HomeMy WebLinkAboutMiscellaneous - 134 FARNUM STREET 4/30/2018 (2) Rio
r 134 FARNUM STREET
210/107.A-0072-0000.0
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0 TOWN OF NORTH ANDOVER
0 .amilmlift p PERMIT FOR WIRING
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This certifies that .... . < 1...../ (!/'.... ... .......... ...........................
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wiring in the b'ilding of..,.1..........................
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ELECTRICAL INSPEC'�OR r
Check #
s
' 554 `1
Commonwealth of M/REGULATIONS
usetts Official Use only
Department of Firces
Permit No. ,j.5V-7
Occupancy and Fee Checked
t Fr-P BOARD OF FIRE PREVENt IO [Rev. 11/99] leave blankAPPLICATION FOR PE PERFORM ELECTRICAL WORK
All work to be performed in accordan •th the Massachusetts Electrical Code(M C),527 MR 12.00
(PLEASE PRINT IN INK OR E ALL INF TION) Date:1 1d�
City or Town of: �� e K To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) 3 Lq
Owner or Tenant 9— S ,— Telephone No.
Owner's Address 9
Is this permit in conjunction with a building permit? Yes ❑ No, (Check Appropriate Box)
Purpose of Building Utility Authorization No.
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:
Completion of the ollowin table may be waived by the Ins ector of Wires.
No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of- Total
Transformers KVA
No.of Lighting Outlets No.of Hot Tubs Generators KVA
No.of Lighting Fixtures Swimming Pool Above ❑ . ❑ Baot.toe mersency Lig ting Unitsj
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiatin2 Devices '
No.of Ranges No.of Air Cond. Tons l No.of Alerting Devices
No.of Waste Disposers Heat Pump Number ITons I KW No.of Self-Contained
Totals: I I Detection/Alertiniz Devices
No. of Dishwashers Space/Area Heating KW Local ❑ Municipal F-1 Other
Connection
No.of Dryers Heating Appliances KW Security Systems:
No.o aterNo.o No. No.of Devices or E uivalent
of
Heaters KW Signs Ballasts Data Wiring:
No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP. Tete communications Wiring:
Z No.of Devices or E uivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
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 coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURAINCEX BOND ❑ OTHER ❑ (Specify:)
Estimated Value of Electrical Work: (Expiration Date)
(When required by municipal policy.)
Work to Start:- ' Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify,,under the..pains and.penalties of perjury,•that the information on this application is true and complete.
FIRM NAME: LIC. NO.: /S'%44—
Licensee: l/ ignature LIC.NO..Sseo o410724c
! (If applicable, enter "exem t"in the lic nse number lin ) .
Address• Bus.Tei.No.:F7 `S7dSifi�
OWNER'S INSURANCE WAIVER: I am aware that the icens does not have the liability insurance overage normally
Y required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent.
{ Owner/Agent
�tSignature Telephone No. PERMIT FEE: S