HomeMy WebLinkAboutMiscellaneous - 550 TURNPIKE STREET 4/30/2018 (12)VA
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Date......<.....:................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that
has pepnissjlt'o��t pftrform,
wiring in the building of,..,...., /qa„r�y ....... at . .................
Al—
.... ........ -cr ........S............. ....... . North Andover, Ty-tass.
am
Fee ... Lic. No.
� � ELECTRICAL INSPECT
Check #
124
i
0
C�
C-Mwnwialtla olcci/laeeac%ue./fe Official use>Onnly
.U°Pa'fit,°"i o`�tiry �irrrktie . Permit No.Oc�
BOARD OF FIRE PREVENTION REGULATIONSy Fee Checked
7] 0eave, blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in awwdeace with the Massachusetts Electrical Code (MECI 527 CMR 12.00
(PLEASE PRINTW INK OR TYPE ALL IMRMAHON) Date: 34
City or Town oh oolruM e4v 2d✓t:t2 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) S:nD 3r—
Owner or Tenant R 2,C'Z U Co- n c A ` Telephone No.
Owner's Address S -.S -a T�eiv ?/k; J'�
Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: UPk'RA&,r t.IGNr1#,r4 ?a Y
Z'II a,rA.,7` role lJTrt,Iit tbMP.PNy Ld4J/T/�ci PAo4&4/vl
Completion ofthe followbw table may be watwd by the Inrnectar ofWirec
No. of Recessed Luminaires
No. of Cell.-Sasp. (Paddle) Fans v
No. of Total
Tranformers KVA
No. of Laminalre Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Above
Swimming Pool In-
❑grod ❑
Bane Unfts�cy LiptMg
No. of Receptacle Outlets .
No. of Oil Barriers
FIRE ALARMSNo.
of Zones
No. of Switches
No. of Gas Burners
o. of, an
InitiatimDevices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Ale Devices
Alerting
No. of Waste Disposers
ea p
Totals:
um r ons
o. o n
Detection/Ale Devices
No. of Dishwashers
Space/Area Heating KWLocsl
❑ Municipal1:1 Other
Connection
No. of Dryers
Heating Appliances KW
n a oity stems:"
Nof vices or Equivalent
No. of Water,
HeatersSigns
NO. o o. o
Ballasts
Data Wiring.
No. of Devices or E uivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications :
No. of Devices or Equivalent
OTHER:
Attach aMtkvW detail ifdeshvd or as regrdred by the Inspector of Wires.
Il Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: L - 2 7 — / i Inspections to be requested in accordance with MSC 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 ^f'mme. to the permit issuing office.
CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:)'. KANOVM /4IS
I certify, under the pales and penalties ofperjury, that the Infomadon on this gppUcadan is true and complete.
FIRM NAME: -r oj44,q T• PELCtl2rN Er.rm-cxr2r Gi+,J1 or
LIC. NO.:.4 /Y 769
Licensee. T ooia S Signa LIC. NO : jF-30,?7.5
af'applicable, enter "exempt" in Ire license member Idte.) jV Bus. Tel. No.: 77V 57T- 750 0
Address: 0 WA -sr- -t'r=AM- 0/737 Alt. Tel. No.:
*Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. No.
OWNER'S INSURANCE WAIVER I am aware that the Licensee does not have the liability-insurance-covange_noimally_ _--
required by law. By my signature below, I hereby waive this requirement. I am the (check one) E] owner owner's a ent
Owner/Agent p PERWTFEE: /ZS�dD
Signature Telephone No.