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HomeMy WebLinkAboutMiscellaneous - 25 COMMERCE WAY 4/30/2018 (10)N° 3472 7 7 Date.....f...�l..�..... r ._ °."`° TOWN OF NORTH ANDOVER • OL p PERMIT FOR WIRING This certifies that T` , �� �' ".. T .............................................................................................. ; ias permission to perform 0'' /f- t (� r a'' d�� t wiring in the building of .......... ...'......`....................................................... r i/ r �� �� 'gat .........�.............`.....�.................. �.......�....... A ,North Andover, Masi. Fee.../..:.(h..... Lic. No. ........... ......................................�.................... ,.- / / ELECTRICAL INsptcrOR Check # Y/J WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 1 1 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 1-17 Occupancy and Fee Checked [Rev. 11/99] 1 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: City or Town of: Qn Ond'CwP,� To the Inspector of Wires: By this application the undersigned gives notice of his nr her intention to perform the electrical work described below. Location (Street & Number)c Owner or Tenant :n co I u's P- S 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 / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: + fl Vlty),(4 i(dJ,(m ( A)i rin 5 Completion of the followink table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil.-Sus . Paddle Fans P (Paddle) r s Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above e ❑ 1 rnd. ❑ No. of BatteryUnits rg ag No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. Initiatintegon an Devices No. of Ranges No. of Air Cond. Tonsl No. of Alerting Devices No. of Waste Disposers P eat Pump Totals: Number Tons o. o elf -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Conncect on [I Other No. of Dryers rY Heating Appliances Key Security Systems: No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: !)( No. of Devices or uivaleht" r No. Hydromassage Bathtubs No. of Motors Total HP firing: Telecommunications.ofD Devices or No. of Devices or uivalent OTHER: Attach additional detail V desired, or as requirea Dy the inspector ql 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 BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work. + U (When required by municipal policy.) Work 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: �P,1l �C , Y yk 1'Y1 I(,� , �t� _ ., LIC. NO.: Licensee: 50., l; N (if applicable, enter "exem Address - 0 W N E R_' ddress:OWNER' INSURANI required bylaw. By my Owner/Agent Signature ?&!/� ko/L/— Signature _ LIC. NO.: " in the license number line.). us. Tel. No -F09 6_S3-_ c� 77 Alt. Tel. No.• E WAI ER: 1 am aware thaU a Licensee does not have the liability insurance coverage normally gnature below, 1 hereby waive this requirement. I am the (check one) ❑ owner—[]owner's a ent. Telephone No. PERMIT FEE: $ r, ACQR- CERTIFICATE OF LIABILITY INSURANCE DATPIMM/DDNYI 12/04/2001 PRODUCER CS08) S86-5310 FAX (508) 559-S113 Cushman Insurance. Inc. 1796 Main Street P.O. Sox 31109 Brockton, MA 02304 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGRTS UPON THE OERT)IFICAT€ HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED Tele -Dynamics, Inc. 56 Manley Street West Bridgewater, MA 02379 INSURER A: Kemper Insurance Co. INSURER B: Arnella Protection Co. INSURERC: INSUREH D: INSURER E: THE POL)CJES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A80VE FAR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 70 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTTAR TYPE OF INSURANCE POLICY HUMBER POOAL;£Y EFFECTIVE POLICY EXPI ; yj L=T. A GENERAL LIABILITY X COMMERCIAL GENtRAL LIABILITY CLAIMS MADE D OCCUR KPZOS021-09 01/01/2001 01/01/2001 EACHOCCVY—RENCE 3 11000,0 FIRE DAMAGE (Any yne 14.0 S S00,000 MED EXP (Any ane person) } lO 000 PERSONAL 8 ADV INJURY S 1- 000.000 