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Home My WebLink AboutWiring Permit - Permits #13009 - 54 LONG PASTURE ROAD 12/19/2014 Date.. ........... ...:V. .... ... °�NonrHq� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING j 88ACHUct 9� This certifies that ...... r ....... ...... , has pennission to perfonn .,' e ` -t c L , P . .. ......... ........... wiring in the building of :........................I............................ at • • •• t....... ...... : ......:. orth Andover,Mass. t ' CCRICAL INS CTO Check# t t he Commonwealth of Massachusetts O icy Vse Only j lDepartment of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 CK# p; sM Occupancy&Fee Checked Rev.11/99) (leave blank) APPLICATION F9R PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accord nce with the Massachusetts Electrical Code(MEC),527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) DATE December 19, 2014 City or Town of North Andover To the Inspector of Wires: By this applicationthe undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 54 Lon Pasture Road Owner or Tenant " evL4� BUILDING CONTRACTOR Hinckly Brothers Inc. Owner's Address CONTRACTORS ADDRESS PO Box 623 Tewksbury,Ma 01876 Is this permit in conjunction with a building permit Yes FX� No Building Permit no. Purpose of Building Residential Utility Authorization no, Existing Service 2 0 0 Amps 1201240 Volts single PHASE Overhead Undgrd x No.of Meters One Mast Service Syphone New Service Amps Volts PHASE Overhead Und rd No.of Meters p 9 Mast Service Syphone Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Install 20kw propane generator with 200amp ATS. Wire new screened porch with paddle fan and outlets. Completion of the foil owing table may be waived by the inspector of wires No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Transformers Total KVA No.of Lighting Outlets No.of Hot Tubs Generators Total KVA �1 No.of Lighting Fixtures Swimming Pool Above grnd In- No.of Emergency Lighting Battery Units No.of Receptacle Outlets No.of Oil Burners FHW FHA FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners FHW FHA No.of Detection and Initiating Devices. No.of Ranges No.of Air Conditioners Total No.of Alerting Devices. Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self Contained Detection/Alerting Totals: I I Devices. t No: Local Municipal of Dishwashers Space/Area Heating KW Connection Connection Other No.of Dryers KW Heating Appliances KW Security Systems: No.of Devices or Equivalent No:of Water KW No.of Signs No.of Data Wiring: Heaters Ballast's No.of Devices or Equivalent _ No.Hydro Massage Tubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equvalent OTHER: V 6 rig �" Attach additional detail if desired,or as required by the Inspector of wires. 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 FX-J BOND OTHER (Specify:) (Expiration Date) Estimated Value of Electrical Work $ (When required by municipal policy.) Work to Start: December 19, 2014 Inspection to be requested in accordance with MEC Rule 10, and upon completion. 1 certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME Leonard Electric, Inc a/� "� LIC.NO. A10638 Licensee Signature,,"' " LIC.NO. Address 154 Fletcher Street, Lowell, Ma. 01854 Bus.Tel.No. (978) 937-8620 Alt.Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the licensee DOES NOT HAVE the insurance coverage or its substantial equivalent as required by Massachusetts General Laws,and that my signature on this permit application waives this requirement. Owner Agent (please check one) Telephone No. PERMIT FEE$ (Signature of Owner or Agent) J�i�,c� � o� IZ- 30_ � �Ea� GENERATOR APPLICATION DATE: LOCATION: OWNERS NAME: GENERATOR kw , NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: PHONE NUMBER: ELECTRICAL GAS RESIDENTIAL COMMERCIAL TEMPORARY LOCATION OF GENERATOR: *ZONING DISTRICT: mPLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL The Commonwealth of Massachusetts .. . Print Form Department oflndustrialAccidents Office of Investigations ' 1 Congress Street, Suite 100 -+ Boston, MA 0211 d-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibiy Name(Business/Organization/Individual): Leonard Electric,Inc. Address: 154 Fletcher Street City/State/Zip: Lowell , MA 01854 Phone#: 978 937 8620 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 20 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 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. FJ Demolition working for me in any capacity. employees and have workers' 9. ❑.Building addition [No workers' comp. insurance comp.insurance.$ required.] 5. We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12T� 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#1 must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Hartford Fire Insurance Co. Policy#or Self-ins.Lic.#:02WECCQ8383 Expiration Date: 6/30/2015 ,r Job Site Address: r �:., ;�`. ^ < " City/State/Zip: ?- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 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 coveraver'fication. I do hereby cerli er the pqms andpeg4ides,ofperjury that the information provided above is true and correct Signature, Date: Phone# 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 Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Cantnet Pprcnn! Phone#: COMMONWEALTH OF M4 -MUSETTS BOAtio OF ELECTRICIANS ISSUES THE FOLLOWING LLCENSE REG 15TERED MAST. ,ELECTRICIAN LEONARD ELECTRIC' I NC RUSSELL C LEONARD iW 154 FLETCFIER STREET W ,U LOWE L L MA 01854 4137 10638 a. . .. 07/31/ 6 27410