HomeMy WebLinkAboutMiscellaneous - 50 MOLLY TOWNE ROAD 4/30/2018 (2) J50 MOLLY TOWNE ROAD
210/065.0-0092-0000.0
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Date.......... 4..7`'...-Olb
t pOR7M�
TOWN OF NORTH ANDOVER
o 4 0 i 0 01 p PERMIT FOR WIRING
Asa^cHusE� '
This certifies that ................1-c'ryv....... lt: ..s,.?'4 �4.I..n...................
has permission to perform ...0�/1..��/?. 2 �„�..... el,!mF.......
wiring in the building of.......... ..,...........................................
at....... ...7�4,0nJ......b......... ,North Andover,Mass.
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Fee..S.,'Kaa.... Lic.No.�.3. 7............................ ::�-
ELECTRICALINSPECTOR
Check #
67J2,
Commonwealth of Massachusetts Official Use Only
Permit No. 1� L
Department of Fire Services
a Occupancy and Fee Checked
r BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] 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: 7. /A O,(
City or Town of: �(/, d e) a k�2 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)
Owner or Tenant 1'126iz L Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No � (Check Appropriate Box)
Purpose of Building Utility Authorization No. 933 , 4,37
Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters
New Service p20D Amps --,10/a v Volts Overhead ❑ Undgrd No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: E��.�tD��y� fJ �7z,Y/�J�— le0
t 719
i Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle) Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting
rnd. rnd. Batter Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection an
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons g
Heat Pum Number Tons K No.o Self-Contained
No.of Waste Disposers
Totals . - .. .. ....... Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Munk'pal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:
r No.of Devices or Equivalent
No.o Water KW No.of No.o 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.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: 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 ❑ BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on t is a !kali is true and complete.
FIRM NAME: LIC. NO.:,>23W4,32
Licensee: Signature LIC. NO.i=,23PL)'
(If applicable, enter "exempt"in the license numb r line) Bus.Tel. No.:
Address: If> Alt.Tel. No.:
*Security System Contractor License required for this work, if a plicable,enter the license number here:
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 PERMIT FEE: $
Signature Telephone No.
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