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Home My WebLink AboutWiring Permit - Permits #13267-1 - 110 BROOKVIEW DRIVE 4/13/2016 2 Date... . �,. ............. .. r►ORT/{ TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING 8 CHUg� This certifies that �:.x� .....�� .. �.d. r. .. .............................................. ...... d has permission to perform ...,. ..,� ..e ...... �..�1 , 0............................ 6 wiring in the building of...... ...� ` a North Andover Mass. Fee.` Lic.No ....... .................................................................................... ........ ELECTRICAL INSPECTOR � Check# '-)27 ommonwealM. off'Va-macA-u-selb umciai use unry1ici T PermitNo. Occupancy and Fee Checked -- BOARD OF FIRE PREVENTION N RE 11LAT1C N [Rev. 1/07] 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 INFORMATION) Date: March 30, 2016 City or Town of: North Andover, MA_ To the Inspector of Wires: 3y this application the undersigned gives notice of his or her intention to perform the electrical work described below. vocation(Street&Number) 110 Brookview Dr 3wner or Tenant Angela Sweeney Telephone No. (617)755-8728 3wner's Address 110 Brookview Dr Is this permit in conjuncti with a building permit? Yes No (Check Appropriate Box) ?urpose of Building lyv_ Utility Authorization No. Existing Service Amps / Volts Overhead Undgrd No.of Meters yew Service Amps / Volts Overhead Undgrd No.of Meters V her of Feeders and Ampacity ation and Nature of Proposed Electrical Work: Installation of a low-voltage,wireless burglar alarm system. Completion of the following table may be waived by the Inspector of lire 1o.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans o.of Total Transformers KVA 1o.of Luminaire Outlets No.of Hot Tubs Generators KVA 1o.off Luminaires Swimming Pool Above In- No.of Emergency Lighting rnd. grnd. Battery Units 1o.of Receptacle Outlets No.of Oil Burners FIRE ALARMS o.of Zones 1o.of Switches No.of Gas Burners o.of Detection and Initiating Devices 1o.of Ranges No.of Air Cond. Total o.of Alerting Devices Tons g Jo.of Waste Disposers eat Pump umber ons No.of Self-Contained Totals: Detection/Alerting Devices 1o.of Dishwashers Space/Area Heating KW Local Municipal Other Connection 10.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent lo.of Water KW o.of No,of Data Wiring: Heaters Si s Ballasts No.of Devices or Equivalent 1o.Hydromassage Bathtubs No.of Motors Total HP elecommunications Wiring: _._._._ No.of Devices or Equivalent )THER: Attach additional detail if desired, or as required by the Inspector of Wire ;stimated Value of Electrical Work: $850.00 (When required by municipal policy.) Vork to Start: March 30,2016 Inspections to be requested in accordance with MEC Rule 10,and upon completion. NSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless -e licensee provides proof of liability insurance including "completed operation"coverage or its substantial equivalent. The ndersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. ,HEC,K ONE: INSURANCE'`" BOND ' ; OTHER (Specify:) certify,under the pains and penalties ofperjury,that the information on t is application is true and complete. 'IRM NAME:Defender SecurijX Company LIC.NO.:C 1355 ,icensee: 2 T7 Ve Tie-71 Signature "LIC.NO.:D 434 f applicable, enter "exempt"in the license number line.) Bus.Tel.No.:800-689-9554 kddress: 3750 Priority Way S Drive,Suite 200,Indianapolis,IN 46240 Alt.Tel.No.:866-502-3559 Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. SSCO-001258 )WNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally -quired by law. By my signature below,I hereby waive this requirement. I am the(check one) owner owner's age t. )wner/Agent Telephone ,ignature No. PERMIT FEE: $ r The Commonwealth of Massachusetts -l— _ Department of Industrial Accidents Office of Investigations i X ''!:� 600 Washington Street Boston,MA 02.1.11 wwrv.nrass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Al)nlicant Information Please Print Legiibl_ Name(Business/Organization/Individual): Defenders Inc. dba Protect Your Home Address:- 3750 Priority Way S Drive, Suite 200 city/state/zip: Indianapolis, IN 46240 Phone#: 317-810-4720 Are you an employer?Check the appropriate box- Type of project(required): 1.M I am a employer with 3 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 g. ❑Demolition workin for me in an capacity. employees and have workers' g Y F tY• 9. ❑Building addition [No workers'comp.insurance comp. insurance.l required.] 5. ❑ We are a corporation and its 10.W Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 l.❑Plumbing repairs or additions myself.[No workers' camp. right of exemption per MGL 12.❑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 till out the section below showing their wotkers'compensation policy information. t Homeowners who submit 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 whetter 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: NI J Insurance Policy#or Self ins.Lic.#: TCJ U B 1116 LO3015 Expiration Date: 07/01/2016 Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the poficy 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 coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is trite and correct. Sip—mature: Date: Phone 9: 66 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 Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: COMMONWEALTH OF MASSACHUSET S CONTROL# BQARD QF �" IMPORTANT ELECTRICIANS ISSUES THE FOLLOWING LICENSE AS, If your license is lost,damaged or destroyed;is inaccurate;or A .REG I ST€RED SYSTEM CONTRACTOR needs to be corrected,visit our web site at mass.gov/dpI for instructions to ensure the proper mailing of your Renewal z Application and any other correspondence. DEFENDER SECURITY CO / PROTECT Y ` ', �w This license is subject to Massachusetts General Laws and STEPHEN G EHRL,L CH regulations.Your license is a privilege,and cannot be lent or 3750 PRIORITY WAY SOUTH assigned to any person or entity under penalty of law.Keep this STE 20.0 ' -tom license on'your person or posted as required by law and/or c I� regulations. INDIANAPOLIS IP1 462Ao-3o1 - 1355 C 07/31/16 38220 I I COMMOIEWEALTH.0i MASSACt USETT i �_;.: CONTROL# �i t T .._ .'lt�tSal .. ...:.�,_Si �..ss_3c.! .. B9Aliti QF " IMPORTANT ELECTRICIANS � ISSUES THE FOLLOWING LICENSE AS If your license is lost,damaged or destroyed;is inaccurate;or A REGISTERED SYSTEhI TEGHPI I C I Ali Esc needs to be corrected,visit our web site at mass.gov/dpI for 3 .� instructions to ensure the proper mailing of your Renewal Application and any other correspondence. STEPHEN C EHRL I CH This license is subject to Massachusetts General Laws and �.. t , N regulations.Your license is a privilege,and cannot be lent or 369 CENTRAL STREET. ,W assigned to any person or entity under penalty of law.Keep this UNIT o license on your person or posted as required by law and/or c t. regulations. FOXBOROUG.H : MA 02035-2637 4340 07/3_1 1:6 45560 t r Employer: DEFENDER SECURITY COMPANY SSCO-001258 STEPHEN C EHRLICH 3750 PRIORITY WY S DR#200 INDIANAPOLIS IN 46240 1 2/0312 01 6 For DPS Licensing information visit: www.Mass.Gov/DPS NOTICE OF COMPLETION OF ELECTRICAL WORK Pursuant to M.G.L. c. 143, § 3L, Stephen Ehrlich hereby provides written notice to the inspector of wires that the electrical work outlined in the preceding permit application has been completed.