HomeMy WebLinkAboutMiscellaneous - 125 FLAGSHIP DRIVE 4/30/2018 (9) BUILDING FILE
Office Use Only
Gibe Team TI uiurdth If -49asYffS Permit No.
leprtment of Vuhiir -Aaf:tq Occupancy,&Fee Checked Sod
BOARD OF FIRE PREVENTION REGULATIONS 527 C111R 12:00 Ursa (leave blank) /_ 0y
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:0
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
(MYi' or Town of NORTH ANDOVER To the Inspector of Wires:
The udersigned applies for a permit to perform) the electrical work described below.
Location (Street & Number)
Owner or Tenant V,�Vc-s
i
Owner's Address -
If
Is this permit in conjunction with a building permit: Yes _ No (Check Appropriate Box)
C Puroose of Buiidino Utility Authorization No.
Existing Service %00 Amos?22—J 10 Veits Overhead Undgrnd VFX No. of Meters _
New Service Amps _1 Voits Overhead Undgrnc (` No. of Meters
Number of Feeders anc Ampacity Z--✓ _ �f
Location and Nature of Proposed Electrical Work /► � r
5 'K5
No. at Lighting Outlets i No. of Hot tics No. of Transformers aA
r
No. at Lignting Fixtures Swimming ?=ci no e- gmc. _ I Generators KVA
No. of Emergency Lighting
No. of Receotac:e Cutlets I No. of Oil Burners I Battery Units
No. of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones 3
No. of Ranges No. of Air CTotal No. of Detection and
cr.c. ;ens Initiating Devices
Heat Tc:at Tota
No. of Disposals No.of?ur^cs 'c^s K:V No. of Sounding Devices
iNo. of Seit Contained
No. of Dishwashers SoaceiArea Heating KYJ Oetect:on/Sounding Devices
Municioai
No. of Orvers Heating Oev:ces KN Local _ Connec^on _Other
No. of No. at Low Voltage
No. of Water Heaters K1: I Signs Baiias:s Wirmc _
Na. i ivcro Massage u^s I No. of Motors Total HP
OTHER:
INSURANCE CCVERAGE: Pursuant to the requirements of Massacncsers general Laws _
1 have a current Liao:iity Insurance Policy inducing Cornc:etec Cceratiens Coverage or its sucstantiat equivalent. YES NO _ I
have suomiree vatic proof of same to the Office. YES = NO = If ycu nave checxeo YES. please inaicate the Itpe of coverage cy
enecKing the approcnate oox. 9R I
INSURANCE rZBCNO = OTHER (Please Scec:`-.t) W+iaxlhopps-��I�" �
(Expiration Dater
Estimarea Value f , iect cai 'Mork S 12DW
Worx to Start Insoec::on Gate nacues:ec: Rough
IL, Final
Signed unser :he P naities of perlu
FIRM NAME �S.a ^�rl' LIC. NO, IL47-�
Licensee Sicna:are LIC. NO.
e �i�Wl ® -7 ---Rus. ret. No.
AddressAA 0 Alt. rel. No.
OWNER'S INSURANCE`NAIVER: I am aware that the L:censee coes net nave the insurance coverage or its suostantiat eautvalent as re-
tluirea by Massachusetts General Laws. and that my signature on :n:s =ermiz application waives this requirement. Owner Agent
(P!ease checx ones
:eiecnone No. PERMIT FEE 5
(Signature of Owner or Agent)
Date.....-�....f-........
.,........
905
TOWN OF NORTH ANDOVER
' PERMIT FOR WIRING
�,SSACNUS�
f
This certifies that ....... .. .. •..... .. � '1....:r............
has permission to perform ..
wiring in the building of .... ./
at.. .. �: ., /(�.. 6.................. .North Andover,Mass..
Fee:. LIC.No.�.1�.v.........
....................
CECTRICAL INSPECTOR
08:51a -f
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WHITE: Applicant-� CANARY: Building Dept: PINK:Yreasurer
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