HomeMy WebLinkAboutMiscellaneous - 220 BOSTON STREET 4/30/2018 / 220 BOSTON STREET
2101107.6-0032-0000.0
L
Date...`" .��.....
a
NOR7M i
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
�,
,S3 CHUS�
This certifies that � �' �• � ......n..z........
.�.!.,.�.r..,.�:.........
. .�:....!
has permission to perform .... �f/L !... G �.. '`
wiring in the building of.. !. Vlz.�-�'�. ..
................
North Andover,Mass.
Fed.:./.. ..0�. Lic.No��. 1.�,1 r- .- !:. . .., 1. ?. //� .....
ELECTRICAL INSPECTOR
Check #
1117
5822
Oficial Use
Commonwealth of Massachrr efts � ��
Department of Fire Sere as Permit No.
Ooalpaacy and Fee Chedcal-���t./ '
• BOARD OF FIRE PREVENTION R ULATtONS ev. 11/991 lave�)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All wok to be palramed in the 14umh seas EWrical Cate(W&Q,s27 CMtt 12.00
(PLEASE PRINT IN INK OR TYPE AU IN.O TION) Date:
City or Town ot: vel' To the Ir1�ipdar of Aires:
BY this application the undersigned gives notice o his fe her intention to perf rrn the electrical work down ed below.
Location(Street&Number) c9-10 }
Owner or Tenant Mi fit'S Tri. h(4 Tdq&=*No. -K-0-9:39
-1?-9:39
Owner's Address
Is this permit in eoeiaaetien wia a buM ng permit? Yes ❑ No (Check Appropriate Box)
Purpose of Building etc.,1 C�e Intg Utility Authorization No.
Eidsting Service,2W _ Amps Lam. /'14Q Volts Overhead Undgrd❑ No.of Meters i
New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
Number of Feeders and Ampacky
Location sad Natare of Proposed Electirics!Work:
edon 0fdef01&Wfttable be watvad the I oroWins.
No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans Transformers KVAI
No.of Lighting Outlets No.of Hot Tabs I Generators KVA
No.of Ligating Moves Swhmming Pool d Above ❑ ❑ loattery Units
No.of Recxptade Outlets Na of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gua Burners °hdda- tin Devices
No.of Ranges No.of Air Can& Ton No.of Akrting Devices
No.of Waste Disposers Tons oho WAleinatrting DWhm
No.of Dishwashers Space/Area Hating KW Loaf ❑ = ❑ Other
No.of Dryers Hag ces KW Na or 'qqrvslat
No.of Water KW o. o.o Dab q+htag;
Beaters $' Ballasts o.of Devices or t
No.Hydromassage Badrtabs No.of Motors Total HP No.of Devices or t
OTHER:
.ldaciraid deeorti(fdairr�torarragaQr+adkrlwhgpec rgfWn=
• INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical wurk may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies,that such cavaW is in farce,and has exlu'bited proof of same to the pennit issuing office.
CHECK ONE: INSURANCE 9 BOND ❑ OTHER ❑ (Specify: rreOU :2he Lo co
( Date)
Esdmated Value ofEledrieal WddC �� WheQ municipal icy.)
( re4�I►9 p�
Work to Start lagwWons to be requested in accordance with MEC Rule IQ,and upon completion.
I ca*,uada the antdpwafta of po ury,thud the lefonnadon on Ibis gppH aadiott is true and cgaode.
FIRn+I NAME: -rnme � lectriCal derv; Qs,-.., -X�- UCNo.: 1511G +\
Licensee: VIn lgmrrc �V Signature LIC.NO.: K9 i
•. "inure monberline -
9'70
Bus.
Td.Na•
Address: 'C`0�x �i�M�ct e�c /lam Old }� Alt.Td.Ne.• ` Z.
r OWNER'S SURANCE W • I am aware that the Licensee does not haPe the liability iastaamice coverage normally �!.�p,C�C-:.r•
1 si below I waive this airemefrt. I am the(dredc one ❑owner ❑owner's
_ Owner/Agent PE1�IIT r'E�S ��� .
v Signature Telglhoae Na .r