HomeMy WebLinkAboutMiscellaneous - 2350 TURNPIKE STREET 4/30/2018 (9)I
.x
I
Date .....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ............... P4
....................................................
-7-1
has permission to perform .......... oel ..... ...........................
....... ....
wiring in the building of ..... ............................................
at ...J. 3.� -0. 7. j.&A r ..... *"North Andover, Mass.
Fee:�m.
-�—... Lic. No..Lq.q�.6311........1. . . . ......... .... *"*** . . I....
LEcrRicAL INSPECTOR
Check #
10667
commenwaaa of Xudac"Ib Official User Only
1Japarfmanf o�.}%ra Jarvica9 Permit No. 10 � 6 7
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/07] 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
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 211 y 11 Z
City or Town of: MM &AR&2g _ 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) 27UR4P1KC ST
Owner or Tenant
L -L C_
Telephone No.
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 / Yolts Overhead ❑ Undgrd ❑
New Service Amps / Volts Overhead ❑ Undgrd ❑
Number of Feeders and Ampacity
No. of Meters
No, of Meters
Location and Nature of Proposed Electrical Work: 195T*LL Fr `qQ %I — 17-0[20;? JD, -7- ,7sat;L�f5�z,,,P,_
TTD 'I-6-Mi0612-1 AZq ' OVEIZI P=—)to SeIQVicc; 'fb T6hAP —fi tL.62
COmDletiOn afthe fallowing table may hp wnivpd by the /ny ..m, of Wi—
No. of Recessed Ltiminaires
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA 1>
No. of Luminaire Outlets
No. -of Hot Tubs
Generators KVA
No. of Luminafres
Above ❑ n- ❑
Swimming Pool rnd. rnd.
o. o Emergency Lighting _
Ba Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
I No. of Zones
No. of Switches
No. of Gas Burners
o. o etect on an
InitiatingDevices
No. of Ranges
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
eat Pump
Totals:
N er
ons
o, oSelf-Contained
Detection/Alerting Devices
_ `
No. of Dishwashers
Space/Area Heating KW
Local ❑ un cipal ❑ Other
Connection
No. of Dryers
Heating Appliances KW
Security ystems:*
No. of Devices or Equivalent
No. of Water KW
Heaters
o. o o. o
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
elecommunications %Vinng:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
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 ® BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury, that the information onthis icado is true and complete.
FIRM NAME: A\ 10 kLECrrRt CA L C0wr1ZACT1 }i{a LIC. NO.:
Licensee: DAV ID 4 A C GAR Signature �C. NO.: 14 9(P 3 A
(If applicable enter "exempt " in the license number line.) Bus. Tel. No.:T5279.3"
Address: I �L,1�'1r?iv - 5�" NCJRT 1�kNUOilE2 t�i8 AIt. Tel. No. T 7Q-�7• �
*Per M.G.L. c. 147, s. 57-61, security work requires Department 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
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: $