HomeMy WebLinkAboutMiscellaneous - 18 EQUESTRIAN DRIVE 4/30/2018 (4)Oy)
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OFFICE PHONE # (908) 388-8129
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Department of Pt�biie Safety permit No.
I
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Occupancy '& Fee Checked
3/90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
A![ work to be performed in accordance with ate,masmchuse^.s Electrical Code. 327 GvtR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORNIAr,n.n_ .___.. - .__ ..____ .___
Dace
�t
City or Town of ✓" D 61V b0 VS n&, To the Inspector or Wires:
The undersigned applies for a permit ;o perfor he electrical workI escribed below.
Location (Street S. Number)
Owner Tenant
Owner's Address
Is ;his permit in conjunction •.%t h a building permir. Yes No I_i (Check Appropriate Box)
Purpose of Building Utiiiv./ Authorization No.
Existing Service Amps r Voirs Overhead ❑ Undgrd 1:1No. or Nleters
New Service -\raps / Volts Overhead ❑ Undgrd ❑ No. of vteters
Number of=eeders and .•km.paci(v
Location and Nature of Prooused Electri,:a1 Work
OTHER:
INSUR.•1NCE COVERAGE: Pursua ;o ;he requirements of ,mai;achusnes General Laws
I have a current Liability Insur c' Poficy including Completed Operations Coverage or its substantial equivalent. YES
of same to ;his orrice. YES NO
If you have checked YES. p ease indicate the type or coverage by checking the appropriate box.
INSURANCE FOND ❑ OTHER❑ (Please Speciry)
V,0
Estimated Value of Electrical Work S )500.,=
Work to Start `�� `� Inspection Date Requested: Rough
Signed under the penalties or perjury.
Final
have submitted valid proof
(Expiration Date)
FIR,v1 NAME ��--++ iN ! N� `- ,O � � l -v N 1 r LIC. NO.
Licensee2b Gl P- M X1.960 U l Signature UC.QNO.Q t001613
Address P-0 S 0 X, (0-1(,o B'us. Tel. No: /%g-32 -94,53 .
OWNER'S INSURANCE WAIVER: Am aware that the Licensee oes not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one)
00
Telephone No :PERMIT FEE S
(Sistnatvre of Owner or Aarnn
TOTAL
No. of Li¢hrin¢ Outlets
I No. of ^ or Tubi
I No. of Transformers KVA
iin.
❑
(�
Nn. of L i¢hrin¢=ixturei
/ Jam'
Swimmtn¢ Pool ¢rnd.
yrid.
�_
Generators KVA
No. or Emergency Lignung
No. of Receotar.!e Outlets
I No. or Oil Burners
I Barte-v Units
No. of Twitch Outlets
I No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Initialing Devices
No. of Sounding Devices
No. or' ,Ranees
otai
No. or' Air Condirione', Tons
No. of Disooiais I
Heat ow,oa, r
?limos
`°, of ion;
K`+N
No. or Seif Contained
No. of DishwashersI
Soace�1.raa Hearin¢
,�,;,/
Cete^ronrSo ding Devices
vtunicioai
-]Other
No. of Olivers
Heatin¢ Devices
K'+v
Loc31l/�J Connection
No. or No. or
Low Voltage
No. of'Nacer Heaters
K':v Siem Sailas,
I
4yirin¢
No. Hvdro Niassa¢e Tubs
I No. of ,vlotors Tota( HP
OTHER:
INSUR.•1NCE COVERAGE: Pursua ;o ;he requirements of ,mai;achusnes General Laws
I have a current Liability Insur c' Poficy including Completed Operations Coverage or its substantial equivalent. YES
of same to ;his orrice. YES NO
If you have checked YES. p ease indicate the type or coverage by checking the appropriate box.
INSURANCE FOND ❑ OTHER❑ (Please Speciry)
V,0
Estimated Value of Electrical Work S )500.,=
Work to Start `�� `� Inspection Date Requested: Rough
Signed under the penalties or perjury.
Final
have submitted valid proof
(Expiration Date)
FIR,v1 NAME ��--++ iN ! N� `- ,O � � l -v N 1 r LIC. NO.
Licensee2b Gl P- M X1.960 U l Signature UC.QNO.Q t001613
Address P-0 S 0 X, (0-1(,o B'us. Tel. No: /%g-32 -94,53 .
OWNER'S INSURANCE WAIVER: Am aware that the Licensee oes not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one)
00
Telephone No :PERMIT FEE S
(Sistnatvre of Owner or Aarnn
T W3
N2 14,9
Date .......A.. A. /7. ?rr
TOWN OF NORTH ANDOVER ,
PERMIT FOR WIRING a
This certifies that ...... T rh C ... : ......
has permission to perform
...... ....... Rx. M.. J. Q. I...............
wiring in the building of...... Ma.k..�h ....... (-- MAq/ ............................... .
