HomeMy WebLinkAboutMiscellaneous - 71 OLYMPIC LANE 4/30/2018 (2)m o by , b to
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Date .................... 7 2 0 .. S ......
.. ....
0 TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that............. J/ e` 1`'
......................................................... : ......................
has permission to perform ........
: T ....... !-�...................................................
wiring in the building of ..... ......... .........
.....................
at ................. ...... Fr . .....
................
... ................ North Andover, Mass.
Fee ....�. Cl..:....... Lic. No ................ .....
'iLECTRICAL INSPECTOR
Check # A/ -f&
8229
G
�e
Commonwealth of Massachusetts Official UseOnly
lug Department of Fire Services Permit No.
Occupancy and lee Checked
BOARD OF FiRE PREVENTION REGULATIONS Rev. 1/07) leaveblank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 1100
(PLEASE PRINT IN INK OR TYPE ALL INFORMA770N) Date: ? - z - o P-
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 Ur, i IM, . Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes C
Purpose of Building /
No ❑ (Check Appropriate Box)
Utility Authorization No.
Existing Service A ps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service Amps t Volts Overhead ❑ Undgrd e"- No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
s
Cc, letion nfthu Fntln. ,1.,.> r.,h/a .,, ., A. ...... .-.,J t,...L_
No. o�Recessed Luminaires
---.. .---_... .. ..... ,.... .....
No. of Ceil.-Susp. (Paddle) Fans
............r .mac --U tly enc Jigrctvr �i rr iir�.
No 0
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool ove Eln- F1
rnd. rnd.
0. o mergency ig ng
Batter Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
I No. of Zones
No. of Switches
No. of Gas Burners
-o-.o-o-.oT Uetechon an
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
eat Pump
Totals:
Number
Fons
o. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal❑ Other
Connection
No. of Dryers
Heating Appliances KW
Security stems:
No, of Devices or Equivalent
No. o. o ater KW
Heaters
o. o o. o
Si ns Ballasts
Data Wiring:
No. of Devices or E uivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
_
a ecommuntcations irtng:
No. of Devices or Equivalent
OTHER:
Attach additional detail it -desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (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 OND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: %%