HomeMy WebLinkAboutMiscellaneous - 263 RALEIGH TAVERN LANE 4/30/2018 (2)N r.�
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TOWN OF NORTH ANDOVER
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PERMIT FOR WIRING
This certifies that . ........... .
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has permission to perform �..:&I— ZZUZ ..d�.kh�.L ............
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wiring in the building of ..... ...... . ..... .....................
............................ A ver, Mass.
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ELEcrRicAL INSPECTOR'
Check #
5648
Commonwealth of Massachusetts Official -l -LF
I I I- . 11 — 11(2 1�
Pen -nit No. 7L
Department of Fire Services V
Occupancy and Fee Checked
assa Zhe
c us tts
're Servces
BOARD OF FIRE PREVENTION REGUL IONS [Rev. 11/99] (leave blank)
APPLICATION FOR PERMI TO ERFORM ELECTRICAL WORK
All work to be performed in accordance with he M sachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT JN 1flNK OR T,.VRE A L F A Date:
City or Town of: To the Inspector of Wires:
By this application the undersigne gives notice cTk� or/beNfiterltion to perform the electrical wQrk described below.
Location (Street & Nober)
Owner or Tena&727��
Owner's Address
Is this permit in conjunction with a build,ingy permit?
Purpose of Building
Existing Service
New Service
."Yes. El No
Utility
No.
(Check Appropriate Box)
rization No.
Amps Volts Overhead [:J -Undgrd n No. of Meters
Amps Volts OverheadEl Undgrd El No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: — Installation of Security system
Completion of the followin tablemaybei ived by the Insnector of Wires
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lightine Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Above [I In-
Swimming Pool grnd. grnd. E:1
- of Emergency Ei—ghting
Battea Units -
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARM
of Zone
No. of Switches
No. of Gas Burners
No. of netl
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
HeatPump
Number
Tons
No. of Self -Contained
Totals:
Detection/Alerting Devices
No. of Dishwashers. .
Space/Area Heating KW
Local Ei Municip�al [I Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:
No. of Devices or Equivalentc)160<
No. of Water
KW
No. of No. of
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail ifdesired, or as required by the Inspector of Wires.
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 [I BOND [I OTHER F1 (Specify)
Estimated Value of Electrical Wor (When required by municipal policy.) (Expiration Date)
Work to Start: ZI-101 �51nspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete.
FIRM NAME: ADI Security Ser�iices 12 r.IiAtnAn n7r- HolliS LILLL LIC. NO.: 1
Licensee: John''S. Bassett Signature LIC. NO.: 1533C
(If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 603 594 5928
Address: Alt. Tel. No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licosee does% not have the liability insur'ance coverage normally
requiredbylaw. By my signature below, I hereby waive this requirement. lamthe(checkone)[I owner El owner's agent.
Owner/Agent
Signature Telephone No._ PERMIT FEE: $
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