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Home My WebLink AboutWire Permit - Permits #11940 - 61 ESSEX STREET 10/17/2013 00&\gg \ `' �. ,\ ISUM a k,ate...... _ ,... ... MEN 00 I US O +; ` N Am ,\ TOWN OF NORTH ANDOVER INEM j . `" !® PERMIT \ 'a $ +Fto►+ ( S \\ O HU5 \\ 1 \\ \ _ MUM � This certifies that ......... \\ M has permission to Q .................... .`.. .., ............................ go the b wiring 2n building of .................................................................... A a at •. ..... 0 , ass. -37 N r t ndo ..F....: Lic. w,` Fee \` \ c, ,Irvp 0,11-11 .................. \ \\ IS, Check : t ti� s 101 _ \ mac_ 4 N Commonwealth of Massachusetts Official Use Only Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.i/07] (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code WC),527 CMR 12.00 (PLEASE PRINT IN INK 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) 3-c',— 57-- i'l Alt) Owner or Tenant es i'14 Telephone No. Owner's Address e K r 7 � �,,ee,4 Is this permit in"conjunction with a building permit? Yes 4K] No n (Check Appropriate Box) Purpose of Building \ F ID Utility Authorization No. Existing Servlce,2 !a Amps 41f Volts Overhead [E] UndgrdE:l No.of Meters New Service Amps Volts Overhead[:1 UndgrdF] No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:Work: yP, ri l Completion of the foll owing table 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 Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above Ei In- n ][;;0�.ote mergency Liglifi—ng grnd. ❑ grnd. ❑ Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS JN' o.of Zones of Detection IndNo. 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 J.NMMbff m �. .]J� r No.of Self-Contained Totals: I iDetection/Alerting Devices No.of Dishwashers Space/Area Heating ILocal D Municipal El Other Connection No. 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 11P Telecommunications Wiring: No.of Devices or Equivalent OTHER: Atiach additional detail if desired or as required by the Inspector of Wires. Estimated Value of lectrical Work: (When required by municipal policy.) 'ct' Work toStart: lei JV 9eo'? Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE,C GE: 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 [I BOND El OTHER F] (Specify:) I certify,under the pains anal penalties ofperjuiy,that the information on this application Is true and comp lete. FIRM NAME: LTC.NO.: Licensee: 6&6 )Crl Signatur LTC.NO.: " a 1-al Bus.Tel.No.: P p Address: .L Alt.Tel.No.: Per rL.G 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)El owner El owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ Massachusetts s Department of Public Safety Board of Building Re rations and Standards Construction per`'_ r sense: CS41158863 CHARLES A FAN 20 BERESIFORD ST lAwrence MA 01843 Forman Caf-rnnssionerr 11 14 � c �c-rt,�s#c•�rtt�rr� t� ?�frrr=�zr_:r�� Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR Tegistr n: 147062 Type: Expiration: 15 Ind° ' ui CHA LES A FAY J . CHARLES FAY 20 BERESFORD ST. LAWREN E,MA 01643 Undersecretary -------------- The Commonwealth of Massachusetts Department oflndustriqlAccWnts Office of Investigations 600 Washington Street Boston,MA 02111 Uf wwwmass.govIdia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print I,e0bYy Naino(Businoss/Organizationgndividual):- k I C-1;z- Address: C x � w° Y� ` city/state/zip: Phone. Are you an employer?Check the appropriate box: Typo of project(required): 1.D I am a employer with_ 4. F1 I am a general contractor and 1 6. []Now construction employees(full and/or part-timo).* have U-ca the sub-contractors 7. [J Remodeling I am solop'.roprictor or partner- listed on the attached shoot.T ship and'have no employees These sub-contractors have S. F1 Demolition working for me in any capacity. workers'comp.insurance. 9. []Building addition [No workers'comp.insurance 5. F1 We are a corporation and its 10.n Electrical repairs or additions required.] officers have exercised their 3.El I am a homeowner'doing all workright of exemption per MOL 11.n Plumbing repairs or additions ,w myself.[No workers'comp. c.152,§1(4),and we have no 12.Q RoofrepAirs insurance required.] employees.[No-workers' 1311 Other comp.insurance required.) 'Any applicant that checks box4l must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they Zre doing all work and then hire outside contractors must submit anew affidavit indicating such. fContraotors that checRtbis box must attached as additional sheet showing the name ofthe sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is Yhepolley and job site information. Insurance Company Name:. Policy 0 or Solf-ins.Lic. Expiration Date: ,To I b,Site Address: City/State/Zip: AtNch a copy of the workers'compensation-polleyileclarqtion page(showing the policy number and expiration date). Failure to secure coverage as requirodunder Section 25A ofMGL c. 152 can load 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. I(toll ereby ceriffiv Un.cler the pal a enaffles ofperjury that the information provided above Is true and Correct. Signature- Date: Z021'71JOLY Phone 0: Official use only. Do not write in this area,to he completed by city or town official City or Town: Permit[License M. Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Lispector 6,Other Ph mi a 44- ❑ 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 8—Permit/Date Closed: Note:Reapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass M Failed Re-Inspection Required ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed Re-Inspection Required ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass[E Failed Re-Inspection Required ❑ Inspectors Comments., Inspectors Signature: Date: ROUGH INSPECTION: Pass N / Failed M Re-Inspection Required ❑ v Inspectors Com nts: Inspectors Signature: Date: FINAL INSPECTION: Pass M Failed Re-Inspection Required ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com