HomeMy WebLinkAboutMiscellaneous - 939 JOHNSON STREET 4/30/2018Date ........� .....'..`./.......
....................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ........... 1,x:'3.-t..............� /r 7G
...................................................................._ :...
has permission to perform f `<
C
wiring in the building of....................,�... . - 't -
.............................................................
atI.3 1 r.. 3 S- North Andover Mass.,
"Fee...S..S...'......... Lic. No. �Cs y3j........... / .:f � .. �. �..!?.`!..'...%...
EEL&TRICAL INSPECTOR
;heck # 7 Z-/ /
n'- - n.
(ItCommonwealth of Massachusetts Official Use Only
Permit No. Z
Department of Fire Services
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 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)
City or Town of. NORTH ANDOVER To the
By this application the undersigned gives-nof his r intention to perform t]
Location (Street & Number) 1,39 Vy� ki
Date:
Owner or Tenant
Owner's Address
•114
$Wires:
work described below.
Telephone No.
Is this permit in conjunction with a b ilding p it? Yes ❑ No Er (Check Appropriate Box)
Purpose of Building �'� ' �� Utility Authorization No.
- Existing Service Amps / Volts Ove erhead ❑ Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work0 0
f�n r�,;nm nra— rnitnwfna tahlo may he waived by the Inspector of Wires.
Attach aaal[ioncu aeLuci e,/ ues�reu, �� ua . oyuu �u y •••� _•• 1-��•�• � •- - ---
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: �� Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability i urance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such cover a is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
I certify, tinder thepains Rnd ennalties�,Qzerju that the inf mation on this application is true and completes �^
FIRM NAME: U�1 + eGt C � LIC. NO.
Licensee: d� ✓ Signature LIC. NO.:
(If applicable, en t t" i h licens number line.) Bus. Tel. No.:
Address: tfi `1A Alt. Tel. No.:
*Per M.G.L c. 147, s. 57-61, security work require s DepartmentgofPub 'c Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent PERMIT FEE. $
Signature Telephone No.
k
...,•,.......,.. , .....,...._....-o
----- of Total
.ransformers
No. of Recessed Luminaires
No. of Ceil: Susp. (Paddle) Fans
KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Above n-
Swimming Pool rnd. grnd.
o. o mergency ig tmg
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of zones
No. of Detection and
No. of Switches
No. of Gas Burners
Initiating Devices
No. of RangesTotal
No. of Air Cond. Tons
No. of Alerting Devices
HeatPump
Number
Tons
KW,.....
No. of Self -Contained
No. of Waste Disposers
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Municipal Other
Local ❑ Connection ❑
No. of Dryers
ea
Heating Appliances KW
Sec Noof-Systems.*
No. of Devices or Equivalent
No. of WaterKW
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
Telecommunications Wiring:
No. Hydromassage Bathtubs
No. of Motors Total HP
No. of Devices or Equivalent
OTHER:
Attach aaal[ioncu aeLuci e,/ ues�reu, �� ua . oyuu �u y •••� _•• 1-��•�• � •- - ---
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: �� Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability i urance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such cover a is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
I certify, tinder thepains Rnd ennalties�,Qzerju that the inf mation on this application is true and completes �^
FIRM NAME: U�1 + eGt C � LIC. NO.
Licensee: d� ✓ Signature LIC. NO.:
(If applicable, en t t" i h licens number line.) Bus. Tel. No.:
Address: tfi `1A Alt. Tel. No.:
*Per M.G.L c. 147, s. 57-61, security work require s DepartmentgofPub 'c Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent PERMIT FEE. $
Signature Telephone No.
k
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