HomeMy WebLinkAboutWire Permit - Permits #12276 - 17 EDMANDS ROAD 4/10/2014 00
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Official Use Only
Permit Na. 2_,L /6,
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS J[Rey. 1/07]V (leave blank
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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 IN INK OR A LL INFO TION) Date:
City or Town of; TO the lnipec6i�f Wires:
By this application the undersigried gives note of his or her intention to perform the electrical work described below.
Location(Street&Number)--2-2— &........Z Z�,S
Owner or Tenant Telephone No.,.I(.17
Owner's Address X
Is this permit in conjunction with a building permit? Yes No El (Check Appropriate Box)
Purpose of Ballding'7`1�_ -7), Utility Authorization No.
Existing Service Amps Volts Overhead Undgrd No.of Meters
New Service Amps' -volts Overhead Undgrd No.of Meters
Number of Feeders and Ampgcity
Location and Nature of Proposed Electrical Work:'
CoM Cation o the lbllowingtable may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Lurninaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above d. El In- N-0.ot Emergency Lighting
gm 91711
d. B!Yea 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
Initiating Devices
No.of Ranges No.of Air Cond, Tons No.of Alerting Devices
Heat Pump , mber N_ f Self-Contained
No.of Waste Disposers I KW o.o
Totals: ....... Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local 0 Mmildpal-_
Connection
® ()titer
Na.of Dryers Heating Appliances KW Security Systems:*
No.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
iring
No.of Devices or Equivalent
,OTHER:
Lj22' 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 S Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURAN��VQJIUUnless 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 BOND [] OTHER 0 (Specify:)
I certify,under the paittv and lties of peduM that the information on this application is true anrdcomplete.
FIRM NAME: Aries Electrical Service and Contro LIC.NO15650a
Licensee: Nor andMichaud IC.NO.- 34594e
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.., 978 6117-0544
Address: 290 Broadway suite 117 Methuen ma 01844 — Alt.Tel.No.:
*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(checkane)EI owner El owner's a t
Owner/Agent
Signature Telephone No. PERMIT FEE., $
ne C4HUnonweaft of It's
Dqmwb)md of al Aeddentr
of In " . tions
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lumbers
ApE!Leaitt Information se �UbtObly
Name � � �NI3 N fRCLS 1,LC
Addr ,,290 RRnArwAy snrT'l'y
City/Sta : Frei-h3,t=n Ift 01244_ ..
Are you an w? op : Type of project(requYred)-
1. l am an employer with _ �® 1 a con � 15"Cl New construction
CUT007em(full awyOr part ftea * have himd the s
2 _am a sole propriv=Letor 7.0 Re t%n8
ship have no
sob_ to have 8.❑Demolition
working.for mre in any capacity. employees and hwe vAxtas,
5.0 We Comp. a corpomtion and its " 'Cal �or tins
3.U I me a nearchr l0
myself'[No workW comp- TWdefoxemptlanpermMOL11.GPlumbing repain;or additions
insurance required]t . c:152,,§101 and vm have no 12.d Ronfrepgft
emplayeaL(no vmdww
] 13"U Other
farerc sB
a6� etu,s "dAftwttgjwor=tdmemdgnbmempiyeL if
Iawan yer#fat dx ee *_ c+efarBdow is ftepeftcy andlebske
info on
Insurance Company
Name: . .Travelters; Ins. ..
iration
Job Site Ad 0 '4
Attach a copy ofthe orl[er8'cx�mpeff t d t 1? ►t Y umber aid earp�iratior,(ate).
Failure to secure COVMV as Uquired under Section 25a of 152 can kad W ft impwition Ofcriminal penalties ofa fine
up to 1-5()0!#iQan&or yew huptbuntuell as vMff as civil penaltiesin the Ibm of"a STOP WORK ORDER a time of
$250.00 a day against violator.13i advised that a copy ofels,3MMent maybe
i dorl ttr Office oflnve sti `ons of the
I:?Ity for Cov o Verification.
X do herby Me pabs mdpenahla 0fPM*vYfiWJkehew=Wau
PmWed above is tme and correct
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Print Name: Normand Michaud PAqwk 978 687 0544
Official use OWY I Do jW wMe In Ms area to ire conrlMd by door town officiat
Issuing AuthorTdy(drele,one):
1"8. oard ofReeth 2. BuildingDepwtment 3,.Cft3ffownClwk 4.Mectrica Inspectw Plumbing Inspector
6.Other
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