GENERAL AGORECATE S Z, 000, 0pp GCN'L AGGREGATE LIMI f APPLIES PER. X POLICY JECT LOC PROIIVCTS - COMP/OP AGG a 2,000,000 AUTOMOBILE LIABILITY ANY AUTO 3342400001 03/27/2001 03/Z7/2002 COMBINED SINGLE LIMIT (Eeecomant) ALL OWNED AUTOS B X X SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per person( $ 1,000,00 X NUN -OWNED AUTOS BODILY INJURY S (Per accldenl) 1,000,000 PROPERTY DAMAGE 1; (Pct accldtl»0 1.000 00 GARAGE UAStLITY AVTC> ONLY - EA ACCIDENT S ANY ALI ro EA ACC E OTHER THAN AUTO ONLY. AGC 5 EXCESSLIA91LITY X OCCUR CJ_ AIMS MAZE 3SX12717102 01/01/2001 01/01/2002 EACHOCCURR£NCF $ 51000,000 AGGRCGATF S 5.000.M A DEDUCTIBLE X KETENTION S s S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY CL942793-01 12/31/2000 12/31/2001 X jTW4DC4V4.4M1US1 V L, EACH ACCIDENT S 500,600 A E.L. DISEASE - EA EMPLOV[ • S SOO, 000 C.L. DISEASE - POLICY LIMIT 1 2 1 000 OTHER 1000, DESCRIPTION OF OPERATIONS/LOCATIONBNEHICLESfEXCLUSIONS ADDED BY ENDORSEMENTrSPECIAL PROVISIONS Aerations usual to the business of the insured: Private Telephone Systems - Sales, Install & Service SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL lO DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Texon , USA BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSC NO OBLIGATION OR LIABILITY ZS Con-unerce Way, Suite 2 OF ANY !GNO UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Frederick Lane 7 «� ACORD TS -S (7/97) ©ACORD CORP ION 19RB I .N2 3 4 6 Nor+rM 3? e• .P - -.... ° 0 10. A SSAC14US�� Date ...1 171 ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ` - � 6 1 ` , ( C � i7 , C4 ! 446 (fommonwea[g of ) adjac1LWelfd Official Use Only _V cc� ��77 mit No. 4. p� - .�LJeRarfinenf o`.}ire �ervice� Per BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Rev. 11/991 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrics Code (NIEC), 527 CNIR 12.00 (PLEASE PRINT IN INK OR TYPE ,ILL 1NFORALITION) Date: City or Town of: A/D, f%VLz5t eV_ To the Inspector of Wires: By this application the undersigned _Ives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 2 �V � ay1 7- � Owner or Tenant j�=�.�� Telephone No. Owner's Address Is this permit in conjunction with a building, permit? Yes No 1 ❑(Check Appropriate Box) 1'w liosc of Building Utility Authorization No. Existing, Service Amps / Volts Overhead ❑ Undgrd ❑ No. of dieters . New Service Amps _ / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: _%G iY/V 7— Con Conr letionoftlreKolb bl Allacn aadltional detail f desired, or as required by the Inspector of ;Vires. 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 cover m ge is ih force, and has exhibited proof of sae to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ O'HIER ❑ (Specify:) - I () t Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certifj•, under the pains and penalties of perjug that the informatiolr oil this application is true and complete. FIRJII NAME: Gr t-8 IPA e_G�-6 e .Se—f'/ C LIC. NO.: S y (10 Licensee: LV�,� Stb"'A,Signature LIC. NO_ � �t``9, d (If applicable, enter "erg nrp!" in the license number line.) a'^Bus. Tel. No..A1S 3,9%-'7SSr] Address:3/ P,1e51Sf/.t./1r_Y/1G-Alt. Tel. No.: y /6"P, OWNER'S INSURANCE WAIVER: I ant aware that the Licensee does not have the liability insurance coverace normally required by law. By my signature below, I hereby waive this requirement. I am the (check onc) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. FP7iR3IIT FLE-: SOao,� nrur la r may oe wan•ea ov Ilre 1Jrs error of Wires. No, of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above ❑ In- ❑ Swimming Pool t o. o mergeucv rg rUrrg rrtd. rnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALAR -111S No. of Zones No. of Switches No. of Gas Burners r`(o. of lletectiorr and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices a No. of Waste Disposers Heat Pum p Number Tons — K�V No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Localt�lullicipal ❑ Connection El Other No. of Dryers Heating Appliances KW Security Svstems: No. of Water No. of No. of ?