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HomeMy WebLinkAboutMiscellaneous - 23 SECOND STREET 4/30/2018 3r 8 Date. �l .....-22,7..&.2, TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING CHUS This certifies that ........................ Y ............. . ..................... ............... has permission to perform ................................................... wiring in the building of .......�z.A.........Ti�......................................... at ....... .... .. ........Z.,............................... .North Andover,Mass. - tii Fee .............. Lic.No�.?.Pzz�� ...... ...................... ELECTRICAL INSPECTOR Check 4 i •++Z—\ Off[cc Use Only The Commonwealth of Massachusetts -� Parris Xo: Department of Public Safety Occupancy 6 Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 3/90 (leave flank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Massachusetts Electrical Code, S27 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORHA 'ION) Date 6 — z,9 ^0 Z City or Town of /VQr4 dA,40V it To the Inspector of Wires: The undersigned applies for a permit to perform the lectrical work described below. Location (Street ik Number) Z //sC© Owner or Tenant ! e fLc)r r\170 h Owner's Address �P✓1 Is this permit in conjunction with a building permit: Yes ❑ No (Check Appropriate Box) Purpose of Building ' Utility Authorization NO. _ Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters New Service Amps / Volts' Overhead ❑ Undgrd❑ No. of Meters Number of Feeders and Ampacity Location and Nature of ProQ�osse�d Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Above In- g g Swimming Pool grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No. of pumps Total Total Tons KW No. of Sounding Devices ' No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local❑ Municipal ❑Other Connection No. of Water Heaters signs No. of Ballasts Low Voltage Wirng No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirement;s of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES O NO[J .I have submitted valid proof of same to this office. YES❑ NO 0 If you have c ked YES, please indicate the type o overage by checkin th�propriate ox INSURANCE BOND ❑ OTHER ❑ (Please Specify) f l- (/ Exp' ation Date Estimated Value'of Electrical Work $ Work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury: r /� r q FIRM NAME �� l C l E� G J- LIC.LIC. N0. Q4 �� C Licensee lger e_X- S/i nature LIC. N0. Address 7 xL td Que sg !, //'X Bus. Tel. No._ Alt. Tel. No.�7 — /� OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S Signature of Owner or Agent