HomeMy WebLinkAboutMiscellaneous - 140 BRIDGES LANE 4/30/2018 (2) 140 BRIDGES LANE
210/104.D-0080-0000.0
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TOWN OF NORTH ANDOVER
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4L PERMIT FOR WIRING
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This certifies that ....,...: ...
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e wiring in the building of.. s�J?��.�1....�l .i1..................
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ELECTRICAL INSPECTOR
Check # / �) Z 2 %f
Commonwealth of Massachusetts Official Use Only /
t -a "� � Department of Fire Services Permit No. L�
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1;"62
City or Town of: 6/14)1 ", (A,)—Cr To the Inspector of Wires,
By this application the undersigned gives notice of s or her,intention to perform the electrical work described below.
Location(Street&Number) ) 'LA A
Owner or Tenant // Telephone No. -�-D7
Owner's Address
Is this permit in conjunction with a building 't? Yes ❑ No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
New Service Amps / v�Volts Overhead F-1Undgrd ElNo.of Meters
Number of Feeders and Ampacity r
Location and Nature of Proposed Electrical Work:
Completion of the following 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
Above ❑ - ocy ng
No.of Lighting Fixtures SwimmingPool rnd. rnd. 11Batte Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones
No.of Switches No.of Gas Burners lq-o.o and
D
Initiating Devices
No.of Ranges No.of Air Cond. Tons No.of Alerting Devices
No.of Waste Disposers eat Pump Number ons No.o e -Contained
P Totals: Detection/Alerting Devices
No.of Dishwashers S ace/Area Heating KW Local ❑ Municipal ❑ Other
t P g Connection
No.of Dryers Heating Appliances KW TecNo oyfDeviices or Equivalent
o.o aterKit o.o o.o Data Wiring:
Heaters Signs Ballasts I No.of Devices or E uivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications inng:
No.of Devices or Equivalent
OTHER:
Attach addhIcnal 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: INSURANCE ® BOND ❑ OTHER ❑ (Specify:)
(Expiration Date)
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and on completion.
I certify,under the pains.and penalties ofperjury,that the information on th' applicado is d complete-
FIRM NAME: ' e LIC.NO.: /!U9
Licensee: Signa LIC.NO.:
(Ifapplicabl ter ' empt"in the license number line.) Bus.Tel..N 4
Address: Q Alt.Tel.No.:
P `ice �-�.A 0A LLJ..A
ar 4 lie M. �G�zl
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
Signature Telephone No. PERMIT FEE: $