HomeMy WebLinkAboutMiscellaneous - 10 WALKER ROAD 4/30/2018 (12)Date ..../..C.�.......
°.,•``° "� TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
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This certifies that......... ° - .
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.............. ..:................................................
has permission to perform .. ..... -..........` �...
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wiring in the building of .:: .a::..:..<X `.'�"' ':,-.rl-'7.
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at . � ........./.- i .- ......,� ................ . North Andover, Mass.
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Fee' .................... Lic. No. l'2 .... :. ...... ....................................
11 ELECTRICAL INSPECTOR
Check # Y'
O 140 Official Use Only
THE COMMONWEALTH OF MASSACHUSETTS Permit No. -
Department of Public Safety
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy & Fee Checked. -35
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00
(Please Print in ink or type all information) Date r- / ,—
To the Insp ctor of WINS:
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number If _441 L 14- Ft d ia'9-P
Owner or Tenant /`7Ez-A7 .0 6,w vcw
i^nea/yny'^e 14751475r6�Q 0-
Owner's Address � a IVA L if c � 1C 6 /W
Is this permit in conjunction with a building permit Yes No (Check Appropriate Box)
Purpose of BuildingC /" P ay Coe Utility Authorization No.
Existing Service Amps Volts Overhead • Undgmd • No. of Meters
New Service Amps Volts Overhead • Undgmd • No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
OTHER: At G 4 ed RY '! �4r TZI& V il�/{��/ (s" /e /-1 14!�, 41-�,
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent INO =
have submitted v d proof of same to the Office YES = NO = If you have checked YES please indicate the type coverage by checking the appropriate box.
INSURANCE&e BOND = OTHER = (Please Specify)
Estimated Value of Electrical Work$___
Work to Start
Signed under the Penalties of pedury:
FIRM NAME
'15-o,a6
(Expiration Date)
Inspection Date Resquested __Rough Final_
6!e4 6- &-of#sy '
LIC. NO.___
LIC. NO. S7 1' �•
�,f Bus. TelNo._ / 6 _ J �/ �s�d 9
Address / ��7 �iXe� % Alt Tet. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
Telephone No._ PERMIT FEE $
(Signature of Owner or Agent)
Total
No. of Lightinq Outlets
No. of Hot fuse
No. of Transformers KVA
Above
In
No. of Lighting Fixtures
Swimming Pool qmd
grnd
Generators KVA
No. of Emergency Lighting
No. of Receptacles Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No of Gas Burners
FIRE ALARMS No. of Zone
No. of Detection and
Total
No. of Ranges
No of Air Cond
Tons
Initiating Devices
Heat Total Total
No. of Di osal
No. Pumps
Tons
KW
No. of Sounding Devices
No./ of Self Contained
No. of Dishwashers
Space/Area Heating
KW
Detection/Sounding Devices
• Municipal • Other
No. of Dryers
Heating Devices
KW
Local Connection
No. of
No. of
Low Voltage
No. of Water Heaters KW
I Signs
Bailases
Wiring
No. Hydra Massage Tuds
I No. of Motors
Total HP
OTHER: At G 4 ed RY '! �4r TZI& V il�/{��/ (s" /e /-1 14!�, 41-�,
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent INO =
have submitted v d proof of same to the Office YES = NO = If you have checked YES please indicate the type coverage by checking the appropriate box.
INSURANCE&e BOND = OTHER = (Please Specify)
Estimated Value of Electrical Work$___
Work to Start
Signed under the Penalties of pedury:
FIRM NAME
'15-o,a6
(Expiration Date)
Inspection Date Resquested __Rough Final_
6!e4 6- &-of#sy '
LIC. NO.___
LIC. NO. S7 1' �•
�,f Bus. TelNo._ / 6 _ J �/ �s�d 9
Address / ��7 �iXe� % Alt Tet. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
Telephone No._ PERMIT FEE $
(Signature of Owner or Agent)