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Home My WebLink AboutWiring Permit - Correspondence - 11 HAMILTON ROAD 6/18/2013 Date........ �OpTH, TOWN OF NORTH AND OVER PERMIT FOR WIRING 9 88�cN�s � � ..; This certifies that ...... � �`-� .. :*, s has permission to perform .. �A �t `d� �y. a �g of....... as the b ' t wrong m t e ....... � Andover, at ..... f t �.. . J.. Lic.No. �� .... Fee � ............... EI.PC TRTCAL�ISPECTOR check# Commonwealth ®f Massachusetts official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked Q BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07j (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts EIectrical Code(NEC),527 CMR 12.00 (PLEASE.fA T IN.INK OR TYPE ALL INFORMATION) Date: City or Town.of: NORTH ANDOVER To the Inspector of Wines: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) �,.111 1��,r Z;C J41 V i, Owner or Tenant /J Telephone No. s 08"^3.? ' Owner's Address S5a r Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service )0& 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 / , i, �� - �y S"` (2 a-r17 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. grnd. -Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No, of Zones No.of Switches No. of Gas P,urners No.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No, of Waste Disposers HeatPump Number ITons IKW No.of Self-Contained ................................................ Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No,of Devices or Equivalent No. of Water KW No.of No.of Heaters Si ns - Ballasts Data Wiring: 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: (rj Q (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with N1EC 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 �S undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. j CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I cent fy, under the pains and penalties ofperjury,that the information on this application is true and cornplete. FIRM NAME: . LIC.NO.: Licensee: / *2i)h ell J � Signature - -- LTC.NO.: (If applicable,enter "exempt"in the license na�mber Zine.) $us.Tel.No. *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 PERMIT FEE: $ Signature Telephone No. ❑ 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 of 2010 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 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass Failed(]' Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: RO GII SP CTION: Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signatu Date: FINAL INSPECTION: Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD' ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com i Fold,Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETfiS BOARD ELECTRICIANS EL ASA'R,EG JOURNEYMAN ELECTRICIAN ISSUES THE ABOVE LICENSE TO: TYPE KENNETH A WELLMAN -E 34 CRESCENT STI APT "3 f SOMERVILLE MA 02145-4301 874929 316.87 E 07/31/13 874929 Fold,Then Detach Along All Perforations