`:o. of Devices or Equivalent Heaters KW g Si ns Ballasts Dam ►✓iriug: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total. I P Telecommunications Wiring: No. of Devices or E uivalent OTHER: Allacn aadltional detail f desired, or as required by the Inspector of ;Vires. 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 cover m ge is ih force, and has exhibited proof of sae to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ O'HIER ❑ (Specify:) - I () t Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certifj•, under the pains and penalties of perjug that the informatiolr oil this application is true and complete. FIRJII NAME: Gr t-8 IPA e_G�-6 e .Se—f'/ C LIC. NO.: S y (10 Licensee: LV�,� Stb"'A,Signature LIC. NO_ � �t``9, d (If applicable, enter "erg nrp!" in the license number line.) a'^Bus. Tel. No..A1S 3,9%-'7SSr] Address:3/ P,1e51Sf/.t./1r_Y/1G-Alt. Tel. No.: y /6"P, OWNER'S INSURANCE WAIVER: I ant aware that the Licensee does not have the liability insurance coverace normally required by law. By my signature below, I hereby waive this requirement. I am the (check onc) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. FP7iR3IIT FLE-: SOao,� A Date. /J D . G/ .. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �.� /V-/SSACMUS� This certifies that s ��?- =! . t !-..................... . has permission to perform . r*. `^ �-f-`�;''.�:�............. . plumbing in the buildings of ... . --L. ............ . r /� at�� ..�--!............ 1}'`''� .. , No h Andover, Mass. 04l �7 1�f Fee-�':�i.... Lic. No.�! 7L � .. ... 1, ! .,,._. -rte.. . ..... . PLUMBING INSPEC OR Check # J "1"T(/ v 5018 MASSACHUSETTS UNIFORM APPLICATION FOR�PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS 6'V f Date % Building Locationa -T- �c)�e'%� Owners Name �°�"%iQ/ co r -, Permit '3ZIT Amount Type of Occupancy. n T4 -"`c1714' X C"'.e 4 / � "„5-C New Renovation 13- Replacement Plans Submitted Yes No (Print or type) / Installing Company Name_a A+(A zi P 4's P f"1 Check one: Certificate ❑ Corp. Partner. Firm/Co. Name of Licensed Plumber: } r-� Pre- r ? d,$ G Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy n Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 13 Agent El I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Ma sach is State PI fig Code and Chapter 142 of the General Laws. BY: Tgneaure oi Liceffseal-m er Type of Plumbng License Title /%3 City/Town icense lNumner Master Journeyman ❑ APPROVED (OFFICE USE ONLY I M1 (Print or type) / Installing Company Name_a A+(A zi P 4's P f"1 Check one: Certificate ❑ Corp. Partner. Firm/Co. Name of Licensed Plumber: } r-� Pre- r ? d,$ G Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy n Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 13 Agent El I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Ma sach is State PI fig Code and Chapter 142 of the General Laws. BY: Tgneaure oi Liceffseal-m er Type of Plumbng License Title /%3 City/Town icense lNumner Master Journeyman ❑ APPROVED (OFFICE USE ONLY vj. N s e Date .... ....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION N This certifies that ...r .................. & I has permission for gas installation' .-..-4—.. in the buildings of . / ......................... at'. .,,North Andover, Mass. Fee. Lic. NO.A) I -ell, . ............ ............ GAS INSF 9CTOR Check# 3 Ur' 14 Y MASSACHUSETTS UNI TFORM APPLICATON FOR PC, RNIIT TO DO G.