HomeMy WebLinkAboutMiscellaneous - 33 MOUNT VERNON STREET 4/30/2018 (2)CS` ';I
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Date ... ?J6..... e2............
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ....................... z:....? .................................
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has permission to performs ..:..!� ..........:.... {a.:.........................
wiring in the building of .......:.. 0
at .... ..... �- :�- ........ ,North Andover, Mass.
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Fee .--�e).2 ......... Lic. No/ 'i/� . .
- ELECTRICAL INSPECTOR
Check # 6 1)2[/J/
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q�& r✓0WW09V"ALW 0T ,'XASS.AG7 SE`ITS
Department of ft6Cx Safety
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Official Use Only
Permit No. Q
orl
Occupancy & Fee Checked.
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 9 0
(Please Print in ink or type all Information) Date
To the Inspector of Wires:
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number &3 - 3-S_ A47., k�G,t AAO AI X77 n
Owner or Tenant C R,% 1 rr iY1 (2 f ,f f A9 4 A11 /�i°3S U ,2 Zky
Owner's Address- 3,�" % . Ve ,eA/41r_1 S r
Is this permit in conjunction with a building permit Yes 0 No 0 (Check Appropriate Box)
Purpose of Building %y%orep- Utility Authorization No.
Existing Service Amps Volts Overhead 0 Undgmd 0 No. of Meters
New Service Amps Volts Overhead 0 Undgmd 0 No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
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 C% NO
�i have submitted valid proof of same to the Office YES C` NO 0 If you have checked YES please indicate the type of coverage by checking the appropriate box
INSURANCE 0 BOND 0 OTHER 0 (Please Specify)
(Expiration Date)
i Estimated Value of Electrical Works
Work to Start Inspection Date Resquested Rough Final
Signed underthe Penalties of perjury:
FIRM NAME LIC. NO.
Licensee R6 S 7- Z lz F n 1 s Z Signature / LIC. NO.
Bus. Tel No.
Address Alt Tel. No.
OWNER'S INS E WAVER:
And tht am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General . at my signat this permit application waives this requirement. Owner Agent (Please Check one)
'meq
c Telephone Noi ` � �0- �d l PERMIT FEE s
Total
No. of Lighting Outlets
No. of Hot fuse
No. of Transformers KVA
Above .0
In 0
- No. of Liahtino Fixtures _
Swimmina:Pool_ omd - _ 0.
ami t; .,, o
Generators.. KVA:..
M
No. of Emergency'Lighting
No. of Receptacles Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No of Gas Burners
FIRE ALARMS No. of Zone
No. of Detection and
Total
No. of Ranges
No of Air Cond
Tons
Initiating Devices
Heat Total Total
No. of Diposal
No. Pumps
Tons
KW
No. of Sounding Devices
No./ of Self Contained
No. of Dishwashers
SpaceJArea Heating
KW
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. Hydro 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 C% NO
�i have submitted valid proof of same to the Office YES C` NO 0 If you have checked YES please indicate the type of coverage by checking the appropriate box
INSURANCE 0 BOND 0 OTHER 0 (Please Specify)
(Expiration Date)
i Estimated Value of Electrical Works
Work to Start Inspection Date Resquested Rough Final
Signed underthe Penalties of perjury:
FIRM NAME LIC. NO.
Licensee R6 S 7- Z lz F n 1 s Z Signature / LIC. NO.
Bus. Tel No.
Address Alt Tel. No.
OWNER'S INS E WAVER:
And tht am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General . at my signat this permit application waives this requirement. Owner Agent (Please Check one)
'meq
c Telephone Noi ` � �0- �d l PERMIT FEE s