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HomeMy WebLinkAboutWiring Permit - Permits #12160 - 50 JOHNNY CAKE STREET 2/12/2014 Date......s .� . �. a......................... f rWRTh °p.�•'o .,;!a TOWN OF NORTH ANDOVER ►- r PERMIT FOR WIRING 88ACHUa� This certifies that %� } Q f 9 has permission to perform . . r ... .. . e I �� ....... ....... ......... ..E..,, ,....................................:.. wiring in the building of at North Andover,Mass. ...... 4 .. .......... .., . a Lic.No. ........... . .. . .. ................ Fee, x �. �� LECTRICAL INSP Check# `,'s 2 C' elmmonwealU of MaMac4aaeth Official Use Only 2 cc�� cc77 7'I�0 epartment of ire Serviced Permit No. � Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (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: 211111 y City or Town-of. _rile'-nf To the In pec of r of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) y e,4,e6 T Owner or Tenant �/ /n 4,V Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes © No ❑ (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: ,; Corn letion o the olloivin table may be ivaivedby the Inspectorof Wires. Trans No.of Recessed Luminaires /2— No.of Ceil:Susp.(Paddle)Fans Total Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- IN-El o Emergency Lighting rnd. rnd. Butte Units No.of Receptacle Outlets /0 No.of Oil Burners FIRE ALARMS No.of Zones of No.of Switches No.of Gas Burners No. Initiating D and itiatin Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g l� 1 3t Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p __..._.._................................. 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 No.of No.of Data Wiring: Heaters KW 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. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 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 on this application is true and complete. FIRM NAME: DAi( I R i^ Lit c;T C/A I_ C0/-J A ' I-LC-- LIC.NO.: Licensee: D A\l t D 14466 4P, Signature LIC.NO.: 0- (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.:9*7 F3 Address: 7 i3�L In G N.r 15► NOR 1M 41,42t i!rr' 111 Alt.Tel.No. �("1 i7 "'.31 "5 7��(�i' *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. i OWNER'S INSURANCE WAIVE, 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: $ i =4U Me Comm itwealth offMassaehasetts Print Form -Bastnn.lf 4 ¢2flTT W'Or""CompaLm 'I bm=ce AJHdavift Buff n[COBftactorsfflec tritms/Plumbers Aunlickhiformagoi Please PrimIga'biv Name(BusinesstOrgani2Biioallndividuai)_ DAVID ELECTRICAL CONTRACTING LLC _ ^� Address_ 87 BELMONT ST NORTH ANDOVE R.Lik 01845 Phtme g- 978-682-6262 smi LQ-Tama� 7 4. rlTarnagene£alcoMat� Type�of p 3ed(ram = =dkorgmiC�e}-1 S n New construction 20 iamasole Fewrorpariner- Emdontbe 7 []R.emodelm; sbipanJd haw nD O glayeess These sub-contmctors have �►�g�-rueast any emFloyvm and have wo&ere Demolition [Noundwe camp- t mg_itt nce} 9 Bu3Tcl gadcl'�tirm rcqdre&l 5-1-1 We area cmparation aril its 10-0 Electrical regain oraddWons a-Fj I am abomeownerdoingall work. II-Ej plumbin.-repairs ora wwrts my'eltDWo vadme saw A&of onperMW- 3 i mquire&j c-157,§1(41�t have no employees-Wo W"keze -3_0 Other comp ms 'erg-1 y�-M�t� ��mustatsnflitauttheseeimbelow gthek - �wfeosa tthisaWfflXY tia tlmyaredou_aaif aad1hen antside �Caat�aemsatc�ekHnshmcmestanade§tiona2sha'ts�cs�gd�n�afthe �� mitauraSniavitogsen OmAtaYees g �te�Pi°YiS' Fsovidet6eir aiuista� h�ktrorrmt> rntihsse �P'-Po��Yisumbea� tmnara�yerifsatts�rn�g�or_ke�s' �mzias�rrm..-a��.��PaYye� �e��zs#Ire mfor62r. �1a rmtlaiisrte Insurance Company-Name: THE HARTFORD Policy#or Self-ins.€ic.#: 08 WEG C48293 ExpirationMARCH 1 201 Date: Job Site Address: j'-0 J2j�,q v -Attach a Copy of the worker eoae iioa ci€yistate/2ip' Fatlure to pe' pc►ley deet-ara€iou;rage{showing the policy namber anal ex .rafion da€e}. semen resverage as required under Section 25A of MO,c.152 can lead-to the fine Up to SL,500 00 andlor one-year i�'�me�as well as civil imposition of critEt penalties a:a of up to 5250{!t1 a penalties is the farm ofa STOP�ORg ORDER and$fine dly against violator_Be advised that acopy of this stafemextt may he forwarded to The Office of esogat ous oftl to DIA for insutauce coeetaage verVication. Idrs,�ehW -#ke f�fhe- - ��sfx rl&bwwis&zeand awrnt ftmavt Cky orTonm: ��Au#hma"€y�c�cle oue� ]L Board aaHeaifh 2-#,, D Citylyuwn QOfitereri� f�b3vec -'I �pr r 1 phone& s }_COMMONWEALTH OF M, ASS,ACHUSETTS BOA D`O E�1: 1 Cl ANS ISSUES FOLLOWING. .LICENSE AS, A RE"G JOURNEYMAN ELEC,TRICI'AN �Z OENNIS B BOMBARD- 60 CORA]„.-ST 3J 94VERM LL MA 01830 2108 13082 8 ..:. . 07/31/16. 39151