HomeMy WebLinkAboutMiscellaneous - 260 SUMMER STREET 4/30/2018 (2)['L%"
Date.., -5 ......... Z ..... 77:��-7
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ......... ...... ..........................
has permission to perform .4�0,7Z:
wiring in the building of ............. IA1
.................................
at....,-9o�42 ....... 52 . . .................. . NorthAmdover, Mass.
Fee. Lic. No�,r..� 1f.7 ...........
diicnucAL iNS
PECTOR
Check #
7266
10
uommonweann or
.
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK
All wmk to be pedonned in amordance with the Mpsachusett3 Electrical Code (bEQ), 527 CIA 12-00
4 _7�� C '94691
el.
Ne r 1-t 19 -
ME SCHEDULE MA61ED 0 TIMATED VALUE OF WORK $10 PER $1000, wEW CONSTRUCTION $26 MINIMUM oo;L �;r-S N
TENANT SPACE, LOW VOLTAGE, REINSPECTION. EXISTING BUILDINGS $20 MINIMUM INCLUDES ELECTRICAL BOXE�, SERVICE
CHANGE. APPLIANCES REPLACEMENTS, SIGNS, POOLS.
By this application the undersigned gives notice of his or her intention to pexfbm the electrical work described below.
Location (Street & Number) Floor/Space No.
Owner or Tenant Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes No El ine No. 888-633-3797
*Ptirpnee of Building P I Utflity Authorization No.
I
OverheadEl Undgrd LJ
OverheadD undgrd El
Existing Service Amps Volts
Nealear*_e Amps Volts
Number of Feeders and Ampacity
at,Kc I -o] I Electrical Work:
Location and N of P posed R
_Ld A-
A j � & /_ _7'6
No. of Meters
No. of Meters
Ire
No. of Recessed Fixtures
No, of Cefl.-Susp, (Paddle) F S
N6.W - --- _ I Total
Transformeys — KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. -of Lighting Fixtures
swlmmingpool Above E3 zmd. El
No. of Xmergeu__E_
Battery Units CY 19mug
No. of Receptacle Outlets
N c I - 070 iTa � �e Z
FM ALARMS
INo. of Zones
No. of Switches
No. of GAS Burners
No. of Ditikfl6n aid7--
Initiating Devices
Nd. Of Ranges
Total
No. of Air Cond. Tom
No. of Alerting Devices
No. of Waste Disposers
er
.................
Ong . . ......
........................
Nlo.'-of Slelf-Contained
Detecid / eftgDe,
MAI Ir Am
No. of Dishwashers
Space/Area Heating KW
,al [I munic
'or Other
Comee on
No. of Dryers
Heating Appliances 1(W
urity S
No. of =VIC'e's or LRquivalent
No—.6f'Water KW
Heaters
No. of No. of
Ballasts, : I , I
Data Wirin
No. of Nevices or Rquivalent
'No. Hydromusage Bathtubs
No. of Motors Total HP
Telecommmications WWng:
No. Of Device$ Or FAMi0lent
OTHER:
electrical work may issue unless
INSURANCE COVERAGE: Unless waived by the owner, no pernift for the perfonnance of
the licensee provides proof of liability ingurance including "completed operatioe' coverage or its substantial equivalw. The,
undersigned certifies that such coverageis-ii�fbrce, and has exhibited proof of same to the permit issuing office.
CBECK ONE: INSURANCE &3-_g6NDE1 OTHER El (SP d V ; 6 k 10� Exp.
Estimated Value of Electrical rk, (MUST BE FILLED IN)
work to Stan: V bWections to be requested in accordance with NEC Rule 10, and upon completon.
I certify, Un er lifiepn s a dpenaMes perjum that the in!flo lio on this application is true and conaplete-
FIRM NAM '70 LIC. NO.:
Licensee: Sipature LIC. NO.:E29127
Bus, Tel. No.,
ADDRESS: e919 LIZ — Cell Tel. No. - k 6PA 7 -
*Security Syst6m ConUactor License required for thjs work; if applicable, enter the license number here
hilitv i �Wnn C coverage RDIUWIY
OWNER'S INSURANCE WAYVEIb I am aware fl -tat the Licem= does not have the liability inwan
reqi&.ed by law. By my signature below, I hercby waivc this requirement. I am ft (chock ono) 0 owner Q owner' nt
Owue�-/Agent
SignapAre Telephone No. PEBMIT.FEE: $
��� e� 3_2�_B� ��l
z
IAORT 6222
Town of North Andover
HEALTH DEPARTMENT
34cmu
CHECK#: I 1 1 �-2- DATE: ZI 1 12-
LOCATION:-')LoQ
H/O NAME:
CONTRACTOR NAME:,N d'�) T)p kon
n r ci
(r)T L
Type of Permit or License: (Check box)
0 Animal $
0 Body Art Establishment $
0, Body Art Practitioner
0 Dumpster $
0 Food Service - Type. $
0 Funeral Directors $
0 Massage Establishment
0 Massage Practice
0 Offal (Septic) Hauler
0 Recreational Camp
0 Sun tanning
0 Swimming Pool
0 -Tobacco
0 TrasIVSolid Waste Hauler
0 Well Construction
SEPTIC Systems
0 Septic - Soil Testing
0 Septic - Design Approval
E�K Septic Disposal Works Construction (DW0
0 Septic Disposal Works Installers (DWI)
0 Title 5 Inspector
[3 Title 5 Report
0 Other (Indicate) $
Hea,IX'Agent Initials
White - Applicant Yellow - Health Pink - Treasurer