� FITTING ype or print) Dt e , 4c)�, NORTH ANDOVER, MASSACHUSETTS Building Locations �J �[ i� �� q e Permit 9 Amount S Owner's Name New ❑ Renovation Replacement ❑ Plans Submitted ❑ (Pint or type )+ � Check one: Certificate Installing Company Name P V�+I ,C\ kI zz—,5 � 1� ❑ Corp. Address ❑ Partner. Business TelephoneFL— /� � _ 7 '��� LWFinniCu. Name of Licensed Plumber or Gas Fitter ��-l? '77744Q ' 0 INSURANCE COVERAGE Check ne: I have a current liability Insurance pcate olicv or it's substantial equivalent. Yes 4u No❑ di If you have checked ves. please inthe type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: [ am aware that the licensee does .not have the Insurance coverage required by Chapter lq21 of the 1\14ss. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ .bent ❑ I hereby certify that all of the details and information I have submitted for entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations pertormed under Permit Issued For this application will be in compliance with all pertinent provisions ufthe �lassach✓tu�State Gas lCu/,arm Chapter 142 of thr General Laws. By: Title CitviTown APPROVED 1)Fnc;?usE!)NI.Y) Signature of Licensed Plumber Or Gas Fitter Plumber ❑ Gas Fitter icense ;vumoer ' Master ❑ Joumeyman -.r (Pint or type )+ � Check one: Certificate Installing Company Name P V�+I ,C\ kI zz—,5 � 1� ❑ Corp. Address ❑ Partner. Business TelephoneFL— /� � _ 7 '��� LWFinniCu. Name of Licensed Plumber or Gas Fitter ��-l? '77744Q ' 0 INSURANCE COVERAGE Check ne: I have a current liability Insurance pcate olicv or it's substantial equivalent. Yes 4u No❑ di If you have checked ves. please inthe type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: [ am aware that the licensee does .not have the Insurance coverage required by Chapter lq21 of the 1\14ss. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ .bent ❑ I hereby certify that all of the details and information I have submitted for entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations pertormed under Permit Issued For this application will be in compliance with all pertinent provisions ufthe �lassach✓tu�State Gas lCu/,arm Chapter 142 of thr General Laws. By: Title CitviTown APPROVED 1)Fnc;?usE!)NI.Y) Signature of Licensed Plumber Or Gas Fitter Plumber ❑ Gas Fitter icense ;vumoer ' Master ❑ Joumeyman Location J Co *1 -e rCe- W No. I — M03 Date MORTN TOWN OF NORTH ANDOVER • Oe 10.?.• 0 }° Certificate of Occupancy $ s�cwust Building/Frame /Frame Permit Fee $ 9 Foundation Permit Fee $ Other Permit Fee $ 310, 00 s) q h TOTAL $ 3 i 00 V Check # �� 15772 Building Inspector I Mr u y �l C ,m U 'C cC L m _Q� (B O U C L N a) Z O O Cn •— 0 C E O � Ea)ca).2 � cn ^ cn L c �- C c9 -0 O O E.,M N L II =-c Z m en C C m M OC) U C N E (5 .a c c m ` 'M C) m a) a C m c>s N o L M --— � �ooa) � c c c O°)` tV b- m •C (1) Q CD a)•0 En •° E in C C Q) =N COJ m .0 U -0 m _j m aoL o in `O (n cn a) O w Z,m Ci .. o 8 E a aL cu O C) U CL O � n..- U U O N U C = o C m � CO 0 n.. m m O O 2 W H _ W _0 U J C (D CM N q a� m � O � X 3 t O O O Z W U U C O 0 m Q) _ R5 .O O O M .Q U H o Q c� Q o O o 'L y.r c 1.1 _ •— — m U O C cz o N — O1.` CL : Z -� Q O O 'S N C1 J 0 w C ,m U 'C cC L m _Q� (B O U C L N a) Z O O Cn •— 0 C E O � Ea)ca).2 � cn ^ cn L c �- C c9 -0 O O E.,M N L II =-c Z m en C C m M OC) U C N E (5 .a c c m ` 'M C) m a) a C m c>s N o L M --— � �ooa) � c c c O°)` 0) O b- m •C (1) Q CD a)•0 En •° E in C C Q) =N COJ m .0 U -0 m _j m aoL o in `O (n cn a) O w Z,m Ci .. o 8 E a aL (B •C Q) � O C) U CL O � n..- U U O N U C = o C m � CO 0 n.. m m O O 2 W w C ,m U 'C cC L m _Q� (B O U C L N a) Z O O Cn •— 0 C E O � Ea)ca).2 � cn ^ cn L c �- C c9 -0 O O E.,M N L II =-c Z cv C N en C C m M OC) U C N E (5 .a c c m ` 'M C) m a) a C m c>s N o L M --— o c Z..r U mZ3 a) >+ L - C . 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O :70N OS�Zo m�e ymS Z. M D Mom H gaoas �?o�ye yz� OZ S1 Z S n0' m t/+2 �G moe OZ � Kom«Kb 0 M o- n Z KSH O DATE W.O• # '20 mslo_ �o3�ox CPTH w~ 'p m C mnmyy c�Sy Orm CT www.baileysign.com m D 7a p>D�� 3yn9 Thom s rive ..s =,a �+g Col. Westbrook Executive Park a Ea ao5 e� N c)ammc ym oe2i ~9 moy Westbrook, ME 04092 O r T m mCl)om 2 m �+Q° �� `rt o 0 207-774-2843 / 1 -800 -539 -SIGN N yay=C �c)„3 HT m Fax: 774-1193 m oys� s���; ye m E -Mail: newsign@baileysign.com a MOM �9x�o ma Z C' T m y �"'�" s = m y ©COPYRIGHT < 2002 r r 3561 v -- Date . .... t TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ ..1....... ,� .C............................... has permission to perform ...1.