HomeMy WebLinkAboutMiscellaneous - 25 DUDLEY STREET 4/30/2018JAI.
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Date.... ..Z..7-.
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1,"`° TOWN OF NORTH ANDOVER
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p PERMIT FOR WIRING
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This certifies that .................5 .
has permission to perform S,—�"��'. ..T y/ - ....1 fes'..........
wiring in the building of ................... .............................
at ,.North Andover, Mass.
Fee....7, ?-� Lic. No. .21{14 ........................
SS e)6 I / !! ELECTRICAL INSPECTOR
Check # ,1600 -?72 �
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1. om wnweahh of Maeaachadettd Official Use Only
cc Permit No. �` 6
2epartownt ol5ire Service6
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 C R 12.00
(PLEASE PRINT OR TYPE ALL INFORAIL4TION) Date:
City oj Town f: A-1) L To the inspector of sires:
By this applicatiot dersigne gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) 49 -Dild z
Owner or Tenant ist 4 vi' 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 ❑
New Service Amps / Volts Overhead ❑ Undgrd ❑
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
No. of Meters
No. of Meters
Completion of thefollowing table maty be waived b), the Inspector of Wires.
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
Swimming Pool Above ElIn- El
rnd. rnd.
o. o mergency tg tng
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FiRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
of Detection and
No. Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
Number
'
Tons
' "'' "
KW . .
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
L Municipal Other
No, of Dryers
Heating Appliances Kms,
Security Systems:
No. of )bevices or Equivalent
No. of Water
Heaters KWI
No. of No. of
Signs Ballasts
irin
No. of Devices or 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 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 airs tntd p nalties of perjury, that the information on this application is true and complete.
FIRM NAME: rin;ys\t)(r e 6QCor4V LiC. NO.: -7 4 Q C
Licensee: ��� ()' i-1 �5 Signature s ,� �r�, LIC. NO.: ss c G it 4
(If applicable, enter 11e xenipt " in the, license number line.) A Bus. Tel. No.: l) _&5% _ LUILI
Address: (55 \t-C,S'- S-1 Wi �Yr)trn16k_. MA Cil SL 7 Alt. Tel. No.:
*Per M.G.L. c. 147, s. 57-61, security work requ' s Department of Public Safety "S" License: Lic. No. JS Co Cab llla,
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: S