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Home My WebLink AboutMiscellaneous - 2350 TURNPIKE STREET 4/30/2018 (5)I A Date ...... mo.x ..... TOWN OF NORTH ANDOVER 4�"Us� � I This certifies that. ......... / has permission to perfo b wiring in the building of ........... at ,�� . .....5Z7..... . PERMIT FOR WIRING .............. ........ .... ............................ ............ . North Andover, Mass. Fee.1a Lic. No .. . . . .... . ... ........................................................ F _ - ELECTRICAL INSPECTOR (-'heck # , k 5280 G Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked u,p [Rev. 11 /99] leave blank APPLICATION FOR PERMIT/TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 r (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: IV, AndQ()e.� 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)A?,GJQ 7 -n6[ Ke `�+) , Owner or Tenant Telephone No. W - Owner's Address 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 f Proposed Electrical Work: Hass cu In-jV\4-cu% e 0e,1P,Li Completion of the following table may be waived by the Inspector of Wires: No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans o. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool rnd. Above ❑ n- rnd. ❑ o. omergency gng Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection an Initiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers eatum Totals um er ons .......... o. oSelf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal n icipl Connection El No. of Dryers Heating Appliances KW SecuritySystems: No. of Devices or Equivalent No. of aterK`,1, o. o o. o nn Data Wiring: Heaters Si ns BallastsJtS No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications r ng: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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 coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE *Ft] BOND ❑ OTHER ❑ (Specify:)R+P lo—C)4 (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) `� ork to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: r'1 Ce- IIo-r^ C.i y r LIC. NO.: -q (,, Licensee: Signature (If upplicub/e, enterer�"exempt " in the license numb r linej Address: (� ` a\ke c.Vt r Csi bY? OWNER'S INSURANCE VAI ER: I am aware 4hat theLicensee doe, required by law. By my signature below, 1 hereby waive tht`3 requirement Owner/Agent Signature Telephone No. LIC. NO.: Bus. Tel. No.:5c tis �cl-,-4Qgrj (� Alt. Tel. No.: not have the liability insurance coverage normally I am the (check one) ❑ owner ❑ owner's agent. PERMIT FEE: $' 100, 0iD MASSACHUSETTS UNIFORM APPLICATION FO�� dv OW or Typal R PERMIT TO DO OASFITTINO Mass Date 19 -?z Permit # Building Owners Namelop / �% yQDd�2 Ty a of Occupancy Llood ere, New p Renovation Replacement p pi Plans Submitted: Yesp No'd. (4 installing .a y' G Buslim " Teleph6ine — 3 f Name, of UcCnsed Plumber or Gas FKter - Z;4 .S INSURANCE COVERAGE: I have aYrrent liability Nlnaumnce policy or Its substantlal equivalent which 11 If you have checked y.g, please Indicate the type coverage by checking th A IWAll y Insurance policy g_ Other type of Indemnity O OWNER'S INSURANCE WAIVER: I am aware that time licensee Chapter 142 of the Masa. General Laws, and that my signature on Signatum-Of or rs Agent E -1 Check one: 10 Partnership i O Firm/Co. . i the requirements of MGL -Ch. appropriate box. Bond O I hereby certimy that all of the details and Information I have! rbmitted (or entered) In above 41 =e and that all plumbing work and quw Installations performed under the peIssued for provisions of the Massachusetts State Gas Gide and Chapter 142 of � of Ucense: >we Plumber na ra t3astitcer , . gty/Town license Numbe IIPi' ` Z the Insurance coverage roqufred `by application waives this requirement, Check one: K3 Agent ❑ true and aonuate to tM beat of etc on will be In oomplianoe with ant ��s�■u��■��o��■qua .a y' G Buslim " Teleph6ine — 3 f Name, of UcCnsed Plumber or Gas FKter - Z;4 .S INSURANCE COVERAGE: I have aYrrent liability Nlnaumnce policy or Its substantlal equivalent which 11 If you have checked y.g, please Indicate the type coverage by checking th A IWAll y Insurance policy g_ Other type of Indemnity O OWNER'S INSURANCE WAIVER: I am aware that time licensee Chapter 142 of the Masa. General Laws, and that my signature on Signatum-Of or rs Agent E -1 Check one: 10 Partnership i O Firm/Co. . i the requirements of MGL -Ch. appropriate box. Bond O I hereby certimy that all of the details and Information I have! rbmitted (or entered) In above 41 =e and that all plumbing work and quw Installations performed under the peIssued for provisions of the Massachusetts State Gas Gide and Chapter 142 of � of Ucense: >we Plumber na ra t3astitcer , . gty/Town license Numbe IIPi' ` Z the Insurance coverage roqufred `by application waives this requirement, Check one: K3 Agent ❑ true and aonuate to tM beat of etc on will be In oomplianoe with ant 0 aFl 110j 1p; # Date .............. ....... 7 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ........... has permission for gas installation .......... in the buildings of .............. ....... ................... at .................. ....... North Andover, Mass. Fee..-.,. Lic. No...... .......................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File 40 Date ....... L i. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that has permission to perform ......g 6z LLR.................... wiring in the building of ..... ......... q��)P ..... ............ ... ..... . ..... .. ....... at �al . ......... . No Andover, Mass. Fee.12-:5. Lic. No. ................. .. ....... ELECTRICAL INSPECTOR Check # 9,39 c s l,ommonweallh of Madlackueetb a p.,tment of 5ire Jervice9 BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Pen -nit No. q1/131 Occupancy and Fee Checked [Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK \11 work to be performed in accordance with the Massachusetts Electrical Co e (MEJ); 527 CMR 12.00 (PLEASE_ PRINT. City or I By :his application t Location (Street & Owner or :tenant ON%ner's :address is this permit in conjunction with a building permit? 1'es ❑ No ❑ Purpose of Building L.istin Service New Service _ (Check Appropriate Box) Utility Authorization No. Amps i Volts Overhead ❑ Undgrd ❑ Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity h Location and Nature of Proposed Electrical Work: e No. of Meters No. of Meters Completion of the following table may be x;aived by the Inspector ofWires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above In Swimming Pool Qrnd. grnd. El : o. o mergency ig mg Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of S-41 itches No. of Gas Burners No. of Detection an Initiating Devices No. of Ranoes � No. of Air Cond. Total Tons No. of Alertino Devices b No. of ��'aste Disposers Heat Pum \umber Tons .................... KW No. of Self -Contained Totals Detection/Alerting Devices No. of Uishvcashers Space/area Heating KW Nlunicipal Local ❑ Connection ❑Other No. of Urgers Heating Appliances K�(r Security Systems:* No. of Devices or Equivalent No. of WaterK"; No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassa a Bathtubs g No. of i\Iotors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired. or as required by the Inspector of Wires. Estimated \' al4m,lesswaived ik: (When required by municipal policy.) \\"ork to Start:Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE by the owner, no pen -nit for the performance of electrical work may issue unless die 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. C'H.FCK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certiji•, under the pains and penalties of pet jury, that the information on this application is true and complete. FI RN NA)IE: C► LIC. NO.a Licensee:ae& c Signature IC. NO.- % 73 7) nppliecrL/e, enter "esem t " in the Lice se nr n?be .'li{re. Bus. Tel. No.. - Address:, ;%/t . �i1( Alt. Tel. No. "Per M.G.I_. c. 1-17, s. 57-61, security work requires Depa -hent 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 tequircd b_,• laic. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's anent. Or%ner:'.Ahent Si-Inature _ _� Telephone No. PERWIT FEE: S ,