HomeMy WebLinkAboutMiscellaneous - 52 MAY STREET 4/30/2018 J -52 MAY STREET T
210/018.0-0009-0000.0
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t 01he �t:IIIIITItalurnith Df �ssar4i itis Pemit No.
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BOARD OF FIRE PREVENTION REGULATIONS 527 VMS 12A0
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Cade, 527 CMR 12:00
(PLEASE PRINT IN INK (?5 TYPE ALL INFORMATION) Date e
M� or Town of o_ __ ANDOVFR To the Inspector of Wires:
The udersigned applies for a permit to perform the electrI ical work described below.
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Location (Street 3 Number) 52- -
Owner or Tenant
Owner's Address 6414,`
Is this permit in ccnjunctien with as building permit: Yes _ No 7Z (Check Appropriate Box)
o;, c--Se of Utility Authcnzation No.
Existing Semite Arps __/ VC1ts Over^eaa Unagma No. of Meters
New Semite Amps ! `/crts Cverneac — Uncgrra _ No. of Meters
Numcer of Feecers ani Ampac:ty All /7,AtiAr
Lccaucr arc Nature cf ?r„ccsec Eiec:,...� 'lcrx`
r /TCIfrS
Tota,
No. or _:g^•mg Cuuets Ne. �. �cs No. at ranstormers KVA
i Acove.-- :n-
No. at L:cnt,ng =:.xtures Sw'mm,ngPoet gine. Generators KVA
No. of Emergency lighting
No. cT P _ _:ac:e Cutlets No. of Cil =urners Barery Units
No. at Swncn Cutlets No. or Gas =urr.ers I FIRE ALARMS No. at 'ones
.a at I No. at Cetecaon arc
No. at Ranges % No. mf Air C.!na. tics Initiating
'avrces
I No.ot meat Total Total
No. of Oiscesais ;ons K.v No. at Stunting Cevtces
No. of Sett contarnee
No. of Cisnwasners - Scace)Area rreaor.g 0etec::cnrScunetng Cevtces
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Muntcteat —Other
No. at -tors i Hea:tic Cevtces KW -ccar connec::cn
No. aT No. or I Law Vcitage
No. of 'Water Heaters Ki! !. Sicns Ballasts Wirmi:
I
No. Hycro .Massage Tubs � No. of `.latcrs Tatar -fP
O-SER.
INSURANCc Pursuant :o the recu,rerr.ents a: '.tassacnuse= zererar '_aws _
I have a current Liacriity Insurance Pout•/ nc:uc:ng C.:rro:etec Oceraucns Czverace or ;ts sues-antral ecutvaient. YES = NO _ i
have suomirec vanC ~riot at same to :ne Office. YES _ NO _ It you nave znecxee YES. -tease incicate the cyae at coverage my
checxrng :he accrocrnate cox.
INSURANCE = BOND _ OTr.ER = ,Please S.el::'y)
(Exotranon Date)
Esurratec Value of Ec.ec:ncat 'Nark 5 FnaI v
Wcrx :a Stan Inscec::cn Cate Racuestec: Rough
f S*-gnea uncer :ne Penalties at pperjuryy /IS�3
F.RM NAME ��'0 /—zo%G A G LIC. NO.
Licensee
S_ ", ��L/e�is� �.e S:gracure � LIC. NO.
Bus. Tel. No. fafl3 -Irfr3 i
AcaressvA" Alt. Tel. No.
OWNER'S IN URANCc WAIVER: I am aware that the _;censee toes rot rave :no Insurance coverage or its suastanttal eautvatent as'te-
5
cu,rea ov Massachusetts General taws. ani :hat my signature an :n:s permit aecucatton waives mts reautrement. Owner Age
(Please cnecx one)
eiecrcrte No. PERMIT FE= 5
5igracure or CNner or.Agent~
2 Date.......
N
NORTH '
4,
T6WA OF NORTH ANDOVER
PERMIT FOR WIRING
CHU
7�
Thiscertifies that ......... .............................. ................................................
has permission to perform ..... ...........V.��..//�.?�///! !/Z
wiring in the building of....V........... .......................................
9 t. ............. .. .
at........ a.......5........... .................................. .North Andover,Mass.
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Fee...J.....4).. Lic.No.-`�9--3Z..........................................................
C�/ (/'Y ELECTRICAL INSPECTOR
06/01/98 09:21 5.00 PAID
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer