The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 29 SAUNDERS STREET 4/30/2018IN Pi 0 Date.1 ........................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... I" %�.> TA.1-1 ................................... . .. .................................. I-" , P I r - has permission to perform ....... R ........ 1� ........................................................ wiring in the building of ...... �Pe�� ........ .................................... at ...... cP...q ....... ....... ............... . North Andover, Mass. .... ... ... .. .. ... ...... . .. ...... .. -1 (j.A Fee ... Lic. No. 5,).44q� ....... I ELEcrRICAL SPECMR Check # n U TIM COMMONWEALTH OFM4SSACHUSEM Office Use only DEPAMMW0FPUXJC4VY "it No. BOAM 0FF&EPREVWH0NRMh4H0NS 527 CM 12 VO Occupancy & Fees Checked APPLICATIONFOR PERART TO PETFORM ELECMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MAS HUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) k Date Town of North Andover \ 1C To the Inspector of Wire undersigned applies for a permit to perform the electrical work described below. Location (Street 6 Owner or Tenant Owner's Address this permit in conjunction with a building permit: Yes" No L.2J (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service AmpsjIL)-/J 0 volts Overhead --"Inderground No. of Meters ED =1 1) New Service Amps Volts Overhead M Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below F1 Generators KVA ground ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal M r ---J Other No. of Dryers Heating Devices KW Connections L --J No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER- PFICIZ I I r0i CIAM-1111;1 ed'! �-�; 1, �M, ;, I �16 I Zvi I IhaNeatmiledvabdpiulofswmtotbeOffim YES drddr)gd]evPm . box. ,NSURANC :E E n BOND Wbik(D&Ut J4� signedunderTr,ptna�of pew. FIRMNANE IbIt , YES I V' NO LJ IfyoubavedrdcedYES,plemnxbcalotbe�4kofoc)v=Wby GRIER ftase Spedy) A /� 3 /C) (/ E;VirafimD*, EAinUcdValwcfEktcd[Wb& $ 11=31-611R�M@ �0-144 Lioe=q Solalm —,6..Ja,k f Fe -TIM LicawNo. 1kfflsPNb 2S -A (I It Bushess TdL No. 6),4-ILt--2�6r A1LTAA?J( 100 45 6WIHZ�S INSURANCEWAIVERlamawate daftl-mw&o nothaveftnmnxcowWoritsgibs=aleqLuvalulasopuedbyNb%adusem Gaual Lam ," dia my stgotate an this pe= applicahm waives ths fucluirernenL (Please check one) Owner Agent Telephone No. PERMIT FEEL3 Signature ot.Uwner or Agent Name Name: Location: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Ci1y I am a homeowner performing all work myself Phone # F-1 F-1 I am a sole proprietor and have no one working in any capacity ElI am an employer providing workers' compensation for rny employees working on this job. Company name: Address cibc Phone Insurance. Co. Policv # Compgny name: Address Cily: Phone Insurance Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,50o.00 and/or one years'imprisomient-as-wefl-as-cix4Lpenatties -o-thelorm4-a-STOP WORK -ORDER -and -a fine -d -($10100)-a Adayagainst ime. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of pegury that the infonnation provided above Js Mm and coffect. Signature Date Print name Phone.# Official use only do not write in this area to be completed by city or town officiar City or ensin-g. 0 Building Dept E]Check Y immediate response is requked Licensing Board F1 Selectman's Office Contact person: Phone #.- E] Health Departmenj n Other At N2 1367 Date. '.? ...... ...... .. .. . ...... ........ 0 0- TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that has permission to perform wiring in the buil 'ng of ......... .................................. at ....... . ....... .................................. . North Andover, Mass. FeeLic. No..-.,.,>. ......... ........... ELECTRICAL,INS-PECTOR 03/26/99 08:56 ir, An WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 0 Or." U" <),*. ne CommonweaM of Massachuseffs WAMOK a& /o-, 2' t & Am Ch,,kd Dejpcirl�� 4f AzWc BOARD OF FIRE PREVENTIOU REGULAnONS 527 CMR T= APPLICATION FOR PERMIT To PEPFORM ELEf-7,RICAL WORK #M1 %Mori( to b- P-i0f� IN ---160 e Wth the M-"achusetu E6coicadCdAL S27 CMR 12:00 (FLEALSE PXUa IN M OR XL -r-ORKMON) City or Town of Alkw Took Inspector'of Wires: The undersigned applies for a PeENiC to perfor= the electrical docribed below. 0 C L 0 Loczr-4-on (Street& Number) Owner or Tenanc 01--ner's Address Is this per=i� in conjunction with -a buildin . g permit: Yes FJ ib iCheck Appropriate Box) Pur-,,ose of Building Utiliq hat��:arion NO. Existing Service 0 /00 Amps AXJ I P0 Volts- Overhead [YalUd NO- Of 11 --ter New Serrice Amps f volts Overhead 0 %dgrd No. of Meters N=ber of 'Feeders and Ampaci Location and Nature of Proposed Electrical Work ki No. of Lighting Outlets No. of Hot Tubs go- of Transformers Total XVA No. of Lighting Fixtures Swimmiag Pool Above M In grnd. LJ grnd. Cenerators 1CVA No. of Receptacle Outlets No. of Oil Burners Ria. of Emergency Lighting ry Units No. of Switch Outlets I%. of Cas Burners FM ALUM No. of Zones go- of Detection and Initiating Devices No—of Sounding Devices So. of Self Contained Detection/Sounding Devices 1,ocalo Municipal ConnectionclOther No. of Ranges Total NO. of Air Cond. tons No. of Disposals Heat Total local No. Of Pumas Ton s Kv No. o f Dishwashers Space/Area Keating KW No. of Dryers Heating Devices KW No. of Water Heaters EW no, of no. of.- Si 'Ballasts Im volLagre 2 No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant,to the Tequirements of Massachusetts Ceneral Laws I have a current Liability Insurance Policy including Coupleted Operation Caverage or its substantial equivalent. YES C3 NO C] I have submitted valid proof of same to this office. YES 0 NO C] If you have checked Y_ES, please indicate the type of coverage by cherki tbe appropriate box INSURANCE a BOND 0 OTHER 0 (Please Specify) r 4 _ A t? C r11 4 1 U__41 - j in 011 _M�iracion DaF-e—) SE �Q alue o e Work to Start .34� Us pection Date Requested: Rou* Signed under the penalties of perjury: FI7;LM NA-HrE License Address Final _ki)Z2 ;.It- Tel- No. 01�",-_R'S INSURA-14'CE WAIVER: I am aware that the Licensee does not have the insurance --cove rage �or;.:s su:)- stan:4-al equivalent as required by 42ssachusetts General Laws, md tb= zy signature on this per=;: acp�ic_tzicn -.jai-;es this requirement. 0 --mer Agent (Plerse one) Te-',e;:hone No. PEFJ4.J7