HomeMy WebLinkAboutMiscellaneous - 34 PINE RIDGE ROAD 4/30/2018 (2)Office Use Only
LL1TIjMjanWeHJt4 Uf faojia#oeftf Permit No.
+4epartment of public 26afetg Occupancy & Fee Checked "
= BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
3190 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
(X*or Town of(1RTN
NANDOVER To the Ins ec�Wires.
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) J ��'/ Op
Owner or Tenant
Owner's Address
Is this permit in coniunction th a building permit: Yes 1-1NoNo (Check Appropriate Box)
Purpose of Building ,. f�W/ /,?5 Utility Authorization No.
Existing Service Amps _J Volts Overhead ❑ Undgrnd ❑
New Service Amps _J Volts Overhead ❑ Undgrnd ❑
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No. of Meters
No. of Meters
No.
of Lighting Outlets
No. of Hot Tubs
Total
No. of Transformers KVA
No.
of Lighting Fixtures I
Above
Swimming Pool grnd. ❑
In -
grnd. ❑
Generators KVA
No.
of Receptacle Outlets
No. of Oil Burners
I
No. of Emergency Lighting
Battery Units
No.
of Switch Outlets I
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
Local Municipal ❑ Other
11 Connection
No. of Ranges
Total /
No. of Air Cond. 3 tons /Z,
No. of Disposals
No.of Heat Total Total
Pumps Tons KW
No. of Dishwashers
Space/Area Heating KW
No.
of Dryers
Heating Devices
KW
No. of No. of
I Signs BallastsWiring
Low Voltage
No. of Water Heaters KW
No.
Hydro Massage Tubs
No. of Motors Total HP
OTHER:
2 //4r
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
I have a current Liability Insurance Policy including Complet�e Operations Coverage or its substantial equivalent. YES NO I
have submitted valid proof of same to the Office. YES YNO = if you have checked YES, please indicate the type of coverage by
checking the appro box. ��� ��♦/
INSURANCE BOND � OTHER = (Please Specify) O ( pvation Date)
Estimated Value of Electrical Work 5
Work to Start
Signed under the Penalties of perjury:
FIRM NAMEnf S Sdnh�A�i
Inspection Date Requested: Rough
L 1 r_-/V/r_~ &"O'Cla
Final
LIC. NO. 2
C
Licensee _�0 �V) P Co Signature LI. NO. 3�19�
��
Bus. Tel. No.
Address � _2�Z, t22 �2�c � � �� 61 J W Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re-
quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. 07r Agent
v/,/p/1' �U1
(Please check one)
Telephone No. PERMIT FEE 5
(Signature of Owner or Agent) x•6565
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y
2592 Date...
ORTN TOWN OF NORTH ANDOVER;
,r 3ray4,.�.o e9hoL EGEC?RlCAi. ,�
PERMIT FORS INSTALLATIONI
� r ,
�9SSNCHUSEt - :3
This certifies that . ... .... .....!?.-
has permission for9.0 installation
in the buil7'z-
of . AZIZA G /192 .......
...
at ':sx,. T�f, l ........, North Andover, Mass.
w
Fee. �f ,T.-- Lic. NO...3!uI .0 ...........................
WMINSPECTOR j
WHITE: Applicant
---CANARY. uilding Dept. PINK: Treasurer GOLD: File