HomeMy WebLinkAboutMiscellaneous - 9 PERIWINKLE WAY 4/30/2018 (2)A, 60 U 3
Date...
.............................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .....
..................................
has permission to perform..................................
wiring in the building of r�� -.1
......................................
...... North Andover, Mass.
Fee.. .... Lic. N04Fyw-
.... . .... . I . . ............
ELEcrRICAL INSP&Mi'0,10'
Check, #
?WE ed%MMM51M? 07 WXSS,4eW499775
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM
Permit No.`Yn 6C�
Dov/
& Fee Checked
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 'ga—' / P--^
To the inspector of'Mres:
Town of _ _ _ _ _ / /T/1/ �/ v' e— -I C
The undersigned applies for a permit to perform the electrical work described below.
Location (Street &
Owner or
Owner's Address
Is this permit in conjunction with a building permit
Purpose of
ri
Yes el� No 0 (Check Appropriate Box)
Existing Service AmpsYa Voits
New Service Amps Volts
Overhead D
Authorization No.
Undgmd t�--�"- No. of Meters
Overhead 1 Undgmd 0 No. of Meters
Number of Feeders and Ampacity,
Location and Nature of Proposed Electrical Work
s2.
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
1 have a current Liability I Policy including Completed Operations Coverage or its substantial equivalent YES = NO
have submitted vat" roofof same to th&Of lice YES - NO - If you haveche.Md YES
INSURANCE BOND - OTHER - (Please Specify) please indicate the �� a b�hxbng the appropriate box.
d
Estimated Value of. Electrical Works (Expiration Date)
Work to Start .S Inspection Date Resquested L O�4 /—Rough Final
Signed under the Pena es ofp"
FIRM NA.0 �// / �`— UC. NO. %� 3
Ucensee d ±r � s Lam. —5r A d I SignatureLIC. NO. % 3
i
���� r^ s. Tel No.
Address LLI p/ tS d %� �yr�i Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
(Signature of Owner or Agent)
QV
Telephone No. PERMIT FEE $'
Total
No. of Lighting Outlets
No. of Hot fuse
No. of Transformers KVA
Above 0
In 0
No. of Lighting Fodu es
Swimming Pod gmd 0
gmd 0
Generators KVA
No. of Emergency Lighting
No. of Receptacles Outlets
Z 3
No. of Oil Burners
Babwy Units
No. of Switch Outlets
-2-0
No of Gas Burners
FIRE ALARMS No. of Zone
No. of Detection and
Total
No. of Ranges
No of Air Cond
Tons
Initiating Devices
Heat Total Total
No. of Diposal
No. Pumps
Tuns
KW
No. of Sounding Devices
NoJ of Self Contained
No. of Dishwashers
SpaceWArea Heating
KW
Detection/Sounding Devices
0 Municipal r Other
No. of Dryers
Heating Devices
KW
Local Connection
r
No. of
No. of
Low Voltage
?No. of Water Heaters KW
Signs
Bailases
Wiring
',No. Hydro Massage Tuds
No. of Motors
Total HP
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
1 have a current Liability I Policy including Completed Operations Coverage or its substantial equivalent YES = NO
have submitted vat" roofof same to th&Of lice YES - NO - If you haveche.Md YES
INSURANCE BOND - OTHER - (Please Specify) please indicate the �� a b�hxbng the appropriate box.
d
Estimated Value of. Electrical Works (Expiration Date)
Work to Start .S Inspection Date Resquested L O�4 /—Rough Final
Signed under the Pena es ofp"
FIRM NA.0 �// / �`— UC. NO. %� 3
Ucensee d ±r � s Lam. —5r A d I SignatureLIC. NO. % 3
i
���� r^ s. Tel No.
Address LLI p/ tS d %� �yr�i Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
(Signature of Owner or Agent)
QV
Telephone No. PERMIT FEE $'