HomeMy WebLinkAboutMiscellaneous - 177 Andover Street�
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Date....:.:!.-...
pOR7N 'I
o� TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
,SSACMUS�
This certifies that .....
. ........ .
has permission to perform ................T..,TT
T �.
.... .......
wiring in the building of ./lJITfJl �4!-�C�T
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at ........ . . n .r1� .....5/ ................... .. .North Andover, Mass.
Fee .l. ..". Lic. Nd. 7 .%.�i��.......A
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ELECTSPECTAR
Check # '
8926
\ l omi»onureaith o�c�l7/�as�ac%u�elf� Official Use
OOnly
oUeparfinent o�.}ire �ervice9 Permit No. [.1 F � �`
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07) eaveblank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLE4SE PRINT IN INK OR TYPE
City or Town of: / Y on
By this application the undersigned v
Location (Street & Number) I
Owner or Tenant
Owner's Address
INFORMATION
AQ_'_1)averL
ice of his or her intention
AN -wove -l< Sr
Is this permit in conjunction with a building permit?
Purpose of Building
Date:
_ To the Inspector of Wires:
to perform the electrical work described below.
Telephone No.
Yes ;y No ❑ (Check Appropriate Box)
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:��
7'% n'1 eAcC.,rt
Completion of thefollowing table may be waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Ceil.-Soap. (Paddle) Fans
o. of Total
Transformers KVA
No. of Lumivaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑ In- d. El
d. rn
No. o tte Units ig ng '
No. of Receptacle Outlets 0
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
Tons
No. of Alerting Devices
No, of Waste Disposers
eat Pump
Totals:
Number
I Tons IKW
No. of Self -Contained'
Detection/Alerting Devices
I
`M
No. of Dishwashers
Space/Aren Heating KW
Local ❑ Connectioumctpan ElOther
No. of Dryers
Heating Appliances KW
ecurity Systems:
No. of Devices or Equivalent
No. of Water I
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or E uivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications firing:
No. of Devices or E uivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Valu of lec cal Work: YI (pJ (When required by municipal policy.)
Work to Start:/a q 1 Qcj Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE RAGE: 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 F1(Specify:)
I certify, under thepains and penalties ofperjury, that the information on this application is true and complete- .
FIRM NAME: R I C i aE Le- G1 Lk '-A (— N LIC. NO.: 17 4 A
Licensee: ,i(pVVN,t7—u Signature LIC. NO.: YO
(If applicable, enter "exempt"i the license number line. Bus. Tel. No .•
Address: 110 d A7 L$�►� <r f" CAVA_ M Alt. Tel. No.: 97f -' tom' 714-1
*Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No.
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
wner'sa ent.Owner/Agent PERMIT FEE: $ /Z4'Signature Telephone No.
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