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HomeMy WebLinkAboutMiscellaneous - 626 CHICKERING ROAD 4/30/2018 626 CHICKERING ROAD 2 1 0i0sa.o-oosa-0000.o Date..�.�.-./ ..`...... ... r DTI:,�O TOWN OF NORTH ANDOVER o a PERMIT FOR WIRING ,sS�ICNUSE� This certifies that ................................................" S � , ... ►' ...................................... le I has permission to perform ' ' °� wiring in the building of.....(!.`e. 'v v .................................................................. G' h.... P r` ?� North Andover Mass. ,Fee....35......... Lic.No.356"IE.....Z:.>C.°.(A I.��J.'u(..0 ELECTRICAL IiSPECTOR Check # L� U A 'I THECOMMOATWE.ALTHOFVlASSACHUSETTS Office Use 1 DEPARTIVIEIV7'OFPUX1CSAFETP Permit No. BOARDOFFIREPREVEMONRF.GULAT70 S527CMR12.W Occupancy&Fees Checked APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MA SACH STS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dates Id//J-/()) Town of North Andover To the Inspector of Wire: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) Gay ck rat rte^ Owner or Tenant 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 Ak) Amps /dt Volts Overhead M Underground No.of Meters New Service Amps / Volts Overhead Underground No.of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA rou ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER' i hmu�IceCovfrage.Rn�Ianttott�era�rterttsofMassadx>sEltsGa�allaws �+ IbaveaomeitLiabkh oePbhcymcudffCCorr#* CovwageoritsabsWWapvalyi YES 1:3 NO IhavestlbniWdvandp oofofsametotheOffim YES IfyouhavedlededYES ple�eir thetypeofcc)wrageby INSURANCEx BOND � OrIBIR (P eSpecafy) 06301/ EVirationDate rktoStart A) �/ U ESTimatedVakieofUschica1Work$ Wo D& Rough Final SignedunderTranaltiesofpetjuiy: HRMNANJE LicaWNo. Liouae r( Signattue A LicffwNo 246 t BusirMTeiNo. J 7r1 t&`- ( r - AItTeLP y 4`75 L2) OWNER'SINSURANCEWANFR Iamawwd-attheLioffwdoesnothavethe covanWoritssulzAx ialeg ivabitaswgiredbyMa%ad semGanalLam �-"thatmysigrbueonthispermitapplicationwaivesthistegtmanatt v(Please check one) Owner 1:3 Agent 17 Telephone No. PERMIT FEE$ �� Signature o _ wner or Agent The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: Address City Phone#: Insurance.Co. Policv#_ Company name: Address City Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00 and/or one years'imprisonments welLas_ci3hi.penaltiesjnlhelnrm-da-STOP WORK ORDJER a.fine4_($1D0M)-aAay.against_me 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 /do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing I] Building Dept [:]Check if immediate response is required .0 Licensing Board p Selectman's Office Contact person: Phone A Health Departmen i] Other �J N° 3 , . i [. Date.....`..... � NOR7M °f'"`° '•�"° TOWN OF NORTH ANDOVER - p PERMIT FOR WIRING SS CHUSE� This certifies that 3 �� s r has permission to perform - t wiring in the building of ................................................................................... f _ at.................................................=............................ ,North Andover;Mass. Fee. .............. Lic.No...........J�.t....................-.......................... ............. ELECTRICAL INSPECTOR Jr Check # I ' WHITE: Applicant CANARY: Building Dept. PINK:Treasurer TRECO t111IONWF.ALTHOFA'IAM(yICIS M office Use o DEPARTh1DV1'0FPUB1ICS4FM Permit No. BOARD 0FFIREPREVEM70NRWMTl0M5270MR 1200 i Occupancy&Fees Checked .�.� U'APPLICATIONFOR PERMIT TO PERFORMaECITZICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MAssACHUssTs ELECTRICAL LADE,527 CMR 12:00 LIC-0, (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) Owner or Tenant 'O-t t_cy-QA f, Owner's Address /���� Ff Y�llf.. Is this permit in conjunction with a building permit: Yes No ® (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service /00 Amps / d0 Volts Overhead a Underground © No.of Meters New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work QX4M*w jiJ1,%(A.- No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground El ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and _I Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal a Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER 41,on041 _s.Qj` .., U�rxreCo,$age PtJrsuar{t�theragtJnartatsoftviassadtJG Laws Iha%ea=MtLiabyhrua=PobcyutidngCurtp��'�C.cmaWcr swbstrtiale*iaiat. YES 1� NO 11hme%hnttadvalidptoafofsarnelotheOfoa YES U NO ❑ ffjouhawdrdWYES,pkasehdic&th&Axofwma@eby&dmg#r BOND MIER A� boatiort Daile w Estim Valuec Extri nI Work WatkuStart 0 hispectionDa9eRequestted Rough Feral Sgneat PMlbesc(pMW FIRM NAME lioaseNa n BtTd Na 0- y AlTe1Na OWNER'SDZURANMWAIV ;IanawaredUtheLsraneoo1111M. As sui9lequivalartasre#WbyM%mdmMC nedLam andthatmysig�adueon�peffr>�appfic�aTwai�thistagt�arrat: (Please check one) Owner Agent ❑ Telephone No. PERMIT FEE$CI -