HomeMy WebLinkAboutMiscellaneous - 39 KINGSTON STREET 4/30/2018 (2)_N
O w
O �
N T.
S"
o0
�CO
CO
oI
gym.
m
Z -m+
j
" 9 6 4 6
Date .... f.. 14. -. /a .......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
A7 -
Thiscertifies that ............................................................ ................................
has permission to perform ..... ... Z,- ..........
wiring in the building of ............. d.. . . .........................................
.. ....... ..... ...
at ............ ............. ...../,j4orth Andover, Mass.
Fee ... Lic. No. ........ j./.X/-
6,
Check#
LommonweaRo// f'laJJackajetb OfficialUseOnly
2ep-artment ogre Servicee Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] 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: Q / 1 _�3// d
City or Town of: Alb?L�g � d,1,I,t, To the Inspector W Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) 's 9
Owner or Tenant
Telephone No. 971- KIS8' 3d3 -
Owner's Address i�___�
Is this permit in conjunction with a building permit? Yes ❑ Pio R (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑
New Service Amps / Volts Overhead ❑ Undgrd ❑
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: 1Jg cC 1 G� 01= C
No. of Meters
No. of Meters
Ur`t of —ire
Completion of the following table may be waived by the Inspector of (Vires.
No. of Recessed Luminaires
:
NQ. of CeilSusp. (Paddle) Fans
o. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Above In-
Swimming Pool nd. ❑ rnd. ❑
i o. o Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
o. of Detection and
Initiating Devices
No. of Ranges
Tota
No. of Air Cond. Tonsi
No. of Alerting Devices
No. of Waste Dis posers
P
Heat Pump
Totals:
Number
_
ons
- -
o. oSelf-Contained
Detection/Alerting Devices
No. of Dishwashers
S ace/Area Heating KW
P g
Municipal Other
Local ❑
Cyyonnect'
No. of Dryers
Heating Appliances KW
Security of Dev es r ivalent
No. of Water
Heaters Imo'
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
1No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommumeations Wiring:
No. of Devices or E uivalent
1
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: P• 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 Q BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete.
FIRM NAME: 01) —� Se u f- es LIC. NO.:
Licensee: mClf Signature LIC. NO.: '�iSC•
(If applicable, enter "exempt" in the lrcen umber line.) Bus. Tel. No.: 0,-1 f_-/ 5_9 -ay
Address: l '' e, L 1 n i crn ) i^. �� \ 1 t 5 , i.3 N O 2 0 4� Alt. Tel. No.:
*Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: I Lie. No.
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. F.PERmIT FEE: $ 2K,
Department 0f P b(ic Safety
7 t,1;`j:-if;'l..;a One Ashburton Place Rm 1301
Boston, Ma 0210.8-1618
License: S - License
Number: SS CO ()00953
I1AitK A BROPHY SR
1 1 1 MORSE ST
\OR'A'f)UU. NIA ;1QnQ
..1
C
Expires: 02107i20 r i
//i..•
J1
(:^r•�.reur.�r
0EPARTIMENT OF PUBLIC SAFETY
S - License
Number: SS CO 000953
Expires: Q2,'07!20,1 Tr. no: 117.0
S -License: ADT SECURITY SERVICE
MARK A BROPHY SR
111 P:IORSE ST
`JOR'hOOD, NIA 02062
Conunissioner
Restricted To: 00
Tr.no: 117.0
Keep top for receipt and change of address notification.
DIG SAFE CALL CENTER: (888) 344.7233
Fold, Then Detach Along All Perforations
COMMONWEALTH OF MASSACHUSETTS .=
BOARD"-
FA = ..AR:EGISTERED SYSTEM CONTRACTOR
I
D