HomeMy WebLinkAbout3.31.1995 - Permits #2190 - 68 TUCKER FARM ROAD 11/20/2020 . \
The Commonwealth oy ma'ssachuse= Office use Only
No. I 1 0
Deparnnrn PetmlL t of Public SaJery — — 6
BOARD OF FIRE PREVElmotl REGULAT1O11S En Cmn 12100 hate
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be periormed In accordance with th'e Masaac,hutens Electnui Code, 517 CMR 12:00
(PLEASE PRINT IN M 08 T7PE ALL I1TE'OHHSTION) Date
City or Town of /�: Q / }►�:. To the Inspector of Wires:
The undersigned applies for a eerait to perform tpe electrical work described below.
Location (Street 6 Number)
Owner or Tenant C-A ::s -F
Owner's Address
Is this permit in conjunction with a building permit: Yes ❑ 110 (Cback Appropriate Box)
Furpose of Building Utility Autboritation N0.
Existing Service Amps / Volts Overhead ❑ Und d❑
6r No. of tkcers
Hew �=-m fizPi 1 Volts Overhead ❑ UndgTd❑ 110. of Meters
Number of Feeders and Ampseity
Location and Nature of Proposed Electrical Work
No. of Lighting outlets No. of Not Tubs No. of Iransformers Total
No, of Lighting Fixtures Swimming Pool AbOVO In-
U`IA
rnd. ❑ Krnd. ❑ Generators RYA
No. of R�aceptacle Outlets No. of Oil Burners No. of Emergency Lighting
Baste Units
No, of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones
No. of Ranges No. of Air Conti Tootaal No. of Detection and
Initiating Devices
No. of Disposals No. of ieatos ToraL TotalrumLLD*
unding Devices
No. of Dtahwashers Space/Area Ileating KWNo.
elfCundingeDevicas
No. of Dryers Heating Devices KW Municipal n ❑Other
Conection
i�o,
No. of Hater Heaters KWiio of ocS s Ballasts titrtn�itage
No. Hydro Massage Tubs No. of Rotors Total lip I
oz>;Ett: APR ^
INSURANCE COVERAGEg Pursuant to the requirements of Massachusetts General Laws
I have a current L abilit Insurance Policy including Completed operations Coverage or its substantial
equivalent. YES NO I have submitted valid proof of same to this office. YES❑ NO ❑
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE ❑ BOND ❑ 0MIt❑ (Please Specify)
Estimated Value of Electrical Work S
piration ace)
Work to Start --" speccion Date Requested: Rough Will call Final
Signed under the penalties of p jury:
FIRM HAitE Peter Needham electrical Co . , Iric . 13213
LIC. NO. A)
Licensee Peter tleedham Signature r ( U� —LIC. No(E)
Address59 Oakland St;reeE e ffforU , MA Zip( _ bus. Tel. No. -395--87-S -r—
Alt. Hal. 110.617- -
OtUMI S INSURANCE VAIVFR: I am aware that the Licensee does not have the insurance covers%* or its suo-
stantial equivalent as required by Massachusetts General awsL� , and that vy signature on this pa it
r
application waives this requirement. Owner Agent (Please check one) 15
Pemit I:ee:
Telephone No. Receipt. (1
Signature of Owner or Atenc)
1 �.
1
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Date..... � •• -�
ib
NORTH
TOWN OF NORTH ANDOVER
° : p PERMIT FOR WIRING
,SSACMUSEt
Thiscertifies that .......................................:........................................................
has permission to perform ......••••...""""""""
l{ ,rs.�r.I ...............................
wiring in the building of......... .• " •"""""""'
.................................. North Andover,Mass. -.
Fee........ ...:..
..... Lic.No. ...........................................................
. ELECTRICAL INSPECTOR
! 0�
PINK:Treasurer GOLD: File
WHITE: Applicant CANARY: Building Dept.