HomeMy WebLinkAboutMiscellaneous - 83 HERRICK ROAD 4/30/2018The Commonwealth of Massachusetts
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80ARG OF FIRE PREVENTION REGULATIONS 527 CMA 12:00 Occupancy A Fee therxec---.JL
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APPLICATION FOR PERMIT TO PERFORM E
to ee artor�ae tR aeeaeane. +a ser ELECTRICAL WORK
(PLEASE PRINT INIINK OR TYPE ALL INFORiAATl0N
`` ``
City or Town of— Iy:y4 k\)t,/� ai Q e� Gate
The undersigned 4PRIIeS for a permit to perform the also
Location (Street d Ntrmberl
Owner or
+:rota described below.
To the Inspector of 4IlireV
Ownar•f Address
1s this peit in conjunction with�
rrnbuilding g permit yes ❑ no (] (Ch";k
Appropriate sox
Purpose Of Suildin Utit'rh Authorization N ?
No.
Eaisttng Service •� r Voss
Overhead [] undgnt Q No. of Metey
New Sondes -Amps r
--- ---V�s Overhead [] Undgrd C1No. of Meters__
Number of Feeder and Arnpacity
Location and Narwe of Proposed Electrical
Ivo. or "ghtins Outlets
INC. of Hot Tubs
TOTAL
No. of Transformers
No. Of Li htfn Fixtures
SwimmingPool __ Above
.13070
In
❑ ❑
fCVA
rnd
Csenerotors
Na. Of Aecaptade Outlets
No. of Oil Burners
No. of Emergency Lig it, ng ICHA
Batt Unita
No. of Switch Outlets
No. of Gas Burner!
No. of Asn sa
Na. of Air Conditioners
OTAL
FIRE ALARMS No. of Zones
No. of Detection and
No. of Disposals
HEAT TOTAL
No. of P"as
TONS
TOTAL
Initiating Devices
No, of Sounding Oevfea!
TONS
XW
No. of Sett Contained
No. of Dishwashers
SoaceJArea Meeting
KW
081ec"111Sounding Devicss
No. of Orvers
Heating Dom"
KW
Local ❑ Munigpal
Connection ❑Ofher
No e1 w.... u�._� .�__
Ivo. of No. of
. _._..._._
HP
OTHER:
,..v...�.c wvaw,ve: Pursuant to the requirements of Massachusetts General Laws
1 have a Current Liability Insurance Policy frtclttding Corltpleted Operations Coverage or its suMentiat re rl#'
Valle proof of Berne to this office. YES C NO O eQuivalertt. YES a NO 0 1 hhaav� o i Dbmitted
tf you have Checltld YES. please indlCate the type of coverage by Checking the appropriate box.
INSURANCE Q BOND ❑ OTHER ❑ (pious Speciy)
Eatlmmed Value of Efeetricaf Work S (Expiration Oats)
Work to S fnapectfon Date Requested: Aou h
Slgned under th0 altfes of perlu7 g final
FIAM NAM `'' ti-� LIC. NO. G 9
Licenses g p,rO'e LC Signature
Addnas t e cw 09.0 +� 1 r t l ` 3 _1 LIC. No.
' U Bus. tel. No.
OWNEA'S INSURANCE WAIVER: I am aware that Ins Ucertsee does not have the insurance Coverage or its S N. 1. No.
PAassachusenS General Lawn, and tnat my Ognsturs on this appliCatfpn wanes this 1n equivalent as required by
roquirement. Owner Agent (Plus check one)
(Slgnature of Owner ev AA.n"+ Telepnorte NO. O�.r.sM M^
��
�� te Cs
Date
2830
.;"f— TOWN OF NORTH ANDOVER ui
0
0
PERMIT FOR WIRING
...........
This certifies that .... .. V!S ... . ..............
. .... ct
T'
has permission to perform ....... .............................. ....................
wiring in the building of ...... AAAYAA17 ................................................
at ...... ?
3 .......
jjw - .................... . North Andover, Mass.
-r-ck .... 12
Feel. ........ Lic. No. 4.4� . ............................................................
ELECTRICAL INSPECTOR
WHITE: Applicant CANARY: Buildin'g Dept. PINK: Treasurer GOLD: File