HomeMy WebLinkAboutMiscellaneous - 255 MASSACHUSETTS AVENUE 4/30/2018N
jC"
C"
0
O D
D
O 2
O C
? fA
Sn m
o �
o C/)
o <
o m
z
m
m
p- The Commonwealth of Massachusetts ' ``° `'S` W''r
P. -frit Na.
l Department of Public Safety r I �I
occupancy S Fee Checked e.A�± �✓
BOARD OF FIRE PREVENTION REGULATIONS S27 C14R 7200 3/90 1fee C eckedblank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed In accordance with the Macsachusetu Electrical Code. 521 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL IITFORHATION) Date 2 — Z (, — % J0
City or Town of NoieTH X"VD,0VE/? To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number)
Corner or Tenant
Owner's Address SAME (9%P G88 - 5a 00
Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization 110.
E%ist ng service Amps / volts - Overhead J Undgrdl 1 No, of Meters _
New Service Amps / Volts Overhead ❑ Undgrd ❑ Ito. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work Installation Of Alarm System
No. of Lighting Outlets
No. of Hot Tubs '
No. of Transformers T�A1
No. of Lighting Fixtures
Swimming Pool Above In-
grnd. ❑ grnd. ❑
Generators KVA
No. of Receptacle Outlets
No. of Oil Burners ,
Batter Emeigency Lighting .
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Self
fSelf ContaineDetection/ding devices
Local ❑ Municipal ❑Other
Connection
No. of Ranges
g
Total
No. of Air Cond. tons
No. of DisposalsNo.
of Heat Total Total
Pumps Tons KW
No. of Dishwashers
Space/Area Heating KW
No. of Dryers
Heating Devices KW
No. of Water Heaters
Signsf Ballasts
irino tag G/H e
fil
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YES ❑ NO ❑ I have submitted valid proof of same to this office. YES ❑ NO
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify)
Estimated Value of Electrical Work S 79/
O D Expiration ate
Work to Start .4-.24-57691 Inspection Date Requested: Rough Final
Signed under the penalties of perjury:
FIRM.NAME A.D.T. SECURITY SYSTEMS NORTHEAST INC.LIC. No. 1231C
Licensee DONALD A BROOKS Signata NO 1231C
Address 60 William Street, Wellesley, 8 s. el. No. 413-732-4400
Alt. Tel. No.617-431-5831 /
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)
Od
Telephone No. PERMIT FEE S
Signature of Owner or Agent
N2 1474
0�
TOWN OF NORTH ANDOVER
Siam.
PERMIT FOR WIRING
4 3
C14US yj
This certifies that .......... ............................................
has permission to perforin,..... ....... :M
...........................................
wiring in the building of ....::-%:.... . .......... 94
at: ......
........... .................................................... .North Andover, Mass.,
Fee Lie- Nn-/
1( /'� cg"�/
...............................................................
ELECTRICAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer