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HomeMy WebLinkAboutMiscellaneous - 29 WINTERGREEN DRIVE 4/30/2018 (2)Date ...1. .... l7 ..��.. "�oTOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that ......... Y4,0.51.......4Z.55-977 7 ............................. has permission to perforin ......pmt(........ ..................... wiring in the building of m........ ......................................... at ......... 1!.!fd�� er °!....................... . North Andover, Mass. Fee��B"- /3 �9P ............ Lic. No€ ............. .�� ................:......6-11.� ... ELECTRINSPECTOR Check # 361A Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only sen Permit No. U q l F Occupancy and Fee Checked [Rev. 9/051 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL I)fRMATION) Date: ld©-- f 7 .— J 6 City or Town of: IV t�r To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) r'/ f,- Owner or Tenant R Xal"Ac/ L/f`��B 7 �y Telephone No.�$pZ r%%J Owner's Address Is this permit in conjunction with a jbjW'ing permit? Yes �� No ❑ (Check Appropriate Box) Purpose of Building /It- Sl e Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires_ No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans v o Total Tr Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above. rnd. rnd. o Emergency Lighting Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. o eteetion and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pum Totals Number. Tons KW .......... No. o el -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local 171 Municipal Connection ❑Other No. of Dryers Heating Appliances KW Security Systems:* No. of evices or Equivalent No. of Water KW Heaters o. o No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecom inunications Wiring: No. of Devices or Equivalent OTHER: Estimated Value of Electrical Work: Attach additional detail if desired, or as required by the Inspector of Wires. (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. 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 ❑ BOND ❑ OTHER ❑ (Specify:) 1 certify, under the ins a d peva s of perjury, that the infyrmation on this application is true and complete. FIRM NAME: A�^s 2Z eGG/u LIC. NO.: 3g9•T Licensee: Signature LIC. NO.d 1-% (Ifopplicable, enter "exempt" ' the license number line' Bus. Tel. Address: 42,X -),f Alt. Tel. No.:Y7?--7ff :33�'-3 *Security System Contractor License required for this work;lf work;'applicable, enter tlie license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ SignatureturaTelephone No. rl�4,y OGc �b-17—B 6 Aupd !9k