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Home My WebLink AboutWiring Permit - Permits #12404 - 97 LOST POND LANE 6/2/2014 A Date., - "a..:.. .s, .. ..�. .................. i "ORTN/ 3? •� ,:°ticoL TOWN OF NORTH ANDOVER o PERMIT FOR WIRING ,88ACHU5� s certifies that ? t :. ... �- r�x This �� E� -f��- 9 � . - � ... has ermission to perform �.: •• u ........... P a................................................. � wiring in the building of � ..... i� North Andover,Mass. �. €-b.. n , ' Feet. ::........ . Lic.No .. :... C i ELECTRICAL INSPECTOR t Check# --- j 1 , Com mon wealth ®f Massachusetts Official U e only Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (P Ciyor Town of. NORTH ANDOWR ) To the ln� e' ctorfLEASE PRINT ININK OR TYPE ALL INFORMATION Date: fi Wi es: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Z,,,q Tele honeNo.Owner or Tenant p Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No F1 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service— Amps Volts OverheadF] -LJndgrdF] No.of Meters New Service Amps Volts OverbeadF] UndgrdF] No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 1,j42 :z, Z'i-"/7 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 3 No.of Luminaires Swimming Pool Above Ei In- N—O.-O-TTinergency Lighting grnd. grnd. F] Battery Units No.of Receptacle Outlets /c-)z No.of Oil Burners FIRE ALARMS �No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cojid. Total No.of Alerting Devices Tons No. of Waste Dis posers Heat Pump ..........j.KW.1 o.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local El Municipal El Other Connection Security Systems:* No.of Dryers Heating Appliances KW No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts . No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eauivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. 'Estimated Value of Electrical Work: 3,S("'110, elo (When required by municipal policy.) Work to Start: % Inspections to be requested in accordance with WC 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 .1 Z7 BOND F1 OTHER El (Specify:) e'I certify, under the pams and 'haltles ofpejwy,that the information on this application is true and complete. FIRM NAME: -Z LTC.NO.: Licensee: '71/ Signature 7;7 LTC.NO.:e�� (If applicable,ent�r "exempt"in the license,numbe line) Bus.Tel.No.:, 41��2 111111`71 1�1� Address: 6'� I-L/1- Ze,p Alt.Tel,No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"8"Licellse. 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 P owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE.- $ 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. El The Permit Extension Act was created by Section 173 of Chanter 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 M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: . Inspectors Signature: Date: ' PARTIAL ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH ECTION: Pass ? Failed j Rde-In ection quired($.) ❑ Inspectors Comments: Inspectors Signature: Date: 'INAL INSPECTION: Pass M Failed Re-Inspection Required($.) ❑ nspectors Comments: Inspectors Signature: Date: :B WEINHOLD ... TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com I The Commonwealth of Massachusetts Depa huent of Industrigl Accide is ' Office o,f lu vestigations 600 Washington Street .Boston,MA 02111 -www.mass.gov/ciia Workexs' Compensation fnsuranceAffidavit:Buffders/ContractorsfE+lectxicxans/Pliimberg A.pplfcalnl-Information Please Print Leallb Name(Business/Organizatton&dividual): ✓ /, c r/ '/`' ' .Address: ' .. City/Stake/Zip: < „>cfr Phone Axe ou an employer?Check the appropriate box: Type of project(required): _1. 1 am a employer with 4. ❑ I am a general contractor and I 6. ❑New contraction employees (fall and/or part-tim.e).* have hiredthesub-contractors 2.(l I am a solo proprietor or partner listed on the attached sheet. 7. E]Remodeling ship aud'ltave no.employees These sub-contractors have S. C(Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Bull ft addition [No workers'comp.insurance 5. ❑ We are a corporation and its MCI Electrical repairs or additions required.] officers have exercised.their 3.El I am a homeowner doing all work right of exemption per MGL 11.E1 Plumbing repairs or additions myself.[No workers' camp. c.152,§1(4),andwehaveno 12.P.R.00frepairs insurance required.] employees.[Noworkexs' 1311 Other comp.insurance required.] *.Any applicantthat checks box#I mustalso fill outthe section below showingtheirworkers'compensationpollcy information. -Homeownerswho submitihis affidavit indicatingtheyR doing allworkandthenhireoutsidecontractorsmustsubmitanewaidavitindicatingsuch, xContractors that checkthis box must attached an additional sheet showkgthe name of the sub-contractors and theirworkers'comp.policy information. ~faman employer that ls•p�oviding workers'compensation insurancefo myempl'oyees Below isttiepolieyandlobsite information. Insurance Company Name:. Policy#or Selfin .Lic.#: e ...� Expiration Date. - �..� Job Site Address, Attach a copy oitbe workers'compensationpolicy declaration.page(showing the policy number and expiration date). Failure to secure covorago,as regM1 od.undor Section 25A ofMGL o. 152 can lead to the imposition,of criminal penalties of a Eno 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of- Investigations of the DIA.for insurance coverage verification. I do Hereby certffi Ui der tree pains and penalties ofperjury Mat the information provided alcove is true and correct, n / Sign attire.- t _ Dater Offaeial use ordy. Do not write in this area,to be completed ly city or town official; City or Town, Permit/License 0 Issuing.Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone ff: B04�1�aF EL.ECTRIGIANS ISSUES THE FOLLOWING LICENSE � AS A "REG JOURNEYMAN ELECTRICIAN in cc I -THOMAS ,J MARMIANI JR 37 JACKSON AVE G�WSETT S. ;1`SSUES TH E FOLLOWiNG' LICE�lSE A5 A 'I ROITERED MASTER ELECTRICIAN THOMAS: J MARM1 AN I J r , t 37 JACK50N AV MA 01960-2 3$ pAB€lfYt713t/?6' 3983 20057 . mm