HomeMy WebLinkAboutMiscellaneous - 166 Pleasant Street ��
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0 PERMIT FOR WIRING
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Thiscertifies that ......... ......................... .. .............................................
has permission to perform ............ .......................................
wiring in the building of...... .:.. t.:.., ........................................................
at..... CS!. ......!.:..<..� .`�.C!.u. ................/z",North Andover,Mass
ELEC RICALINSPECTOR
Check #
Commonwealth of Massachusetts official use(W3
rtment of Fire Services Permit No_ (�
O« piney and Fee CheckedOn
0
BOARD OF FIRE PREVENTION REGULATIONS Rev. 11/99] aem blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),327 CMR 2.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:
City or Town of: .�ll� . q��, „� To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the ectrical, ork described below.
7-1
Location(Street&Number) �� � `f q(1 �Q.ap1-140AVI AXIII
1 ,5
Owner or Tenant (U Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Bog)
Purpose of Building 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: -r
t P/ 0 <SE AL10A) ice,r.
compledon the o table=be waived by the kmor0owes.
No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans NO.of
Transformers KVA
No.of Lighting Outlets No.of Hot Tabs Generators KVA
No.ofLighting Fbft 5� Swimming Pool arnd, El d. El Ba 01 Imergency Lipting
atto Units
No.of Receptacle Oats No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.o n and
Initiating Devices
No.of Ranges No.of Air Cond. T Tons No.of Alerting Devices
No.of Waste Disposers Heat Number Tons No. Self-Contained
Totals• Detection/ . Devices
No.of Dishwashers SpaedArea Heating KW Local ❑ Connection ❑ Other
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No.of Dryers Heating Appliances KW Sec No.o=- or Equivalent
No.of Water
of No.of
Beaters KW °• Ballasts oZ Data Wiring:
signsNo.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunicationsuvrg•.
No.of Devices or valent
OTHER: 7 ��-�.w�-�, -�`v`�s_
Attach additional detail tjdes1red,or as required by the Inspector of Wires.
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 opeaatioe coverage or its substantial equivalent The
undersigned certifies that such is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE 77B ND ❑ OTHER ❑ (Specif3r)/Werc 4 a n fS mss_ 3 as o3
Date)
Value of ec�i Work. Q< O t7(When required by mtmicilydl p�cy)
Work to Start: a$ Inspections to be requested in accordance with MEC Rule 10,and upon completion
I certify,under pains and penaJdac ofpedkry,that due Wormatat on this qqd a don is flue and compkie.
FIRM NAME: ui, ofij/v rl, C LIC.NO.:
licensee: i9(I L QJ9 j I ) Signa LIC.NO.:
(Ijapplicable enter" "t the] a line) Bns.Tel.No.- o3-y.P3-;t
Address:37/ /.fi'f'e a f/ IQ dOOks g Nf-1 0310 6 Alt.Tel.No.:
OWNER'S INSURANCE WAI • 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 nt
Owner/Agent
Signature Telephone No. PERMIT FEE:$ QO, 4