HomeMy WebLinkAboutMiscellaneous - 1341 OSGOOD STREET 4/30/2018 1341 OSGOOD STREET
210/034.0-0011-0000.0
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NORTI{
TOWN OF NORTH ANDOVER
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ELECTRICAL INSPECTOR
Check/
Official Use Only
Permit No.
ae�s°,t�` Saaetq Occupancy&Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00
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---7J �- L OZ--
To the Inspector of Wires:
Town of North And
The undersigned applies for a permit to perform the electrical work described below.
Location(Street&Number ('00 5�
Owner or Tenant Y—c A
Owner's Address � l
Is this permit in conjunction with a building permit Yes ❑ No 9' (Check Appropriate Box)
�j /�f✓�v� � Utility Authorization '
Purpose of Building / ttY q
Existing Service /00 Amps Z0 't Voits Overhead B Undgmd ❑ No.of Meters 1
New Service ZCQ Voits Overhead M/,*' Undgmd ❑ No.of Meters
Number df Feeders and Ampacity
Location pnd Nature of Proposed Electrical Work
Total
No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA
M
Above ❑ In ❑
No.of Lighting Fixtures Swimming Pool grnd ❑ 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
Total No.of Detection and
No.of Ran es No of Air Cond Tons Initiating Devices
Heat Total Total
No.of Diposal No. Pumps Tons KW No.of Sounding Devices
4 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 Signs Bailases Wiring
No.Hydro Massage Tuds No.of Motors Total HP
OTHER:
r
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws s,
I have a current Liability Insurance Policy includin�g C mpleted Operations Coverage or its substantial equivalen YE NO =
ve-submittvalid proof of same to the Office t E NO = If you have checked YES please indicate the type of coverage by checking the appropriate box
INSURANC = BOND = OTHER =.(Please Specify)
(Expiration Date)
Estimated Value EI ctrical Work$ LL/L rte/
Work to Start L, Inspection Date Resquested Rough Final
Signed under a enalties of perjury:
FIRM NAM,E/. —tel LIC.NO.�AS,
Li�.ensee!" IGr�Q H�i t�Ci�O.LJ/gz�i� Signature LIC.NO. Z7
Bus.Tel No.LQ?j 2,8-Z—-L
AddressJk�� Alt Tel.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. PERMITTEE $
(Signature of Owner or Agent)