HomeMy WebLinkAboutMiscellaneous - 30 CHATHAM CIRCLE 4/30/20187m,
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4640
Date .....
1�1 LORT"
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
S.2 US
This certifies that ....... ........... / ........... A..4 ........
has permission to perform ....... ......... /Zoepf.n � .........................
,�wlrmg in the building of ..... fq �'R ...........................................
at ..... C ..... North A�nd�ov
Vee.J.170. Lic. Nox�. ........... M1. 9 ... I . ........
ELEC
Check # % MCAL INSPECTOR
Official Use Only
Permit No. 3
Occupancy & Fee Checked_
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 527 C 0
,/R 1 :0
(Please Print in ink or type all information) Date ?
To the ln*ector of Wires:
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Itf, -* I
Location (Street & Number Id -'- \JQ
Owner o
Owner's
Is this permit in conjunction with a building permit _ Yes
Purpose of Building &.,' -
EAsting Service___-----------�AmPs
New Service 7V01 AmPS42��—Voiki:�,Ve--
Nurn4 of Feeders and Ampacity
Location and Nature of Proposed Electrical Work -:
No 0 (Check Appropriate Box)
UtilityAuthorization
Overhead D Undgmcl 0 No. of Meters
Overhead 0 Undgmd 0 No. of Meters 1-19�
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO
have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the b?
no!f?�age by checking the appropriate box
INSURANCE = BOND = OTHER = .(Please Specify) Sa
IlExpirAkin Mile)
Estimated Value of 1pect7dal Work
Work to Start 1.�Z -to Inspecilon Date Resquested Rotte-1-1, Final
Signed under a(*.9,f
FIRM NAME A LIC. NO.
44
U�ensee Signature , V-;4 1C. NO.
Bus. Tel No.
Address Alt Tel. No.
OWNER'S INSURANCE WA)VER: I am aware that the ic ges does 60-t have the insurance coverage or Its substantial equivalent as required by Massachusetts
I
General Laws. And that my.# I ignature on this permit application waives this requirement owner Agent (Please Check one)
Telephone No PERMITIEE $
(Signature of Owner or Agent)
Total
No. of Lighting Outlets
No. of Hot fuse
No. . ofTransformers KVA
Above 0
In 11
No. of Lighting Fbdures
Swimming Pool gmd 0 gmd 13
Generators KVA
No. of Emergency Lighting
No. of Receptacles Outlets
No. of Oil Burners
Battery Units
No. of Switch Ouflets
No of Gas Burners
FIREALARMS No.ofZone
No. of Detection and
Total
No. of Ranges
No of Air Cond
Tons
Initiating Devices
. Heatf Total Total
No. of Diposal
No. Pumps
Tons
KW
No. of Sounding Devices
No./ of Self Contained
No. �, bishwashers
Space)Area Heating
KVV
Detection/Sounding Devices
0 Municipal 0 Other
No. of Dryers
Heating Devices
KW---
Local Connection
No. of
No. of
Low Voltage
No. of Water Heaters KW
Signs
Bailases
Wiring
No. Hvdro Massage Tuds
No. of Motors
Total HP
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO
have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the b?
no!f?�age by checking the appropriate box
INSURANCE = BOND = OTHER = .(Please Specify) Sa
IlExpirAkin Mile)
Estimated Value of 1pect7dal Work
Work to Start 1.�Z -to Inspecilon Date Resquested Rotte-1-1, Final
Signed under a(*.9,f
FIRM NAME A LIC. NO.
44
U�ensee Signature , V-;4 1C. NO.
Bus. Tel No.
Address Alt Tel. No.
OWNER'S INSURANCE WA)VER: I am aware that the ic ges does 60-t have the insurance coverage or Its substantial equivalent as required by Massachusetts
I
General Laws. And that my.# I ignature on this permit application waives this requirement owner Agent (Please Check one)
Telephone No PERMITIEE $
(Signature of Owner or Agent)