'a employer with 10 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.n I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, U Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t 9 ❑Building addition required.] 5. We are a corporation and its 10.®Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LEI Plumbing 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 employees. [No workers' 13.❑ Other 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. #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: Travelers Tnsurance Company Policy#or Self-ins.Lic.#: XEUB 4 3 5 9 T 6 6 214 Expiration Date: 1 1 /2 4/2 01 5 Job Site Address: `7 O L' Y'en+_ POt_)� 1?_WJ City/State/Zip: MD Ar,doU2r VDA 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 caii lead to the imposition of criminal penalties of-a tine 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 certi ,uqdar thepains andpenalties ofperjury that the information provided above is true and correct. Signafore: —� Date: O Phone#: (61 7 ) 466— 920 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#: uommonwealzn Ot ikAassachusetts A D'O Department of Public Safety EL E CTii 1&1 ANS, ISSUES .THE:. FOLLOWING LI'CERISE AS License: HE-127670 .R.S.GIS.TERED MASTER: ELECTRICIA NICHOLAS IWANGELAL 387 PROSPECY_ PLAICE'10,06 SYSTEMS ELECTRICAL SERVICES I NC REVERE MA 62151, NICHOLAS WANIIELO 387 PROSPECT AVE: RE.VtRE Expiration: .MA 02151-3861 Cominissione., 12/19/2014 13646 A 0.7/3-111/16" 59282 mum r,-.f Co n5f rwc fion sa,f rv.50 r This card acknowledges that t r"OlEni is StMesSfUliY Completed a CS-104549 1 0-hour Occupational S 'to a ty And Healthftining Course n Cons tructl U On SO*and Health -.FLO NICHOLAS ,AN 9"C 387 PROSPECT & 1A UP-151 REVEREI J E,, n (T!Wner na ne—print or type) 1211 91M 5 (Courseend dots, STATE OF NEW,HAMPSHIRE COMM,Orlwealth of massachusetts BUREAU OF ELECiAIC NEW, &LICENSING AL L Department Of Public Safety NAMENCH OLAS DANGELO License: SS-001934 1.9233 M 2. NICHOLAS YANGELO 3, i weslev St Chelsea MA 022150 EXPIRES: 12/31/2014 92- COMMISSIr"(1pr Zxofratlon 08/15/2015 -CHUSETTS 2v CICENSE '14 ....Q.VER,S COMM, i ". 01.9 6888833 12.19-2014 12-19-1954 0 Wis 98T 04T M HP R7 14 DANGELO J87 PROSPECT AVE REVERE,MA l 10. Sim 32151.3867 I }gyp 0MIMON, EAL`H OF A �f 6�f(:HPJSETT 1 Mlssichusetts R�.I�n4d`f�� @�.e F7 j.L�dt +' ��>.� '�� . . Board of p ��Ar7� � arOU _ ELECTRICIANS ISSUES THE FOLLOWING LICENSE Lieens : CS-104447 AS A REG JOURNEYMAN ELECTRICIAN NICHOLAS ADA)VGELO 307A Ridge Rd. NICHOLAS A V ANGELO Y ;.`gig Revere MA 02151 307 RIDGE RD REVERE MA 02151-3880 Cominissione-F 10/21/2015 go 4 97/1/16 t 33 to N ?m vet�, 5 i 6'V Commonwealth of MaS aChuSeft STATE OF NEW HAMPSHIRE Class A Large Capacity ELECTRICIANS BOARD License to Garry Firearms(M.G.L.c.140,5131) i,cense Number Date of Issue: xpiratzon Date a 12286400A 04/26/2011 ., 10/2,1/2010 NAME: NICHOLAS A UANGELO Issuing U'V/Town REVERE ^{� Restrictions:Target 6 NuM+nF _^ 1248 J 9 AIN DANGELO,NICHOLjlij A 307A RIDGE RD REVERE,MA 02151 EXPIRES: 10/31/2016 1 Commonwealth of Massachusetts Department of Public Safety License HE-130902 NICHOLAS A DANGELO ` 307A Ridge Rd. Revere MA 02151 Expiration: Commissioner 10/21/2015