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Home My WebLink AboutWire Permit - Permits #7836 - 23 FRANCIS STREET 11/28/2007 \� \ NO 3 ` ate �p § . IS, ..<,... I Ma MUM MMMIM \� 1I ME U TOWN OF N `\ 46 z fi �" F � \ ING a\ o \ MMIN * r = s10 ....,. :..... ....... :..... ... .. IMMIN RM ml IRIS .. ..,..........e...,...........,. 4 This certifies that ..... ................... 1 ��` ll I� \_ IME ge has�ertnissan tc�perform - \ ME a El ...... 'rin in tixe building of P _ . :.,...... , t�rth lover, ass, \ \\ INMAN at y _:�... sFcrot Fee...: L,ic. No. ..,..,.... � crRIcA Ix$ Check # � \\ Commonwealth of Massachusetts -- <31�1ia iasl �s4,Only fM Permit No. j Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/d7 I 1 (Iv4s oalai7k) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All xorlc to be pertbrined in accordance with the Massachusetts Electrical Code(MI'C:), 5?7('MR 1100 (I'I,.l1:�I,5E I REQ'IrN INKOR TYPEALL INF'O1iWA170N) Date.Al J—/ B this application the undersitn C'."it�y or Town wn of: } �/ To the inspector of Wires: S �d Div � � intention� � p work described below. , y pp es notice of his or her to dorm the electrical Location (Street Number) ' Owner or Tenant AUSir-, t ��r1 _- Telephone No. Owner's Address _ Is this permit in conjunc ion with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building w1.,de Utility Authorization No. Existing Service. Amps / Volts Overhead F] Undgral ❑1 No. of Meters New Service, Amps / Volts Overhead ❑ Undgrd E] No. of Meters Number of Feeders and Ampac.ity Location and Natureof"Proposed Electrical Work: Completion of the following table may be A,aived by the /n,�pecloNo. of dy'ires. No.of Recessed luminaires No.of Ceil.-Sua.s o�� Total E (Paddle) Fans Tr KVA No. of Luminaire Outlets No.of Hot Tubs Generators KVA No. of Luminaires Swimming Pool At7ove ❑ in- ❑ o:o mar*ency ig a rug rnd. rnd. Battery Units __-- rNo. of Receptacle Outlets No.of Coil Burners FIRE: ALAL2MS No.of Zones No. of Detection anal of Switches No. of Csas Burners of lean es No.of Air C'ooacf. Toth No. of Alerting Devices Tons No. of Waste Disposers "eat Purtrp Numlaer ons 1�. o of"Self-C.ontainei Totals: Detection/Aterting Devices Municipal No. of Dishwashers Space/Area Beating KW 2eecomin Connection ❑ Other No. of De~�ars Heating Appliances KW ys tams of Devices or Ec uLvalent No. of Water No. of No. of iring: Heaters KW Sions Ballasts of Devices or P,c uivalent No. Hydromassage Bathtubs No.of Motors 'Total HP evices± �rtng: No. of Lavaca~ or E uivalent OTHER: ilttach additional detail of desired, or as required by the havl-actor Of 1.1/ircy 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 perlbrrmtnce 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 shine to the permit, issuing office. C ilf`.0 K ONE: INSURANCE ❑ BOND ❑ OrITIER (❑ (Specify:) t eerirl)�, aandNr tlae plains aaarallaeracalties of e�jnry, thart tl e infornxation on this application is trite aRnd complete. F1RM NAME: __.. LIC". [°of .) � 2 Licensee. Signature z LNC:. NO.: / I l c!enm�t na he lic�rnse rrt.araa�l7car line) � ,, �l Bus. '1"cl. I`�ca.:,_ ""�l�aa7hccd7le, ruler -,, Ad Alt.. Tel. No.._____—__._ Address:ss *Pei- M.G.1.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 nol. have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. 1 am the(check Lane)n owner E owner's agent. Owner/Agent late"fi'] 1-T i E,E. $ Signature Telephone No. The Commonwealth of'Massachusetts Department of Industrial Accidents Of fice o f Investigations } ' 7 600 Washington Street t: Boston, MA 02111 A. www.mass.gor�/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Apl2ficant Information Please Print Le�ibl Name (liusitaesslC}rt ani�,atican/tndividutili:�— �� rC e.. ...._� -- __ .__-._..__. Address: / _ 64 PV1. ° �%_ _...__... -- City/Mate/Zip: t - � ._ - ..