HomeMy WebLinkAboutMiscellaneous - 47 HIGH STREET 4/30/2018 (5) 4LIL
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Datel. ........................
NORTI�
°� •�tia TOWN OF NORTH ANDOVER
* * PERMIT FOR WIRING
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This certifies that (IL.......:...........:....................P..................
has permission to perform „ .., .....V.�,,,,,,,.,,. ^
. ...................
wiring in the building of. .`.I.c A—..) `��
at ..,4-
........ w3.'. - :... ... '�3................ .,North Andover,Mass.
Fee....�.�...1... ........Lic.No. ej �...... ........!..'b
.................... ..... ............ ............ ....
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l!4 Ll CAL INSPECTOR
Commonwealth of tVMassachu:-etts Official U(sye Onlv
' - Department of Fere Services Permit No. 6
ri0Clnrin11r] nfC1-C70L71nCh7CC7l ; J �
BOARD OF FIRE PREVENTION REG UL AMONS Occupancy and Fee Checked
[Rev. 111991 leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Mass tchuseits Electrical Cotte(MEC),527 CM12 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ?_1;)Y_ 13
City or down of: N A ndv (/ c, To the Inspector of Wires.
By this application the undersigned gives notice of his or her inter tion to perform the electrical work descr bed below.
Location(Street&Number) 41 H,' n _>-rSv�'�� Q� Map: Lot:
Owner or Tenant yyl��-� �t G,-)+f^4kr t' �� rcj,�2 Telephone N). v
Owner's Address
Is this permit in conjunction with a building permit? Ye; Jni No ❑ Building Permit l -
Purpose of Building �r,r,,,,w, �� , [ _ Utility Authorization No. _
Existing Service Amps I Volts Over head Undgrd ❑ No. of A[eters
New Service Amps / _Volts Over head❑ Undgrd ❑ No.of A[eters �—
Number of Feeders and Ampacity
Location and Nature of Proposed EIectrical Work: Su 1 }o -3 7,_= 1 / Dc .tom -
Com h`ion of the bllowin table may be waived by he It-s/sector of Wire;
No,of Recessed Fixtures No.of Ceil:Susp.(Pack le)Fans o. of Total
_ Transformers KVA
No. of Lighting Outlets No. of Hot Tubs Generators �KVA
No.of Lighting Fixtures Swimming Pool ❑ In- ❑ o.o mergency g Tiing fi
+ rnd. 7rnd. Battery Units
No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS Nn.of Zones
No.of Switches No.of Gas Burners No. of Detection and
Initiating Device i
No. of Ranges No. of Air Cond. Tons No.of Alerting Devic es
No. of Waste Disposers Heat Pump umber.....'ons K o.of Se f-Containe+l
Totals: .....
- - lletection/Alertin Dices
No. of Dishwashers Space/Area Heating K'�' Local ❑ 1VItgnicipa
Connectio i C! Other
No,of Dryers Heating Appliances KW Security Systems: �s -
No.of Devices or Equivalent
No. of iter IOW No. of � `� off.off Data Wiring: 30
Heaters Signs I.'allasis No.of Devices or EquivalentNo. Hydromassage Bathtubs No. of Motors "otai HP Telecommunications'Vl�irgng
No.of Devices or uivalent
OTHER: � l
Attach a,lditional detail if'desired, or asrequired by t—1mvector of Wires.J
INSURANCE COVERAGE: Unless waived by the owner,no pej mit for the performance of electrical woi k may issue unless
the licensee provides proof of liability insurance including"comple ed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibitt d proof of same to the permit issuing off ice. �-
CI-3ECK ONE: INSURANCE 91 BOND ❑ OTHER ❑ (Sr ecify:)
(E.:pira:i7. on Date)
Estimated Value of Electrical Work: _5 �� (When re Xuired by municipal policy.)
Work to Start: 9 y-l Inspections to be requested in aa:ordance with MEC Rule 10,and upon c.imp etion.
.1 certify,under the plains and penalties of'perjury,that the infor`n,:tion on this application ds true and cern;mete. .--�
FIRM NAME: CC-5, In,It�rq Te ChnIt-IG.�fcS ;hL M 1 l<e �✓ LIC. NO.: �_ gC!
Licensee: ^?/G'�
! /1 9 Signature LIC. N�).:
(If'app!cable, enter "exempt"in the license number line.)
A
Bus.Tel.No.: _
/- 7y- 703U
Address: .�S /�loeA-Fv"ck I r �li'C 5 /c�/tc (h Y�'g /li(� Ait Tel.No.:7$/- &,Y41- x;1.3 J
OWNER'S INSURANCE WAIVER: I am aware that the License,-does not have the liability insurance co✓erage normally
required by law. By my signature below, I hereby waive this requin ment. I am the(check one)❑owner ❑ owner's agent.
i Own er/Agent
Signature _ Telephone No. PERMTI'FEl,': $