HomeMy WebLinkAboutMiscellaneous - 22 APPLEDORE LANE 4/30/2018 (2)I
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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ........ ........ L/Q.�%.! ... V..r.n. .................
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has permission to perform ......
wiring in the building of .............
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at .......... ..................... Z Nor ' th Ando,rass.
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Fee ... Lic. ..................
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Check # ELEcriticAL INsPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
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BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Official U e Only
Permit No. `P S
Occupancy & Fee Checked
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 51i27 CMR 12:00
(Please Print in ink or type all information) Date L I i 2 i-) m�
To the Insfor of Wires:
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number AiiL6,'�C,)Q -F / N Z A, I,\ -
Owner or. en=t 6 - oo iz. c " n f s
Owner's Address
Is this permit in conjunction with a building permit r Yes ❑ No E (Check Appropriate Box)
Purpose of. Buildinx Utility Authorization
Existing Service Amps Voits Overhead ❑ Undgrnd ❑
a New Service Amps Voits
Number of Feeders and Ampacity
G Location and Nature of Proposed Electrical
No. of Lighting Outlets
No. of Lighting Fixtures
No. of Receptacles Outlets .
No. of Switch Outlets
No. of Ranges
~ J, No. of Diposal
No. of Dishwashers
J
No. of Dryers
No. of Water Heaters KW
No. Hydro Massaqe Tuds
No. of Meters
Overhead ❑ Undgmd ❑ No. of Meters
No. of Hot fuse
Above ❑ In ❑
Swimming Pool grnd ❑ grnd ❑
No. of Oil Burners
Generators KVA
No of Gas Burners
No. of Emergency Lighting
Total
No of Air Cond
Tons
Heat
Total
No. Pumps
. Tons
of
No. of
of
KVA
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO =
have submitted valid proof of same to the Office YES= NO = If you have checked YES please indicate the type of coverage by checking the appropriate box.
INSURANCE = BOND = OTHER = (Please Specify)
Estimated Value of Electrical Work$ (Expiration Date)
Work to Start Inspection Date Resquested Rough Final
Signed under the Penalties of perjury:
FIRM NAME LIC. NO.
Lfgensee Signature LIC. NO.
Bus. Tel No.
Address Alt Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
UK
Agent)
No. PERMITTEE $ ��"
Generators KVA
No. of Emergency Lighting
Battery Units
FIRE ALARMS No. of Zone
No. of Detection and
Initiating Devices
total
KW
No. of Sounding Devices
No./ of Self Contained
KW
Detection/Sounding Devices
❑ Municipal ❑ Other
KW
Local Connection
Low Voltage
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO =
have submitted valid proof of same to the Office YES= NO = If you have checked YES please indicate the type of coverage by checking the appropriate box.
INSURANCE = BOND = OTHER = (Please Specify)
Estimated Value of Electrical Work$ (Expiration Date)
Work to Start Inspection Date Resquested Rough Final
Signed under the Penalties of perjury:
FIRM NAME LIC. NO.
Lfgensee Signature LIC. NO.
Bus. Tel No.
Address Alt Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
UK
Agent)
No. PERMITTEE $ ��"
F,