HomeMy WebLinkAboutMiscellaneous - 70 Matthews Lane o II
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980
H°RTI,
3?°;t�`` AL TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
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;,SSACMuSE�
This certifies that r-k. Y LIYG�� L
has permission to perform 'fie lw /f Uva r
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y�U�cJ�U l� C u
wiring in the building of
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North Andover, ss.
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Fee..................... Lic.No..�1. `1 ......... .. .......... P ................
( LECTRICAL INSPECTOR
G ( 660/97 14:20 310.00 PAID
WHITE:Applicant CANARY: Building Dept PINK Treasurer
e
Office Use Only
01le &U1111D11weal it of ttuadluuttg Permit No.
3 rpartuutit of Vublic .0ttfta0 Occupancy,& Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
3/90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date _ - 3 ` /
q
City or Town of NORTH ANDOVER To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) �bT -7, -70 /V C P_+`(-A c l S N'e-
Owner or Tenant __PIAYP,wo-C Y kt)
Owner's Address __4&0 Pal-k, YL- A)A-f�__
Is this permit in conjunction with El; building permit: Yes/f] No ❑ (Check Appropriate Box)
Purpose of Building S/lulu e, Utility Authorization No. 70 V 3 Z
Existing Service Amps —1 Volts Overhead ❑ Undgrnd ❑ No. of Meters
New Service Z0 O Amps Ito / 2YU Volts Overhead ❑ Undgrnd No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work )zt, �I.r
No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total
KVA
No. of Lighting Fixtures Swimming Pool Above In
grnd. ❑ grnd. ❑ Generators KVA
No. of Emergency Lighting
No. of Receptacle Outlets No. of Oil Burners - Battery Units
No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones
No. of Ranges No. of Air Cond. Total No. of Detection and
tons Initiating Devices
No. of Disposals No.of Heat Total Total
Pumps Tons KW No. of Sounding Devices
No. of Self Contained
No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices
No. of DryersHeating Devices KW Local Municipal ❑Other
❑ Connection
No. of No. of Low Voltage
No. of Water Heaters KW Signs Ballasts Wiring
No. Hydro Massage Tubs No. of Motors Total HP
..OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
1 have a current Liability Insurance Policy including Com eted Operations Coverage or its substantial equivalent. YES7 NO ❑ 1
have submitted valid proof of same to the Office. YES N NO ❑ If you have checked YES, please indicate the type of coverage by
checking thea ropriate box.
INSURANCE VP BOND ❑ OTHER ❑ (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work$
Work to Start 6— 3`9`2 Inspection Dale Requested: Rough bQl(( cr—u Final
Signed under the Penalties of per ry:
FIRM NAME ZQWr� C¢. 1^7 LIC. NO. //2 7A
Licensee(114 lis Signature LIC. NO.
Tel. No.
Address
11112A Ila --c �, /IO�fti�►� BAlt. Tel. No. SUS- ayl,
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re-
quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent
(Please check one)
Telephone No. PERMIT FEE
(Signature of Owner or Agent)
X-6565