HomeMy WebLinkAboutMiscellaneous - 75 JEFFERSON STREET 4/30/2018 (2)N �
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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .......
has permission to perform...........................��..`z1..:.�1............................
"wiring in the building of .......F! < .......�............................
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aat........................................................................... . North Andove MaS
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Fee � /: ... Lic. No.l`.?...TY..............
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ELECTRICAL INSPECTOR
Check #
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Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. 37
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
LEASE PRINT IN INK OR TYP L IN ORMATION Date: i 1h62
City or Town of: , ���yff To the Inspector o Wires:
By this application the undersigned Ives notrce�� or her intention to erform the electrical work described below.
Location (Street & NuR�ber) �p ��.i!�li�.
Owner or Tenant
Owner's Address
V7
Is this permit in conjunction with a building permit? Yes ❑ No Ljd (Check Appropriate Box)
Purpose of Building Utility Authorization No.
��xsting Service Amps / Volts Overhead ❑ Undgrd ❑
New Service Amps / Volts Overhead ❑ Undgrd ❑
No. of Meters
No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Installation of Security system
Completion of the following, table may be waived by the In.cnertnr of Wiroc
No. of Recessed Fixtures
No. of Ceil: Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Swimming Pool Above In-
rnd. ❑
o. o Emergency Lightingrnd.
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
o. of Detection and
Initiatin Devices
No. of Ranges
No. of Air Cond. Total Tons
No. of Alerting in Devices
No. of Waste Disposers
Heat Pump
Totals:
Number
'
Tons
I
KW
I
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems: /
No. of Devices or Equivalent l
No. of WaterKit
Heaters
No. o 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.
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:)
1!2 y� (Expiration Date)
Estimated Value of El ct 'cal Work: S�, — (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the pa ns andpenalties of perjury, that the information on this application is true and complete.
FIRM NAME:
Licensee: John S. Bassett Signature
(If applicable, enter "exempt" in the license number line.)
Address:
OWNER'S INSURANCE WAIVER: I am aware that the Lid, see does
required by law. By my signature below, I hereby waive this requirement.
Owner/Agent
Signature Telephone No.
Dc HnIlis NH LIC. NO.: 15_1,1(,
LIC. NO.: 1533C
Bus. Tel. No.: 603 594 5928
Alt. Tel. No.:
not have the liability insurance coverage normally
I am the (check one) ❑ owner ❑ owner's a ent.
PERMIT FEE: $,�j - "