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HomeMy WebLinkAboutMiscellaneous - 566 FOREST STREET 4/30/2018 (2) 566 FOREST STREET 210/106.6-0097-0000.0 I 9930 -.�.. Date..... NORTp °f,"`°:•�"� TOWN OF NORTH ANDOVER PERMIT FOR WIRING ��SS�cMusE� This certifies that h has permission to perform .......... L��GaS wiring in the building of............... ............................ r at....................................(.....................................Z....orth Andover,Mass. Fee..?.� 4 ©.. Lic.No.4'�J�S .................... L INSPECTOR Check # 7 r k C,ommonwealtk of t'//a6.4achaietti Official Use Only cc�� Permit No. ��3 d Apartment o f Sire Service Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank u,p APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C),5 7 CMR 12.00 (PLEASE PRINT K OR TYPE ALL INFORMATION) Date: City Tow of. N(.)rw nnAow To the Inspector of Wires: By this applicati ndersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) LS 5+ Owner or Tenant -,34zohm Swvoidjo Telephone No. ho- ' -iq Owner's Address -510Mt- Isthis 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❑ Und rd No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: l�SCJ--Mil-NA�5 D &-511�1 j'�= �1 Completion o the ollowin table may be waived b the Ins ector 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 SwimmingAbove In- o.o Emergency ig mg Pool rnd. E] rnd. E] Batte 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 vi h Devices No.of Ranges No.of Air Con d. TotalTons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained ._........................................................ Totals: Detection/Alerting Devices ftM4 pa No.of Dishwashers Space/Area Heating KW cal Connectq�pion e Y No.of Dryers Heating Appliances KW Security Systems. No.of Devices or Equivalents. No.of Water KW No.of No.of ring• Heaters Signs Ballasts No.of eveva ent r 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:, 33, 60 (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:) Self Insured I certify,under the pains and penalties of perjury,that the it formation on this application is true and completes FIRM NAME: ADT Security Services Inc. , ( , \ LIC.NO.: C-45 Licensee: Mark A. Brophy Signature . CJS - LIC.NO.: C-45 (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.•978-657-0443 Address: 155 West Street, Suite 6 Wilmington, MA 01887 Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. 00953 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 E]-owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ yj``�, Date.... TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING US This certifies that ..........I.......�49 .4........................................... has permission to perform ...... ........................................ wiring in the building of.............. ........................................ at..4 �Ag��r...I ............................ .Aorth Andover,Mass. Fee.5...... ..... L i c.N o. F3,V.............. A.- ELE RICAL INS Check # 11 Slo� QnFir) Commonwealth of Massachusetts U ficial Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked Rev. 1/071 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: e" IV City or Town of: NORTH ANDOVER � � 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 � =�� e r y s(— Owner or Tenant �„ v� ti 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. Existing Service Z d7aa Am /ii Volts"" Overhead � Und rd g ❑ No.of Meters New Service Amps �/ Volts Overhead❑ Undgrd No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: r. Com letion o the ollowin table maybe waivedby the Inspector of Wires. No.of Recessed Luminaires z G No.of Ceil.-Susp.(Paddle)Fans °•° Tota — Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool ove ❑ n- ❑ o.o mergency ig ng rnd. rnd. Batter Units No.of Receptacle Outlets No.of OR Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners. No.of Detection an Initiatin Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers eat ump um er ons p Totals: o.o e - ontame Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Localunic pa ❑ Connection ❑ Other No.of Dryers �/ Heating Appliances KW ecur ty ystems: o.o iterNo.of Devices or E uivalent Heaters KW o.o o.o Data Wiring: Signs Ballasts No.of Devices or E uivalent z No. Hydromassage Bathtubs No.of Motors Total HP TeI4 trtng: ' OTHER: No.of Devices or E uivalent 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 94, OND ❑ OTHER ❑ (Specify:) certify,under the pains and penalties of perjury,that the information on Misapplication is true and complete. FIRM NAME: LIC.NO.: gy 3-3 Licensee: Signature LIC.NO.: Tx (Jf applicerble, en ,r "e_rempt"h Nie license number line.) Address: z Bus.Tel.No.:/.P _2 /94e *Per M.G.L c. 147,s. 51-6 1,security work requires Departm of Public Safety"S" License: Alt.L cl.No. 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 C]owner Owner/Agent owner's agent. Signature Telephone No. PERMIT FEE: $ ..�' � _ , . ., _ n ,r .. i� _ � ' � �� � a . _ .� . . i i <<. j '• - � ,� . � � � t - .� � - i • � .� .� 1 � i �r' � r. . � � , ' F - � 1 1 � i � � i. .. � � .� - i .. Date..l%... ........ NORTH .t'e 0 TOWN OF NORTH ANDOVER 0 41 PERMIT FOR WIRING AcmU This certifies that ..... ...... ............................... .................... ....... ... has permission to perform ................. wiring in the building of..-. ... ............................................................ at... .,- .6...... r.....................North Andover,Mass. Fee.1z .......... Lic.No.Zaas_e_.4.. .� ........)..............7.4J. ................ ELECTRICALo.sNSPECT4R Check # 6 7 :/_8 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked 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 CVe 527 CM- 12.0 (PLEASE PRINT IN INK OR E AL FORM IOA Date: City or Town of: To the Iof Wires: By this application the undersigns giv s notice of hi or her tnt ntion tgerform the electrical work described below. Location(Street&Numb r) Owner or Tenant Telephone No. Owner's Address — Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Autho ization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity r Location and Nature of Proposed Electrical Work: Completion of thefollowing 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 Above In- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ grnd. ❑ 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 Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of elf- ontained j Totals: Detection/Alerting Devices l No.of Dishwashers Space/Area Heating KW Loc Municipal ❑ Other ion Security S stNo.of Dryers Heating Appliances K tyems:* es or Equivalent No.of Water K`,�, 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. 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 na BOND El OTHER [I (Specify:) I certify,under the pains pei s of perjury, t the informs on on this application is true and complete. FIRM NAME: LIC.NO...-700-5 G Licensee: yo— Signature LIC.NO.:3 (Ifapplicable, enter--exempt"in the license number line.) No. 7-1 y ,ddress: St peAAlt.Tel.No.: *Security System Contractor License required/for this work;t ap icabl ,er11�rttte�icensenumb x here: 55GO 0 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.