HomeMy WebLinkAboutMiscellaneous - 60 Beach Wood Drive i
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TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
r. ;,SSACMUSE� ,
This ifl 6'.��'
certes that .J ,. sl .....................................................................
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has permission to perform ..1; � .... :
?" wiring in the building of .l�,-...1..../. 12j,...1 �cr .
at..?12Z). �....�... ..... . . ..,North Andover,Mass.
Fee... Lic.No� .. .... .
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A- r W3.3............ELECTRICAL. .
INSPECTOR.................
Check # ✓���
5349
Commonwealth of hfassachusettsOf icu Use Ouly
Department of Fire Serv;ces xi'crmit No. �37
BOARD OF FIRE PREVENTION REGULATIONS " Occupancy and Fee Checked
(Rev. 11/991lug io
(leave blank
APPLICATION FOR PERMIT TO PERORM ELECTRICAL WORK
All work to be performed in accordance with the Massachuse Electrical Code(NEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE A L INFO TI ) Date: G—/ 3-oy
City or Town of: o�V\ To the Inspector of Wires:
By this application the undersigned gives notice o his or her in ienti to perfo the electrical work described below.
Location(Street& Number) lleq ck W00 �f7�
Owner or Tenant �^, e,(`1 Telephone No.
Owner's Address 3. o , v\L MA
Is this permit in conjunction with a buildin permit? Yes ❑ No (Check Appropriate Boa)
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: t. N,� f GSl -.MgSS E`12C ,
Completion o e ollowin table be waived b the Ins ector o Wires.
No.of Recessed Fixtures No.of Ceil.-Sus . le Fans No.of Total
p (Paddle) Transformers KVA
No. of Lighting Outlets No.of Hot Tubs Generators KVA
No. of Lighting Fixtures Swimming Pool rnd.ove ❑ n- ❑ Batte Units o.o nits cy ig mg
1121,
rnd.
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
No.of Waste Disposers Heat Pump I Number Tons I KW No.of If-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers S ace/Area Heating KW Local ❑ M Connection
l ❑ Other
p g Connection
No.of Dryers Heating Appliances KW ecunty :
Na of Devic
es or Equivalent
No.of Water KW o.o o.o Data Wiring:
Heaters Signs Ballasts Na of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Te Na of Devices or Wiring:ications uivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
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 cer fres that such coyerage is in force,and has odiibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)/- 16`31`O
(Expiration Date
Estimated Value of Electrical Work: (fin req ' eebci pal licy.)
Work to Start: L42 Inspections to be requested in a d 10,and upon completionI certify,under thhe i s and ertaHies of p rjury,that the info ' n true and complete:
FIRM NA E: �OG(,0 v i LIC.NO.
Licensee: Signature LIC.NO.: . - a 3T1
(if applieabl a ter"exempt"in t a licen aq ber line.) Bus.Tel.No2n-(O
Address: S t 4 2T�c /� d a Alt Tel.No.: =7`a C
OWNER'S INSURANCE WAIVER: I am awa a that the Licensee does not h e the liability insurance coverage normally
i] required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑owner ❑ owner's agent.
Owner/Agent U 0
PERMIT FEE: $
Signature Telephone No.