�.�.xP� �y....................{ .............................. .e..........S� (� wiring in the building of ............................................... 'GZ............ ;j at1-1 � x �....� ` .. ,North Ando r, a�............................. ....................Fee ....(J. Lic. No. C .......... ... ............................. G 'j ELECTRICAL INSPECTOR Check # .30 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. S aL Occupancy and Fee Checked tev. 11/991 (jr,vr Mgnkl APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:I —�V Q —D_ City or Town of: L. O 0 A01) e 2 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) � Owner or Tenant e )c bt� u Telephone No. C)7 -?--9' Owner's Address a� Is this permit in conjunction with a building permit? Yes ❑ NoJ (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 Proposed Electrical Work: Installation of Burglar Alarm %W— Cont leti", o tl 11 bl Attach additional detail if desired, or as required by rite Inspector of Wires. INSURA,NCE 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:) (Expiration Date) Estimated Value of Electrical Work: S (When required by municipal policy.) Work to Start: l c,)-0 Inspections to be requested in accordance with MEC Rule 10: and upon completion. 1 cert, under the pains and penalties of perjury, that the information on this application is true and complete FIRM NAME: ADT Security Services 111 Morse Street, NorAood,/ANIA 920G?� _LIC. NO.: 1533C Licensee: Johns. BassettSignatur h� /f ,� LIC. NO.: 1533C (If applicable, enthr "exempt "in the license number lite.) / ° Bus. Tel. No.: 781278 113 Address: i / Alt. Tel. No.: 11`�P--4 -S9 -j9aB OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not hm:e the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (clieck one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: SS re o ower to a nta- be N•aived by the Ins ector• o Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers ICVA No. of Lighting Outlets _ No. of Hot Tubs. Generators KVA fro. of Ligfiting.Fixtures----- -. SivimminLPool . Above _❑ .In- ❑ . o. o mergence ig„hng. - rnd. arnd. Battery Units - - No.. of Receptacle Outlets No. of Oil Burners FIRE ALARbIS No. of Zones No. of Switches No. of Gas.Burners No. o TDetection an Initiating Devices No. of Ranges No. of Air Cond. TonsTota No. of Alerting Devices No. of Waste Disposers Heat Pump Number _------` Tons KW _........._...._ No. o el - ontained Totals: Detection/Alerting, Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal 11 Other ction No. of Dryers Heating Appliances KW Se rite este ,,ll w No. of Water KW� No. of No. of o. o eyices or E uivalent Data Wiring: Heaters Sins Ballasts No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by rite Inspector of Wires. INSURA,NCE 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:) (Expiration Date) Estimated Value of Electrical Work: S (When required by municipal policy.) Work to Start: l c,)-0 Inspections to be requested in accordance with MEC Rule 10: and upon completion. 1 cert, under the pains and penalties of perjury, that the information on this application is true and complete FIRM NAME: ADT Security Services 111 Morse Street, NorAood,/ANIA 920G?� _LIC. NO.: 1533C Licensee: Johns. BassettSignatur h� /f ,� LIC. NO.: 1533C (If applicable, enthr "exempt "in the license number lite.) / ° Bus. Tel. No.: 781278 113 Address: i / Alt. Tel. No.: 11`�P--4 -S9 -j9aB OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not hm:e the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (clieck one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: SS