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HomeMy WebLinkAboutMiscellaneous - 372 MASSACHUSETTS AVENUE 4/30/2018Date....." 1W TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUS� r. Thiscertifies that ................. .,�..�...........1..................................................... has permission to perform .............. .ZGh .t � .....'...`....�.... ........ � wiring in the building of ................................................... at ....... .�. ...... . �F ...................... . North Andover, Mass. /� o0 Fee... Lic. No.....�c�s. .................. . LECTRICALINSPECTO s Check # / -7 10662 n p 2, o. as w o ax t R Com' ti N N N N F: G o-p,IN pwi n o R. p o ~n Ort K y �•o o o oco CD � o co 0 p g 0 O G N 0 -P6' ,� o O N `V CYO �i py pproN�� C,crCNO~ m .o CD N w� o w�a..-c b 'pa'' p r iff wccp' tn7 P. N d w o C CD CD p co coo a p w CCD d 010.0 N O G k+' r3• M p P i38 C P w+bp N o` ,n a.Mp •r -,pa; l -t .dfo b o p 0 o8: w ON N P a C tm c�rr (menti o� j' Perm; t No. d ..i is a ervice6 _ r, BOARD OF FIRE PREVENTION REGOccupancy aid Fee Checked _ (Rev. 1/071 (leave blank) APPLICATiON FQR.PERMITTTU PERFO-Ri11�.�LE�.:I RIGAL V�0 All work to be performed in accordance with the Massachusetts Electrical Code(\•lEC),'527•.C1vlR 12.00 WORK (PLE4SEPRIA!TIAt fiVK OR TYPEALL IIVFORkMTI A) 'pate: .� /U Cif ' ur TMN:ii of': _ — IN - r `t ovek- To the bispeccor of fires: (3y this application the undersigned eives notice of his or her intention to perform the electrical work described below, Location. (S(i cct Nuinbcr)' 2�� Owncr orTenn nf V. ✓1 7_7+L. I ele�htine No, 7Y OivncP- Address Is this permit in conjunction with a building permit? yes � . No ® (Check Appropriate Bax Purpose of Building'_ ) Existing Senlee ;imps I �lrolts NewSetvire Amps _/ _Val(_s Numbct�nf;>w`ccders and Ampacity Location and Iqature of Proposed Electrical Work: Utility Authorization No, 'Overltend Undgrd ❑ No. of Metcrs _ Overhead 0 Uridgrd r No. OfNjeters Estimated Value of Electrical Work: � (�'� D Attach additiono! detai(if desired or as required by the /nspector oj)t'ires. (When required by municipal policy.)`. - Work to S(art: Inspections to be requested in accordance with NM -C Rule,] 0, an;d upon completion, INSURA.NCE,COVER,A E: Unless waived by the ownei:, no permit for the performance of electriW work may issue unless (lie licensee provides. proof of liability insurance including "dbfn le(ed operation" coverage or its substantial. equivalent. The undersigned c.er(i les that such coverage is in force, and has exhibited proof of same to the pemtif issuing office. CHECK OW: INSURAI\ICE M BOND Q'. OTI-t-ER (] (Specify:) Self ' Insured • I certify, u?rder the paints and penalties of perjury, that the1nf .rnta(iot) ort this applicat(ort is true nrrd complete, 171 RM I�'AM.E: ADT Secur- i-ty Se Service's. r zees " LIC.'NO,: Licensee: Mark .Ia . Broplly ____ Signature tljaop(icable, enrr: "exempt 4! ut'the license number lbie..l LIC. NO.: C - 4 5 Address: 18 Clinton Drive 1-lollis. -NH Bus. TeLr\'o.:,603-594-592E3 -'Per M.G.L. c, 1'47, s. 57-61, security work requires Department of Public Safet' "S" License; Alt Li No 009$3 OWNER'S INSURANCE WAIVER: 1 am aware that (lie Licensee does not have the liability insurance coverage normally required by law; "By my signature below, 1 hereby waive this requirement. I am the (check one) ❑ own.er ❑owner's agent. Owner/Agent- Signature Telephone No.'' ct'LRjl�t'�'FEH. $ %�� No. of Recessed Luminaires Completlon of1. Ig table mov be wowed by rhe hisoecror of fl'ires. No. of Ceil.-8usp. (Paddle) Fans No• o1 Total '----- No. of Luminaire Outlets INo: of Hot Tubs Transformers I,`'VA -- Grtierators MVA 1'0. of Luminaires �SWinQ pool imitt.Above In- t ❑ 'o. o mergerlcy tg i.ttng orad. �rnd: : Batte,ry Unit, tlets \'o. ofeceptacle OuOr.Oil N.O. Burners FIRE ALARMS. ho: tif zones No. of Sit itchesNo. or Gas, urners No. 01 Defection and - No. of Ranges . — — \o: OrAir.Cond. 1 oral : Initia(InQ'Derices Tons No• of Alerting b'eyiccs ' No. of Waste Disposers P f eft Pump Number Pons X11 ............................................. ...............: Totofs; ........... leo of.SclC= "ontaitae No. of IJishwaslicrs Space/Area I e.pting .K}V t7ctectibn/Alerting.J�eti�ices L cal M Muntctpat - (t'o.oCDryer, Heating Appliances M�}r' :. '. Conn'c•ction Q -0ch-a cctirit� Svstems;n o, of Water No, of. ' , No. of i)evices or .bivalent Heaters IClit -- o. of Signs Ballasts Data Wiring: —'q No, Iiydromassate Bathtubs ------- _� — . No. of Mo(ors Total Ill' No, of Devices or Equivalent I elecomtriunicatlon's 1Viring; OTI4ER: !