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Home My WebLink AboutWiring Permit - Permits #13034 - 464 FOSTER STREET 12/13/2014 .A- ..................... 0* TOWN OF NORTKANDOVER PERMIT FOR WIRING U ............................................................ This certifies ...... .................. has permission to perform ........................ .............'U........................... wiringin the building of.....t,............................................ ..........-.............I.............................. at n North Andover,Mass. .................U- ....... ...... ........................ ........... CTRIC .. .... ........ Fee...... ................Lic.No. ELU AL INSPECTOR Check# Letter View Page I of I Official Use Only rr Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [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: November 04,2014 ----City or Town of: North Andover,MA_ To the Inspector of ires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 464 Foster St _ Owner or Tenant Phil Parker Telephone No. (978)686-6746 Owner's Address 464 Foster St Is this permit in conjunction 'th a b 'Id' permit?___Yes No 91 6 T! ml wl ----(Check Appropriate Box) Purpose of Buildin"'aa Utility Authorization No. Existing Service— Amps I Volts Overhead Undgrd ____No.of Meters New Service Amps Volts Overhead El........... ,,,,Undgrd —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 osll o f fillos,ing table inay be waived by the InsI)ector 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 O.of Luminaires Swimming Pool Above In- No.of Emergency Lighting grnd. grrid. —Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS o.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin.p.Devices No.of Ranges No.of Air Cond. TotalTons No.of Alerting Devices No.of Waste Disposers Heat Pump timber rolls 1KW No.of Self-Contained --Totals: IN Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local [�-1 Municipal Other -1 Connection No.of Dryers Heating Appliances KW Security Systems:* L1 No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts I_No.of Devices or Equivalent o.Hydromassage Bathtubs No.of Motors Total HP [relecommunications Wiring: No.of Devices or Equivalent IOTHER: Attach additional detail if desired,or as required by the Inspector of Wires. res. Estimated Value of Electrical Work: $850.00 (When required by municipal policy.) Work to Start: November 04,2014 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no pert-nit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 1A BOND OTHER (Specify:) I certify, under the pains and penalties of perjury,that the information oilY A-7 is true and his op ation complete. FIRM NAME:Defender Securit��_ompany 0>4� LIC.NO.:C 1355 Licensee: 4 JJe, bll!� Signaturq.:��J' LIC.NO.:D 434 (If applicable,enter"exempt"in the license number Bus.Tel.No.: 800-689-9554 Address: 3750 Priority Way S Drive,Suite 200,Indianapolis,IN 46240 Alt.Tel.No.: 866-502-3559 *Per M.G.L. c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic. No, SSCO-001258 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) owner L'I owner's agent. Owner/Agent Telephone Signature No. 1PERMIT FEE:$ 1,h https://www.citizenserve.com/Admin/WorkOrderDocuments?Action=ViewDocument&D... 12/17/2014 The Commonwealth ofAfassachttsetts Department of IndecstrialAccidents Office of Investigations 1 Congress Street, Suite 100 Boston, AM 02114-2017 tvlvw.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Con'tractors/Electricians/Plu nib ers Applicant Information Please Print Lgzibly Name (Business/Organization/individual)', Defender Security Company, Address: 3750 Priority Way S Drive Suite 200 City/State/Zip:Indianapolis, IN 46240 Phone#:800-689-9554 Are you an employer? Check the appropriate box: Type of project(required): I am a employer with 3 4. ❑ I am a general contractor and I 6. ❑New construction employees (Full and/or part-time),* have hired the sub-contractors !.ElI am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g; ❑ Demolition workingfor me in an capacity. employees and have workers' y p ry• 9, ❑ Building addition [No workers' comp. insurance comp. insurance,x required,] 5. ❑ We are a corporation and its 10.� Electrical repairs or additions ).❑ 1 am a homeowner doing all work officers have exercised their I IQ 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 K I must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Con:ractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have mployces. If the sub-contractors have employees,they must provide their workers'comp.policy number. am air employer that is providing workers'compensation insurance for my employees. Below is the policy and job site nfornration. nsurance Company Name: MJ Insurance Inc _ 'olicy r-or Self-ins, Lic.#:TC2JuB11OBL22613 _-Expiration Date:10/7/2#� 2-Ci t Ph' I ) City/State/Zip: ie 1 lob Site Address: � 1 r Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 9ne up to S 1,500.00 and/or one-year impris6nment, as well as civil penalties in the for of a STOP WORK ORDER and a fine )f up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of tnvestigations of the DIA for insurance coverage verification. 1 do hereby certify carder tee pains and penalties of perjury that the informatioie provided above isf true and correct. Si¢nature: K6 +��` Date: 1 Phone 8665023559 Official use only. Do nor write in this area,to be completed by city or town official. City or Town: Permit/License 4 Issuing Authority(circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone A:• i Commonwealth of Massachusetts Department of Public Safety j De I S-uvil\S.Stem, S-Ltccmc License: SSCO-001258 STEPHEN C EHRLICH 3750 PRIORITY WY SDR#20( INDIANAPOLIS IN 46240 Expiration: Commissioner 1 2/0 312 0 1 6 Please visit our web site at http://www.niass.gov/dpl/boards/EL DEFENDER SECURITY CO / PROTECT Y STEPHEN C EHRLICH (FA) 3750 PRIORITY WAY SOUTH STE 200 INDIANAPOLIS IN 462110-3815 Fold,Then Dolarh Alone All Perforations «. COMM_ONWEALTH OF MA.SSACHUSETTS , BOARD OF ELECTRICIANS ISSUES THE FOLLOWING LICENSE AS A REGISTERED SYSTEM CONTRACTOR 'w DEFENDER SECURITY CO / PROTECT Y ;N STEPHEN C EHRLI"CH 'a in 3750 PRIORITY WAY SOUTH Z STE 200 INDIANAPOLIS IN 46240-3815 1355 `P 07/31/.16. ,. 38220 I�rFJPa isli+�!PuL•.[ a Y. COMMONWEALTH.OF:,MA►SSACHUS�TTS; ® 8QMM.0 ELECTRICIANS; "ISSUES THE FOLLOWING UICENSE • Yd ., A REG I STEREO rS`(;STM TECHNI C i A ' STERHEN C EHRL 1`CHIn I: 369 CENTRAL 'STREET> j FOXBOROUGH :,MA 02035 2637 434..;�.. 07/31:/.�1.6<... `;; 45560 nrrr�srer,. 34JUMMIR