HomeMy WebLinkAboutMiscellaneous - 328 Middlesex StreetDatei-%; 7-0.1
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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
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This certifies that .?�-./../-... Al .
.............................. ....................................
has permission to perform ........ ....... .......................................
wiring in the building of ...........
...........................................
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........ ............. -0. ... I ... ............ ",North Andover, Mass.
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Lic. No . .............
Fee-`' . I . ............. ..... ........... ............... ..,rt..............
ELECTRICAL INSPECTOR
Check
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
0
.C\- Commonwealth of Massachusetts otTicial use onl
Department of Fire Services Permit No. 3 , J
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 11/991 leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00
(PLEASE PRINT IN INK ORTKS
ALL9,.\,,-,-
F0TION) Date: 4S — O"t " �0 1
Cityor Town of: � •\ To the Inspector of Wires:
By this application the undersigned lives notice of It ier intention to erform the electrical work described below.
Location (Street & N.u,pber)(�eS t�(`' -�
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit?
Telephone Nol—fb f ]Xof --
Yes ❑ No ® (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts
New Service Amps / Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Overhead ❑ Undgrd ❑
Overhead ❑ Undgrd ❑
No. of Meters
No. of Meters
CmmnlPtinn nr'tho rnllnwina rnhla —, ho -;-,4 R,. tha nnt.,...,rW:..
No. of Recessed Fixtures
No. of Ceil: Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures._..
Swimming Pool Above ❑ n- ❑
rnd. grnd.
o. of Emergency Lighting
Battery Units.
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners /
No. of Detection and
Initiatin Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alertin Devices
g
No. of Waste Disposers
Heat Pum
Totals:
Number
_ _
Tons
�"
KW
.........
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑Other
Connection
No. of Dryers
Heating Appliances KW
SecuritySystems: [y
No. of Devices or Equivalent Ly
No. of Water
Heaters
o. o o. o
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired. or as required by the Inspector of Wires.INSURANCE COVERAGE: Unless waived by the owner, no permit for the perfonnance 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:)
(Expiration Date)
Estimated Value of Electrical Work: 43 .3 (When.required by municipal policy.)
Work to Start: 1 Inspections to be requested in accordance with NEC Rule 10, and upon completion.
I certify, under the pains and penalties of perjury, that the information on this.application is true and complete -
FUM NAME: ADT Security Services 111 Morse Street, Notovo j, MA 02062 LIC. NO.: 1533C
r
Licensee: John S. Bassett Signature
(If applicable, enter "exempt" in the license number line.)
Address:
OWNER'S INSURANCE WAIVER: I am aware that the Li nsee does
required by law. By my signature below, I hereby waive this requirement.
Owner/Agent
Signature Telephone No.
/ LIC. NO.: 1533C
Bus. Tel. No.: 781-278-1169
Alt. Tel. No.: 781-278-1131
not have the liability insurance coverage normally
I am the (check one) ❑ owner ❑ owner's agent.
PERMIT FEE: $ 3 5y Q