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HomeMy WebLinkAboutMiscellaneous - 1600 OSGOOD STREET 4/30/2018 (61) 1I� I I i i I { i I I I i uper TabsOvwdnd%Fddm I 90%LargerLabeTArso I wmvdWIPNUw I� 1000 05boo& �1 rSup;r.T9bOverszeaid s 90%Larger Label Area ••M�.►o S M EAD KEEPING YOU ORGANIZED Na 10501 awep - " tls&b U$A GET ORGAN®ATSMEAMCOM low 'y —/8-0 '7 Date.................................. t N°RTM 1 3:;•_';,`'° ma TOWN OF NORTH ANDOVER o p PERMIT FOR WIRING �7SgACMUSE� This certifies that d Yf t.: . ��tG � ......................... ................................................. has permission to perform ©� F �iT v� ................. ../�...'.................................................. wiring in the building of.©x :f...x...:.1...66 5 �`d2 .. ...! ....'........ -5,—.... North Andover,Mass. at...................... A ..... ............ f, Fee.../25 . Lic.No..��.�D .! ........... ./.. �h.!.!�......... -^� ELECTRICAL INSPECTOR Check # 2 7166 Commonwealth of Massachusetts Official Use only ' Permit No. Department of Fire Services Occupancy and Fee Checked 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 INFORMATION) Date: 111-1 l a-i City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intentio to perform the electrical work described below. Location(Street& Number)M0 OS ppa Street HOOPS Utz tAope. Owner orTenantI6l00 aloo Si( LLL oz1y P4e!!Y HAvAMCh -;dTelephoneNo IR-"s- 5 t Owner's Address 3 OQ,\-Ace Pc,04 AN"61 Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters New Service f S v Amps 1.10 / 109 Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: w,k Lo") 20 l 2,1A Ro CYL �40 2; Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above E] In ❑ o.o 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 Tons g No.of Waste Disposers Heat Pum Number Tons KW No.of elf- ontamed Totals Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: !� Attach additional detail if desired, oras required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 1 0-+ 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 cov age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE M BOND ❑ OTHER ❑ (Specify:) I certify,under tli wins and penalties of perjury,that the information on this application is true and complete. FIRM NAME: M,`..L ELe4rtiC Co , Xwc LIC. NOALS03A Licensee: 1,QP,%4 %C =�P i (`C'S Signature ,S' LIC. NO.: (If applicable, enter "e�p in the license number linea Bus.Tel. No.:1.03-IL5" 7a2, Address: 1 �� U2 �c.��M . :�•M ©a&C) Alt.Tel. No.: *Security System Contrac'or License required for this work; if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, 1 hereby waive this requirement. 1 am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $/�— o- r` ti