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Home My WebLink AboutWire Permit - Permits #12787 - 205 CAMPBELL ROAD 10/3/2014 } .._ 0 V� 8..... ate ....D ..... ... ...IN s- , M 001;T y OF NORTH ANDOVER J1701 TOWN NU . ON RING �� \\ ` \\ This certifies that �y . . ... `\ NON— IN has den `ssion t erfc O \\ wiri g i the building o REINEmW `\ O n - _ North Andover, ass. \\ .. o ` at .... . x �� -_ ::. r_.a. INK F ................. Lic. c , a.._...,. . . _ ..._....,. EL RucA.IN pECTOR gs- SEE I Emil ,\ \\ \ 01 IS \\ \ a T \ `\`\ Commonwealth of Massachusetts Official Use Only Permit No. 14� Af I Department of Fire Services 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(MEQ,527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date:O C I 3� J0 IV City or Town of.- NORTH ANDOVER To the Inspector oy Wires: By this application the undersigned givq notice of his oy her intention to perform the electrical work described below. Location(Street&Number) 90S NOWhe // rye) " Owner or Tenant ZOWOrtq LIVie' Telephone No. Owner's Address ME Is this permit in conjunction with a building permit? Yes F] No Fff (Check Appropriate Box) Purpose of Building ) 5 Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps Volts OverheadF] Undgrd [J No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: A-e(d belre- lvr- 74?A4�7 6,41ey.....Rec. 40 k"4 kr Ae"'r4r 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 K-VA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above Ei In- n IVE.—oTE—mergency Lig ting No.of Luminaires Swimming Pool grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS IN' o. of Zones of Detection and No.of Switches No.of Gas Burners No. Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat pump I N!j ..........J.KW No.of Self-Contained Totals: ........... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local Municipal n Other Connection it Devices of Dryers Heating Appliances KW Secur No.y 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 No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eq uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. 'Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with VMC 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 cov3rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE r BOND D OTHER E] (Specify:) I certify,under the pains andpenalties ofp rjul that the�, orniation on 7plication is true and comp lete. -4-Ae- FIRM NA :il 11t/t-e LIC.NO.: O iT-1;1-0 Licensee: I I't S kel- signature 6-111� p LTC.NO.:- (If applicable,ente "ex mipt"in the license nZ, er line.) Bus.Tel.No.--nl�j�-7 !k �000 AA .4 Address: Z A#i 6 ove Alt.Tel.No. 41 �0 P- 6- *Per M.G.1,c. 147, s.57-161,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(check one) owner [I owner'Lagent. Owner/Agent Signature Telephone No. PERMIT FEE: $ The commonwealth of Massachusetts - - Department of Xndi(striol Aceld'e is Of-ce of investigations 660 Washington Street .Boston,MA 02111 Uf -www:massgov1dia ' workexrs' Compensation Insurance.Affidavit:Buffders/Contractors/Elcc�r xexa�s!','lurxcbe�c� Ap icant Woar atxan Please Priwl x,e 'bz Name,(Businesslorgankatlonftdividu A � Address: _S bek . 0 City/State/Zip- i e^ 4 l.'llono#: 2 I` 6 �(_— _? Are au an employer?cheek the appropriate box: Type of project(required): 1. Z am a employer with_ 4• El I am a general contractor and 1 6 Q Now construction employees�full and/or parE time�* have hiredthe sub-contractors listed on the attached sheet.� 7. ❑Remodeling 2.E] I am.a sole proprietor or partner ship and`l:ave no employees These sub-contractors have 8. C[Demolition working forma in any capacity. workers' comp.insurance. 9. C]Building addition [No workers' comp.insurance 5, Q We are a corporaIion,and its M Electricalrepairs or additions required..] officers have oxercised.theix light of exemption per MGL 11.[,]Plumbing repairs or additions ri 3.El I am a homeowner doing all work g p p myself.['oworkers'comp. c. 152,§1(4),and we have no 12,Q Roofrepairs insurancerequired.]i employees.[No workers' 1311 Other comp.insurance required. x.Any applicantihat checks box4f must also fill outthe section below showingtheir workers'compensationpolioy information. t-Horneowners who submit Phis affidavit indicating they s'ra doing all work and then hire outside contractors must submit a new affidavit indicating such. TConiractors that cheek this box must attached an additional sheet showing tho name of the sub-contractors and their workers'comp.policy information. f am an employer that isproviding workers'compensation insurance formy employees. Below is fhepoliey an4job site infarmation. Insurance Company Name: Policy 0 or S eli-ias.Dic.#: Expiration Date: A, - I'ob Site Address: c C City Attach a copy of the workers'compensation.-policy declaration page(showing the policy number and expiration date). Nilurc to secure coverage as required.under Section 25A ofMGL o.152 can lead to the imposition of criminal penalties of a :jne up to$1,50 0.00 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 ibis statement may be forwarded to the Office of Investigations of the DZA.for"ce coverago verification. X do here ertzfj uttal pia a altles ofperjury that Me information provided above is true anal eora eet. Si ature Data: Phone# C , Dfelal use only. Do not write in this area,to be completed by city or town official. City or Town: PermitfUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown.Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other y u Contact Pexs on: Phone 6: 10/3/2014 Division of Professional Licensure:License Search The Official Wpbsite of the Office of Consumer Affairs am.,J Businfass Regulatin.n(OCA13R) 'Division of Professional Licensure Mass.Gov Mass.Gov Home State Agencies A-Z Topics Home > Division of Professional Licensure> ONLINE SERVICES .... . ............... ......................... ............. .................. ......... Check a License Check A Professional License Locate a Licensed Professional By the Division of Professional Licensure Online Address Change Contact the Agency ............... ................ More... Name: CHRISTOPHER W. VINING REFERENCES& Business: WARREN INDUSTRIES INC RELATED INFO NORTH ANDOVER, MA Disclaimer Regarding NEW SEARCH Website License Searches **This Licensee has additional Licenses, click here to view them.** Glossary of License Status ........ . ...... ....................................... .......................................... ............ Codes ll Licensing Board: ELECTRICIANS More... License Type: MASTER ELECTRICIAN TYPE CLASS: A License Number: 20980 Status: CURRENT Expiration Date: 7/31/2016 Issue Date: 2/26/2009 Exam Date: 2/26/2009 School: WHITTIER REGIONAL VO This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. bo.,n by tho Lmd"si0nn" (E')2007-2011 Commonweafth of Masiachu.sefls Site Policies Contact Us http:/Ilicense.reg.state.ma.uslpublic/pubLicenseQ.asp?board—code=EL&type_class=—A&Iicense—number=000020980&color=bIue&lb=EL 1/1