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Home My WebLink AboutMiscellaneous - Bear Hill RoadN 9819 Date ..... pORTIy TOWN OF NORTH ANDOVER a minim, 0, PERMIT FOR WIRING CHUS This certifies that ....... �A' 4. 42 ..... 4��f'41 .................................... has permission to perform ... f ��. -& .................................... wiring in the building of .... 9M.0 .............................. at , North An dover, Mass. Fee...A7....... ic.No.A1-721I.O.- U, W" ........... cA. Ixsrroa Check # Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 0) ` Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] 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) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perfonn the electrical work described below. Location (Street & Number)_ Owner or Tenant 'TJ W Owner's Address 'i Qq 0 QWP( ')C-', Sdcktb \ Telephone No. 97$ 4'18' o Iso Is this permit in conjunction with a building permit? Yes 12 No ❑ (Check Appropriate Box) Purpose of Building W-kbv J MA I Utility Authorization No."35'-5 Existing Service '00J Amps 170 0 2 Volts Overhead ❑ Undgrd (' No. of Meters New Service '3!j6 Amps \2-a /7-40 Volts Overhead ❑ Undgrd [`]' No. of Meters t' Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: tn54z\y\t;v4 SCrV C r L� T- qtA Wirt Comnletion of the following tnhla mnu ha wnivod by thn 1--t— of Wi— No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators L KVA fJ6 No. of Luminaires Swimming Pool Above ❑ n- ❑ rnd. 2rnd. o. o mergency Lighting Battery Units No. of Receptacle Outlets S No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: I Number Tons - * '] KW �� "" No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW * Security Syystems:or Equivalent No. of Devices W No. of ater KW Heaters o. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage BathtubsNo. of Motors �j Total HP �j Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 000 (When required by municipal policy.) Work to Start: t2 1 o 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 insurance 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 MOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, th t the information on this application is true and complete. `�7N FIRM NAME: C - L (C C L� Q 0-,\ u C,ki Gyv LIC. NO.:An 2 c) Licensee: Cp� Signature LIC. NO.: A% t 7 231 p (Ifopplicable, enter "exejjn�pt" in the license number line.) 1 Bus. Tel. No.:��S1 631 2-%Z �f Address: 6yltll�ir S Y� (t�k_"A AA � Q lei Alt. Tel. No.: '7Rl 3%1 32Z.y *Per M.G.L c. 147, s. 57-61, security work requires Department of Public 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 Signature Telephone No. PERMIT FEE: $ 1'7- P`77 el 5 260" Date .... !�..�..7 7. . TOWN OF NORTH ANDOVER Np RTIy o p PERMIT FOR GAS INSTALLATI01; 'SA US _ t1J This certifies that.. �.:t.. �� .�� . .`...+....JL' ~• . has permission for gas installation ... .-. . t ...............N. . in the buildings of ...... ..............�. . at �.. l��:. ..�. �.... a:... , North Andover, Mass. GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer W MAP MASS CHUSETTS UNIFORM . PLICATON FOR PERMIT TO DO GAS FITTING PARCEL or prin Date �� /�° 19 I lq-jn In A191JU V L,tt, IVIAJJAI,A UJ6 1 13 . Building Locations / Permit 9�_ Amount S ;v-,,,.,., // Owner's Name l ,� w JjFA New' �,�/ Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print or type) f v�I 2��LL*H7C, Check ont;;�ertificate Installing Company Name I Corp. Address J d �0 �\ ❑ Partner. Business Telephone _ O ❑ Firm/Co. e Name of Licensed Plumber or Gas Fitter �(�k .(per 1 A`J y 14 INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent\ Owner ❑ Agent ❑ ( hereby certify that all of the details and information 1 have submitted (or entered) in above appy a -lion are e and accurate to the best oFmv knowledge and that all plumbing work and installations p o ed der P ii ued or t s pplication will be in compliance with all pertinent provisions of the Massachusetts SO e Ga od and F 142 th eral Laws. By: Title City/Town ROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber yl 2, go ❑ GWste*jr er 1cenL seiner ❑ Journeyman ITH. FLOOR (Print or type) f v�I 2��LL*H7C, Check ont;;�ertificate Installing Company Name I Corp. Address J d �0 �\ ❑ Partner. Business Telephone _ O ❑ Firm/Co. e Name of Licensed Plumber or Gas Fitter �(�k .(per 1 A`J y 14 INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent\ Owner ❑ Agent ❑ ( hereby certify that all of the details and information 1 have submitted (or entered) in above appy a -lion are e and accurate to the best oFmv knowledge and that all plumbing work and installations p o ed der P ii ued or t s pplication will be in compliance with all pertinent provisions of the Massachusetts SO e Ga od and F 142 th eral Laws. By: Title City/Town ROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber yl 2, go ❑ GWste*jr er 1cenL seiner ❑ Journeyman