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HomeMy WebLinkAboutMiscellaneous - 638 CHICKERING ROAD 4/30/2018 CKERINGROAD 767H 0021_0000.0 Date....k........ I....../4.......... NOprH TOWN OF NORTH ANDOVER s PERMIT FOR WIRING ssgCHUs� This certifies that ...................... / �- !.�.�.�'..................................... has permission to perform .... .1 r)(.1 1....... ....a. ��. ........................................... wiring in the building of... .S�. ,..... ................................................ at ..(I.- ..... �,II�.. .�..�.. ......� North Andover,Mass. Fee.. .J...................Lic.No.�)AW. ......( K. ..r. ..... ............................................ ELECTRICAL INSPECTOR Check# Z 5 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked y BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] 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: o-11 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) Owner or Tenant Terr-t Telephone No. Owner's Address (a S? C w cAt,er-i tic, rU . Is this permit in conjunction with a building permit? Yes ❑ No [X (Check Appropriate Box) Purpose of Building Tb�,,. y6Q5, Utility Authorization No. Existing Service I Su Amps dao / >'%Volts Overhead ❑ Undgrd[N No.of Meters ' New Service 60 Amps / Z`�-O Volts Overhead❑ Undgrd © No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: NgA^r4c ch_)� Q0­4- Completion of the ollowin 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 No.of Luminaires Swimming Pool bove ❑ In- ❑ o.o Emergency Lighting rnd. rnd. Batte Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS I 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 Number Tons KW No.of Self-Contained Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water KW 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 E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 3d�, (When required by municipal policy.) Work to Start: Q-3\-S Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived b the owner,no permit for the performance felectrical r m y p p ance o wok 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:) I cert,under the pains and enalties of perjury,that the information on this application is true and completes FIRM NAME: LIC.NO.: -�,C)180 A Licensee: Q,r�Q 'I,,��;,1�,� Signature N.� r LIC.NO.: (If applicable, enter "exem t"in the lic nse number line.) 'i Bus.Tel.No.• Address: �k T"a4 Auc< (3r�,r�hj A44• 0(835- Alt.Tel.No.: ct7�-31G-IIG *Per M.G.L c. 1.47,s. 57-61,security work requires Department of Public Safety "S"License: Lic.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)❑owner ❑owner's a ent. Owner/Agent SignaturTelephone No. PERMIT FEE. $ 55`—