HomeMy WebLinkAboutMiscellaneous - 186 SANDRA LANE 4/30/2018 (2)N
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TOWN OF NORTH ANDOVER
IT* PERMIT FOR WIRING
This certifies that .............. ...............
has permission to perform..Jr_ r H2
wiring in the building of
...........
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��orth AM
ECTRICAL IN
Fee. Lic. ......
............. . .. ..... ..... .....
ECTOR
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Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIC
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APPLICATION FOR PERMIT TO P
All work to be performed in accordance with the Mas:
(PLEASE PRINT IN INK OR t
City or Town of.
By this application the undersigi
Location (Street &,Nqmbejr)
Owner or Tenant
or
Official sp
Permit No.
Occupancy and Fee Checked /
S [Rev. 11/99] leave blank
:ORM ELECTRICAL WORK
etts Electrical Code (MEC), 527 CMR 12,PO
Date:7/U&,/
To the Inspector e Wires:
to perform the electrical work described below
Telephone
Owner's Address
Is this permit in conjunction with'a building permit? Yes ❑ No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Arrps / 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:
Installation of Security system
("n- I,f,.,., Pi h. f 11.,...:,,,, f,.1.1- . 1... ...,. .,.a G...r__ ■_____._ -r
No. of Recessed Fixtures
No. of Cell: Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
AboveIn-
Swimming Pool rnd. ❑ rnd. ❑
o. o Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. 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
g
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 O�
No. o Water KW
Heaters
No. of No. o
Signs Ballasts
Data Wiring:
I No. of Devices or E uivalent
No. Hydro,-rassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail iJ desired, 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 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 ❑ (Specify:)
(Expiration Date)
Estimated Value of Elpetripl Work: (When required by municipal policy.)
Work to Start: 6�3 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the pain andpenalties of perjury, that the information on this application is true and complete.
FIRM NAME:Security LIC. NO.: 1q1-1(,
Licensee: John S. Bassett Signature LIC. NO.: 1533C
(If applicable, enter "exempt" in the license number line.) Bus. Tel. No.• 603 594 5928
Address: Alt. Tel. No.:
OWNER'S INSURANCE WAIVER: I am aware that the Li , see 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
Signature Telephone No. PERMIT FEE: $ ,
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