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HomeMy WebLinkAboutWiring Permit - Permits #12808 - 1900 TURNPIKE STREET BLDG K 10/8/2014 f t /11 Date............ ................... O� AORTH q� TOWN OF NORTH ANDOVER o PERMIT FOR WIRING 4 i •,s w gsACHUS� This certifies that .......r..................................°. ......... r, .................... ...............,. G has permission to perform ., wain in the building of k g g at ....`........A. ...... ............................`.......r ....... ...... .......North Andover,Mass. flee....... Lic. No ,,. . F f'� E-c RICALINSPECTOR Check# ���' Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 1V -W Occupancy and Fee Checked 04 BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07j (leaveblank �4 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 Q (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: 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) NO(.}{, A",\a,(r /Ao- Owner or Tenant t Bagib „ c cad- Telephone No. 3 o- Owner's Address #Uq 4,40,1(( M6 cco,m GIs this permit in conjunction with a building permit? Yes RA No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters I-R New Service U 0 Amps / �-`{b Volts Overhead❑ Undgrd)rL\7J AQ04eters- lNumber of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ( ,/„� iZ�( Ut Completion of the following table may be tivaived 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 No.of Luminaires Swimming Pool Above ❑ In- Elo.o mergency Lighting rnd. grnd. Batter 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 r - Initiating Devices No.of Ranges No.of Air Cond. Tons Tot No.of Alerting Devices No.of Waste Dis posers Heat Pump Number Tons J.KW No.of Self-Contained p Totals: I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local[IMunicipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* Devices or Equivalent No. of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications evices Equivalent._ " OTHER: -- Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of lectrical Work: ` �b D -W (When required by municipal policy.) Work to Start: l p Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO E: 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 co erage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) Icertify,under thepains and penalties ofperjnry,that the information on this application is t e andcomplete. FIRM NAME: . 0LOw, LIC.NO.: Licensee: bok`d Signature LIC,NO.: P,- (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.:, t'�� ) , Address: n 0 6 Alt.Tel.No.: Ct1� *Per M.G.L c. 147,S.57-61,security work requires epartment o ublic Safety"S"License: Lic.No. I 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. Owner/Agent PERMIT P'EE: $ 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-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 R—Permit/Date Closed: ***Note:Reapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 0 Failed M Re-Inspection Required($.) ❑ Inspectors Comments: 7177tM-C,44 elc /?-V_4 Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed 0 Re-Inspection Require ($.) ❑ Inspectors Comments: rog y Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re-Inspection Required ($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: ! Inspectors Signature: Date: FINAL INSPECTION: Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of'.Massachusetts Deparhuentof'XndustriglAceldd is 0,face of Investigations 600 Washington.,Sheet .Boston,.MA 02111 UV wwMmass govIdla Workexs' Compensafon.Insurance A dayff:Bufftiers/ContractorafElectxxczaos/PZiiinberq A.'p'pReant Wormation Please Prim;LeRA Na1be(BusinesslOxganizationgnd%vidual):. I S f q 1 ri 6 City'/State/Zip: �1,A *bf\ Phone#: Are your an employer?Check the appropriate box: Type of project(required): 1.C] I am a employer with 4. El I am a general contractor and I 6. El Now construction F employees(full and/or part tinge).* have nedthe sub-contractors 2.[] I am a sole proprietor or partner- listed on the attached sheet. `/• Remodeling ship and'haveno.employees These sub-contractors have 8. []DeanOlition woAdng forma in any capacity. workers'comp.insurance. 9, E]Building addition rKo,workers' comp.insurance 5. We are a corporation and.its 10.❑Electrical repairs or additions required.] officers have exerolsed.theix 3.El am a homeowner doing all work right of exemption per MOL 11.❑Plwnbingrepairs or additions myself.[No workers' comp. c.152,§1(4),and we have no 12, Roofrepaixs insuraracexequixed.]i employees.[No workers' 1'319 other-- ®o4L(u,,c, t/ P comp.insurance required,] "Any applicantthat checks box#1 must also fill outthe scction be16w showingtheir workers'compensation policy information. -Homeowners who submit this affidavitindicatingtheys'redoingallworXand then hire outside contractors must submit anew affidavit indicatingsuch. tContractors that cheAthis box must attached an additional sheet showing the name of the sub-contractors andtheir workers'comp.policy information. fain an employer that isproviding workers,compensation insurance for my employees Below is thepolley and job site information. Insurance Company Name: Policy#or Self ins. iL'ic.#: 13r?t" 0 I 04 10 ExpirationDate: ` 0 lob Site Address: � � ��(n�t�G � Pity/State,/Zip: fLd l f f AM u,e 4 M -• Attach a copy oltte workers'coanpensationlaol1cy declaration page(showing the policy number and expiration date). Failure to secure coverage as requI d under Section 25A.ofMGL c. 152 can lead to the imposition of eriminal penalties of a five 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. Be advised that a copy of this statementmay be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do Hereby cent urirler'tl pains andpenaftles ofperjury Mat file i ormation pr'ovidled above is true and eorrect, Sig nature: Date: D C Rhone#: - Official use only. Do r2ot write in this area,lobe completed by city or town official City or Town: Permit/License# Issuing A nthority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Pexs on: Rhone#: 0-f : .-011MMONWEALTH OF MASSA&bSETTS BOARp©P C ECl R I c ANS ; ; I IssU 7.THE' F01_LOY�'►,lG,'LICENSE sW ELECTRICIAN {h AS°; A REG IOURPdEYMAN a IZ MiCHA L A FARINA 23 H ORCHARD AVE � 1 NAVERHI�L ... MA 01830 438' 12g55 �> 07I 65600 31 f ,6