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HomeMy WebLinkAboutMiscellaneous - 26 WOODBRIDGE ROAD 4/30/2018, N2 2" 5 6 2 Date ........ 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING 4L �,SSACNU This certifies that ..... 1) P .............................. has permission to perform ................ ...... f ...... .................... wiring in the building of ......... ...... 1 ........................................... at ....... XA ...... ��).Q d . .. ................... . . North Ando7r X/ 7 j Fee .... 6n, 0..: 0 �. L i c. Nod F ......... ...... . ............ e:. ............ ELECTRICAL INSPECTOR Check # S --7z7 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer f vwudi Uso viuy / i(o Permit No. e�l2nLME'4,.4?; 0�1 nr4S5,4eW&S5? 7s Dr -exs 4 PO#/- Saps Occupancy & Fee Checked_ BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 qMR 12:00 (Please Print in ink or type all information) Date v zoo To the I ecto of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number d' l-3 1.x.9 oo ) �d < i Owner or Tenant &,e 2 ,rO' �T- ttW I� Owner's Address S Ft P.,.- Is this permit in conjunction with a building permit Yes ❑ Purpose of Building f (/ Existing Service 6 (5 Amps L d Voits ` New ServiceJC)0 Amps,,9 VO _Voi`tss 1 Number of Feeders and Ampacity _(� P 4 Location and Nature of Proposed Electrical Work S Rc�c G No OW (Check Appropriate Box) Utility Authorization No. " Overhead Undgrnd ❑ No. of Meters Overhead V Undgmd ❑ No. of Meters l OTHER' 6 FSC cD V' S f)F INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Comp d Operations Coverage or its substantial equivalent YES =O have submitted valid proof of same to the Office YES = O = If you have checked YES please indicate the type of cove y checking the appropriate box. INSURANCE = BOND = OTHER = (Please Speci J (Expiration Date) Estimated Value o EI ctric I Work$ ? S©. o 0Work to Start -2 �O .0 caQ Inspection Date Resquested Rough Final Signed under th nalti s o pe 'ury: (v FIRM NAME LIC. NO. i Lkensee Signature �^ LIC. NO. l�'Ia'"� 13Z. Tel N6 ( gopf� % v Address Ait Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General LAws. And that my_sign$pre on this permit application waives this requirement. Owner Agent (Please Check one) (Signature of Owner Telephone No. ?Z� (0?J b/6fERMITFEE $ r Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA I No. of Lighting Fixtures { Above ❑ In ❑ Swimming Pool grnd ❑ grnd ❑ Generators KVA �1 No. of Receptacles Outlets No. of Oil Burners . io. of Emergency Lighting Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total of Di osal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained �1+Vo. No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other �No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Si ns Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER' 6 FSC cD V' S f)F INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Comp d Operations Coverage or its substantial equivalent YES =O have submitted valid proof of same to the Office YES = O = If you have checked YES please indicate the type of cove y checking the appropriate box. INSURANCE = BOND = OTHER = (Please Speci J (Expiration Date) Estimated Value o EI ctric I Work$ ? S©. o 0Work to Start -2 �O .0 caQ Inspection Date Resquested Rough Final Signed under th nalti s o pe 'ury: (v FIRM NAME LIC. NO. i Lkensee Signature �^ LIC. NO. l�'Ia'"� 13Z. Tel N6 ( gopf� % v Address Ait Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General LAws. And that my_sign$pre on this permit application waives this requirement. Owner Agent (Please Check one) (Signature of Owner Telephone No. ?Z� (0?J b/6fERMITFEE $ r