The URL can be used to link to this page

Home My WebLink AboutWiring permit - Permits #12594 - 400 BEAR HILL ROAD 8/7/2014 I Date..... .. .. y e ....... .f. .. b TOWN OF NORTH ANDOVER PERMIT FOR WIRING gBACHUS� This certifies that ........ ... ....... ........................................ has permission to perform - b y ` 4'1 d �/., rlf.� ............ - wiring in the building of ..V ....... .......................................................... at .......a :..... rF`f`. :.......... , North Andover,Mass. Fee = Lie. No ��4 °' --3. .... ELECTRICAL INSPECTOR Q5 Check# ` k ( .aunonwealth of!//a,45acl etb Official Use Only Permit No. eL.JeParttrt¢nt o��ire�ervice3 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 INFORM4TION9 Date: Y16, f/- City or Town-of: Nop- To the Inspe'or•of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant c� ----- 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: 4 et `�rj D >k " r � 9t � t }tJsi d�#� S lJ vec �JS /. fit t ,4 s c L,r r ,P�di� i 3 sii" Com lesion o the ollowin table m be ivaived b the Ins ector o 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 No.of Luminaires Swimming Pool Above El In- o.o Emergency Lighting rnd grad. Battery Units No.of Receptacle Outlets 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 Cond. Total No.of Alertin Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: - - ---'-� Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal EJ Other Connection No.of Dryers Heating Appliances KW Security Systems:x No.of Devices or Equivalent No.of Water. KW No.of No.of Data Wiring: Heaters Si s 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 fhires. 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. CHECI{ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pants and penalties of perjury,that the information on this application is true and complete. FIRM NAME: D/\ I P L= Llr C:T tZ I CAI_ G 0 N 1 R/� 1. L LC: LIC.NO.: Licensee: Mt s7 14!}6(2/l n Signature LIC.NO.: 1 W y t✓ 3 (Ifapplicable,enter "exempt"in the license number line) Bus.Tel.No.•9 78 'b6•7.•o MI) Address: (i ► �L iYtGN 7- hT t�i t7 )IN O-4 to 114 LrI '�`3 Alt.Tel.No.:c 7 *Per M.G.L.c.147,s.57-61,security work requires Department of Public 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)❑owner ❑owner's agent. ent. Owner/Agent Signature Telephone No. PERMIT FEE. $ L, /SZ -L Gas�sJ� �slN1 ,! The Commonwealth of Massachusetts Department oflndustria[Accitlents Office of Investigations I Congress Street, Suite 100 Boston,IVA 02114-2017 a www.mass.gov/ilia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name:DAVID ELECTRICAL CONTRACTING LLC Address: 87 BELMONT ST City/State/Zip:NORTH ANDOVER, MA 01845 Phone#:978-682-6262 Are you an employer? Check the appropriate box: Business Type(required): 1.❑ I am a employer with 8 employees (full and/ 5. ❑Retail or part-time).* 6. ❑Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7_ Office and/or Sales(incl. real estate, auto, etc.) employees working for me in any capacity: [No workers' camp. insurance required] 8. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152, §1(4),and we have 10.❑Manufacturing no employees. [No workers' comp. insurance required]** 11.❑Health Care 4.0 We are a non-profit organization, staffed by volunteers, with no employees. [No workers' camp. insurance req.] 1200ther ELECTRICAL CONTACTING *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. I am an employer that is providing tvorlrers'eompensatioti insurance for my employees. Below is the policy information. Insurance Company Name: FEDERATED MUTUAL INSURANCE CO Insurer's Address: PO BOX328 City/State/Zip: OWATONNA, MN. 55060 Policy#or Self-ins. Lic. # 9353694 Expiration Date:MARCH 1, 2015 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 ins ance coverage verification. I do Hereby certify, under tl e p s an t Ities of perjury that the information provided above is true and correct. Signature: Date: J Phone#: t 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.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#• www.mass.gov/dia OORTH BUILDING PERMIT s��°y R4ao '6 TOWN OF NORTH AN OV APPLICATION FOR PLAN EXAMkINATION Permit NO: I Date Received Date Issued: SRCHlSs449 O*UR-TANT:Applicant must complete all items on this page LOCATION Q t .' � � PROPERTY OWNER ;9 ' '''MAP NO: PARCEL. C1 BONING DISTRICT, Histonc{ Istr�ct, , .. .. yes no ` Lachine Shop kfillaw =yes , n TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑ New Building- 00ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑Demolition ❑Other ❑.Septic o;UUlI Flondplain ' ❑Uetlapds ❑ tltershDr�ricf WaterlSewer_ n . c Identification Please Type or Print Clearly) 4 OWNER: Name: r f 1 1 } Address: f 1 r CONTRACTOR NarrBe Pl�or,e f' �_ � Address Supr�risor's C�r�struclon License: , : ` E at .. Home inm nt License: Ems, Da ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.SULDING PEPAIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST EASED ON$125 00 PER S F. Total Project Cost: FEE: $ Check No.: Receipt No.: MOTE: Persons contracting with unregistered contractors do not have access to tFi mark, �tgnature-cf Ag ntJUwner. Slgr�ature o c ntr tar Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 70,223.00 m $ - $ 842.68 Plumbing Fee $ 105.33 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 105.33 Total fees collected $ 1,153.35 400 Bear Hill Road 123-15 on 8/5/2014 Remodel 3 Bathrooms