HomeMy WebLinkAboutMiscellaneous - 185 MAIN STREET 4/30/2018I
I
Date ..... .—..JS '41.
TOWN OF NORTH A VE
p PERMIT. FOR WIRING
This certifies that
has permission to perform p �/T �� 8 f�- ` `
..............................................................
wiring in the building of ....... U �' c- we ...................................................................
/� / 7 4,jlp sT
at...../l....................................... ........................ , North Andover, Mass.
Fee.. Sir. PIC9.... Lic. No %...... .
ELECTRICAL INSPECTOR i
Check # 1 G 1
66,
Commonweafm o/ Maoeaejwelb Official
Use Only
2eParimen1 o/sire.y.rVic89 Permit No. Ct Zf
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 1/07) (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: 2 Z d
City or Town of: 00 AOL Uel 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) /ham'—/ 77 I-MYA) -S i'
Owner 'or Tenant
Telephone No.
Owner's Address _ Al C
Is this permit in conjunction with a building permit? Yes ❑ No �� (Check Appropriate Box)
Purpose of Building �alel/t N� Utility Authorization No. 6 7-9'9 Z.GO
Existing Service /Od Amps /Zo / 240 Volts Overhead 2— Undgrd ❑ No. of Meters Z
New Service 2.00 Amps /2V / 2'70 Volts Overhead �-v Z
!� Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: e1OtfiCC
y 109446 e ±e 200 �9blP ,, l
Adam aaaaronat detail y aestred, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
,( Work to Start: Z - Z 3 —D 9 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
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 cover a is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE Q BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury, that the informationon this application is true and complete.
FIRM NAME: LIC. NO.:
Licensee: p TSiture LIC. NO.:(Ifapplicable, enter 'gxempt" in the license number lineBus. Tel. No.•
Address: 2- i(5P.//ZSe ALJ t'_ l�{GN , O / &' `f Alt. Tel. No.:9 79,47 ZSf Z O
*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 11owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $
tv -01, V [riC Jullumnx
more may oe waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. or Tota
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑ n- ❑
o. of Emergency'Ughung
rnd. grnd.
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS INo. of Zones
No. of Switches
No. of Gas Burners
o. 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:
-umber..
ons. ......._,
NCof elf- ontaine
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ unicipa
❑Other
Connection
No. of Dryers
Heating Appliances KW
SecuritySystems:*
No. o Heaters KW ater
No, o aas
Signs Ballasts
No. of Devices or Equivalent
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
TelecommunicationsWiring:
No. of Devices or Equivalent
OTHER:
Adam aaaaronat detail y aestred, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
,( Work to Start: Z - Z 3 —D 9 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
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 cover a is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE Q BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury, that the informationon this application is true and complete.
FIRM NAME: LIC. NO.:
Licensee: p TSiture LIC. NO.:(Ifapplicable, enter 'gxempt" in the license number lineBus. Tel. No.•
Address: 2- i(5P.//ZSe ALJ t'_ l�{GN , O / &' `f Alt. Tel. No.:9 79,47 ZSf Z O
*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 11owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $