HomeMy WebLinkAboutMiscellaneous - 134 Academy Road / 134 ACADEMY RD _
BUILDING FILE
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Date....f?.-. .. ....�1 . .
NORTH
°f •``°;•1"� TOWN OF NORTH ANDOVER
- p PERMIT FOR WIRING
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This certifies that ............. �-J. .i`1 ..... .�-�z. .................
has permission to perform .......t5;�-A.v...-.. G t, r! ..........
wiring in the building of / :........ .p5 .-P.
at.............. ... ....�!L. . , orth Andover,Mass.
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Fee..,57577. ^ Lic.No; ;/� �i. ' . ................ .. .
E RICAL INSPECTOR �
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Check !/ �� r
{ 7478
\ Commonwealth of Massachusetts Official Use Only
721 -
Department of Fire Services Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank)
1 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Codec.�Q,527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: Jy h`e 2-0 , 0-7
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her i tention to perform the electrical work described below.
Location(Street& Number) dein
Owner or Tenant �0 1 C q OG 1 Telephone No.
Owner's Address Q /r
Is this permit in conjunct•on with a building permit? Yes ❑ No (Check Appropriate Box)
Purpose of Building Utility A t orization No. I
Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: 2 h Zo (� 1 Lp !!o
1. e Le
q Cona letion of the following table nzay be waived by the Inspector of Wires.
No.of Total
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA
t No. of Luminaire Outlets No.of Hot Tubs Generators KVA
1 No.of Luminaires Swimming Pool Above ❑ In- F] [No.o Emergency Lighting
rnd. rnd. Batterl Units
No.of Receptacle Outlets No. of Oil Burners FIRE ALARMS No.of Zones j
No.of Switches No.of.Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No. of Air Cond. Total No.of Alerting Devices
Tons g
No.of Waste Disposers Heat Pump Number Tons K No.of Self-Contained
Totals: ... ., . Detection/Alerting Devices
No. of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
No. of Dryers Heating Appliances KW Security Systems:
No.of Devices or Equivalent
No.of Water KW No. of No.of Data Wiring:
Heaters Signs Ballasts INo.of Devices or Equivalent
No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
f OTHER:
Attach additional detail if desired, or as required by the Inspector of 14"ires.
Estimated Value of lectrical 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 performance 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 covera is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:)
I /certify,under the pains and p Wallies of e ury the infor tion opplieation is true and complete
FIRM NAME: --a G� l( LIC. NO.:
Licensee: Signature LIC.
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(if applicable,ent ^ 'e. nip nithe license na�n�er line.) ,I /� Bus.Tel.
Address: (�/� I y(Od Alt.Tel. No.
*Per M.G.L c. 147, s. 57-61,security work req es Department of Public Safety "S" License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent.
Owner/Agent PERMIT FEE: $
Signature Telephone No.
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