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HomeMy WebLinkAboutMiscellaneous - 261 WAVERLY ROAD 4/30/2018V u4t (F-ummunwealth, of fRusar4adw 01111111:11111 Use on t wmk No. _ Erpm1mrnt of Public $aftfq occuptt,ftcy A Fee Chedted = BOARD OF FIRE PREVENTION REGULATIONS 527 CSIR 12:00 30 On" 1:11'°ItI APPLICATION PERMIT TO PERFORM ELECTRICAL WORK performed In accordance with All work to be the Massacnusetts Electrical Code, 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) © _ or Town ofNORTHANDOVER Date To the Inspector of Wlres: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Nber) =2 Owner or Tenant 1/�V �41� J �- z. Z j^—�—��O Owner's Address 4L.- Is this permit. in conjunction with a building permit: Yes _ No �' (Check Appropriate Box) Purpose of Building, Utility Authorization No. 'a Existing SBrviC Amps __/ �� Volts OVerhead�ci' Und rnd + 9 L. No. of Meters 1) New Service Amps _J Volts Overhead _ Unagrna C No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work��/f.�` J r C_9 �!er2 No. of Lignting Outlets I No. of Hot -.:cs I No. of Transformers Total KVA No. of Lighting Fixtures i Swimming Pcoi ADcve.— In- r— I grno. — grno. '— Generators KVA No. of Receotacre OutletsNo. I No. or Oil corners of Emergency Lighting. f3anery Units No. of Swrtcn Outlets I No. or Gas 3urners FIRE ALARMS No. of Zones i No. of Ranges I No. cf Air C--rc. ,olai No. of Detection and Cns Initiating Devices No. of Oisocisals I No.of Heat To:at -otat Purr.zs :ons KVI/ No. of Sounding Devices No. of Serf Contained Oetection/Sounafng Devices r No. of Dishwashers SoacerArea Heat r.a KW No. Of Dryers ( Heating Devices KWLocal - Municioar 'Other Connection , No. of No it7 No. of Water Heaters KW Signs ?ailas;s Low vatage Wiring No. Hyaro Massage Tubs I No. of Motcrs 7otai HP OTHER. t INSURANCE CCVERAGE. Pursuant to the reoutrements of Massacni sers ;eneral Laws 1 have a current Liaotlity Insurance Policy including Comc!etec Ccerations Coverage or its substantial e0uivarent. YES = NO — 1 have suomrtteo valid proof of same to the Office. YES = NO = If you nave Checxe0 cYES, p(11ase rrWiCate the type Of coverage oY checking the approoriate oox. _ _ INSURANCE = aONO = OTHER - (Please Scec:'y) ��--���i� Estimated Value of E!ectncal Work S (Exorration Gaul work to Start �� - Insoec:ion Oaie ;;acces:ec: Signeo under :he Penfes of penury FIRM NAME ��� ✓- `d , Rough Final Licensee UC. NO. f� 01Address/ f O l�c��/✓=•�1i✓211�8�/ ��i�C3c� Bus. Til. No.�� ✓�-� Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aw re that the t-:censee Coes nor nave the insurance coverage or its su0atanii al equivalent ae re• oulreo by Massacnusetts General Laws. ane that my signature (Jn :his Jermrt aopitcatton waives this toQulrement. Owner Agent (Please ch*Cx onoi• _ ;inone No. __PERMIT FEE (Signature of Owner or Agent) 142 1237 ;' "cia u SA us Date.................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that"�� Z) 6—tz, ..................................................................... has permission to perform ............. ........ ....... I ..................... wiring in the building of'4�� 2:3 .. ............ ........... . ............ � P—e . �L ........ .......................................... ............................. ...... .... ; ...................... . North Andover, Mass. Fee..'06(:-!� ...... Lic. No . ... ............................................................... 0 ELECTRICAL INSPECTOR '4 -#. 7J3 10/20/97 09:47 15.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 3535 Date.. � ................. TOWN OF NORTH ANDOVER .d. VIA PERMIT FOR GAS INSTALLATION ��iq A .................. This certifies that ... � ............... .. ............. has permission for gas installation ......... in the buildings o f ........................... at ...... North Andover, Mass. 67" . ............... Fee;.b. . Lic. No. GAS �NCTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Paint or Type) NO 9,_f4 I'4Ni)Q t1R< , Mass. Date_Pla) 19_1�_ Permit # Building Location 061 t,J'4 V 42 �- it Owner's Name Myr- f ► rAAJ 001e✓el N, U91, Noo ✓ 0 0(p Type of Occupancy_ I� FSI 7t"N T rq G New ❑ Renovation ❑ Replacement 2 Plans Submitted: Yes❑ No ❑ Installing Company Namee-'Ae 9 T A .:r -lm MA T rl 120 Check one: Certificate Address_ 3(--) 0_0A c H 1V% A. ry i- f , ❑ Corporation 111 r 7 N U E fJ 01 rl 0 l ❑ Partnership Business Telephone_ 6-91 -9 9'7 f Q�"Firm/Co. Name of licensed Plumber or Gas l=itter ' 0 jBE P_T INSURANCE COVERAGE: I have a current abiitty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Y04 Yes l�' No ❑ If yob have checked Ye, please indicate the type coverage by checking the appropriate box A liability insurance policy 01" Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ 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 the pe ' i ed for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ne Laws. BY T52etr f License: mber ure of Licensedu or atter Title er Ucense Number 9333City/Town urneyman (OFFICE NEW CM Installing Company Namee-'Ae 9 T A .:r -lm MA T rl 120 Check one: Certificate Address_ 3(--) 0_0A c H 1V% A. ry i- f , ❑ Corporation 111 r 7 N U E fJ 01 rl 0 l ❑ Partnership Business Telephone_ 6-91 -9 9'7 f Q�"Firm/Co. Name of licensed Plumber or Gas l=itter ' 0 jBE P_T INSURANCE COVERAGE: I have a current abiitty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Y04 Yes l�' No ❑ If yob have checked Ye, please indicate the type coverage by checking the appropriate box A liability insurance policy 01" Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ 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 the pe ' i ed for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ne Laws. BY T52etr f License: mber ure of Licensedu or atter Title er Ucense Number 9333City/Town urneyman (OFFICE A r T-7 2 4),. - M �:', d ' 2 H F- W N O O O f H ¢ O W Z d O W Z 0 F a U J d d W W A r T-7 2 4),. - M �:',