HomeMy WebLinkAboutMiscellaneous - 1600 OSGOOD STREET 4/30/2018 (87) 1600 Osgood Street \
Building#34
Date...... .:.. :'?...... ..�....
NORTI,
°ft"'°;• '"° TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
,SSACMUS
This certifies that ! „.O GC v eeg/'
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has permission to perform ......... .1. ?�!�r�t...... T�/. ..
wiring in the building of.... ........................................................
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................... . ................................................ .North Andover,Mass.
Fee...L110:�.p.. Lic.No. 1.4..233 4,
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LECTRICALINSPECCOIC
Check # SP- 3
8 ,109
-^Of-cial-Use Only
Commonwealth of Massachusetts
-
Permit No. �
- Department-of Fire Services
Occupancy and Fee Checked 1
BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] 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 JXFORMI TION) Date: L- (o- p 8
City or Town of: To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below. `
Location(Street&Number) L00 6-oo lt.. S e e,'i" Ru1' i # Ury
Owner or Tenant Z,Zpmpt or,C+S Telephone W.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No �, (Check Appropriate Box)
Purpose of Building no �CTVrl 11q Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Completion o the ollowin table may be waived by the Inspector of Wires.
rl of
No.of Recessed Luminaires No.of Ceil: TransSusp.(Paddle)Fans Total
Trsformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ o.of Emergency Lighting
rnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
g Tons
No.of Waste Disposers Heat Pum Number Tons KW No.of Self-Contained
Totals Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ other
Connection
No.of Dryers Heating Appliances KW Security yyf Devimc:or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or E uivalent
it No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsNo.of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: ,� (When required by municipal policy.)
Work to Start: I Q.b Inspections to be requested in accordance with MEC Rule 10,and upon completion.
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 ❑ (Sp ' :)
I certify,under the pains and penaltieserjury,that the info ton n th'as- e and complete:
FIRM N OGC.O O �p-
LIC.NO.: 2.133
Licensee: C A t Signatur IC.NO.: I ZZ
(If applicable,enter "exempt"in the license number line.) Bus.Tel.No.: Wp 2g�-
Address: OU Alt.Tel.No.: 41!1. 7 I
*Security System Contractor License required for this work;if applicable,enter the license number here:
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 ------- --- ------