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Home My WebLink AboutWiring Permit - Permits #13035-1 - 9 COBBLESTONE CIRCLE 1/15/2016 Date............................................. TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING N. Hut$ This certifies that ........... ' /......... ...... ......................................................... has permission to perforin ........... ............... .................................*............... wiring in the building,of........ ................... ................. ................ at ............. . ..........?.,North Andover,Mass. 9............. .......... ............. ...... Fee...... .................Lic. No. ................. ... ..................... ................................... ELECTRICAL INSPECTOR Check# d Commonwealth of Massachusetts Official Use,Only Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank) 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 MFORMA TION) Date: City or Town of: NORTH ANDOVL'R To the Inspector of Wires: By this application the-undersigned loves notice of his or her intention to perform the electrical work described below. Location(Street&Number)_,5 Owner or Tenant AA�rjra,e4 Telephone No. Owner's Address I Is this permit in'conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building - vzk: i d4m Existing Service_ Amps volts Overhead n UndgrdF] No.of Meters New Service Amps Volts Overhead n UndgrdEl No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: `ate d�, 4C 1,A) Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires :> No.of Ceil.-Susp.(Paddle)Fans No.o Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above D In- No.of Emergency Lig ting grnd. grnd. El Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No. of Zones No.of Switches No.of Detection and 9 No.of Gas Burners De vices evices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons Heat Pump j,Nty.i)nR er I Tons I KW No.of Self-Contained No.of Waste Disposers Totals: ' ...........I............ .......... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑El Municipal r] Other Connection uroity S ystems:* No. of Dryers Heating Appliances KW SecN .of Devices or Equivalent No. of Water KW No.of No. of Data Wiring: Heaters Signs Ballasts . No.of Devices or Eguivalent Wirin : No.Hydromassage Bathtubs No.of Motors Total TIP Telecommunications No.of Devices or Equivaglent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Wofll (When required by municipal policy.) Work to Start: T fs—pections 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. CHECK ONE: INSURANCE 121� BOND F1 OTHER D (Specify:) Icerfify, underme alns anal senallies ofpeijuiy,that the information on this application is true and coin,plete, LIC.NO.: -2!1Z3,+ FIRM NAME: ry"A-/' cd*,t - - "I I I (' ,,/ - > Licensee: Signature LTC.NO.:, Address: (Ifapplicable,enh* "cx`e'mpt"'zn the#tense number line) Bus Alt.Tel.No.: 1 ,4 '79 *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.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(chock one)[I owner D owner's agent. Owner/Agent PERMIT Signature Telephone No. 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 Chapter 240 ofthe 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 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass(] Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INS CTION: Pass M V Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: ''—'� Date: FINAL INSPECTION: Pass M Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of.Nlassaehusetts N : s Department of IndustrialAeeldents M w 1 Congress Street, Sr ite 100 N tl Boston,MA 02114 2017 ±~ �r www rnass.gov/dia ' Workers,Compensation Insurance Affidavit:Build.exs/Contractors/.GZectricianslk'lumbexs. TO BE FILED WITH TBE PERMITTh'TG AuTilORITY. Please Print Le 'bl A licant fufOrmadOuSV „Y Name(Business/OrganizationAndividual): Address: <= � .• " ...... ... city/state/zip: : Phone#, r Type of project(�equlred), t�reyoua employer2Cheektheapprroprlatebox' em to ees felt and/or part-time).' 7. ❑�]6*'constrd6 lon 1•� am a employer with l) y 1 am a sole proprietor or partnership and have no employees VVorking forme in 8. Q Remodeling any capacity.[Noworkers'comp.insurance required.] 9. ❑Demolition 3.[]I am a homeowner doing all work myself.[No workers'comp.nrsurance required.]t 10 F 1 Building addition 4 n I am a homeowner and will be hiring contractors to conduct all work on my property. I will —I 11 electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole l2�[ Plumbing repairs or addition 1.< proprietors with no e 6mployees. 5.�I am a general contractor and 11?aVe hired the sub-contractors listed on the attached sheet. 11[]Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 14 Other 6.QWe are a corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that check'bbic#1 rrirast also fill.out the section below showing their workers'compensation policy information. t Homeowners who sub his b' of staatt indicating ed n additional doing showing the n all worka,nd ame of theen hire a d st to wls must hether or t a now poottr those, nt ties,have such, tside contract tContractors that check „ , employees. If the sub-contractors have employees,they must provide their workers'camp.policy number. X am an employer that is pr'ovidiriguworlcers'compensation insurance for my employees. Below is the porky andyofi site Znsn information.rane an l�7 Comp yame: . G''�'� ,� .��., Expiration Date� .�) .. Policy#or Self ins.Lie.#: City/State/Zip: t e Address:Site Job Sit �"� ��" ° � .. .A, a copy of the workers' compezzsation policy declaration page(showing the policy number and expiration date). on punishable by a ffilb up to$1,500-00 Failure to secure coverage as required a sd zvi penalties in§he form of as STOP 25A is a criminal rWOzRI,ORDER and a fine of up to $2550.00 a and/or one-year imprisomnent,as well a p day against the violator.A copy Of this statement may be forwarded to the Office of ft vestigations of the DXA.for insurance X do hereby r�tz u n„m the pu.0.111" .f.lr J Yinformatione is true and correct. Y fY pro,. . coverage verification. . - an � ^, „u^� aloes o er�'ur tlzut the Date•provided above ..H r Si ature: Phone##: .0 Official use only. Do notivrite in this area,to he completed by city or town official. Permit/License City or Tovvn• Issuing Authority(circle one): i 2.Building Department 3.CRY/Tow I.Board of Health. n Clerk A.Electrical Inspector 5.Plumbing inspector 6.Other Phone# Contact Person: t Commonvyealrh ofA4a usetts DivisionbfRegistratior ,N Board of,Electn' "` RYAN'S R 1� 4LISAL � o NORTH R Master Elec� ja 21833-A 07/31/2016 e •p0932 License No, i^xpiratidn Date. . Serial No, i