HomeMy WebLinkAboutMiscellaneous - 950 Waverly Roadr
The Commonwealth of Massachusetts
_{ Department of s°rcry a: r.,. rne�k.a
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130ARD OF FIRE PREVENTION REGULATIONS 527 CMR 1`00 3/90 (leave blank)
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APPLICATION FOR PERMIT TO PER�FOR�MalELE27 CMR GTRiC�AL WORK N
All work to be performed In accordance with the Macsac,
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(PLEASE PRINT TIN INR OR TYPE AU INFOMMATION) Date
City or Toon of To the Inspector of Wires:
The undersigned applies for a permitto Jorm the electrical work d�es/c�ribed below.19
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Location (Street S Numbe)
owner or Tenant "
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Owner's Address �/� ny�Z_
Yes ❑ No ❑ (Check Appropriate Box)
Is this permit in conjunction with a building permit: +y
Utility Authorization NO. 70 / illlJ ! !
Purpose of BuildingIt ^l
Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters��,
Existing Service Su
New Servicey Amps n�
6 / �CfQ Volts Overhead iindgrd ❑ No. of Meters
Number of Feeders and Ampacity �1
Location and Nature of Proposed Electrical Work ,t
No. of Transformers KVp
No. of Lighting Outlets No. of Hot Tubs, "'''
Above In- KVA
No. of Lighting Fixtures Swimming Pool grnd. ❑ grnd. ❑ Generators
No. of Emergency Lighting
No. of Receptacle Outlets o. of Oil Burners Batte Units �;4�•.
Burners FIRE ALARMS No. of Zones
No. of Switch Outlets No. of Gas "'.
Total No. of Detection and
No. of Ranges No. of Air Cond. tons Initiating Devices
No. of Heat Total Total No. of Sounding Devices
No. of Disposals Pesos Tons KW'
No. of Self Contained
No. of Dishwashers Space/Area Heating Detection/Sounding Devices ;
Municipal
No. of Dryers Heating Devices 131 Local❑ Connection❑Other .1• ' ''',
No. of No. of Low Voltage "
No. of Water Heaters Ballasts Wirin
Si s
No. Hydro Massage Tubs No. of Motors Total HP
OTHER: Baa.
the requirements of Massachusetts General Laws
IfISUPA:ICE COVERAGE: Pursuant .to
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial.
equivalent. YES❑ NO ❑Y I have submitted valid proof of same to this office. YES❑ NO [3
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify) Expiration Date) -
Estimated Value of Electrical Work S Final~
Work to Start Inspection Date Requested: Rough i
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Signed t."4er the penalties of perjur;
LIC. NO.
FIRM NA14E Signature reIC. NO.��, � `��,/� � � • r t�'� :
Licensee 1`L _ Bus, Tel. No.��fiO3 Semis/ 3j
Address . LL Alt. 'Tel. No. •.
t..
adNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub-
stantial equivrlent as required by HassachusSpts General us, and that my signature on this Pe it
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applic waive requirement. Owner'V Agent (Please nch%e�ckQon�e)
FEE
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' Telephone No. PERMIT �L
Signature of Owner or Agent
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TO
4 - - H94
Date .....7 .. cZ
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ..... R..Q.Y. &.a ......... ..............................
has permission to perform ...... N., C. W ........ ..............................
wiring in the building of ......AT t.. ...... f?') c.kv ..........................................
at ..... ...................................... . North Andover, Mass.
Fee ..#-7 j�
....... z�: ....... Lic. No. ...............................................................
ELECTRICAL INSPECTOR
C 09/29/97 13:02 75.00 PAID A\
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer