HomeMy WebLinkAboutMiscellaneous - 40 GRANVILLE LANE 4/30/2018 (2) 40 GRANVILLE LANE
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ull� l':jljjj jll�Pt�1111 Iaf Permit No. ,J
ilepartItterrt of VublIt fett� Occupant/& Fee Checked
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BOARD OF FIRE PREVENTION REGULATIONS 527 C'dR
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Cade, 527 CI R 1200
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date IS
(G)Q or Town of NORTH ANPOVFR To the Inspector of Wires:
The udersigned applies for a permit to perform the elecF* cal work described below.
Location (Street 3 Number) � E
Owner or TenantQJ
Owner's Address _/
is this permit in conjunction with a building permit: Yes v No I (Check Approoriat2 ?ox)
Purocse of Building Utility Authorization No.
VGi'•,S Overread _ Unagrnd r' No. of Meters
xtsting Service Amos _J _
New Semite Am, Ps _J Volts Cverr:eae _ Uncgrnc � No. of Meters
Numoer of Feeders ane Amcacity
Lccadcn and Nature of Proposed ar r t lcrVc
Total
I No c - _s Na. of ranstormers KVA
No. of L:gntmg Outlets � � �•
I Above~-- 1n- — I
No. of Lighting Fixtures i Swtmming ?cat grna. _ crnc. I Generators KVA
No. at Emergency Lighting
No. ct =ecectacie Outlets No. of Oil 3umers Battery Units
FiP.E.atARMS No. of Zones
No. of Switch Outlets No. or Gas Surners I
Totat No. of Oetec:ian and
No. of Ranges i No. at Air Ccrc• tans Initiating Oavices
Heat Total otai
No. of Oisoosals Nr Tans K.v I No. of Souncing Cevices _
IooPur-os
No. of Sett Contained
i I
No. of Dishwashers .-
ScacetArea Healing KVV Oetec::oniSouncing Devices
Municiaai :Other
No. of Driers
Heating Oev:ces KW Lccai Connect:en
No. ct No. at i Low Voltage
Sa Iasis Wir;nc
No. of Water Heaters KW
Signs
No. `ivro Massage Tubs No. of Motors Total
cHP
OTHER:
INSURANCE CCVERAGE: Pursuant to the reau,rements at aassacn"a-s general Laws _
I have a current Liaotiity Insurance Polio/ inctucmg C;:rna:etee Oceratiens Coverage or Its suostanaal equivalent. YES 140 I
nave suomittee valid proof at same to the office. YES _ NO _ 1t -;cu nave cnecxee YES. ~tease inalcate :he type at coverage cy
checxtng the aper nate Cox. Loh) JCOD
INSURANCE BONO = OTHER =�11P!easa Spec:yl tExCiratwn Oat.,
Esumatea Valueof Eterncal Work S w)S Finalai
o
INarx ;o Start • rj Insec:ton Oate ?acnes:ac: Rough
Signed under the Penalties of perjury:
AJC. Na. X07 ----
FiRM NA-MEC. NOr• /�I�3
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-7 us. Tal. No.
O , I H / Alt. Tei. Na.
Address
OWNEa 5 INSURA WAIVER: 1 am aware that tre L:censee aces not nave one nsurance coverage or its suos:anual eguwalenA ent
autrea ov Massachusetts General Laws. and ;hat my signature on :n:s Cerrito aepncauon waives this regwrement. Owner 9
(P!ease cnecx one)
-
' etecnane Na. ___.------ PERMIT Fcc 5
//_ Signature of Cwner cr Agenn `j'jV
Date........ .w..;,;1-...-�s�s�:-�::•-.,,�`--,.�•y.:;,,;;T�x��S's-+';.��.-.�.iga�l;'xw,.-.tix...;;�.
k.S/!.T.
1° 395
t NORTH
:°•� `"-:°�"°oma TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
SSACMUS�
This certifies that .......3-..Q.S...... . 4JkR
has permission to perform ....... .. C..... ..............................
wiring in the building of........ .........�.�,. vCN..................................
at 4/-.cJ...GR4 �,vd!l.� .. p�, . ,North And ver ass.
Fee...b..-AP.... Lic.No.�. .. %0 ....>ELEcrRicAI*. .......
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