HomeMy WebLinkAboutMiscellaneous - 33 VILLAGE GREEN DRIVE 4/30/2018 (2)Commonwealth of Massachusetts
t, Department of Fire Services
� BOARD OF FIRE PREVENTION REGULATIONS.
Official Use Only
Permit No. f I
Occupancy and Fee Checked
[Rev. 11/99) leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICA lU 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 INFORMATION) Date: /_
City or Town of: eoAr) J o V e,— To the f isnc-,rtnr of Heil ps:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street �
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building 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: T e a Ga F, re is a 11 1U✓'J
Conipletion of the follnwin.�, table mut be vruived by the Inspeeror of Id irr.,.
No. of Recessed Fixtures
No. of Lighting Outlets
No. of Cell.-Susp. (Paddle) Fans
No. of Hot Tubs
No. of 'Total
Transformers KVA
Generators KVA
Nu. of Lighting Fixtures
n- n.
Swimming Pool rnd. AboveEl 7-
o. o Bnttery Units Units rg brie
No. of Receptacle Outlets
No..of,Qil.Burners
FIRE ALARMS
No. of Zones
No. of Switches]
No. of Gas Burners pZ
No. o etection and
Initiating Devices
No, of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
Number
Tons
KW
No. of el - untained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating ICW
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:
No. of Devices or Equivalent
No. o atero.
Heaters XW
o o. o
Signs Ballasts
Data Wirin g
No. of Devices or E uivolent
No. Hydromassage Bathtubs
No. of Motors Total HP
Ia ecommunicutions rang:
No. of Devices or Equivalent
OTHER:
Anach additional derail ijdesired, or as required by the Inspector of il'ires
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability,!pstfrance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverafe is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND [3 OTHER ❑ (Specify:)
�;�. (Expiration Dale)
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start:,L Inspections to be regyested in accordance with MEC Rule 10, and upon completion.
1 cerrt5, under thepains and penalties ojperjury, that the information on this application is true and complete. /
FIRM NAME: 6400 C4-/ 6 LIC. NO.: 1G 31¢
Licensee: ,(*wc/ I-e"46od& Signature --- LIC. NO.:
(If applicable, enter " e.rempl " in the license number line Bus. TeL No.:977 66 Z - 62-�2_
Address: Alt. Tel. No.:97,r 3 r r S-7 3,�/
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
Signature Telephone No. PERMIT FEE: S I
Date .....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ........b.4pl-a .... F - 4 t.-< 7 .................................
has permission to perform .... 60.4. F�e— ....................
4
wiring in the building of Lv-&z&7(-;0 .It.. ...'s)-.? .., 4-a .........
at ...33.... 0 4.1(41T. . North Andover, Mass.
Fee 50. P7
4... Lic. No. �YJA-3./r ............... - - -, .1 -, 0,
ELECTRICAL INSPECTOR
Check #
1417 0