HomeMy WebLinkAboutMiscellaneous - 148 MAIN STREET 4/30/2018 (44) A. I
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y Office Use Only
;;;;(( (� ��t �,,,j•�,� {{.��,�, Permit No.
Him 11 (90mm0ntuml �j 1f '.111t�,�n ettg Oxupartcy b Fee Checked
1 1)evurtmCttt of public %&tp 3l90 (leave blank)
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12.00 Ward
Area
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 / j
(PLEASE PRINT IN INK OR PE ALL INFOR ATIO Date 3-;2`T-qly n
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City or Town of !I 41 To the Inspector of Wires: M
The undersigned applies for a permit to perfor the ele9trical work described below. O
Location (Street 8. Number) ,, �D �
Owner or Tenant L I N DA FA P,1 A
v
Owner's Address z
Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box) I
z
Purpose of Building Utility Authorization No. m
Existing Service Amps—1 Volts Overhead El Undgmd 1:1 No.of Meters o
New Service Amps_l Volts Overhead ❑ Undgmd ❑ No, of Meters ::a
C)
Number of Feeders and Ampacity a
Location and Nature of Proposed Electrical Work I n s t a 113 t i o n of alarm s y s t e m
No.of lighting Outtets No.of Hot Tubs No.of Transformers Total
KVA m
Above In- I
No,of Lighting Fixtures Swimming Pont gn-id Elgrnd. D Generators KVA mv_
/ No.of Emer g C>
J gency Lighiin Z
No.of Receptacle Outlets No.of Oil Burners Battery Units n
O
No.of Switch Outlets No.of Gas Bumers FIRE ALARMS No.of Zones
No. of Ranges No.of Air Cond. Total No.of Detection and
tons Initiating Devices C)
Heat Total Total
No. of Disposals No.of o
Pumps Tons KW No.of Sounding Devices
No.of Self Contained z
No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices v
M
No. of Dryers Heating Devices KW Local Municipal Other �
vection ❑
No.of No.of Low Vollage n
No.of Water Heaters KW Signs Ballasts Wiring C>
No. Hydro Massage Tubs No.of Motors Total HP 1/l R-6
OTHER: v
11 7 m
m
z
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INSURANCE COVERAGE:'Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy includ- rM
Ing Completed OperationsF Coverage or its substantial equivalent.YES O NO Q 1 have submitted valid proof of same to the Office. n
(� YES O NO O If you have checked YES,please indicate the type of coverage by checking the appropriate box. i
INSURANCE M BOND O OTHER Q (Please Specify) 22n
1 (Expiration Date) Di-
Estimated
Estimated Valuef Elect .cal Work 5 / c 7
Work to Start �. Inspection Date Requested: Rough Final �— 42 O
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Signed under the Penalties of Perjury:
FIRM NAME a LIC. NO. 2 31(r
Licensee Signature LIC. NO.
Address 60 William 8t./Wellesley, MA 071 13 I Bus.Tel.No.617-431-5800An,Te1,No.b I 7=4'31=9R37--
lf, ER'S
,ONVNER'S INSURANCE WAIVER:1 am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re-
,' p. ,(�C.4 ed bfl.Masaadxuetts`General Laws.and that nV signak"on.this lhis
Permit appicatb^waires regtrlrert►enl Owner __ Agent
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Telephone No. PERMIT FEE$ /
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Date......
.� >r 2954
NORTI{
6 TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
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certifies that ..........A. ip
.. �............. ...`............t.. ...............................
This certiL
has permission to perform ........";-C.(.........j¢..19�R`. '! .............................. M
wiring in the building of..... q 1'-�s....o
at....f. ff....1/l�lGL.`. ^.....5T...................................North Andover,Mass. M
Fee. .... Lic.No.J :-)& —
ELECTRICAL INSPECTOR
C`l ' (66 Ci
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File