-7G : 1`Io, of Devices or Egtiiyal. 1 Estimated Value of Electrical Work: � (�'� D Attach additiono! detai(if desired or as required by the /nspector oj)t'ires. (When required by municipal policy.)`. - Work to S(art: Inspections to be requested in accordance with NM -C Rule,] 0, an;d upon completion, INSURA.NCE,COVER,A E: Unless waived by the ownei:, no permit for the performance of electriW work may issue unless (lie licensee provides. proof of liability insurance including "dbfn le(ed operation" coverage or its substantial. equivalent. The undersigned c.er(i les that such coverage is in force, and has exhibited proof of same to the pemtif issuing office. CHECK OW: INSURAI\ICE M BOND Q'. OTI-t-ER (] (Specify:) Self ' Insured • I certify, u?rder the paints and penalties of perjury, that the1nf .rnta(iot) ort this applicat(ort is true nrrd complete, 171 RM I�'AM.E: ADT Secur- i-ty Se Service's. r zees " LIC.'NO,: Licensee: Mark .Ia . Broplly ____ Signature tljaop(icable, enrr: "exempt 4! ut'the license number lbie..l LIC. NO.: C - 4 5 Address: 18 Clinton Drive 1-lollis. -NH Bus. TeLr\'o.:,603-594-592E3 -'Per M.G.L. c, 1'47, s. 57-61, security work requires Department of Public Safet' "S" License; Alt Li No 009$3 OWNER'S INSURANCE WAIVER: 1 am aware that (lie Licensee does not have the liability insurance coverage normally required by law; "By my signature below, 1 hereby waive this requirement. I am the (check one) ❑ own.er ❑owner's agent. Owner/Agent- Signature Telephone No.'' ct'LRjl�t'�'FEH. $ %�� This certifies that .............. Date ....../.� �..."... TOWN OF NORTH ANDOVER PERMIT FOR WIRING has permission to perform .. �'.� .................. A................................................... wiring in the building of ..,..:.:......... 22z at .. ...... :�...::-r��........................... . North Andover, Mass. Fee .............. Lic. No. ............. ................................ I .......... ....... ELEcrRIcALINSPECMR Check # V 7188 Commonwealth of Massachusetts Official Use Only Permit No. �%B �J` Department of Fire Services Occupancy and Fee Checked c`P� BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL 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: 1-3o-02 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 372 /P1G SS - A V Q Owner or Tenant . v d 'l Q V I Owner's Address A -2 7 f-1 CA Is this permit in conjunction with a building permit? Purpose of Building Existing Service 16 O Amps 209 / I20 Volts New Service f -e"61 Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Re-- C oCA+e)9 r&1n 9,e 0041 Telephone No. 6.9?- 2 2 SZ Yes © No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ® Undgrd ❑ Overhead ❑ Undgrd ❑ k-) 4 c G•Pn A J J I n No. of Meters No. of Meters S Reee✓*-dp Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above Eld.❑ rnd. rnd. o. o mergency ig mg Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection 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. oSelf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecom munications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 3 o0 . t7 (3 (When required by municipal policy.) Work to Start: 2- 3 - d % Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance 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:) I certify, under the pains and penalties ofp rjury, that the information on this application is true and complete. FIRM NAME: o ll i G) %d/1 LIC. NO.: //034-/3 Licensee: 6 - �-tJa 4aA Signature LIC. NO.: (If applicable, enter "exempt" in the license ,('umber line.) Bus. Tel. No.: Address: & �r"/1 V le L -J AV/? Alt. Tel. No.: *Security System Contractor License required for this work; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by la4. By my signature below, hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent) ��'� Q �� p y� 6 - �2 y2 Signature �J '�"�I Telephone No. PERMIT FEE: $ ✓