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Home My WebLink AboutMiscellaneous - 64 WAVERLY ROAD 4/30/2018I -,^e ki Date.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... A ....... ��IE ..................... -- -1 W P"R ...................... has permission to perform IV ................ wiring in the building of .............. .. P.Ilo ........................................... at ..... 6Y ..-Z .... L�U �M;;CYY .. eD ................... . North Andover, Mass. F e e L i c. N o ..... 4- - - mw--'-'� �- .......... ELEcrRicAL INSPECTOPR�)"' Check # 6991 Commonwealth of Massachusetts Official use only Department of Fire Services Permit No. C' J / Occupancy and Fee Checked J 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 Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALLQort— RMATION) Date: ( � d4� City or Town of: �u To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pG, the electrical work described below. Location (Street & ber) 6 �—a �e C, �, -*�. Owner or Tenant fit" 1 Owner's Address Telephone No.gd 31 Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Generators KVA Utility Authorization No. Existing Service L Amps / Volts rOverhead No. of Receptacle Outlets Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity No. of Ranges l No. of Air Cond. Total No. of Alerting g Devices �— 0 Location Nature of Proposed Electrical Work: ��r`jti� Number I v� G�4— --((and _Jf G � No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. o Water KW Heaters No. of No. o Signs Ballasts Cmmnlvtinn nfthe fnlln ... ;h tl,ht, No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. o Tota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. grnd. o. of Emergency Lighting 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 l No. of Air Cond. Total No. of Alerting g Devices �— No. of Waste Disposers Heat Pum Totals Number I Tons KW I I No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW 1_ Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. o Water KW Heaters No. of No. o Signs Ballasts Data Wiring: 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: t �� (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:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee:�j�j/ T, 6G��/L Signature O,: 031 (If applicable, enter "exempt" in the license number line.) Bus. el. No.: Address: Alt. Tel. No.: *Security System Contractor License required for this work; if applicable, enter the license number here: OWNER'S IN RA CE WAIV R: I am aware that the Licensee does not have the liability insurance coverage normally required by laWBSi ur elow, 1 hereby waive this requirement. I amthe(checkone)❑ owner ❑owner'sagent. Owner/AgenQ7Y �(j� 5 (3 PERMIT FEE. $ Signature Telephone No. ,_-.000111110 r---c4-tw eq Date../. - TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... has permission to perfdfffi-� --<I-� ....................... .......... :4 ............. ........ ............... wiring in the building ....................... I ............................................. at .... 4f/-.�... .... ....... A '02— �- ........ . North Andover, Mass. Fee ....... ............. Lic. No 47j/ . . .... JIPWP"— I Check # 64) 7 �P� .......... ................ li�E- C -r' R*I*C* A**L' 'INSPEM -Lzlej- 7 A Commonwealth of Massachusetts Official use only Department of Fire Services Permit No. rpy(lZ BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked u,p [Rev. 11/991 (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: 1-30-06 City or Town of: NORTHANDOVER 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) 64-66 WAVERLY RD. Owner or Tenant JOYCE CONOLLY Owner's Address SAME Telephone No. 978-082-2071 Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Boz) Purpose of Building INSTALLING 3110V SMOKES Utility Authorization No. Existing Service Amps Volts Overhead[—] Undgrd ❑ New Service Amps Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: INSTALL 3 110V SMOKE DETECTORS IN COMMON AREA Completion of the following table mav be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans o. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures ove - Swimming Pool d. E]rud. E]No. o . -on Units mergency Lighting No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of. Switches No. of Gas Burners o. of Detection an Initiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pum Totals Number ons / ................ o. oSelf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local N Conncection El Other No. of Dryers Heating Appliances KW ecunty stems: No. of Devices or Equivalent No. o Water KW Heaters o. o o. o Signs Ballasts Data Wiring: No. of Devices or Eq uivalent No. Hydromassage Bathtubs No. of Motors Total HP elecommumcations Wrong: No. of Devices or E 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 certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE N BOND ❑ OTHER ❑ (Specify:) 11-06 (Expiration Date) Estimated Value of Electrical Work: $585.00 (When required by municipal policy.) Work to Start 1-30-06 Inspections to be requested in accordance with NEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and oomplde. FIRM NAME: SALVATORE SICARI LIC. NO.: E31832 Licensee: SALVATORE SICARI Signature LIG NO.: E31832 (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 781-231-9833 Address: 8 LAURA LEE CIRCLE SAUGUS MA. 01906 Alt. Tel. No.: 781-820-1346 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, l hereby waive this requirement I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent P ERMIT FEE. Signature Telephone No. Dat'e.1-S TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING. This certifies that TO VA 4/4 4. .1717 ............. V has permission to perform .................................... plumbing in the buildings of / ,a at ................................. North Andover, Mass. Fee4WS.-�. . . Lic. NqX�V .. ...... /PLUMBING INSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS ,` Date -3/j S)0- ('0 Building Location l v�+� �%„]Owners Name e�41&1�2�s7< Permit # � G FTC / J ! / Amount Type of Occupancy>''� S t q",.,�,�y-� 1�,�,� v l New 0 Renovation Er Replacement Submitted Yes ❑ No (Print or type) Installing Company Name v�'Jq'tT?�tn� r%%g,✓,✓/� Check one: Certificate Corp. Partner. Firm/Co. Name of Licensed Plumber: IA-v-�,-)0.4.,�A Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability policy ❑ Other type of indemnity ❑ Bond 107, have been made aware that the licensee of this application does not have any one of the above Owner ® Agent 11 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Cha ter _A1'42 of the eneral Laws. " &� C—� By: Signature Ot LlcenSeClum er Type of Plumbing License Title City/ROVED (OFFICE USE ONLYwn icense 147713er Master ❑ Journeyman L.1 1' • i .W.MW.M.....W..WITSMONE .M---M...WNMNMMWNMNMMNNNNWNMNMMNWM. -.O..-O-....OM.-M.--.--M- , / 1. N...M...-M....W.....-..-- 1 1 ' ............NWWWNMW-..MM- NNNWMMM.....t-......N..-- .i m 5.m...t....-ommmmmommmmmt (Print or type) Installing Company Name v�'Jq'tT?�tn� r%%g,✓,✓/� Check one: Certificate Corp. Partner. Firm/Co. Name of Licensed Plumber: IA-v-�,-)0.4.,�A Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability policy ❑ Other type of indemnity ❑ Bond 107, have been made aware that the licensee of this application does not have any one of the above Owner ® Agent 11 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Cha ter _A1'42 of the eneral Laws. " &� C—� By: Signature Ot LlcenSeClum er Type of Plumbing License Title City/ROVED (OFFICE USE ONLYwn icense 147713er Master ❑ Journeyman L.1 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that 3. �� ............. has permission for gas installation ............................ -17.4 .. in the buildings of k at .................................... North Andover, Mass. Fee Lic. No.,?(,�B ...... Gki I'NSPECTOR Check #2� 01--2 'A .; AV%ACHLSYM UNIFORM AM ICATON FOR PERM TO DO GAS FITTING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations 0wner�' ame New Renovation Replacement Plans Submitted ❑ Permit # Amount S (Print or type) ,, // C e one: Certificate Installing Company Name U.✓A7Nfl�J- /%%q,�,,�i{ Corp. .address S�A '1-A�-� �'�b S1, , el—V4 ❑ Partner. Business Telephone 57.)4 -a77- 96'93 Firm/Co. Name of Licensed Plumber or Gas Fitter \br/. INSURANCE COVERAGE • Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 13 No� If you have checked yes, please indicate the type coverage by checking the appropriate box. D Liabi ty insurance policy � Other type of indemnity Bond er'�ene®ra].LaV<s' aware that the licensee does not have the Insurance coverage required by Chapter 142 of the las�signature on this permit application waives this requirement. Check one: Si nature of Owner or Owner's Agent Owner Agent 13 -- 7 � 1), Mal awl vi Lilt ucja,a, auu jiumnauvn , nave suomrrrea for enrerea) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in ccmpliance with all pertinent provisions of the Massachusetts State GasC\/ an Chapt r 142 of the General Laws. tle ity; Town IAPPROVED,CFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ® Plumber 1:95A,?a Gas Fitter Cicense Number er Master Journeyman 3. - K- 6 (. Date .......... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING. This certifies that YX 1.�� ................ has permission to perform ............ .............. U. A. /. 1. r I plumbing in the buildings of Ro!n(� ..... at .. , North Andover, Mass. PLUMBING INSPECTOR Check# 'S06 14 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS f j Date Building Location Owners Name 4.S / / �y �t a /-Permit Type of Occupancy /C ---S P yp,14 �uv�5 Amount (O�.t. New Renovation Replacement Plans Submitted Yes ❑ No Nam 1' • i �.-....-WM.....-...-. .