HomeMy WebLinkAboutMiscellaneous - 1650 TURNPIKE STREET 4/30/2018 (5)tr�
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Date ..... 15-0w-44�(
.............................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .........................................................
has permission to perform ............. ........
91
wiring in the building of ....... .....................................................
...... . . ........... . North Andover, Mass.
Fee ... 7� ....... Lic. No
—ELECTRICAL INSPECTOR
Check #
5248
1
�a
Commonwealg of V a4eacltuielb
2eparintent o��ire �ervice4
BOARD OF FIRE PREVENTION REGULATION
Official Use
Permit No:
Occupancy and Fee Checked
,ev. 11/99) tl��.•F t,i ,t•�
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Mass3cllus6ls Electrical Code (EIEC), 527 CMR 12.00
(PLEASE PRINT LV INK OR TYPEALL INI"ORAL 1 TION) Date: �ig �� a2 7
City or Town of: &t44n ig ndo UCS` To the Inspector of 1,gyres:
By this application the undersigned gives notice of his or her intennfion to perform the electrical work described below.
Location (Street S Number) '7"urn ;A4ntS7�rPe T'S ID
Owner or Tenant t...k> �yrt< fen Telephone No. p t
Owner's Address . -_l %8 7 i /✓ /op
Is this permit in conjmtctioti with a building permit? Yes ❑ No
ySl (Check Appropriate Box)
Purpose of Building . Utility Authorization No. Sas�j/s"
Existing Sery ice Amps / Volts Overhead ❑ Undgrd 19 No. of Meters
New. Service Amps / Volts Overhead ❑ Undgrd
❑ No. of Meters,
Number of Feeders and Arnpacity 760 /A.10. Va)*
Location and Nature.of Proposed Electrical Work: L�CD�facere (�/Qd 3 ��9NEL.•
lOoq .tet .
-
No. of Recessed Fixtures
-
No. of Ceil: Susp. (Paddle) Fans
•• ..� •.au vcu aY' !aC 117J CCIoI' O/. 11'!IY'S.
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Swimming Pool. Above ❑ In ❑
o• o mergency tg tting
rnd. rnd.
Batte Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALAR1tIS \'o. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiatin Devices
of Ranges
Totallo.
No. of Air Cond. Tons l
No. of Alerting Devices
1\'0. of 'Waste Disposers
Heat Pump
Number
— - -
'Tons
-
K�V_
- -''
No. of Self -Contained
Totals:
Detectiotl/Alertinc, Devices
No. of Disin'vashers
Space/Area Heating KtiV
Local ❑ IVluuicipal
EJ Connection Other
No. of Dryers
Heating Appliances KW
Security Systems:
No. or Water
No- or f
o' o•
No. of Devices or Equivalent
Ileatcrs KNV
Sins Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or E uivalent
OTHER:
n uucn uuu utuna[ autau l aesirea, or as required by the Inspector of (Vires.
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 X BOND ❑ OTHER ❑ (Specify:)
Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date)
Work to Start:--$- — Q + Inspections to be requested in accordance with MEC Rule 10, and upon completion.
Icertify, luetler the pains and penalties ofperjury, that the information on this application is true and complete.
FIRA I NAI\•IE: i 1 Q 1'L ���`t-f`t C.. �k— LIC. NO.:__'Qq&'_ /_,�-
Licensee: 445
(If applicable, en
Address:
OWNER'S IM
required by law
Owner/Agent
Signature
W 1'CgCVE QAV Signature & C4A_kA,4_LIC. NO.:
T •'ewnlpt " in the license number line.) Tel. N o. 97&' 741i12Si7 V
Alt. Tel. No.:
U RANCE WAIVER: I am aware that the Licensee docs not have the liability insurance coverage normally
By my signature below, I hereby waive this requirement. I am the (check onc) ❑ owner ❑ owner's agent.
'Telephone No. P1Rt1fIT FEE: S
ROUGH Fimm nel
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