HomeMy WebLinkAboutMiscellaneous - 333 FOREST STREET 4/30/2018 (3)l�
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Date......... '.�'..:�.............
400-0-0-l;
`- oo TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .........S-.rV t.lJt �
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has permission to perform .. ��..�%.r�' `�1 ��'�(�CCCfff ......................
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wiring in the building of ......................................... ....................
at .........Ii. �.. %...�. �� .. �.......... ,� G.-::.. ,'North Andover�'�Mass
... ... .....
f� //JJ s_ f�
Lic. No.i ."' ..... a_.�r......... f.. ...........
ELECTRICAL INst3ECTOR
Check N
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
C—Im' 's"Au I�c7�amacllssjah
"b -P "is," l q!Jervlees
BOARD OF FIRE PREVENTION REGULATIONS
oliteial Use nary
[Pelars:41, No.
ccupancy and Fee Checked
v. 11/99] Icave block
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perromted in aicmdmss
ee with am Maachusotts L{Wetrtcal Code n;AttiCl, SI7 LAIR 12.00(PLCrISC PRINT IN INK Ole TYPE .ILL IsVr01a,&I ?YONj Date: City or Toi it of: '�
AL¢ gj4v dLQQy.�J2 - To I/ie /ns/�eclor of it�ires:
BY this application the undersigned gives ,1 once o bis or her Intention to perform the electrical work described below.
Locatiun (Street S Number) 333 •F�
Telephone No.
Owner's Address
is this permit its eonjuttetimi with a bulldingpermil' Yes No
❑ (Cilcck Appropriate Itis)
Purpose or Luilding U1111lr Authorization No.
Ealstlmg Service A 0--n Anips //0 /a2�CVOILs Overhead ❑ Uud rd
IVc�--_Sc i — g Q- Nb. Grtltetcr:
__ Anips I Volts Overhead ❑ Unagrd ❑ No. orbieters,
Number Or Feeders and Amp2city
Location and Future of Proposed Electrical NYork:
Nu. or Recessed Fixtures
.W;6 .•f..V.l e i ullul►ul
No. o[C131.-Swp. (Paddle) Fans
wwa >Hav De n-at►rd by rbc hu error oillires.
INO. at
Transformers KV.1
No. of Lighting Outlets -No.
or 11u1 Tubs
Ceneralors KVA
No. or Lighting Fixtures
S►vluutdug Poul—move E3n-
Crud. rud.
o. o tnergency g ug
BatterUnits
No. of Receptacle outlets
No. of Oil Burners
FIRE ALARMS
No. air zones
No. or Sbvitcltes
No. of Gas Burners
No. OrDetection an
notatin Devices
No. of Ranges
No. crAtrCond. Tons
No. of Alerting Devices
No. of Waste Disposers
cat ullsp
Totals:
Number
I
ons
o. of Self-contained
electiotl/Alertin Devices
I I
Nu: or Dishivaslters
SpacciArea Heating KNY
Local [juul pa
Connection ❑ Otter
No. or Dryers
11cating Appliances
Security ysteuu
No. or Devices or Equivalent
o. o acct
Heaters K�V
o.o t o. o
lNo.oFillotorsSigns iollass
Wuggs
Noor Devices orE uivalent
Dtconlnlull
No. Hydromassage Bathtubs
Total iIP
c] Gas wiring..
Yo. or Devices or E uivalent
OTHER:
Attach oddidmial dstaU i(dukold. or as requtred by the lnspeetor q(Mrej.
INSURANCE COVERAGE: Unless waived by the ownet, nopermit fat the performance of electrical work may Issue unless
the licensee provides proof or liability Insurance lncluding "completed operation" coverage or its substantial equivalent_ 11te
undersigned certiries tllnt =,,telt coverage is In force. end lies exitlbited proorof sans io the petmil isauutg once.
CHECK ONE: INSURANCE [f' DOND ❑ orri•1ER ❑ (Speedy: L. — / ;P- a o
( Pira n Datc)
Estimated Value of Electrical Work' c9- a -v -v (NAten required by nutltieipal policy.)
Wurk to Start:_ 6 -aD —02 av / Inspections lobe requested in accordant: withMEC Rule 10, and upon completion.
1 ccrrifj•, it to der Net pains aird penaltles ofiterfurp, dish the lnjssrinadon on this opplicativn is liar asst cassplvte.
Ir1I1l1 NAIVE: (J �r o dli o LlC.NO.s�,s ;J'3�
Licensee: Z2,04I OeT4942 U, fV 6 Signalur LIC. NO.:
(japplicoble, closer "avellopt" in she llcelar nusnberUuc) 11--j. Tel.
Address: All. Tel.11u.----
OWNER'S INSURANCE WAIVE R: l ani awarc that the Licenuce dovi npl havo the liability Insurance coverage normally
required by law. 13y my signature below, I hereby waive this requirement. I am the (check one) ❑ owncr 0 owner's agent.
Owncr/Aecut
Signature 'Telephone No. A URAUrT FE-, C: S r