HomeMy WebLinkAboutMiscellaneous - 93 MILLPOND 4/30/2018'IV
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N2 1859 Date ......... 7
TOWN OF NORTH ANDOVER
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PERMIT FOR WIRING
This certifies that ........ ......... I -L ..........................
has permission to perform .... P) Ct C
..........
........ ...
wiring in the building of ........ C—r�
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at..... ........ ....... n.�'f 1 ..... 6)!' a ............. orth ov r', 'ass.
.10 Fee..."7 ... Lic. No. Z .. . ........... ; V. .........
LEcrRICAL INSPECTOR
UV 09hQi4:56 30-00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
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ne Commonwealth of Mas�achusetts Peraft No. olftce If" out ( YC5- 9
Department of Public Safety
� ; Occupancy & Fee Checked
( LI�Jll OF FIRE PREVENTION REGULATIONS S27 CMR 12M 3/90 (leave blank)
r, E R PERMIT TO PERFORM ELECTRICAL W
AXM=A-1JML B
ORK
All vmrk to be performed in accordance with the Mawachuserts Electrical Code. 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORM &TI ON) Date
City or Town of /. I .
1= To the In.3pector of Wires:
The undersigned applies for a permit to perform the elect I ricl work descr.
Location (Street & Number) Y, O� Afd/ 1941015-1 1 MAP -- U
Owner or Tenant RPM
Owner's Address 0
Is this permit in conjunction with a building permit: Yes n No M--gu>o; psq,
Purpose of Building, 4?6:f
a- Utility Authorization NO.
Existing Service Amps Volts Overhead Undg-rd No. of Meters
New Service Volts Overhead Undgrd El No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets
No. 6E Hot Tubs
No. of Transformers Total
KVA
No. of Lighting . Fixtures
Above in- E]
Swimming Pool , grnd. grnd
Generators KVA
No. of Receptacle Outlets
No;. -oE Oil Burners
No. of Emergency Lighting
Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Self -Contained
Detection/Sounding Devices
Local 0 Municipal F]Other
Connection
No of Ranges
No. of Air Cond. Total
tons
No. of Disposals
No. of Heat Total Total
Pumps Tons KW
No. of Dishwashers
Space/Area Heating KW
No. of Dryers
Heating Devices KW
No. of Water Heaters KW
No, of No. of
Sign Ballasts
Low Voltage
Wirinit
No. Hydro Massage Tubs
No. of Motors Total HP
INSURANCE COVERAGE1. P&;rsuant to the requirements of Massachusetts General Laws
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I have a current:6,a 2.8 Insurance Policy including Completed Operations Coverage or it�;-�tantial
equivalent. YES _ NO I have submitted valid proof of same to this office. YES[131 NO 0
If you have chee YES, please indicate the type of coverage by checking the appropriate box.
15W
INSURANCE UR'BOND M OTHER 0 (Please Specify) lo?
Estimated Value of Electrical Work S tExpiration Datt)
Work to Start Inspection Date Requested: Rough__Z!�/�/ Final
Signed under the pen4lties of perjury: F,9?,Sfcae,rvS,6sr.- 10a 6A. I't 90e!�l e4vo
FIRM NAME_ _ 6166577 /r" LIC. NO. AP
Licensee Signature LIC. NO.
Address 2f
.4 6/91,/6Bus. Tel. No.
92 =7 0Z c --
Alt. Tel. No. J / 0 — 0 L -W
OWNER'S INSURANCE WAIVER: I am aware that the Liceqsee does not have the insurance coverage or its sub-
Atantial equivalent as required by Massachusetts General Law , and that my signature on this permit T
application waives this requirement.. Owner Agent (Pslease check one)
Telephone o.
(Signature of Owner or Agent)
C-�
PERMIT FEE
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