... . Z M
Y 2
at ......... ..... F-7 ......�.........Q....' ............... . North Andover, Mass.--
Fee....Y0. Lic. Nol..WT ..............................................................
ELECTRICAL INSPECTOR
6 11J-7?�
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
v
01 4z Lfummuniuraith of gusz#urtts
&PMtnzn1 of Vuhl.ir f-afitq
BOARD OF FIRE PREVENTION REGULATIONS 527 VJR 12:00
Office Use Ont
Permit No. ,7_
Occupancy A Fee Checked
3190 peave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12*100
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date �
(XW or Town of NORTH ANDOVER To the Ins ctor of Wires:
The udersigned applies tar a permit to perform the electrical work described below.
Location (Street & Number) yr
Owner or Tenant/—
Owner's Address ,Fes- e6i lew
Is tits permit in conjunction with a building permit: Yes. _ No � (Check Appropriate Box)
Purpose of Buildina Utility Authorization No.
Existing Service Amos Vcits Overhead _ Unagrnd lot"No. of Meters
New Service Amps _J Voits Gverheac _ Uncg;na _ No. of Meters
Numoer of Feeders ana Ampacity
Location aria Nature of Prccosea Elec:ncal :NarK
H i No. at :ranstormers local
No. oc _:gnttng Outlets I No. _. :.ct ':Cls KVA
No. at Lighting Fixtures i Swimming Pao, �o. _ Srnc. _ I Generators KVA
No. of Emergency Lighting
No. at Recectacie Outlets No. at Cif 'Burners I Earery Units /
No. at Switch Outlets
No. at Gas Eurners
I
FIRE .ALARMS No. of Zones
No. of =e[ecttan Ano
I
No. of Ranges I No. at Air Corc. Tota,
tons
In,uaung Oavtces
No. at Sounaing Oev,ces
No. of Se,t Containea
!I
No. of Oisoosais I No. --r Heat Tata, Tota,
Pumas Tons KW
No. of Oisnwasners -
! SoaceiArea Hearing rg
K
OemcnanrSouncing Oev,ces
Local Mun,cioa, —7 Other
_ Connection _.
No. at Oriers I Heauna Cev:ces KW
'' No. at No. at
Law voltage
No. of Water Heaters KY1
i Signs 9adas;s
Wiring
+
No. Hycro Massage Tubs
I No. at Motors Tota, FiP
OTHER:
INSURANCE CCVErIAGE: Pursuant ;o trio reau,rements of Massacnusers genera, Laws
I have a current Liao,iity Insurance Poiicy inc!uctng C--mc:etec Ocerauons Czverage or :is suostantial eeuivaient. YES = NO = I
have sucm,rea vatic proof at same to the Cttics. YES = NO = It you nave checxea YES. please :no,cate ;he type at coverage Cy
checx,ng the approor,ate cox.
INSURANCE = SCNO = OTHER = (Pease Scec:fy)
� GB (Expiration Octet
Esttmatea Value of E!ectncai Work S
¢ Worx :o Start Insoecaon Oats Racues;ac• Rough Final
Slgnea unser the Penalties of perjury:
FIRM NAME UC. NO.
Licensee _ E iL IV € � r 2 / �Q R)Signature A / LIC. No. /•2 7 y 7 S�
Acaress �� �✓ / �= SfFC �✓ i7�
m
OWNER'S INSURANCE WAIVED: I am aware that the _:tens a Claes not nave th?tn.u,!Nnc...v�d�03 tanttai e(3!valent as re.
ouirec by Massachusetts General Laws. aria that my signature on :n:s aermte aopt:cauon waives this reemrement. Owner 11.5— Agent
-retecnone No. :& 7 7.S�D PSAMIT FEE S '
ignature wner or Agen c•3�n5
Date ... {1/9 J��
1127
A
N0..EE
3i°�' `` tiooLTOWN OF NORTH ANDOVER
p A' PERMIT FOR WIRING S
,SSACMUSE�
This certifies that �' . Z
...................................................................................
has permission to perform ..... ... . ",s.............. ......... ......... ...
Pd
wiring in the buildin of ... ............ .. .... ............................... ..
at ..... ��................. ...-:.....�-..-.-..--. ...... . , North Andover, Mass
fir/
Fee...`�-.�....t........... Lie. No..... .......... �..................................................
ELECTRICALINSPECTOR
7 14:43 35.00 PAID
y
m-iITE: App cant QCANARY: Building Dept.
Location
No.
��
Date
TOWN OF NORTH ANDOVER
I
I
Certificate of Occupancy $
Building/Frame Permit Fee $ 7d, CW
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $��
Building Inspector
Div. Public Works
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