HomeMy WebLinkAboutMiscellaneous - 742 WAVERLY ROAD 4/30/2018 (2)_�
F
r N° 2436 Date...../
TOWN OF NORTH ANDOVER
o , p PERMIT FOR WIRING
,SS CMUSE�
This certifies that
!. .. ..T........ S. e ............. ......::.f...................
has permission to perform ,�-t ° I ✓� S
.........................................................................
wiring in the building of ..... ..
..................................................
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at .......7.. .c ....... �?..�. r.P.. �y/.............VE�c*ril�c�AL
orth And, ver s.
Fee........... ........... Lic. No.............. �...................... ...........f .....
4 INSPECTOR
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Check # fl
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Commonwealth of Massachusetts 011icial Use Only
Department of Fire Services Permit No. 43
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 11/99] (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: G I y.. 0 e)
City or Town of: @J C) ,r t} P�10�0 vt,E To the hzrpector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street &Number) '`/t CA V t? C l Uec
Owner or Tenant 01� t �- %� t r Telephone No. 5/ 0 �4
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No [ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
r . New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: (A C rr-
- i'nnrnln6nn nftlro fell.,,. .. t..hl., ......1,�, .,.,7 l....1.., i..____. _t•rm__
No. of Recessed Fixtures
_'... '__. _.. _, ...- ............ .«.....
No. of Ceil.-Susp. (Paddle) Fans
...,•r .... ..,...c.. v arc a.0 cuvr v rr t�eS.
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators K -VA
No. of Lighting Fixtures
Swimming Pool above ❑ n- ❑
rnd, rnd.
o. o Emergency Lighting
Batten 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
Initiatin Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
b
No. of Waste Disposers
Heat Fu-m`p
Totals:
Number
-- **-'-I---*-
I Tons
1KW
"*-
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local El un ❑ Other
ction
No. of Dryers
No. of W ater°
Heaters KW
Heating Appliances KW
o
°' °
Signs Ballasts
unt stems: ake0ve-r
• o evrces or E uivalent �
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 delail ifdesired, 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 ❑ BOND ❑ OTHER ❑ (Specify:)
Q A.1 -
Estimated Value of Electrical Work:
/V
(When required by municipal policy.)
(Expiration Date)
Work to Start: � /19/" Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: ADT Securitv Services 111 Morse Street, NonA)O(„ MA 02062 LIC. NO.: 1533C
Licensee: John S. Bassett Sionatur / LIC. NO.: 1533C
(Ifapplicable, enter "exempt"in the license numberlille.) Bus. Tel. No.: -7R1 -27A— 1
Address: Alt. Tel. No.: 603-..594-59 resi
OWNER'S INSURANCE WAIVER: I am aware that the Li ensee does nol have the liability insurance coverage normally ONLY
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑owner's agent.
O�� mer/Agent
Signature Telephone No.
4
Location rd`�dJ�
No., ';;� Date
y -J
04/06/99 11:01
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
Building Inspector
52.00 PAID Div. Public Works
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