__ � Phone #� _...__ �� W&— Are you an employer? Check the a.ppropriate box: Type of project(required): 1.❑ f am a employer with 4. ❑ 1 am a general contractor and l _ ❑New a;c�zawut-uction Pa. riployees (full and/or part-time).* have hired the sub-contractors 2. 1 am a role proprietor or partner- listed on the attached;sheet. 1: 7. ❑IZetnodelin<?, ship and have no employees These sub-contractors have 8. ❑ DeTnolition working for the in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its a. reClttired.] officers have exercised their l0.❑ Electrical repairs or additions a right of exemption per MGL 1 ED Plumbing repairs or additions 3.❑ 1,am a hr,>meowner, doing all work g p myself. [No workers' comp. c_ 152, §1(4),and we have no 12,❑ Roof repairs insurance required.I .l. employees. [No workers' � p 13.n Othcr6` v ,e, _ comp. insurance required.] *Any applicant that checks box H I mast also till out tyre section below showing their workers'compensation policy info oration. Homeowners who submitthis affidavitindicating they are doing all work and then hire outside contractaa•s muSt'Sub nit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workcts'comp.policy inPorinalion. I am ten employer that is providing workers'compensation insurance for my employees. below is the policy tend jolt site iea f s�rm t¢tion. lnsurarrce C�ornpany Name ___. Policy 4 or Self-'ins. Lie. fl L`xpiration Data, ,lob Site Address: _ City/State/Pip: Attach a copy of the 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` I1 500.00 rand/or one-year imprisonment, as well as civil penalties in the form of a S'7"(--)P WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of lnvestigations of the DIA for- insurance coverage verification. f w p f p'Jury f p e is tragic tent/correct. I do laer�ebv ct auzrl tlzt. aim an Date: lr nalties o c r'ur that the information provided above Si�nature,� _ Phone /: Officicel arse orady. I)o teot write in t/xis area, trr be ctrin ted by city or town official. City or'Town: Permit/License Issuing Authority(circle one): 1. hoard of Health 2. Building Department 3.City/Town Cleric 4.Electrical Inspector 5. Plumbing Inspector 0.Other Contact Pe soil: Plume 04/14/2008 15:59 FAX 978 475 1192 ANDOVER ELECT WJ UU I 19 Dale Street Andover,MA 01810 Phone: 978-475-4995 Fax:978-475-1192 FAX wi _it@ car mcast.net, of From: Name; Townof North Andover Sander's Name; Robert I Branco,President Attention:Peter Murphy, Electrical inspect" company;Andover Electric SerVICSA,Inc RE- Miscellaneous Town Permits Date sent., 4/14/08 Fax number: 978-688-9542 Phone number: 978-688-954S of oaqes includino cover vase: 2 F Urgent 4 For Review Please Comment Please Re MessW1 4/14/08 Dear Peter: Pag #2 is art updated list of town electrical permits. "a T you for your cooperation on these repairs. If-you have any questions,or require any additional i o tion,please do not hesitate to call me. ervy truly you u Rort>J. Branca President 04/14/2006 15t59 FAM 978 475 1192 MOVER ELECT 4/14/200 Town Electrical 'Work Permit Log Location Work Com ete i rave t Troubleshoot calcr Yes Town Hall Troubleshoot heat in Town Manager office Yes a►ter t Troubleshoots stall new rely s suriplillol.1 Water DTt Yes Steven Estate Remove re 1 existin outside fix es Yes Steven Estate Furnish i ll li ht in closet Yes Water t R l we corroded fixtures Yes Water Dept (Boston Mill Re lace er enc battery Yes Water Dept (Alcott Village) Repair 4' fluorescent fixture&mount Yes Water Dept (Winter St Troubleshoot re air fixtures Yes Water Dept 131ue Rid� Troublesboot&re 5air fixtures Yes Coachman Lane Disconnect& wire new ca resor Yes Water Dept Wire solenoid valve in basement Yes Police Station Remove and replace 200-nUanel No Andover Electric 19 Dale St Andover,MA 0 1810 979-475-4995