HomeMy WebLinkAboutMiscellaneous - 189 Rosemont Drive � �9 /�����o��
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The Commonwealth of Massachusetts office Use only
3.:..� Department of Public Safety
Permit No.
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BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 oaw
Panty 3 Foe Check /.
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APPLICATION FOR PERMIT TO PERFORM ELECTRIC
An wok to be performed In&=rdu40 with 04Massecnusens Eteciveal code.U7 CMR 1200 ELECTRICAL ®RIC
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION
Date
City of Town of '
The undersigned applies for a permit to perform the electrical work described below. To the Inspector of Wires:
Location (Street $ Number) 7` Zv
Owner or Tenant�L Z ,?7(J n• o
Owners Address
Is this permit in conjunction with a building permit
yes ❑ no J9
Purpose of BuildinX144 Utility Authorization No. (Ch-.k Appropriate Box)
Existing Service Amps----f--_Volts
Overhead CD Undgrd ❑ No. of Meters
New Service Amps f Volts
Overhead Cl Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nat-le, of Proposed Electrical W r
o ,
No.of fighting Outlets Na. of Hot Tubs TOTAL
KVA
No.of Liohtin Fixtures Above((''--��In INo. of Transformers
Swimmin Pool rnd.LJ rnd❑ Generators
No. of ReCaotacle Outlets No. of Oil Burners No. of Emergency Lighting KVA
Battery Units
No. of Switch Ovtiq s No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Ranges No. of Air Conditioners TOTAL TONS No. of Detection and
HEAT Initiating Devices
No. of Disposals No. of Pumps TONS TOTAL No. of Sounding Devices
KW No. of Self Contained
No. of Dishwashers Soace/Area Heating KW Detection/Sounding Devices
No.of 0 ars Heatin Devices Municipal
KW Local ❑ Connection ❑Other
No. of Water Heaters KW No, of Na. of Si ns low Voltage
Ballasts Winn
No.of Hydro Massa a Tubs No. of Motors Total HP
OTHER: '�
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ I ha_ave submitted
valid proof of same to this office. YES ❑ NO ❑
If you have checked YES, please indicate the type of coverage b checking the o - r;
9 Y g appropriate box.
INSURANCE ❑ BONO ❑ OTHER ❑ (Please Specify)
Estimated Value of Electrical Work $ SEP 3 0 1996 (Expiration Date)
Work to Start Inspection Date Requested: Rough - -" -
Signed under the penalties of perjury: Find
FIRM NAME
Licensee LIC. NO. e
6' D Signatuur h D
Address r. ,� S( / 3Q �'3 ��_�!!���7�C`11.5�� Ti¢r11� LIC. NO
Bus. tal. No.&4&:3 .Z 7 ��J
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its subst ntial equivalent as required b
Massachusetts General Laws, and that my signature on this application waives this requirement. Owner Agent (Please check one y
(Signature of Owner or Agent) Telephone No. PERMIT FEE $ ��y�
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Date . ......... ..
. 2 487
i�, t NORTFr,
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
'. ;�SSACHUSE�
This certifies that ........-....
� ��'JCA!
�r
has permission to per
wiring in the building of......... 4�... . ......:�41. . ..5...:..................................
....
at...... ..n.......R..0.5.c:(�'.°.`�.............t/.R.:. ..... ,Nor/Anove s.
Fee �.LC04.. Lic.No. . T. S,. ........... c.a.../ . .... . .. ......
ELECTRICAL INSPECTOR
l/ 04 PAID '
WHITE:Applicant CANARY: Building Dept. PINK.Treasurer