HomeMy WebLinkAboutMiscellaneous - 157 LACY STREET 4/30/2018 157 LACY STREET
210/105.D-0063-0000.0
a Date.... c�. .�.
NORTIi
°ft�``°;°•'"° TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
ACMUSES
This certifies that .......; ��t..j�.! -.........../% ���. �'�
...... ...........................
has permission to perform ......S. r�.s..c: .......
1/�4
` ............................
wiring in the building of.... .P...(. ..................................................
sat.... ................7 R f.yl.....5 .'............. �E=R�i&AIL
North Andover,Mass
.... .
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Fee.. ..s....'....... Lic.No .f? ........... ,-.IX....'.. ......... .
INSPECTOR
Check # O !
5082
Official Use Only
Permit No.
Occupancy&Fee Checicd
BOARD OF FIRE PREVENTION REGULATIO 527 CMR 12:00
APPLICATION FOR PERMIT T PE . ORM ELECTRICAL WORK
All work to be performed in accordance with a Ma dlusetts Electrical Code 527 C R 12:
(Please Print in ink or type all information) Date 0
Tv the I n s p 'tor 6f'rllrir ea:
Town of North Andover
The undersigned applies for a permit to perform the elect al work described below.
Location(Street&Number 5rmC
Owner or Tenant too u -e
i
Owner's Address
Is this permit in conjunction with abuilding permit Yes 0 No (Check Appropriate Box)
Purpose of Building 5( Utility Authorization No.
Existing Service / Amps�Voits
/ Q Volts Overhead 0 Undgmd a No.of Meters
New Service L/ Amps Overhead 0 V Undgmd 0 No.of Meters
Number of Feeders and Ampacity �'IQ I(�V C6 v to 0 i`v d7
Location and Nature of Proposed Electrical Work
Total
No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA
Above 0 In 0
No.of Lighting Fbdures swimming Pool gmd 0 gmd 0 Generators KVA
P No.of Emergency Lighting
No.ofReceptacles Outlets No.of Oil Burners Battery Units
No.of witch Outlets No of Gas Burners FIRE ALARMS No.of Zone
Total No.of Detection and
No.of Ranges No of Air Cond Tons Initiating Devices
Heat Total Total
No.of Di 1 No. Pumps Tons KW No.of Sounding Devices
NoJ of Self Contained
No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices
0 Municipal 0 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:
a
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I havt!a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES=NO a
have submitted valid proof of same to the Office YES= NO - If you have checked YES please indicate the type of coverage by checking the appropriate box.
INSURANCE - BOND - OTHER - (Please Specify)
(Expiration Date)
Estimated Value of.Electrical Work$
Work to Start Inspection Date Resquested Rough Final
Signed under the Pznalties of perjury:' T 7,�
FIRM NAME V -eG� LIC.NO. & ✓�
" ' TC/ •
Licensee J 7�V'� �J Signature LIC.NO.
B
Address 4 �i C�i81� ' us.Tel No.
Add Ad Alt Tel.No.
OWNER'S INSURANCE WAIVER: I am aware t at the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws.And that my signature on this4>ermit application waives this requirement. Owner Agent (Please Check one)
Telephone No. PERMIT FEE $ i
(Signature of Owner or Agent)
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