HomeMy WebLinkAboutMiscellaneous - 115 FLAGSHIP DRIVE 4/30/2018 115 FLAGSHIP DRIVE
210/107.C-0083-0000.0
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Office Use Only
u If Magoar4ugEfts Permit No.
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+43epttrtment of VUblfz _afPtU_ Occupancy& Feu •^.h?cked .✓tea t
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 1
3/90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORD
All work to be performpd in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Data
(XV or Town of�9 Ii�Q��F _"— To the Inspector of Wires:
The udersigned app:'ies for a permit to perform
the electrical work des-ribed below.
Location (Street & Number) ._
Owner or Tenant U 'l/
Owner's Address
Is this permit in conjunction with a building permit: Yes ❑ No / — (Check Appropriate Box)
P of Building Utility Authorization No.
I
Existing Service Amps _—J Voits Overhead ❑ Undgrnd f❑ No. of Meters
New Service Amps _J Volts Overhead I—; Undgrnd No. of Meters
Nun ber of Feeders and Ampacity
Location and Nature of Proposed Electrical Work _
Total
No. of Lighting Outlets Ne.�HotubsNo. of Transformers KVA
L
}y Above In-
No. of Lighting Fixtur s `/ Swimming Pool grnd. 7L_ grnd. ❑ Generators KVA
Na. of Emergency Lighting
No. of Receptacle Outle No. of Oil Burners I Be.ttery Units
No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones
Total No. of Detection and
No. of Ranges I No. of A.;; Gond. tons Initiating Devices
No.of Heat Total Total
No. of Disposals Pumps Tons— KW No. of Sounding Devices
No. of Self Contained
No. of Dishwashers I Space/Area Heating KW Detection/Sounding Devices
I. Municipal r -
No. of Dryers Heating Devices KW Local ❑ Connection I Other
No. of No. of Low Voltage
No. of Water Heaters KW I Signs Ballasts Wiring
No. Hydro Massage Tubs No. of Motors Total HP /
OTHER: ,5
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
I have a current Liability Insurance Policy including Co oleted Operations Coverage or its substantial equivalent. YE NO I
have submitted valid proof of same to the Office. YNO _ If you have checked YES, please indicate the type f coverage by
checking the ap riate box.
INSURANCE1�BOND = OTHER = (Please Specify) (Expiration Date)
Estimated Value of Electrical Work S
Work to Start Inspection Date Requeste Rough _ Final
Signed under the Penalties o: p rl Qom_ LIC. NO. �
FIRM NAME �� / �//► - -
Licensee v`►�` Signature //��,,,,�� LI�LIC. NO.
BUS.
/�,�,
Bus. Tel. No. !��•s=`'== 28
Alt. Tel. No.
Address
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equrv. ent as re-
quired by Massachusetts General Laws, and that my signature on this permit application waives this; requirement. Owner Agent
(Please check one) 06
Telephone No. PERMir FEE S
(Signature at of Owner or Agent) x•6565
I° '748
f pOR7►r� �� � �ti
?°•.�`` "�,� TOWN OF NORTH ANDOVER
o
PERMIT FOR WIRING r
�SS�cHusE�
fThis certifies that ...... .....��:2,,4.r��........ .. . .:.
has permission to perform . ... $
wiring in the building of.
at l/J , .. . .. .. ................. .North Andover;,Mass
Fee . ...Tn...... Lic.No/ .. ,5.�� ......
ELECTRICAL INSPECTOR Ijk3 y
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WHITE:Applicant CANARY: Building Dept. PINK:Treasurer i