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Home My WebLink AboutWiring Permit - Correspondence - 202 GREAT POND ROAD 2/20/2013 a Date .....1 , p►ORTy TOWN.OF NORTH ANDOVER ® PERMIT FOR WIRING �988ACHOW V 9 + a � Fa � This certifies that - r........., �' �...� r..tom: .... .r.. ...:n. has permission to perform ........................................ 9� ................................................ wiring in the building of......... a i � t � , l ^� ,North Andover,Mass. at @ Fee. Lic.No. :' . t .... ELECTRICAL INSP9CF0R p Check 9 Commonwealth of Massachusetts Official UseOnly Department ®f Fire Services Permit No. 1� t Occupancy and Fee Checked �M BOARD OF FIRE PREVENTION REGULATIONS [Rev.l/07] (leave blank 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 PRINT ININK OR TYPE ALL INFORMATION) Date: �—2Z, • \__Zz, City or Town oh 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) Zo2 lj,-��¢- Pub Owner or Tenant ^ C,4. � e\\� `re- Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No Q (Check Appropriate Box) Purpose of Building Utility Authorization No. - 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: e �l ^i,,o kc,) 5J,t,,,2, (.A, C-1 w•< — Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No,of Cell: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 No, of Zones No.of Switches No.of Gas Burgers into.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. Tons Tot No.of Alerting Devices No,of Waste Dis osers Heat Pump Number Tons KW No.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other p g Connection No.of Dryers Heating Appliances KW Security Systems:* Y No,of Devices or Equivalent No. of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent No.H dromassa e Bathtubs No.of Motors Total HP Telecommunications Wiring: y g 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: S-2�D-k 3 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 ofperjury,that the information on this application is true and complete. FIRM NAME: - (,��n c. CA �A c-y. III c LIC,NO.: I y'41- Licensee: �.c.�,e,,Z �f��lZ Signature LTC.NO.:_�/S'42� (If applicable,en "exem t"in the license nz�mb line.) Bus.Tel.No.:,G°3' ZS S-'14`tS' *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)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT 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 of2010 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 Ins ection Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass n Failed Re-Inspection Required($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 2 Failed(' Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: 'OUGH INS ION: Pass • Failed 0 Re-Inspection Required($.) ❑ I ispectors Comments: nspectors Signature: end f A — i� Date: �- NAL INSPECTION: pass M Failed Re-Inspection Required($.) ❑ spectors Comments: ispectors Signature: Date: WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts -" Department of Industrigl 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 Les=ibly Name(Business/Organiization4ndividual): A e,', .- Address: 777 City/State/Zip: Sp �., IJ y- Phone#: 3 - 4S 2. 1 5(,916 Are you an employer?Check the appropriate box: Type of project(required): 1.R I am a employer with 2v 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7 Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9• ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL ME]Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.❑Other comp.insurance required.] *An°jy applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i 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 checkthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie..#: ��L�{ Z 5 t^ Expiration Date: 7 — (S- l� job Site Address: �— G �*�— �"�`�— City/State/Zip: J J - 4✓✓&,,J - KA,4- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL 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 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 r z under fie pains andpenalties ofperjury that the information provided above is true and correct. - Si mature: Date: 5- 2J- Phone#• T C-903 p1 S-L t4 S-(,C,, 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other - Contact Person: Phone#: f COMMONWEALTH OF MASSACHUSETTS ELECTRICIANS IS' EREt MASTER ELECTRICIAN YS-UES THE ABOVE°U1GENSE TO_ i A.LPI# E ELECTRICAL. $ERV=I:CE .ILV m RIEHARD F DELV'ECCHIU 7 D, IELD ST ` SALEM Nth 030'7 137 b.. i GENERATOR APPLICATION DATE: 6-9-to4 d?-> LOCATION: OWNERS NAME: ,,�,.�,.� GENERATOR kw Zo NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: PHONE NUMBER: c>s ® CEECTRICAL GAS RESIDENTIAL COMMERCIAL TEMPORARY LOCATION OF GENERATOR: "'ZONING DISTRICT: CONSERVATION APPROVAL r NOTES 1. NORTH ARROW TAKEN FROM L.C.C. 33537 D. 2. BOOK/PAGE AND PLAN REFERENCES ARE FROM ESSEX (NORTH) REGISTRY OF DEEDS LOCATED IN LAWRENCE, MA. SB/DH I (FND) N/F V 19'23'43"W 112 FOX HILL ROAD 90.00, (TIE) REALTY TRUST L.C.BK.86/PG.293 N70'5339 T 194.99' C) `GATE CHIMNEY // cc) 32.7' 4 BAY WINDOW O � t j ;ry tv CONCRETE O N INGROUND O (A p POOL PRO OSED 21'X 14' LO �z o N 1 ST RY ADDITION (AREA-294f S.F.) t o : TINGEX/STING WOOD DECK & STEPS `" CHIMNEY TO BE R4ZE0) " 126.4' N + Y. GATE -+ q GATE c, p j F` o SHED I��''`T■�y � o�Oo GAZEBO TOWN OF NORTH ANDOVER ASSESSORS MAP 37C, LOT 24 AREA=35,067+ S.F. SB/DH (0.81±AC.) (FND) R=25.00'1 L=38.97' 110.30 S71'18 00 70.00' { CH=35. 14' 74 59 40'1N N64'02'37"W GREA T P R D (PUBLIC 1, VARIABLE WIDTH) t North Andover MIMAP May 20, 2013 I I i ,r ^r G.�/ � Y i� ��i./ r �yr1 � � �liL � w Tm"N�✓GLi7t1.iL19,L "/r�/'/l�` r 6� �� °il: �I : ��w�r,��rr,��m n �r� Glyd?�✓are I I, l � �� r / I��lir „r � Gr'. ii /� ✓//��V/I �j r�/ �� is ii/ 'i" �� did%%/Yl��/olr )i✓A�,�(/' �,�� s , ri �✓/ r// r� l/l / mm/ �r " e / r r . 1� 1 i r / r /r /�,r ✓ w�/i d/ -� r 4 / r„� � � f i i �'/��l/�i �/ % %1�� I v✓�i�4 1/ � e r%//i%1 i 9 i ii„I✓ /lY /G l� // r �ii Grp !i!/ � ��`r� 4illj ' ��%. �I� j�;; i�i��%(!/r%�//ri/lf 11W�,��r J//%�iGl/rlF/i��lr �� r��r/r/% /�/✓/ r �. i p�.� ym„i). /i /,<��%� � j ° ��r/rf'�✓� �j� i/// ir/✓� ��%ll .I /�i / fr i Pr✓ d r l r v r�%1i l/ r ^,pro' ,�✓ ,/l �lr/lm�,j='✓/ / r 9 yr/, % i/�i r »/✓i ,�pJ/��1�„- i r� �;�!/'//;qy/ i%I��i� �'L r" r�r�4"'� /r✓i��1��/� / � �r �, Intarslates Interstate —Major Roads Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Roads Meters Dala Sources:The data for this map was produced by Merrimack C o Easements 1 pOR TH q Valley Planning Commission(MVPC)using data provided by the Town of p t4r o .t. Nodh Andover.Additional data provided by the Executive Offs of :d MVPC Boundary rtr eyi °+y Op Environmanlat AffairslMassGIS.The information depicted on this map is Parcels for planning purposes only.II may not be adequate for legal boundary definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING 41 `� y THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT ...... `* Ir ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION �SSACHUs�i 1"=143ff W °