HomeMy WebLinkAboutWiring Permit - Permits #12414-1 - 66 BRIGHTWOOD AVENUE 6/22/2015 Date...
.......... .........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
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This certifies that
has permission to perform.
wiring in the building of.......... ......
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...... ........]Xorthi"dover,Mass.
Fee............. ..............Li
.. ............
ELECTRICAL.INSPECTOR..................
Check#
Official Use Only
Commonwealth of Massachusetts
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Department of Fire Services Permit No. VZ �,-k
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev- 1/071 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 2a---- t
City or Town of: NORTH ANDOVER To the Inspector 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 A-r- &Y(V 4 ej - Telephone No.
Owner's Address UG 61',,rAl -,,(tig9d
Is this permit in'conjunction with a building permit? Yes GP No ❑ (Check Appropriate Box)
Put-pose of Building ke�. Utility Authorization No.
Existing Service 16"� 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:
�9 v4k- ?
I �,3 Completion of the following table may be waived by the Inspector 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
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners C:> FIRE ALARMS JNo, of Zones
No.of Switches I No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
HeatPump Number r,,..l Tons I KW No.of Self-Contained
No.of Waste Disposers Totals: I I—' ** " *[" ' * Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local El Munlc'PP' D Other
Connection
No. of Dryers Heating Appliances KW Security Systems:*
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 Total HP Telecommunications Wiring:
No.of Motors No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Ores.
Estimated Value of Electrical Work: r 0 C.",-43 (When required by municipal policy.)
Work to Start: ,- 1%5,- Inspections to be requested in accordance with hMC 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 1p BOND F] OTHER F1 (Specify:)
I certyy', under th epains and en alties ofp ejuiy,that at the information on this application is true and complete.
FIRM NAME: .bfb 14-MA-10 &C-4-f LIC.NO.: 2-117,ZA,
Licensee: 4114M Signatu LTC.NO.:
(Ifapplicable,enter "exempt"in the license number line) Bus.Tel.No.:
Address: 12 �2 Am� ,Kj,, 6jaAcyz Alt.Tel.No.:
*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)El owner D 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.
❑ 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 Inspection
Pass Failed n' Re-Inspection Required($.) ❑
Inspectors Comments:
Inspectors Signature: Date:
SERVICE INSPECTION:
Pass Failed Re-Inspection Required($.) ❑
Inspectors Comments: .
Inspectors Signature: Date:
PARTIAL ROUGH INSPECTION:
Pass M Failed 0 Re-Inspection Required($.) ❑
Inspectors Comments:
Inspectors Signa ure: Date:
ROUGH INSP CTION:
Pass 0 Failed 0 Re-Inspection Required($.) ❑
Inspectors Comments:
01
-
Inspectors Signature: Manvyz,/� Date: S
FINAL INSPECTION:
Pass Failed 0 Re-Inspection Required($.) ❑
Inspectors Comments:
Inspectors Signature: Date:
DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .•.....dweinhold@townofinerrimac.com