HomeMy WebLinkAboutMiscellaneous - 21 DUDLEY STREET 4/30/2018Date ........ !0.-../.P.-.07
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
i
This certifies that ........ al Sjq.a7 T E f/r C'E
has permission to perform ............
wiring in the building of ................�l .v.....
................................
at ............. 1....avpL�Y Sr-
..... ............................................. .North Andover, Mass.
j 153.E
..... Lic. No..�..(...!.9...�.�Fee...... %
6 ELECTRICAL
s........ .
INSPECTOR
Check # --s 70 7 79
7705
6
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C v�nonmaaCth c�^�A� Official Use Only
cc''77�� ��JJ Permit No.
`7 %D -S�
_Uapa.4na,cf o�Jira �irvirad
Occupancy and Fee Checked _
BOARD. OF FIRE PREVENTION REGULATIONS [Rev. ]/07] leave blank)
APPLICAT.'ON FOR PERMIT TO PERFORM ELECTRICAL WORK
All work -to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMP,X11c,
(PLEASE PRINT LV,i TK OR TYP L FORMATION) Date: C
City or Town of: To the Inspector of Wireg:
By this application the undersigned gives no ice o. his of her intention to perform the electrical work described below.
Location (Street & Number)
�`Z
Owner or Tenant
Telephone No. 4,2k ZJ-r--01 f
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No n (Check Appropriate Box)
Purpose of Building
Existing Service Amps / Volts
New Service Amps / Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Utility Authorization No.
Overhead ❑ Undgrd ❑
Overhead ❑ Undgrd ❑
No. of Meters
No. of Meters
e. G u r 7q
Li 5re/n
Completion of the following table may be waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
r o uta
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool gAbove ❑ n- ❑
rnd. grnd.
o. o mergency Lighung
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
o. oetection anInitiating Devices
No, of Ranges
No. of Air Cond. Tonal
No. of Alerting Devices
No. of Waste Disposers
P
eat Pump
Totals:
um_er
ons
_...•._' - --
o. oSelf-Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances KWSecuritySystems:
* L
No. oT Devices or Equivalent
No. of Water
Heatrr.�
No. of No. of
Data Wiring:
No. of Devices or E uivalt4ii
No. Hydromassage Bathtubs
No. of Motors Total HP
7 eTecnamunications R'irrng:
No. of Devices'or Equivalent
p
OTHER: /9 CZZ .(el
/ Attach additional detail if desirec4 or as required by the Inspector of Wires.
Estimated Value of Elect ical Wo G —m - (When required by municipal policy.) .
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE OV RAGE: 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:)
1 certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: Ptb—T Se -Curt: Sc recces LIC. NO.: S3 3
Licensee: /7 r1. 774//o/z- Signature IC_ NO.: /C
(If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: J S9G
Address: /9 t? L ( t(./T- 1 be- c /i(S .UH °- Alt. Tet. No.:
*Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. S C= Gr
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
Signature Telephone No. PERMIT FEE: S WAD