HomeMy WebLinkAboutMiscellaneous - 399 MAIN STREET 4/30/2018 (2)�J
TheMassachusetts
Commonwealth of MossQch usefYs •- Y � ^ � -
Department ofRiblic Sofcty ��••r` s". �j
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occwrawcy
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BOARD OF FIRE PREVENTION REGULONS S27 CMR IM 3/90 y3Z,�
(148.4 •18w\) ^�
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed In accordance with the Magaachuscru Eleetrkal Code. S27 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORHATION) Date C�—�Z_
City or Town of I/ / iLl�d6�Y�t Io the Inspc—ctcr�of Hires:
The unc4,rsigned applies for a permit to perform the electrical work described below.
Location (Street 6 Number)_ /!4,17 S�
C-ner or 'Tenant _fe
1-7 11
Owner's Address
Is this permit in conjunction with a building permit: YesNo
❑ (Check Appropriate Box)
A:rpose of Building jo - ,/ 1-„t , Utility Authorization NO.
Existing Ser -.ice LI! Amps 12-a / YG Volts Overhead
Undgrd C Ho, of
New Service Amps / Volts Overhead ❑ Und d C]8r No. of mMeters
Nuber of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
-7,71/�iUr1
No. of Lightistg Outlets
No. of Hot TubsTotal
No. of Transformers O
':o. of Lighting Fixtures Z
Swlming Pool Above ❑ In-
❑
KVA
grnd. grnd.
Generators KVA
No, of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting
No. of Switch Outlets
No, of Gas Burners
Battery Units
FIRE ALARKS No. of Zones
No, of Ranges
No. of Air Cond. Total
tons
No. of Detection and
Nc of Disposals
No. of Heat Iotal Iotal
Initiating Devices
Pu=ps s,+
No, of Sounding Devices
;10. of Dishwashers
Space/Area Heating XW
No. of Self Contained
Detection/Sounding Devices
No. of Dryers
Heating Devices KK _
Local ❑ Municipal �Othtr
Connection
No. of Water Beaters Ku
No, of o4 o
Si s Ballasts
Low Voltage
Wiring
No. Hydro Massage Subs
No. of Motors Iotal HP
OAR:
INSURANCE COVERAGE: pursuant to the requirements of Massachusetts General Lava
I have a current Liabll t• Insurance Policy including Com leted
equivalent. YES [l�0 I have submitted valid pro -of of same �toorthis noffice ageE EI -90- or its substantial
If you have checked YES; please indicate the type of coverage by checking the appropriate box
INSURANCE BOND E] OTHER n (Please Specify) _-�
Estimated Value of Electrical Work S
cork to Start_41/ ,>•- 9 ./ Inspection Date Requested:
Signed under the penalties of perjury:
(Expiration ate
Rough Lt/ r11-iS G- Final
FIRM NAME
IC.. N0.
Licensee i7 ,t Slgnature4
LIC. N0, f 3
Address - c'r /L,r - / ��u el. No.
Alt. Tel. No.
WLR'S INSURANCE WAIVER: I am aware that the Licens does not have the insurance coverage or is sub-
stantial equivalent as required by Massachusetts General ws—and that my signature on this permit
application waives this requirement. Owner Agent (Please check one)
Telephone No, PERMIT FEE Si LA 1 0
Signature of Owner or Agent
Date ....
2576
TOWN OF, NORTH ANDOVER
0 4 g�,ICOL
E
.el
0 PERMIT FOR I STALLATIOW
SS,C u
This. certifies that I �F
hag permission for 00 installatibn�
in ui in �s 0
,the b I f ......
0-4—
a t North Andover,. ass.
m
-4
ee,. C., olyf �$ .. ...................................
40 INSPECTOR
WHITE: Applicaint C&ARY: Building De t. PINK: Treasurer GOLD: File
Location
No. Date
TOWN OF NORTH
ANDOVER
Certificate of Occupancy
$
Building/Frame Permit Fee
$
C S Foundation Permit Fee
$
Other Permit Fee
$
Sewer Connection Fee
$
Water Connection Fee
$
TOTAL
$
-51
-
Building Inspector
04/19AW 1138 394 PAID
9703 Div. Public Works
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