HomeMy WebLinkAboutMiscellaneous - 426 FARNUM STREET 4/30/2018 / 426 FARNUM STREET
210/107.A-0013-0000.0
Date........1...... (�.r /.3
Th .
; ooh TOWN OF NORTH ANDOVER
03�
PERMIT FOR WIRING
s$�caus�
This certifies that .;Ik.a........ I ................' i t ...................:....:......
has permission to perform .. �!.c,. � S �✓� -
....... ..................................................................
wiring in the building of..17.............. L!? .......................................................
at ........ ,North Andover,Mass.
-l`r .-.J J.... ;.....Lic.No. . ..71/E..............rLESP ..........
CMCAL
Check# 3 `/
117
Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No. -7 Z Ll
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 11/991 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
Al]work to be performed in accordance with the Massachusetts Electrical Code(MX),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPyo
LL INFO ATION) Date: S" /3
City or Town of: / es% ,1,ef4,,C , 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) j/�6• 14;0 /y U iyJ ST
Owner or Tenant Telephone No.so J•--3;:-,o
Owner's Address /l -
Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box)
Purpose of Building u,it��� Utility Authorization No._ 1Y,
Existing Service /00 Amps /?o /,7yo Volts Overhead ® Undgrd ❑ No.of Meters /
New Service /aG Amps /20 /,pyb Volts Overhead® Undgrd ❑ No.of Meters e'
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
-Completion of the following table mai4e wahj6ld'by the Inspector of Wires.
No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Lighting Outlets No.of Hot Tubs Generators KVA
No.of Lighting Fixtures Swimming Pool Above ❑ In ❑ o.o Emergency Lighting
ti rnd. rnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
g Tons
No.of Waste Disposers Heat Pum Number Tons KW No.of Self-Contained
Total p Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances Kit Security SDevices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
� OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
t' 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"c verage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of s e to the permit issuing office.
CHECK ONE: INSURANCE] BOND ❑ OTHER ❑ (Specify:) =0
(Expiration Date)
Estimated Value of Electri al Work: (When required by municipal policy.)
Work to Start: -/� /3 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
I certify,under thea %md penalties of perjury,thatthefnf do on this application is true and complete.
FIRM NAME: 6C a•1s2 "al"//� , "ir LIC.NO.: lq/ 7/ /k
1.Licensee: asPa// /vr'.r�c ignatur fl/ LIC.NO.: �/y/G7
(If Uo applicable, entP
em "in the license number line.) Bus.Tel. No.:!1�.I`-&-J
Address: . �FtlX k T6-6>ri4'SeO ftp/ 011-7C Alt.Tel. No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licenscle 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 a ent.
Owner/Agent
Signature Telephone No. PERMIT FEE. $