HomeMy WebLinkAboutMiscellaneous - 19 HALIFAX STREET 4/30/2018 19 HALIFAX STREET
j 210/026.0-0010-0000.0
1
�I
I
i
r�
Dater Z.7.—1?/
r
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that . . . . f. . :Sh .�< . �. . . . . . . . . . . . . . . . . . . . .
has permission to perform /,� .. . . . . . . . . . . . . . . . . .
wiring in the building of . . J: !..... . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . . r/.,y. . . �.. ,. �f.a. . . . SfJ . . . . ,N^ AndovertTO ,Mass
ic. No. , yy33 .
i ELECTRICAL INSP
t
Check#/3G Z_3
G
11119
1 - _
t
1 Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank
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 W INK OR TYPE ALL INFORMATION) Date: 7 ?-7%Z
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)
Owner or Tenant T. %Z dj r o ,'/�' „ Telephone No.
Owner's Address f -C
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service ?!GG Amps l /L Yui 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:
Completion o the following table maybe waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
r
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above n- ❑ o.o Emergency Lighting
rnd. rnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Tons TotNo.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
p Totals: Detection/Alerting Devices
No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other
P g Connection
No.of Dryers Heating Appliances KW Security Systems:*
Y No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
a Hydromassage Bathtubs No.of Motors Total HP Telecommunications
No.H Wiring:
Y g No.of Devices or E uivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: / -Z7/z_ 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 cove�BoND
orce,and has exhibited proof of same to the permit issuing office.
CHECK ONE: 1NSU_RANCE ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: . -t5 le LIC.NO.:
Licensee: o ^¢ /, Signatur L7f—
Lice
7f— : 133
(If applicab e, ter "exempt"in the license number line.) Bus.Tel.No.: �_7
Address: X Alt.Tel.No.:
*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 ❑ owner's agent.
Owner/Agent PERMIT FEE: $
Signature Telephone No. 7.�
s
r
�nsp ectQxs'copame�ats: '
fflispmforesignatuz'e-) fmilfials) .^ Pate
'asse +aiTecl--� exnsectiox�xecaize ( 0.00)- [
�n�ieetox¢'c4 exits: '
( spe toxs'�'zgnature 0 7�ztia date
'assetl--� azIe�--j
Re-imp actiop-repirea($6OA Q). �
aspectors'coxnxaents: '
[lnspectoxs',�ignatuxe��o ina`tas)
Date .• .
V!i CAI WATI ONAL O , ::
ssel.--jailer--[ e-znspectiox�xequixe ( �O.OD) ( .
, ectbrs'
Commits,
6aspectoxal,mature-io jUlfgals) Pate
r ,
�i�Py-'tCJl1,�d'I"�A.f11vJ:3:� • ` •
'ed�� � �'azzerl�•( �- 'ate�nspectiottzec�uiretl(��d,OQ)•-[ �
BCtors9 C4M7Ci1�I1�9:
5
a spectors' zgnatuxe m Jnitials) Plate '
�M TA 0-s a P'W.rVn ITrr.T.Vla a-►TM ate►.M.Pre nv ..Q-rmv.w qw.���A Ira'R*W,MRp'Rpgpp.yl x.q lrn*-p