HomeMy WebLinkAboutMiscellaneous - 142 Sandra Lane A, V
OMce Use Only
use (F.Gmuwnwe>xlth of fflaji ettPermit No. '
Bevin tntm of Public gafrtq Occupancy A Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS 521 CMR 12:00 1 M pealte blank)
APPLICATION FOR PERMIT TO PERFORM- ELECTRICAL W0. K
All work to be performed in accordance with the Massachusetts Electrical Code, S27 CMR 2:00
(PLEASE PRINT IN,INK OR TYPE ALL INFORMATION) Date
Qi}if or Town of. --NORTH A NDOV .R To the Inspector di Wins.
The udersigned applies for a permit to perform the electrical work described below.
c I /
Location Street & Numbere12 a
Owner or Tenant
Owner's Address /ZJ�to
Is this_permit in Conjunction with a building permit: Yes _ No C (Check Appro ri
Puroose of Building l FA- M,(G.e11 Utility Authorization N 4
Existing Service Amps —J Volts Overhead ;.t Undgrnd ❑ No. of Meters r G
New_ Service Q Amps /,94�5;1/ Voits Overhead Unogrna No. of,Meters 1_
Number of Feeders and Ampacity
u
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets I No. of Hct 'cs ( No. of Transformers Total
KVA F
4r..
No. of Lighting Fixtures I Swimming Pcoi Above— In- r
Brno. _ grno. _ Generators KVA
No. of Emergency Lighting,
No. of Recectacie Outlets I No. of Oil Surners I Battery Units ;
No. of Switch Outlets I No. of Gas Surr.ers FIRE ALARMS No. of Zones
TOtai No. of Detection and .
NO. of Ranges I No. of An Ccr.c. 3•
:chs Initiating Devices
Heat Total Totai
No. of Disoosais I No.of
Pur-.=s :ons KW No. of Sounding Devices (•
No. of Sail Contained
No. of Dishwashers I SoacerArea Heaaro Kvi Detection/Sounding Devices
No. of Dryers I Heating Cev ces KW Local i Munieipai
.` Connection ^Other i
No. of No. at Low Voltage !
No. of Water Heaters KW I Signs 9a las;s Wiring
No. Hyaro Massage Tubs t I No. of Motors Total HP r i,
OTHER: V
INSURANCE COVERAGE: Pursuant to the requirements at t.tassacr.csers ;enerai Laws
1 have a current Liaoility Insurance Policy including Ccmc etec Ocerations Coverage or its substantial equivalent. YES NO = 1
have suomineo valid proof of same to the Office. YES T�_ NO = If you nave checked YES, please indicate the type of coverage oy
checking the appropriate box.
INSURANCE } BOND = OTHER = (Please Scec:�w) "
(Exovanon Daal
Estimated Value of E!sctncal Work S
Work to Start Insoecaon Date Aacues:ec: Rough Final
j. U•.
Signea unser the Penalties of perjury:
FIRM NAME UC. NO.
Au:
Licensee S 424!!�;CSigna:ure UC..NO.
!� l� / R� Bus. Til. No.
Address 1 v!/�G Y �G'f Y �cJ!t'� V-,< Alt. Tel. No,
OWNER'S INSURANCE WAIVER: I am aware that trio L:censee coes not nave the insurance coverage or its suostamisl equivalent as re-:,
Quirea by Massacnus*tts General Laws. and that my signature an :his -ormit aopiication waives this requirement. OwnerAgent
(Please cnecK oner
Teteonone No. PERMIT FEE S
(Signature of Owner or Agent
Date........ . .. . ........
TI)
1145
TOWN OF NORTH. ANDOVER
0
PERMIT FOR WIRING
This certifies that ........... 9.f........... ..........................
has permission to perform ...... ........Oum. ...,p ...............................
e?
wiring in the building of..... 1. ....I IL......................... ti
(v:....... ver
at...........................5.... .. ?..........?...... .... Oorth Ando ss.
oo
Fee... .....:...... Lic.No/./.1. -6..... 72
C0(, LECTRICAL INSVECT'0R***-***
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer