HomeMy WebLinkAboutMiscellaneous - 10 LIBERTY STREET 4/30/2018 (2)koRT)l
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Date..................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that,X
k--- .... /1, * , , '2"
has permission to .......................
wiring in thfbuilding of .............
..... ...... .....................
.. ........ ;7 ...... . NorthUdover, Mass.
Fee..IJZ,Ifd Lic.
...................
ELEcTRicAL INSPECTOR
Check #
Commonwealth of Massachusett
Department of Fire Services
BOARD OF FIRE PREVENTION REG TIONS
APPLICATION FOR PERMIT
All wo* to be padomed in ac=da4 ce with
(PLEASE PRINT IN INK OR TYPE
City or Town of:
By this application the JPv
Location (Street & Number) •
Owner or Tenant
0
Permit Nm 4
OCCUP11OCTand Fee CheekW i30
11/99] e- blank
6 PERFORM ELECTRICAL WORK
Masswhuscm m«ettical code CMEL 200
Date: I� Q -
�- To the Inspector of Wk -es:
in rwrfnm the electrical wok described below.
Telephone No. 1'6 •O U• �Iy
Owner's Address ❑
Is this permit in conjunction with a building permit?
Yes No (Check Appropriate Bog)
Purpose of Utility Authorization No.
Fasting Service Amp
/ Volts Overhead ❑ Undgrdd ❑ No. of Meters
New Service APs
/ Volts Overhead ❑ Undgrd ❑ Na of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
of Recessed Fi:tans _
of Cai.�- (Paddy) Fansof
Lighting Outlets
of Hot Tubs
rN
of Lungraturdes
mming Pool
❑ ❑
of Receptacle 01109ts
No. of Oil Burners
of switches
Na of Gas Bwm=
of Ranges
No, of Air Cond.
T
Tom
Pomp Naber Tons KW
of Waste Di�sosers
Totals:
Of Dishwashers
SpacelArrtt Heating
KW
Beating APPS
KW
. of Dryers
afar �'
°' of
Banasts
Heaters
Hydro�e Bathtubs
Na of Motors
Total HP
ble uta be waived theIa. if
Ins r
was Ws KVAl
:aerators KVA
Units
TIRE ALARMS No. of Zones
Bio. Doors and
leimtift llevices
Vo. of Akrting Devices
No.
oDevices
local❑ Mt�a�don ❑ Other
Com
No. off= or Equivalent
Data Wiring:
No. of Devices or Equivalent
T vi
ran- ofOeviasorEgmvalent
Am a&Wwaaff dtqforas"PIM o! MI.—F-- y •._—
INSURANCE COVERAGE: Unless waived by tine owner, no Pert i;or the PerbMMM of dcdncd work may issue unless
f of liability insluanoe including completed op atioe eo�BF or its substntial equivalent. The
the licensee provides proof is in force, and has eanbited proof of same to the Permit issuing off ce.
undersigned cxatifies that such coverar
CHECK ONE: INSURANCE 0 BOND ❑ OTHER ❑ (Specify') 4Y�� CDEQ; CSC�1 - e)
Estimated Value of Electrical Wow ( (fin required by municipal PdiCY--)
Wodc m Start oC ws to be requested in with MFC Rule 10, and upon oompletioa
I , � - o f ,y that du infararah►aa ORA& & apprcadna is tine mrd
L Ct
LIC. NO.: ( 11
FIRM NAME:
1 LIC. NO.:da
licensee: Bus. Tel. NO. -.k - ` y0
(jlapp1 aablc Q "in the unease ntanba -
Address• ere " G�aware\tdboat�� �Alt. Td. No.: �mtatly
OWNER'SINSURANCEWAIVER: 1 athe licensee docs not have the liability ovim.Ej per's agcnL
required by law By my signature below, I>e�y waive this reVn=wmL 1 am the (tjredc ane) ❑
Owner/Agent Telephone No. PESMIT FEE: `
Signature
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