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Home My WebLink AboutWiring Permit - Permits #13190-1 - 95 LYONS WAY 3/16/2016 Date. `.. .�� ............. OF NORTh��. a;� $ TOWN OF NORTH ANDOVER . a PERMIT FOR WIRING CHU This certifies that ............ ,d ........ has permission to perform ..,�. t 7' F ... wiringin the buildi g of........ ............................................................................... k at ....... �...... X� ..............................North Andover,Mass. ........ ....... . Fee-9, ..........Lic.No. s�.� . ................................................................................... ELECTRICAL INSPECTOR Check# � _ Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Chocked BOARD OF FIRE PREVENTION REGULATIONS [Rev. i/o7j (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code ,5 7 R 1 12.00 ,� 7 �, (PLE-48EPRflVTbVJN1C OR TYPE ALL)WFORWTION) Date: rly, City or Town oh NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of h* or her mitentio to perform the electrical work described below. r 1/1 74 Location(Street&Number)- I'D 7-V0,4s Owner or Tenant e%Xlte Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes 91, No F1 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service_ Amps Volts Overhead D Undgrd[j No.of Meters New Service Amps Volts Overhead n UndgrdF] No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: oi dy rive.- od Completion ofth e fo table10 wing (4ina'jy;be waived by the Inspector of Wires. No.of Recessed Luminaires No,of cil.-Susp.(Paddle)Fans I No.of Total Transformers le-VA No.of Luminaire Outlets No.of Hot Tubs Generators KVA F]Above In No.o mergency ig ting No.of Luminaires Z/—Swimming Pool grrid. ❑ Lyr-nd. Batter Units No.of Receptacle�Outlets FIRENo.of Oil Burners I ALARMS JNo. of Zones of Detection and No.of Switches No. of Gas Burners No. Initiating Devices Tot No. of Ranges No.of Air Cond. Tonsal No.of Alerting Devices No. of Waste Dis HeatPump I Number �Icw— o.of Self-Contained p osers Totals: Detection/Al'erting Devices F71 Connection n Other No.of Dishwashers Space/Area Heating KW Leal❑1—:1 Municipal Heating Appliances KW Security Systems,* No. of Dryers No.of Devices or Equivalent.._ No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts . No.of Devices or Eguivalent 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 Elect ical Work: (When required by municipal policy.) Work-to Start: Inspections to be requested in accordance with MEC Rule 10,and-upon completion. permit for the performance of electrical work may issue unless INSURANCE C�V i�, GE: Unless waived by the owner,no poi the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove ge is h force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND [I OTHER [I (Specify:) I certify, under theppains, ndp It' wfpeiltay,that the information on this application is true and complete. plete. FIRM NAME: . '.7"6e,cr ZLea" -Ir LIC,NO.: Licensee: Signature LTC.No.: ?V.',in lice se n 'n el I Bus.Tel.No. Address: Alt.Tel.No.: (fapplicable,enter "ex 211 L *Per M.G.Lc. 147,s.57-61,security work requires Department of dblic Safety"S"License: Lie.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)[j owner E] owner's agent. Owner/Agent ❑PERMIT r,EE: $ 771 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-tern 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 Inspection Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INS ECTION: Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: ar4tt `4- Date: FINAL INSPECTION: Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com r The Commonwealth ofMassgchusetts Department of. ndustrialflccidents -- d 1 Congress Street,Suite 100 Boston,AM 02114-2017 yy;ywt www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE TILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibl Name (Business/Organization/Individual): p . M Address: R ct �ff2 City/State/Zip: K Phone#: J &Z Are you an employer?Check the appropriate box; Type of project(xequired): 1.❑I am a employer with employees(full and/or part-time).* 7. New construction 2.1W I m a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition-- ensure that all contractors either have workers'compensation insurance or are sole 11. " lectrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance,$ 6.[J We are a corporation and its officers have exercised their right of exemption per MGL c, 14.Q Other 152,§1(4),and we have no,employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t homeowners who submif this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors 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,'tliey 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: Policy#or Self-ins,Lic.#: Expiration Date: F � Job Site Address: City/State/Zip: Attach a copy of the workers' Cmpensation poli declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORD ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer 'y nder the pains an nalties of per jur that the information provided abov is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area,to he completed by city or town official, City or Town:_ Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: : : COIUIMON�IIEALTH SETTS.. OF mASSACHU '$OARD OF I ,ECTRICIANS ISSUES THE :FOLLOWING L:NCENSE AS A`: REGISTERI"D MASTER LECTRIGLAN EDWARD T SWEET 87 BRUCE RD ' cwi VALTHAM h1A 02453-6964 t 6852 A 'o7/3J:/:16 . . 106790