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HomeMy WebLinkAboutMiscellaneous - 1770 SALEM STREET 4/30/2018I Date ........ Of , &O °TM 0 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING SSA�MUS� This certifies that ........m....R,41'..'C......................................... has permission to perform ....... i 7 ' ........C' t' ................. wiring in the building of ..:....%`?�'� Gam: . ................................................................. 7 7© $;� S .. .. , North Andover, Mass. at............................................................ a - Fee:35.....�....... Lie. No.3..��. ............... ..... ............. ......:.4. E[.�crx�cn�. INsracroR Check # 7355 Commonwealth of Massachusetts - Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. > Occupancy and Fee Checked [Rev. 1/071 (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: #ILO 7 City or Town of: NORTH ANDOVER 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) 1776 &%«. S f Owner or Tenant Heal doe n Telephone No. Owner's Address -50'^'4L Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps New Service Amps Number of Feeders and Ampacity Volts Yes e— No ❑ (Check Appropriate Box) Utility Authorization No. Overhead Undgrd ❑ No. of Meters Volts Overhead ❑ Undgrd ❑ No. of Meters Location and Nature of Proposed Electrical Work: A otd Floc. LY of( Completion of the following table may be waived by the Inspector of 14, res. 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 ❑ In- 1:1o. rnd. rnd. o Emergency Lighting Batter Units No. of Receptacle Outlets / No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 3 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 Heat Pump Totals: Number Tons KW No. of Self -Contained 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 Heaters No. of No. of Signs Ballasts ata Wiring: 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, or as required by the Inspector of N"ices. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Oph7 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C VERAGE: 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 0— BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of erjry u, that the information on this application is true and complete. FIRM NAME: -en.. VlKt 9�•�wr- LIC. NO.: Licensee:"Izomos X. &1JPW- Signature —174010.4 x Rae(& LIC. NO.: 336-704 (Ifapplicable, enter "exempt' i the licens n:mz er l'ne.) Bus. Tel. No.•tW' Y67'"91Y Address: l OW / d. fOee 24.E : / iv 4336S-3 Alt. Tel. No.: '0 3 JOW - 79,? *Per M.G.L c. 147, s. 57-61, security work require 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, 1 hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ SignatureturaTelephone No. m 2 Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING. This certifies that ........................... has permission to perform-.-..... .......... .... . plum,bing in the buildi9n s of .... . . . . . . . . . . . . . ' at. . °' ............ Nqrth Andover, Mass. Fee t, Lic. No .......... % ........... PLUM BIPINSPECTOR Check 731 4 MASSACHUSETTS UNIFORM APPLI (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location 7 Of New 1:1 Renovation 13/ Replacement n TION FOR PERMIT TO DO PLUMBING Date Permit # Amount mss. Plans Submitted Yes F1 No 11 (Print or type) Installing Company Address e 1<" RncinPsc Telenhnne Check o Certificate i Corp. a_5-.7 J" 11 Partner. Firm/Co. Name ofLicensed Plumber: Insurance Coverage: Indicate the of insurance coverage by checking the appropriate box: Liability insurance policy12 Other type of indemnity 11 Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations pajormed under P it Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Stqpelumbin hapter 142 of the Ge 1 Laws. By: Signatureamicensect riumBer e of Plumbing License Title City/Town icen e um , Master �anJoume ❑ APPROVED (OFFICE USE ONLY