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HomeMy WebLinkAboutWire Permit - Permits #11480 - 75 CHESTNUT STREET 3/28/2013 �... \;' �\ \ u l e , `~� Ell` \\ we Date ......... .........TOWN OF NORTH ANDOVER Alml 110, BE 10 Im \ _ \\ WIRING° _ - �•s s I \ ~ oQ T'•` \ : o \ is certifies that 1. vy ll ... ................................... \\ \' has Permission t0 perforrf, A-- �\ ...... ... .:.. E z wiring in the buildi of tIBM \ .. ME V� ......................................... b: - ; .�,... ...,t No And©v s.Fee o IN I tic. No tw I SIX" INsrs Rheck# Al Ng a g \ \l Commonwealth of Massachusetts Official Use Only l Department of Fire Services Permit No. ow Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev- 11071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code QNIEQ,527 CMR 12.00 (PLEASE PPaWTININK 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)—I V U� St- OwnerorTenant LA Lau'i'l n�16-1 (, LAI Telephone No. ID .,-2, Owner's Address +1" 11A 4'±ja Qt ue,r i o4ti Is this permit in conjunction with a building permit? Yes ❑ No F] (Check Appropriate]Box) Purpose of Building Utility Authorization No. Fxisting Service Amps Volts Overhead F] Undgrd[1 No.of Meters New Services ervic Amps Volts Overhead F] Undgrd F] No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the followin 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 Luminalre Outlets No.of Hot Tubs Generators KVA No.of Luminaires Above Ei In- W-0:-OTEmer ency Lighting Swimming Pool grnd. grnd. El Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo. of Zones No.of Detection and No. of Switches No.of Gas Burners Initiating Devices 73- Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices Heat Pump Number I Tons I KW No.of Self-Contained No. of Waste Disposers Totals: I——.....................*1........................I....................... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal E] n Other 15111 Connection No.of Dryers Heating Appliances KW Security Systems:' No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Si-f4us Ballasts No.of Devices or Equivalent T-elec-( aunicatiolis Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No._2f Devices or Eguivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Rres. 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. CHECK ONE: wsuRANcE E] BOND El OTHER 0 (Specify:) -1 certify, tinder the pains and penalties of perjury,that the in rnuit1,,,.-9nth1sa complete. .fo application is true and com e e FIRM NAME; LIC.NO.: Licensee: Signature LIC.NO. 9� 646 WE MP bus.Tel.No.exe in (If applicable,ente t— the license number line.) Address: el Alt.Tel.No.?��� Per M.G.L c, 147,s.57-61,security work reqiWDopartmerit 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)0 owner El owner's agent, Signature Telephone No.__--I PERMIT p The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): .5-- 1 . Address L�� City/State/Zip: Phone#: e Are you an employer?Check the appropriate box: Type of project(required): . 1.❑ I am a employer with _ 4. ❑ I am a general contractor and I employees(fulI and/or part-time).* have hired the sub-contractors 6. El New construction 2. am a sole proprietor or partner- listed on the attached sheet. 1 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, workers' comp. insurance. 9. Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.[]Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f 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 their workers'comp,policy information. I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #:_ Expiration Date: Job Site Address: City/State/Zip:_____ At'tachppy of thle'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 insurance coverage verification. l do hereby certi y u der the s andpenalties ofperjury that the information provided above is true and correct. Si nature: Date: 11-3 Phone#: 6 ,y5— 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.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: phone#: , ~ o To Whom |t May Concern, ~ ~ Due toa difference of opinions,Joe Gnassis will not bedoing the finish electrical work on our house ot 75 Chestnut St. in North Andover MA. Sincerely, Ed8'Tina Collins -07-2122:43 DBD 9786885505>> P 1/1 Joseph M Grassis 19 North Street Andover MA 01810 9786976955 July 19, 2013 Dear Mr Murphy, This letter is to inform you that I am removing my electrical permit for 75 Chestnut Street home of Edward and Tina Collins. Mr. Collins has continued to do electrical work while I was not there. I no longer feel comfortable using my license for this job. If you have any questions please do not hesitate to contact me at the location listed above. Yours truly, Joseph Grassis ` �ICTRI IANS . .�G JQURNEY'{t1iAN EL ECTRlCIAi SE M EP If 14 GRSt [ T°H ST 171 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 penuit application has been accepted by an Inspector of Wires appointed pursuant to M.G1 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. 1:1 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. 11 Rule 8—Permit/Date Closed: Note:Reapply for new permit 0 0 Permit Extension Act—Permit/Date Closed: Trench Inspection Pass Failed Q Re-Inspection Required Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed Re-Inspection Required 0 Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required 0 Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass X Failed Re-Inspection Required D Inspectors Comments: A Inspectors Signature: C�U gz J1 Date: FINAL INSPECTION: Pass[M Failed Re-Inspection Required El Inspectors Comments: 7- )?J , Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC, MA. .......dweinhold@townofmerrimac.com