-- ' -...M-..M ................ 11' mm-..m-mm..mmm----.-m--.. W,gtlolrce-"Emnmmmmmmmmmmmmmmmmmmm MMM MWMMMWMMMMMMMMMMMMMMM MMM MMMMMMMMMM ■MMMM mmmmm ■�� Wilooluffeoliimmmmmmmmmmmmmmmmmmmmm MM (Print or type) Check one: Certificate Installing Company Name 0401--A- ❑ Corp. Address Z A 449 � Partner. BusinessTelephone ,6 -a??- 96tU � Firm/Co. Name of Licensed Plumber: 1�v4��1✓,✓� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Q Other type of indemnity ❑ Bond ❑ I, the undersigned, have been made aware that the licensee of this application does not have any one of the above Signature Owner -- MT Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State P]ur9bing bode and Chapter 142 of the General Laws. IBy: Title City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License icense Mumner Master . ❑ Journeyman �^ � AF Date . ......... 4, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that 6!10 A ............... has permission to perform ............ ....................... plumbing in the buildings of �!�'? !�i.)u .......... at,,t .............................. North Andover, Mass. re*e L I c. N o. a . ...... 1. , '.'. * * I * ' * * ' * ' PLUMBING 1;��SPECT*�ZR Check # N MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location Date Permit # % Amount s New Renovation Replacement-[] Plans Submitted Yes13 No (Print or type) Check one: Installing Company Name ❑ Corp. DPartner Firm/Co. Name of Licensed Plumber: , v `�ta,� IW,9, WA Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Li ity insurance policy ❑ Other type of indemnity ❑ Bond ❑ Certificate I, the undersigned, have been made aware that the licensee of this application does not have any one of the above Owner Agent I herey certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of th& General Laws. By: OVED (OFFICE USE ONLY Type of Plumbing License sg:�26 icense NumDer . Master ❑ Journeyman 1 3-- 1' N MN MMM MM MMMMM um MMMMMM ................... mmmm MM (Print or type) Check one: Installing Company Name ❑ Corp. DPartner Firm/Co. Name of Licensed Plumber: , v `�ta,� IW,9, WA Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Li ity insurance policy ❑ Other type of indemnity ❑ Bond ❑ Certificate I, the undersigned, have been made aware that the licensee of this application does not have any one of the above Owner Agent I herey certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of th& General Laws. By: OVED (OFFICE USE ONLY Type of Plumbing License sg:�26 icense NumDer . Master ❑ Journeyman 1 3-- 0 CH S Date.. J.—IT--o- 6 .. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that YA Vk 41 . ell A C41-1 .......... .... ....... has permission for gas installation ............................ in the.buildings of .(q.z/746.r. 055 ... IU ( t V. �6i � 7. ZT ....... at .................................... North Andover, Mass. Fee. �i�� .... Lic. No.� 4$ ... .... . . ..... GAS INSPECTOR Check# ?no �r 5492 iIv 5�qZ 1�(1,1,%ACHCSE M LNIFORNI APPUCATON FOR PERNIlT TO DO GAS FITTING (Type or print) Date �3_ X62 NORTH ANDOVER, MASSACHUSETTS Building Locations New D Renovation I`^ Sr Permit # J �� 1— Amount $ Owner s Name � 7m-ent DPlans Submitted D (Print or type) CtLeLk one: Certificate Installing Company Name '`''`11✓N✓� Corp. Address "'� Partner. Business Telephone S -0 –a77 -98V � Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE• Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes NoO If h hecked es lease indicate the type coverage by checking the appropriate box. you ave � y_, p Liability insurance policy D Other type of indemnity Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent13 hereby certify that all of the details and information 1 nave suomittea dor entereu) in aoove appttcanon are true anu accurate to the best of my knowledge and that all plumbing :work and installations performed under Permit Issued for this application will be in ccmpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Genual Laws. ) Title City; Town IAPPROVED,OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter D Plumber '0�- Ra�9 Gas Fittertie , um er Master otimeyman I n oil — MM MMMMMMMMMMMMMMMM= wwco�wwwlwww�■www■ww��■�www■ ��w�wiw�wwww��■w■��w��w■ ww��■�w�ww��ww��ww��■w��■ 0• Iltwwwwww�wwwwwwwww�w�w■ wwMwMMMMwwMMMMMMMMMMM ww�wwww�wwiw■wwwwwwiw■w��■ (Print or type) CtLeLk one: Certificate Installing Company Name '`''`11✓N✓� Corp. Address "'� Partner. Business Telephone S -0 –a77 -98V � Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE• Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes NoO If h hecked es lease indicate the type coverage by checking the appropriate box. you ave � y_, p Liability insurance policy D Other type of indemnity Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent13 hereby certify that all of the details and information 1 nave suomittea dor entereu) in aoove appttcanon are true anu accurate to the best of my knowledge and that all plumbing :work and installations performed under Permit Issued for this application will be in ccmpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Genual Laws. ) Title City; Town IAPPROVED,OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter D Plumber '0�- Ra�9 Gas Fittertie , um er Master otimeyman I Date..................