HomeMy WebLinkAboutMiscellaneous - 94 MAPLE AVENUE 4/30/2018Date...... 4'5...
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p PERMIT FOR WIRING
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Thiscertifies that ...... ............................................................................ !�? ......
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has permission to perform /,........ ............... t �...............
^ wiring in the building of . ....................
at Z62'..
. .. , North Andover, Mass.
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.µ. ELECTRICAL INspECTo
Check # M( v
56'1
0
Office use only
=- The Commonwealth of Massachusetts N4
Drpurrm erlt of Public SoJciv...,� a I=
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 124)0 190
APPLICATION FOR PERMIT TO PERFQRy ELECTRICAL WORK
All work to be performed In accorEence with the Massachusetts Eicc iest Code, 511 GMR 11200
((PLEASE PRI14T IN INK OR TYPE ALL INFOi►MMON) Date/.
City or Town of t�]np� OAgoo 1•e� /16 the Inspector of Willi..
The undersigned applies for a permit to perfd
Location (Street & Number)
(Si�or Tenarc �P�l_ L_�{��C✓
Owner's Address
Is this permit in conjunction with a building
the electz4k,/
work described below.
A,
'54�- A4W6C�}G'�+.Dnalt62Ag
ro. t: Yes (1 NO Wreck Appropriate Box)
Purpose of Building Utility Authorization tom.
Existing Service 100 /yaps 120- 12IC 0 volts overhead E' Undgrd ® No. of Dieters s
New Service Amps / Worts Overhead 0 Undgrd ❑ No. of Meters
Number of Feeders and Ampacity,
location and Nature of Proposed Electrical Work }��A,�t✓�� ���9�� �1�25�1 �
No. of Lighting Outlets
No. of Not Tubs
No. of Transformers Total
EVA
No. of Lighting Fixtures
SwimmingAbove In -
Pool nd. ❑ rnd. ®
Generators iCVA
No. of Receptacle Outlets
No. of 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. Self Contained
Detection/Soultding Devices
Local® Municipal �Otber
Connectiofl
No. of Ranges
No. of Air Cond. Total
tons
No. of Disposals
No. of HeIotas Total
No. of Dishwashers
Space/Area Heating KH
No. of Dryers
Heating Devices IIWJ
No. of slater Heaters RH
No, Q No. of
Sigm Ballasts
Lot+ Voltage
WD r fl
No. Hydro Massage Tubs
No. of Motors Total HP
arm:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liabilit Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YESO NO 0- 1 have submitted valid proof of same to this office. YESO NO 61
If you have checked YES, please indicate the type of coverage by checking the appropriate bol
INSURANCE ❑ BOND 0 OTHER 0 (Please Specify)
p rat on to
Estimated Value of E1 trical stork $
Work to Start
Signed under the Ities of perjury:
FIRM YNNE LIC. NO.�
Licenser: I��4�lC,QSiC� L���i�t Signature LDC. NO..` zo...
Address Cao &96�&a4) St :s&ZTzC%(Z.&2 0`Y, _ Bus. Tel. No.
Alt. Tel. No: A C171
OWIMI S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coves or its su li-
# stantial equivalent as required by Massachusetts Ce"eral 4ws, and t my signature on this permit
Appli Coln waives "this requirement. Owner Agent (please check one)
tit Telephofte NQ. _6, -- 2c� PERMIT FEE S
(Signaftt4mof Omer