HomeMy WebLinkAboutMiscellaneous - 65 MAIN STREET 4/30/2018 i
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t /L�1 idle l'SIIllIIIiIIIT11Iedth If �' ficar#iil� Permit No. P
3partmz it of VtIhUr —*itfPtIl Occupancy& Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS 527 VVIR 12:00 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 00
17
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
(XX or Town of NORTH NDOVFR To the Ins ector Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant 1014wro ` 6`-`"
Owner's Address
Is this permit in conjunction with a building permit: Yes _ No (Check Appropriate Box)
Purpose of Buildino Utility Authorization No.
Existing Service Amps _J Veits Overhead _ Undcrnd No. of Meters
New Service Amps —J Voits Overhead _ Unccma r No. of Meters
Numcer of Feeders and Ameacity
Location and Nature of Prccosec Electrical :'Jcri<
Totai
No. at L:gn:ing Outlets I Nc. of 'o: - bs No. of Transformers KVA
I Abcver— in-
No. at Lighting Fixtures O i Sw mming Pool grno. _ cmc. _ ! Generators KVA
No. of Emergency Lighting
No. at Recectacie Outlets No. of Oil =urners .Sarery Units
No. at Swncn Outlets No. ar Gas ?urners I FIRS ALARMS No. of Zones
_ Total No. of Cetec:ion arta
No. of Ranges No. of Air Cora. tons Initiating Oavices _
"eat Total Total
No. at Disposals No.ct
?::n'=5 No. -at Souncing Oev ces _
Tons K'YV
i No. of Sett Cantainea
No. of Cisnwasners - ScacetArea Hearne Kw Oe:ecttarvSouncing Devices
Lcoat — Munwicai Other
No. of Driers Heattna Devices Kw Conneccton
No. at No. of Law Voltage
No. of Water Heaters K`PJ i Sicns Sailasts Wir:nc
No. Hvcro Massage Tubs I No. of ?.Motors atat HP
oTHEP:
INSURANCE COVERAGE: P--,rsuant :o the reeuirements of rAassaC-;set:s general 'Laws cIt
NO
I have a current Liao6ity Insurance Policy inctuc:ng m^-etee Ocerauons C„veraae or is suostanttal ecuivatent. YES.have suemitteo valid proof of same to the attics. YE-5-� NO = It you nave cnecxee YES. please noicate the typcoverage Cy
checxtng the app orate cox.
INSURANCE SONO = OTHER = (Pease Scec:ty) (Expiration Oatel
Esttmatec Value of E'.ectncal Warx 5
Worx :o Start Inscect:on Data Aacues:ec: Rough Final
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-. Signed unser :h altles t pe ry: ivr�,
_ UC. NO.
FIRM NAME
Licensee Signature U
Alt. Tet. No.
Acoress
r or is suostannal eeutvalent as re-
OWNER•S INSURANCE WAIVER: I am aware :Rat the Lace see noes not nave the insurance coverage Agent
euirea ov Massachusetts General Laws. ana that my signature an :n:s cermlt acpttcatton waives this reeturement. Owner ,r�
(Pease cnecx one) (^(!
eiecnone No. PERMIT FE= 5
(Signature of Owner or Agents
t
1 Date....:..S/�o �f
NORTH
3+°e.' TOWN OF NORTH ANDOVER
0 . A
40 PERMIT FOR WIRING
,SSAC14USEt
This certifies that ... /J cc L
. .................................... .....
has permission to perform ......R- Rj , t
n .......................................
wiring in the building of..... . « f�?n �;
................. ........
....................................... _
at....... ..5..../ti:1 G. .:!.....5....................................... .North Andover,Mass. .
A
Fee......
........... Lac.NoJ.r .��!?/.
. .................................................
ELECTRICAL INSPECTOR
E: Applicant CANARY: Building Dept.0""' INP7i6wer 20.00 PAID