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that.. A YNAA wfl.ftel.4� .............. -has permission for gas installation ............................ in the buildings of . . (a.V:. (e ("'� .... .... ST.... Wr. � at .................................... North Andover, Mass. Fee. Lic. No. GAS INSPECTOR Check# 5491 ,vIASSACHCSETTS UI�IIFORM APPUCATON FOR PERM TO DO GAS FITTING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations z - �4/Y f` Permit # A rnount Owner's Name New ❑ Renovation Replacement ❑ Plans Submitted ❑ 1� (Print or type) e Cl cone: Certificate Installing Company Name �Y'+ ►n>'A'`� U Corp. Address 5�'Q "lam" ZAP ❑ Partner. Business Telephone ,.So$ - a77-9AI?g ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter MURANCE COVERAGE- Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ Noll If you have checked Vis, please indicate the type coverage by checking the appropriate box. Liability insurance policy 1:1Other type of indemnity ❑ Bond 1:3 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent ❑ t hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter I42 of the General Laws. j By: Title City;Town ,\_PPRUVED,GFFICE GSE ONLY) Signature of Licensed Plumber Or Gas Fitter ` ® Plumber Gas Fitter license , um er Master Journeyman 1ST. FLOOR 5TH. FLOOR -- (Print or type) e Cl cone: Certificate Installing Company Name �Y'+ ►n>'A'`� U Corp. Address 5�'Q "lam" ZAP ❑ Partner. Business Telephone ,.So$ - a77-9AI?g ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter MURANCE COVERAGE- Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ Noll If you have checked Vis, please indicate the type coverage by checking the appropriate box. Liability insurance policy 1:1Other type of indemnity ❑ Bond 1:3 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent ❑ t hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter I42 of the General Laws. j By: Title City;Town ,\_PPRUVED,GFFICE GSE ONLY) Signature of Licensed Plumber Or Gas Fitter ` ® Plumber Gas Fitter license , um er Master Journeyman j Date ... 0 . 4C .. ...... .. .... ... ... ... TOWN OF NORTH ANDOVER This certifies that/) I ................ PERMIT FOR WIRING has permission to perform ...... X -,,.T,- ..... wiringin the building of ........ ..................................... ............................... at .............. ...... Z./. ......... ,�orth Andover, Mass. W 6-0 S-/ 0 Fee..................... Lic. No . ............. ..................... .. .......... .. Check # Z -e EL�EcrmmcAL INS 6P63 AV J Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 6 0,09 Occupancy and Fee Checked [Rev. 9/051 (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 I FO TION) Date: Amc,"�f C1, Mi City or Town of:! /U,;r-j � 0�eAO je, - To the Inspe for of res: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) � Ul b,-v&fir (\A Owner or Tenant Owner's Address 6'4 L)4 v&i Telephone No. Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building ?,(? "-x �,? C- ( Utility Authorization No. Existing Service Amps o / 13o Volts Overhead -PT Undgrd ❑ No. of Meters New Service Amps o Overhead � Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �Z -- Completion of the followingtable may be waived by 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 Swimming Pool Above ❑In- ❑—IV57. rnd. rnd. 5-TEmergency ig ing Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. o Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: I Number Tons K No. o Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Mun'c'pal ❑ Other Connection No, of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: 4 p �} Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value4ofEctrical Work: (� (When required by municipal policy.) Work to Start:2 Inspectioi s to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE CRAGE: 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:) 1 certify, under the p ins and penalties of perjury, that the information on this application is true and complete. FIRM NAME: tef i fe, LIC. NO.: LiceI'T' &Af _ ignature LIC. NO.: (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 0 7 3113,00,;5 -- Address: Alt. Tel. No.: *Security System Contractor License required for this work; if applica e, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law B y si u below, 1 hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent✓/7%✓;�//�� Signature Telephone No.`Z-/F- Nd',( -YIN FPERMITFEE. $ po,t,A Ct- 9-14 _09 Ax-� (�^ v to -. ac-- AftT A 10