The URL can be used to link to this page

Home My WebLink AboutWiring Permit - Correspondence - 5 HARWICH STREET 6/29/2015 Date. . aoRrH Of TOWN.,';�•�°o� TOWN OF NORTH ANDOVER F p PERMIT FOR WIRING l ,88ACHU n This certifies that ....... ..... ....... .............................................. has permission to perform wiring in the build' of.... ..........6, at ........ .........I............................... Nprth Andover,Mass. t o� a e� Fee...... .................Lic.No. .� ....... ... ,.... F ELECTRICAL INSPECTOR Check# �� ,�"� � c z .� Official Use Only ( o,�t.mont�reafi t. o a-jJa .uJa ry Permit No. l!'1 apaartmaad ol_7ire Sarvicei Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATION [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: June 11,2015 ____,.,___-_City or Town of: North Andover,MA_ 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) 5 Harwich St Owner or Tenant Zachary Oneil Telephone No. (978) 886-1448 Owner's Address 5 Harwich St Is this permit in conjunction with a building permit? Yes I No�.a -.(Check Appropriate Box) Purpose of Buildin t� a r;, (,�("i 6 ( ,,�,' Utility Authorization No. Existing Service Amps / Volts.__ _..___Overhead _._._-___,_Undgrd�....�_____,_No.of Meters New Service , .,._ Amps / —Volts-,,---_Overhead _.___-_Undgrd I I_ __ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: _Installation of a low-voltage, wireless burglar alarm system. Completion of the followirn table,inay be waived by the Inspector of Wires. o.of Recessed Luminaires No.of Ceil.-Susp. (Paddle)Fans o,of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- j o,of Luminaires Swimming Pool , o,of Emergency Lighting rnd. grnd. Battery Units o. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones o.of Switches No.of Gas Burners o.of Detection and .............. Initiating Devices o.of Ranges No.of Air Cond. Total o.of Alerting Devices Tons g o.of Waste Disposers Heat Pump Number Ons KW No.of Self-Contained Tot I' IT I Detection,/Alcrting Devices o.of Dishwashers S ace/Area Heating KW Local Municipal p g h..I Connection '� Other Security Systems:* o.of Dryers Heating Appliances__ KW No.ofDevicesorEquivalent No.Of Water KW o.of NO.of Data Wiring: Heaters Signs Ballasts No.Of Devices or Equivalent o.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: $850.00 (When required by municipal policy.) Work to Start: June 11, 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 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 the pains and penalties of perjury, that the information o� trs p `ati ,Iss true and complete. FIRM NA1VI +: Defender Securit Con n "f' ,?' LIC.NO.: C 1355 Licensee: % Signature LIC.NO.: D 434 (If applicable, enter"exempt"in the license number line.) . _.. . Bus.Tel.No.: 800-689-9554 Address: 3750 Priority Way S Drive, Suite 200,Indianapolis,IN 46240 1 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 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 Telephone PERMIT FE Signature No. � (� The Commonwealth of Massach uselts Department of IndustrialAccidents Office of Investigations 1 Congress Street, Sidle 100 Boston, AM 02114-2017 ivww.nzass.gov/dirt Workers' Compensation Insurance Affidavit: B uilders/Co nlractors[Elec tricia ns/P1 u nib e rs licant Information Picase Print Legibly le (Business/Orga-iization/tndividual): � Defender Security Company,. ress: 3750 Priority Way S Drive Suite 200 /State/Zip: Indianapolis, IN 46240 Phone 9:800-689-9554 ou an employer? Check the appropriate box: Type of project (required): I am a employer with 3 4. 0 1 am a general contractor and 1 6. E]New construction employees (full and/or part-time).' have hired the sub-contractors ' _ ' listed on the attached sheet. El Remodeling I am a sole proprietor or partner- 8 E] Demolition ship and have no employees These sub-contractors have employees and have workers.' working for me in any capacity. 9. EJ Building addition 4. comp. insurances [No workers' comp. insurance 5. 0 We are a corporation and its 10. Electrical repairs or additions I am a homcovmcr doing all v.,ork required.] Fz�officers have exercised their Plumbing repairs or additions right of exemption per MGL myself, [No workers' comp. c. 152, §1(4),and we have no 12,[]Roof repairs insurance required,] t employees. [No workers' 13,E] Other comp, insurance required.] . iplicant di3t checks box�I must also rill out the section below showing their workers compensation policy information. owners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ciors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have ces. If the sub-contractors have employees,they must provide their workers'comp.policy number. ' ?n employer drat is providing workers.'compensation insurance for my employees. Below is the policy and job site..lip nation. incc Company Name: MJ Insurance Inc 10 7 1?e+4 2—0 P o r S e I f-i n s L i c, Jr":T C 2 J u B 110 8 L 2 2 6 13 Expiration Datc: I J Y" i(e Address: citylstate/zip:.�� ,I, a copy of the workers' compensation policy declaration page(showing the policy number and`'expiration date). ,c to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties ol'a .p to S 1,500.00 and/or one-year impris6nmem, as well as civil penalties in the'form of a STOP WORK ORDER and a fine to 5250.00 a day against the violator. Be advised that a copy ofthis statem.prit may be forwarded to the Office OC doations of the DIA for insurance coverage verification. tereby certify under the pains altdp1c)nalties of perjury that the information provided above is true and correct. Date: V_C� . ...... 8665023559 Ticial rise only. Do it ot write in this area, to be completed by City or tO;V,, 0ffiCial' tv or Town! Permit[License uing Authority (circle one): Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5, Plumbing Inspector Other ontact Person: Phone �S Commonwealth of IAassachusetts j Department of Public Safety Securit}1clemc ti- Licence License: SSCO-001258 STEPHEN C EHRLICH 3750 PRIORITY WY S DR#206 ' INDIANAPOLIS IN 46240 Commissioner Expiration 12/03/2016 i .a,COMMONWEALTH.OF-MASS 6HOSET ..i.:. -- •-.80AAQOF .ELE.GTR ISSUES ,THE FOLLOWING L'tCENSE A °,R„EG'I'ST.EREO;SYST:EM TECHN I C I A STERHEN C EHRLICH 'N W 369 CENTRAL�* STRE.ET. ' '�•' ': ±� UN:I T_�9 <FOXBOROU.G.H .MA 02035-2637 434 °o' O'7/3<?./;:t6:. 45560 Plcase visit our web site at liLLp://�,A.Ad.niass .gov/dpl/boards/EL DEFENDER SECURITY CO / PROTECT Y STEPHEN C EHRL I CFI (FA) 3750 PRIORITY WAY SOUTH STE 200 INDIANAPOLIS IN 46240-3815 Fold,Then Oolarh Along All Perforations COMMONWEALTH OF MASSACHUSETTS S, i C3� DOARD OF ELECTRICIANS ISSUES THE FOLLOWING LICENSE AS A REGISTERED SYSTEM CONTRACTOR Q cc a DEFENDER SECURITY CO / PROTECT Y STEPHEN C EHRLICH w 3750 PRIORITY WAY SOUTH W S E 200 zi INDIANAPOLIS IN 46240-3815 1355 C 07/31/16 38220